Rodríguez García, CarlotaRuano Raviña, AlbertoPérez Ríos, MónicaMartín Gisbert, LucíaVarela Lema, María LeonorCandal Pedreira, CristinaRepresas Represas, CristinaRey Brandariz, JuliaValdés Cuadrado, LuisAgustí, Álvar2023-06-142023-06-142023Respiratory Medicine 214 (2023) 107284http://hdl.handle.net/10347/30673Introduction Chronic Obstructive Pulmonary Disease (COPD) is the third cause of death worldwide. While tobacco smoking is a key risk factor, COPD also occurs in never-smokers (NS). However, available evidence on risk factors, clinical characteristics, and natural history of the disease in NS is scarce. Here, we perform a systematic review of the literature to better describe the characteristics of COPD in NS. Methods We searched different databases following the PRISMA guidelines with explicit inclusion and exclusion criteria. A purpose-designed quality scale was applied to the studies included in the analysis. It was not possible to pool the results due to the high heterogeneity of the studies included. Results A total of 17 studies that met the selection criteria were included, albeit only 2 of them studied NS exclusively. The total number of participants in these studies were 57,146 subjects, 25,047 of whom were NS and 2,655 of the latter had NS-COPD. Compared to COPD in smokers, COPD in NS is more frequent in women and older ages, and is associated with a slightly higher prevalence of comorbidities. There are not enough studies to understand if COPD progression and clinical symptoms in NS are different to that of ever-smokers. Conclusions There is a significant knowledge gap on COPD in NS. Given that COPD in NS account for about a third of all COPD patients in the world, particularly in low-middle income countries, and the decrease in tobacco consumption in high income countries, understanding COPD in NS constitutes a public-health priorityeng© 2023 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/bync-nd/4.0/)http://creativecommons.org/licenses/by-nc-nd/4.0/COPDNon-smokersSystematic reviewPopulation characteristicsjournal article10.1016/j.rmed.2023.1072840954-6111open access