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Smoking Patterns in African Americans and Whites With Advanced COPD^*

^* From the Department of Pulmonary and Critical Care, Temple University School of Medicine, Philadelphia, PA.

Correspondence to: Wissam Chatila, MD, Temple Lung Center, 763 PP, 3401 N Broad St, Philadelphia, PA 19140; e-mail: chatilw{at}tuhs.temple.edu

Background: The prevalence and mortality associated with COPD increases with age, with higher rates observed in whites than African Americans. Causes and explanations for smoking-related racial differences on the respiratory system have not been determined.

Objective: To investigate racial differences in smoking patterns and lung function in patients with advanced COPD.

Design: Retrospective record review of patients with advanced COPD.

Setting: Outpatient pulmonary clinic in a tertiary-care urban hospital.

Patients: One hundred sixty patients with advanced COPD (80 African Americans and 80 whites) referred for either lung volume reduction surgery or transplantation evaluation.

Data collection: Demographics, smoking profile, pulmonary function testing, arterial blood gases, and exercise stress tests were compared between African-American and white patients.

Results: Despite comparable pulmonary function, African Americans were younger at presentation and had lower overall pack-years of smoking than whites (58 ± 10 years vs 62 ± 8 years, and 44 ± 23 pack-years vs 66 ± 31 pack-years, respectively; p < 0.05 [mean ± SD]). Additionally, African Americans started smoking later in life than whites (18 ± 5 years vs 16 ± 4 years). Similarly, women presented at a younger age and smoked less compared to men (58 ± 9 years vs 62 ± 9 years, and 49 ± 28 pack-years vs 61 ± 29 pack-years, respectively; p < 0.05), without showing any difference in lung function or exercise performance.

Conclusion: Among susceptible patients with advanced COPD, African Americans and women seem more prone to the effects of tobacco smoke than their counterparts.

Key Words: chronic bronchitis • emphysema • ethnicity • smoking

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