Who knew non-smokers can get Chronic Obstructive Pulmonary Disease too?

Though many people have never heard of Chronic Obstructive Pulmonary Disease (COPD), most are familiar with the term “emphysema” which, as they will also know, is commonly found among smokers. Emphysema is an aneurysm or bulge in a blood vessel caused by a weakness in the blood vessel wall of the air sacs in the lungs which leads to a disease doctors refer to as “Chronic Obstructive Pulmonary Disease”. If you thought that the main cause of the disease is smoking, you would not be wrong. However, there can also be several other causes. Unfortunately, even if you don't smoke, it doesn't mean you can’t get COPD.

Non-smoker exposure

Nevertheless, the main cause of COPD, accounting for up to 90% of cases, is smoking. The disease is more common in males than females as males generally smoke more than females. However, current data indicates that women in some groups of the population are smoking more than before, leading to higher incidence of COPD among females. Why are non-smokers also at risk of catching COPD? The answer is that there can be other causes such as air pollution (particularly PM 2.5), smoke from cooking in the household, and smoke from combustion. These kinds of smoke can stimulate inflammation of the trachea and air sacs, leading to irreversible and increasing obstruction of air exiting the lungs. Genetic factors can also be involved. One such example is Severe Hereditary Deficiency of Alpha-1 Antitrypsin, where patients with deficiency of this enzyme are found to have COPD at a young age and with no history of smoking. However, such incidences of the disease among Asians is very rare.

You can easily spot initial symptoms yourself

If you cough and have a lot of phlegm in the morning, are easily tired when undertaking activities, have shortness of breath, tightness in the chest or whistling, a lot of weight loss and atrophy of the limbs or, in some cases, purple mouth and nails, you may be well on the way to COPD. Those most at risk are those who smoke heavily, defined as more than 20 cigarettes a day for more than 20 years. In all these cases, please consult a doctor for a diagnosis.

Get a diagnosis from a doctor

Spirometry is very important for diagnosis as it gives a reading of the severity of COPD. Diagnosis of COPD can be done in a number of ways, including chest or lung x-ray, CT scan, arterial blood gas analysis, depletion screening test for alpha-1-antitrypsin (AAT), and others. The doctor can recommend the most suitable test method to the patient to plan for further treatment.

Impact on lifestyle

COPD affects daily life and work, with symptoms that make it easier to get tired than normal. Those with severe symptoms can still feel tired even when taking a break from heavy exertion or exercise. In addition, those with COPD have an increased risk of various diseases associated with smoking, including myocardial infarction, high blood pressure and congestive heart failure. Other effects of COPD include GERD and osteoporosis. It also increases the risk of infection of the lower respiratory tract. It can also impact mental health: there is an increased incidence of depression among COPD patients compared to the general population.

Treat the disease with the right approach

COPD is an incurable disease. Therefore, prevention is the best course of action. Once the disease has occurred, the goal of treatment is to reduce symptoms so patients can live their daily life without getting tired and enjoy a decent quality of life. Both drug- and non-drug treatments are prescribed for COPD. The main drugs used for treatment are bronchodilators, inhaled corticosteroids, and antibiotics. Selection of medication depends on the severity of the symptoms and the patient's response to the drugs available. In terms of non-drug treatment, physical therapy can be very helpful and can reduce hospitalization and death rates. Other non-drug treatments include oxygen therapy which is prescribed for patients with severe symptoms. Surgery may be necessary to remove large air sacs. Lung transplants may also be considered but they are difficult to arrange and have high risk of complications. Vaccination against influenza and pneumonia is also highly recommended for patients with COPD.

Prevention better than cure

Self-protection is the best way to avoid COPD. We should reduce the risk in every way we can. That includes quitting smoking, avoiding air pollution in daily life and work by wearing a dust mask and using air purifiers and other effective means. We should also mind our health by choosing healthy food and exercising regularly. An annual health check-up is another must. Those who are particularly concerned can add a detailed lung examination to the check-up program.

This article has been verified for accuracy by Dr. Patawee Boontanon, Infectious Disease Pathologist, Queen Sirikit Hospital.


• Faculty of Medicine Siriraj Hospital, Mahidol University

• Bumrungrad International Hospital

• Corporate Communications, Faculty of Medicine, Ramathibodi Hospital

• Rilay CM, et al. JAMA. 2019;321:786-797

• Rabe KF, et al. Lancet. 2017;389:1931-1940

• Faculty of Medicine, Ramathibodi Hospital