COPD Onset and Plaintiffs with Lung Disease

Several recent papers call into question the commonly held thresholds for age and smoking history associated with the onset of COPD, especially in women. Such early-onset COPD has been confirmed in patients in their 20’s.  These findings suggest a fresh approach to take with plaintiffs with obstructive lung disease who are current or former smokers but appear to be too young or have too little smoking history for a COPD diagnosis.

Recently, Inga-Cecilie Soerheim and colleagues (2009) reported that women may be more vulnerable to the effects of smoking than men, something previously suspected but here to date unproven. In their study, Soerheim et al. evaluated COPD subjects under the age of 60 (early onset group) and COPD subjects with less than 20 pack-years of smoking (low exposure group). In both of these subgroups, women exhibited more severe disease and greater lung function impairment than men. Dr. Soerheim stated, “The gender difference in COPD susceptibility seems to be most important when smoking exposure is low. Women may tolerate small amounts of tobacco worse than men.”

Consistent with the observations by Soerheim et al, individual cases of early onset COPD are reported in the literature. For example, in  [A case of early-onset COPD with recurrent pneumothorax] 2009, Terashima and colleagues reported the case of a 29 year-old woman who visited their hospital with shortness of breath on exertion and a productive cough. The authors diagnosed the woman with severe early-onset COPD. They stated, “…several factors, such as high susceptibility, pulmonary infection during her childhood, bronchial asthma, malnutrition, smoking history from an early age, and long-term passive exposure to cigarette smoke may have contributed to the development of early-onset COPD…”

Early onset COPD cases are not limited to women, however. In a Case Report in 2007, Gupta and Agarwal reported on a 24 year-old man who presented with an 8-year history of progressive shortness of breath. The man had been a heavy smoker since the age of 9. The authors diagnosed the man with COPD on the basis of spirometry and high-resolution computed tomography (HRCT) results.

In light of the mounting evidence for the possibility of COPD occurrence in younger people with shorter smoking histories than previously thought, some researchers have recommended early screening for COPD through the use of spirometry to test for airway obstruction.  (See Screening for and early detection of chronic obstructive pulmonary disease by Soriano Zielinski and Price). This growing body of evidence also provides defense attorneys with another factor to consider when young plaintiffs, especially women, with minimal smoking history allege an injury, occupational or otherwise, resulting in obstructive lung disease.

For additional information on COPD and other human toxicology issues contact Dr. Jamie Coleman or Dr. Frank Mink.