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A pair of lungs with air pollution, an inhaler, a DNA strand, and secondhand smoke around them

COPD in People Who Don’t Smoke: How Can This Be?

So, you live a healthy lifestyle, including avoiding tobacco smoking. That must mean that you’re guaranteed protection from chronic illnesses such as COPD. After all, people who don’t smoke don’t get COPD, right?

Unfortunately, that is not true. Even if you live the healthiest lifestyle and never smoked a cigarette in your life, you could still end up with COPD. It’s not common for this to happen. Smoking is the biggest risk factor for developing COPD, but not all smokers get COPD. And, according to a fact sheet put out by the National Institutes of Health, 10-20% of COPD patients have never smoked.

There are a few other reasons why people who don’t smoke may still be at risk for COPD:1

  • Air pollution. This can include both indoor and outdoor pollutants, often from the burning of fuels. But it can also include volatile gases, fumes and dusts, industrial and traffic exhausts. Often, this type of exposure occurs on the job.
  • Secondhand smoke. Think of this as a sort of indoor air pollution. Now, you’re not going to be at high risk for COPD if you happen to pass by a group of smokers when entering a store. But if you live with someone who smokes, you are.
  • Chronic poorly-controlled asthma. If you’re an asthmatic who has frequent (or constant) symptoms, your airways are at risk for succumbing to the damage associated with COPD.
  • Genetics. If you have a genetic disorder known as an alpha-1 antitrypsin (AAT) deficiency, you may develop COPD, and at a younger age too. AAT is a protein that protects the lungs. When you don’t have enough of it, your lungs deteriorate. It can also cause liver damage. Only about 1-5% of people with COPD have this condition.2

How non-smokers experience with COPD is different

People who currently smoke, former smokers and people who have never smoked will all have roughly the same symptoms once COPD manifests. These include:3

The difference is that symptoms in people who have never smoked tend to be milder. We know that COPD is not always diagnosed until symptoms begin to interfere with daily life, rather than just being bothersome. By the time symptoms are that bad, COPD has often already caused serious lung damage. Since non-smokers’ symptoms are milder to begin with, this means their COPD is often in the latter stages by the time they even know they have it.

Once a non-smoker has COPD, however, the progression of their disease is much the same as it is in a former smoker. Exacerbations are just as likely to occur.

How to be a proactive non-smoker

So, if not smoking doesn’t provide total protection against COPD, what’s a non-smoker to do? Well, I will encourage you to still focus on living your healthiest life possible. A healthy lifestyle protects you against many other illnesses besides COPD, including heart disease and cancer. And, of course, do your best to protect against air pollution, occupational exposure to chemicals, fumes and dusts, as well as secondhand smoke.

In addition, if you even suspect you might be experiencing some of the symptoms of COPD, you might ask yourself the 5 simple questions below. These questions were developed by researchers at Weill Cornell Medical College. They were part of a study looking for better ways to identify people with COPD.4

  1. Have your ever lived or worked in a place with dirty or polluted air, smoke, second-hand smoke or dust?
  2. Does your breathing change with seasons, weather, or air quality?
  3. Does your breathing make it difficult to do things such as carry heavy loads, shovel dirt or snow, jog, play tennis, or swim?
  4. Compared to others your age, do you tire easily?
  5. In the past 12 months, how many times did you miss work, school, or other activities due to a cold, bronchitis, or pneumonia?

Answering “yes” to any or all of these questions does not necessarily mean that you have COPD. But it might be a basis for further discussion with your primary care doctor. Together, you may decide whether further testing and evaluation might be needed.

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

  1. Jindal, S. (2018). Chronic obstructive pulmonary disease in non-smokers - Is it a different phenotype? Indian Journal of Medical Research, 147(4), 337. doi:10.4103/ijmr.ijmr_10_18
  2. Izaguirre Anariba, D. E. (2019, July 26). Alpha1-Antitrypsin Deficiency. Retrieved from
  3. COPD. (n.d.). Retrieved August 2, 2019, from
  4. The American Thoracic Society. (2016, October 28). Novel Approach in Primary Care Setting May Help Identify Patients with COPD [Press release]. Retrieved August 2, 2019, from


  • HuwP
    3 months ago

    Thank you for this article. I am 47 and have Moderate COPD, which is almost Severe. I have never smoked and spent my youth exercising. I was an amateur boxer as a teen.

    I find it really frustrating when people assume that my condition is the result of smoking.

    Thank you for a very practical article.

  • Lyn Harper, RRT moderator
    3 months ago

    Hi HuwP – I find that very frustrating as well! I try to just ignore that type of person and move on with my life. Sometimes I have to grit my teeth a little though.
    Best – Lyn (site moderator)

  • jenny1123
    3 months ago

    I started out feeling pretty good this morning. By the early afternoon I’m exhausted. I haven’t done much…but, I’m stressing out over my pulmonary function test I’m going in for tomorrow. Can someone tell me what I’m in for..? Theirs so much I’m still learning..newly diagnosed less than 2 months ago. Any information much appreciated…

  • Leon Lebowitz, BA, RRT moderator
    3 months ago

    Hi again, jenny1123, and thanks for this post. In another post, I already provided you with some information about the PFT diagnostic test that you have scheduled earlier this morning. I see that my colleague, Lyn, has provided an explanation here as well.
    Wishing you good luck!!
    Please let us hear back from you. when you’re ready.
    All the best,
    Leon (site moderator)

  • Lyn Harper, RRT moderator
    3 months ago

    Hi jenny1123 – Don’t worry at all about the pulmonary function test. You’ll do great! There’s really nothing to worry about, it’s a very common diagnositc test that will tell the doctor a lot about your lung function.
    They’ll have you breathe into a machine that will measure volumes, flows, and how well your lungs do the work of exchanging the gases their supposed to.
    If you don’t understand somthing while it’s happening, just ask. The technician doing the test should be able to give you a good idea of what’s happening, although they won’t be able to tell you the results.
    Let us know how you make out.
    Lyn (site moderator)

  • Leon Lebowitz, BA, RRT moderator
    3 months ago

    Hi again, rhonda, and thanks for chiming in here. Some technicians/therapists have more time and the ability and knowledge to provide a good explanation for many patients. However, it is always the physician who is the final authority in patient care situations. Leon (site moderator)

  • rhonda61hobo
    3 months ago

    I think the technician can explain better sometimes than the lung doctor.

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