Chronic obstructive pulmonary disease (COPD) is a significant cause of morbidity and mortality worldwide. However, resources and research funding for the prevention, early diagnosis, and development of new treatments for COPD are insufficient compared to those for other chronic diseases.1 An important reason for this situation is that COPD is a self-inflicted disease caused only by smoking, and other risk factors are largely ignored.2 Particularly in low-income and middle-income countries, the environmental or occupational inhalation of various harmful gases and particles, especially biomass-burning smoke exposure (BBS), also contributes to an increase in the prevalence and burden of COPD Fig. 1.3,4

In the article “Toward the elimination of chronic obstructive pulmonary disease”, published by the Lancet Commission, many risk factors can lead to COPD in every stage of life, from the gestational period to old age. COPD can be classified into five types based on major risk factors: Type 1: Genetics, Type 2: Early-life events, Type 3: Infection, Type 4: Smoking and environmental tobacco smoke, and Type 5: Environmental exposure (indoor pollutants, occupational exposures, and ambient air pollution). The classification that prioritizes risk factors encourages prevention, early diagnosis, and the development of new treatments for COPD. This approach aims to reduce the global burden of COPD, although the disease may not be eliminated in the near future.2 Similarly, one of the Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2023 strategy report updates included the classification of COPD according to etiotypes. In this classification, cigarette smoking COPD (COPD-C) and biomass and pollution exposure COPD (COPD-P) are included under “environmental COPD”.5

Biomass-burning smoke exposure (BBS) can aggravate COPD in smokers and non-smokers. However, data on the tobacco smoking and BBS histories of COPD patients and their combined effects on disease outcomes are lacking.3,6 In this study, we compared the clinical, laboratory, and prognostic features of patients with COPD whose exposure histories were documented by conducting face-to-face interviews.