Chronic obstructive pulmonary disease, known as COPD, is a common condition most often associated with smoking. However, nonsmokers, and even people who have never smoked, can also develop the disease.

According to 2011 research, just over 20 percent of people diagnosed with COPD are nonsmokers. Other causes, such as environment and genetics, play a more significant role than originally thought.

In this article, we will look at how nonsmokers can develop COPD, along with the symptoms and what happens after a diagnosis is made.

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COPD may describe a range of conditions, including bronchitis, asthma, and emphysema. Asides from smoking, COPD risk factors include genetics, environment, and age.

In COPD, the airways that bring air in and out of the lungs become inflamed, inefficient, and blocked, making breathing difficult.

If left untreated, the inflammation worsens, and the symptoms become more severe. In severe stages, even everyday activities, such as walking up stairs, can cause shortness of breath.

The most common forms of COPD are emphysema and chronic bronchitis, but the term also covers some types of asthma and bronchiectasis.

COPD causes 3 million deaths per year worldwide and ranks as the fourth largest cause of death. In the United States, it is the third leading cause of death.

As many as 50 percent of people with the disease do not realize they have it, mainly because they consider the symptoms to be normal signs of aging.

According to the Centers for Disease Control and Prevention (CDC), nearly 16 million adults in the U.S. currently have COPD.

Other factors apart from smoking that increase the risk of COPD include:

Secondhand smoke

Exposure to someone else’s cigarette smoke as a child or adult may increase the risk of COPD. This includes a baby’s exposure to its mother’s tobacco use before birth.

Environmental factors

Examples include dust and chemicals in the home, the outdoor environment, and the workplace. Environmental factors also include air pollution and smog.

People in contact with coal dust and crystalline silica through their work are at increased risk. An estimated 15 percent of COPD cases may be linked to the workplace.

Other industries where workers face an increased risk are rubber, plastics, textiles, leather, and construction.

Respiratory problems

These include respiratory infections as a child or adult, and other respiratory conditions, such as asthma.

A recent study showed that nonsmokers who had asthma were 8.3 percent more likely to develop COPD than those without the condition.

Genetic factors

A deficiency in a substance called alpha-1 antitrypsin, a protein made in the liver, may account for up to 5 percent of people with COPD.

Alpha-1 antitrypsin deficiency (AAT) is estimated to affect between 1 in every 3,000-5,000 people in North America. Individuals who smoke and have AAT are at greater risk of COPD.

Experts also note there are a wide variety of genes at work that are continually being identified through research. These inherited factors put people at greater risk of COPD, even as nonsmokers.


Age is also a factor in developing COPD. Most people with COPD begin to experience symptoms over the age of 40. The chance of developing the condition increases with age, with those over 65 most at risk.

Recent research also shows that more women than men now report the disease.

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Symptoms of COPD may include shortness of breath, and an inability to exercise without experiencing breathing difficulties.

The symptoms are the same for nonsmokers as they are for smokers. These symptoms include:

  • shortness of breath after even short periods of low-level exercise
  • wheeziness
  • coughing that produces excessive amounts of phlegm
  • tightness in the chest
  • tiredness and low energy levels
  • intolerance to exercise that results in any of the symptoms above
  • nagging, persistent cough

Long-term effects

People who have COPD have an increased risk of experiencing the following:

  • feeling breathless after everyday activities
  • having depression and other mental illness
  • being unable to work or socialize as they want to
  • needing special breathing equipment
  • experiencing confusion or memory loss

Other diseases that are more likely in people with COPD include heart disease, asthma, stroke, congestive heart failure, arthritis, and diabetes.

A breathing test called spirometry, also known as a pulmonary function test or PFT, is used to diagnose COPD. A person blows into a machine that measures the ability of the airways to move the air out.

The result shows how much air a person exhales and how long it takes to do so. It is quick and painless and is carried out by a doctor or other trained healthcare professional.

A doctor will likely perform a physical examination as well, as the result of the spirometry can be affected by other factors, such as general fitness, heart disease, abnormalities of the chest cavity, and smoking.

In some cases, a doctor may also recommend a blood test, a chest X-ray, or CT scan of the chest.

Others factors that aid a doctor in diagnosing COPD include evaluating the following:

  • quality of life due to breathing symptoms
  • need for hospital visits due to breathing problems
  • frequency of chest infections
  • frequency of flare-ups of breathing problems
  • breathlessness during normal activities
  • oxygen levels in the body

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Oxygen therapy may be recommended as a treatment for COPD.

There is no cure for COPD at present. The earlier the disease is diagnosed, however, the more that can be done to ease the symptoms.

There are many ways that COPD can be treated to improve quality and length of life. These treatments include:

  • inhaled drugs that relax the muscles and open the airways
  • flu, pneumonia, and whooping cough vaccinations
  • oxygen therapy
  • antibiotics to treat chest infections
  • anti-inflammatory drugs called glucocorticoids, a type of steroid hormone

Exercise techniques, education, and support to help breathing may also help. This is called pulmonary rehabilitation. Research suggests that it can be effective in treating the symptoms of COPD but is, as yet, underused worldwide.

Certain activities such as singing classes and tai chi may also improve symptoms and quality of life in people with COPD.

To reduce the risk of COPD, the standard advice for nonsmokers, other than not starting to smoke, is to avoid high-risk environments and occupations.

These may be areas where there are fumes from tobacco, high air pollution, diesel, and where things such as straw, grass, and animal dung are burned as fuel. People should also avoid industrial cleaning agents that may pose a chemical hazard.

If anyone thinks that they may have any of the symptoms mentioned in this article, they should consult their doctor.

COPD is more common than believed, as many people may consider it part of getting older, particularly if they have never smoked. Half of those who have COPD do not recognize the symptoms, so it goes undiagnosed.

Research, education, and global efforts are helping to diagnose the disease earlier, however. This will aid more effective treatments and perhaps help to delay progression to more advanced stages.

The ability to predict how people will be able to cope with the disease and manage their lives is also improving. This means that more people should be able to continue living their lives without losing their independence following a diagnosis of COPD.