You notice that you’re feeling tired all the time, short of breath and can’t get rid of a nagging mucus-filled cough. These all could be symptoms of chronic obstructive pulmonary disease (COPD). But you’ve never smoked a cigarette in your life and that’s a smoker’s disease, right? Yes…but not always.

What few people realize: About 25% of people who show signs of lung disease and airway obstruction don’t smoke and never have…and about 10% of people formally diagnosed with COPD have never smoked.

Since most never-smokers are unaware that they could be at risk, they tend to blame early COPD symptoms on ailments such as allergies, asthma or lingering colds. Even doctors may fail to consider COPD in never-smokers. As a result, many patients with early—and mild—COPD aren’t taking the necessary steps to protect their lungs. That’s a problem because undiagnosed COPD not only can affect one’s quality of life, it also can lead to flare-ups, hospitalizations and even early death. What you need to know… 


COPD is the third-leading cause of death in the US, and it affects 15 million adults—more if you count those with impaired lung function that has gone undetected.

COPD is a broad term that’s used to describe a number of lung diseases, including emphysema (damage to the alveoli, small air sacs in the lungs)…chronic bronchitis (inflammation of the large bronchial tubes)…and some cases of severe asthma that do not completely reverse between flare-ups or exacerbations. COPD is a progressive disease—it develops slowly (often over decades), and the symptoms always worsen over time.


Giving up cigarettes is the best way for smokers to guard against COPD. For nonsmokers, many common COPD risk factors are tricky (or impossible) to avoid. For example…

Asthma. Roughly 40% of COPD patients have a history of chronic obstructive asthma, and many of them have never smoked.

Pneumonia or other severe respiratory infections. People who have these illnesses in childhood experience lung damage that increases their risk for COPD.

Genetics. Among nonsmokers with COPD, 1% to 3% have alpha-1 antitrypsin (AAT) deficiency, a genetic defect that can lead to damaged alveoli and emphysema. Anyone who has a first-degree relative with COPD is at increased risk for this genetic defect.

Environmental factors. These can include smoke (for firefighters)…dust (agricultural workers and miners)…chemical fumes (manicurists and janitors)…and air pollution (everyone). Scented products, such as candles or air fresheners, can irritate the lungs, too. Anything that chronically irritates your lungs, such as secondhand smoke, can increase risk for COPD.


If you have any of the symptoms described earlier, you should ask your doctor to test you for COPD. Past-smokers and those who work in high-risk industries—coal miners, for example—might want to get tested even if they don’t have symptoms. Anyone with asthma should be tested for pulmonary function at least once every five years.

Red flag: It takes you longer than expected to recover from colds, the flu or other respiratory illnesses. Someone who’s healthy will generally start feeling better—with less coughing and shortness of breath—within a week or two. In my practice, I’ve noticed that those with early COPD take several weeks or even months before they’re fully recovered. Other symptoms include a nagging cough, wheezing and tightness in the chest.

The most common lung test is called spirometry. With this test, you blow into a tube that’s connected to a machine that measures both your lung capacity and how quickly you’re able to exhale air. The test takes only a few minutes, and it can detect early COPD even when you don’t have symptoms.

If spirometry shows your lung function to be normal, you won’t need other tests unless your doctor feels there’s a strong chance that you have COPD based on your symptoms. In that case, he/she might recommend other lung-function or imaging tests (such as a chest X-ray or CT scan).

Exception: If your lung function is impaired but you don’t have any obvious COPD risk factors, your doctor will want to know if there’s a genetic cause. A blood test for AAT deficiency is done routinely for those who test positive for impaired lung function, as well as for those who develop COPD symptoms at an early age or have a family history of the disease.


Most patients with COPD will need to use treatments such as bronchodilators and inhaled steroids—and perhaps use supplemental oxygen when the disease advances.

Patients with AAT deficiency can take a synthetic form of the missing protein, given weekly in IV infusions. Some studies have shown that the treatments help protect the lungs…others have been less conclusive.

To keep your lungs healthier…

Try to breathe clean air. If you have a smoky fireplace, clean the chimney, or don’t use the fireplace at all. Wear a dust mask or respirator (see below) if you’re tilling a field or working in a woodshop. Do your best never to breathe secondhand smoke. Helpful: Check the Air Quality Index (AQI) in your area by going to the EPA website People with COPD or other lung diseases may be advised to stay indoors on days when the AQI is elevated.

If you’re moving: Go to, search “State of the Air” and plug in possible zip codes to see where the air is cleanest—and where it’s not.

Avoid toxic fumes. This includes fumes from oven cleaners, drain cleaners, paint, etc. If it makes you cough or burns your nose, you shouldn’t be breathing it.

If you must use such products, wear a respirator. A respirator labeled N95 will protect you from particulate matter (such as dust or sawdust), while respirators that contain chemical cartridges will protect you against fumes from cleaning supplies and similar products.

If you have COPD, also eat a healthy diet, with lots of fruits and vegetables, and exercise if you can. Doing so can reduce symptoms and add to your quality of life.

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