Researchers in COPD epidemiology should be investing their time, energy and skills into areas other than smoking, according to a leading respiratory and public health physician.
In an editorial in Thorax, Professor Guy Marks said policy and practice regarding smoking prevention and cessation were unlikely to be changed by further research into the dose-response relationship between smoking and COPD.
Professor Marks, who leads the Respiratory and Environmental Epidemiology group at the Woolcock Institute of Medical Research, was responding to research that found smoking duration was more strongly associated with COPD than pack-years.
“There is an important role for further epidemiological research on COPD, but probably there is little to be gained by further interrogating the role of smoking in causing this disease,” Professor Marks said in the editorial.
“Instead, we need to focus on the importance of other, potentially avoidable, causes of COPD, including occupational exposure to dust and fumes, indoor and outdoor air pollution, early-life nutrition and respiratory infections, including tuberculosis.”
Professor Marks told the limbic that nobody would argue smoking was not still a very high priority from a policy point of view.
“I think we know that smoking is the major determinant of COPD and that’s been known for 30 or 40 years but I don’t think there is a great deal to be gained further by rediscovering that fact.”
“As we move to reduce the prevalence of smoking in the population then the relative importance of other factors will become greater and we need to be in a position to act on those.”
For example, it was still uncertain how important air pollution was as a contributor to obstructive airways disease, particularly at low levels of exposure.
“For some outcomes of exposure to air pollution it seems there are benefits to be gained by further reducing exposure even at low levels such as those that exist in Australia. But we don’t yet know whether that is the case for obstructive airways disease.”
“I think we need to know more about the role of occupational exposures. Not just in big industrial complexes but I think there are many more people being exposed in cottage industries and small businesses where we don’t the nature of the exposure or the nature of the adverse effect on people’s health.”
He said the contribution of early-life nutrition and respiratory infections to COPD were particularly important in Indigenous populations in Australia and globally.