An Overview of COPD in Nonsmokers

You can develop COPD even if you have never smoked

Patient talking to doctor about COPD in never smokers
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Chronic obstructive pulmonary disease (COPD) is considered a disease of smokers and former smokers, but experts estimate that approximately 25% of those who develop the disease have never smoked. Risk factors for nonsmokers include exposure to toxins (secondhand smoke and others), genetic predisposition, and respiratory infections. And while COPD is typically less severe in nonsmokers than in smokers, the condition can still cause shortness of breath and coughing, which are generally more noticeable with physical exertion. 

Symptoms

If you develop COPD without having had a history of smoking, you may experience a number of respiratory effects due to the condition. In general, the same symptoms of COPD that affect smokers and former smokers also affect never smokers. But the overall effects are milder if you have never smoked.

Symptoms of COPD in nonsmokers can include:

  • Dyspnea (shortness of breath)
  • Wheezing when you breathe
  • Persistent, dry cough
  • Productive cough (coughing up mucus and phlegm)
  • A tendency to develop respiratory infections
  • Fatigue
  • Chest tightness
  • Trouble sleeping

You can experience any combination of these symptoms with COPD. In general, your symptoms are likely to be more noticeable when you exercise or physically exert yourself. If you don't have a history of smoking, your cough may be milder and you are less likely to cough up phlegm.

Illnesses and infections can trigger a COPD exacerbation, worsening your symptoms.

Nonsmokers with COPD have fewer hospitalizations and fewer episodes of pneumonia than smokers or former smokers with COPD.

Complications

Over time, COPD can impair your breathing, even when you are at rest, making you feel that you are gasping for air. Your blood oxygen level can decline to a degree that requires supplementation with oxygen.

COPD is a risk factor for lung cancer, even among nonsmokers. And it also increases the risk of developing heart conditions, such as heart failure.

Causes

There are a number of risk factors associated with the development of COPD in never smokers. Having more than one of these risk factors can further raise your likelihood of developing COPD.

Furthermore, if you have had long-term or high levels of exposure to risk factors (such as secondhand smoke or other inhaled toxins), there is a chance that your COPD may progress to a severe stage—causing substantial effects on your quality of life.

Secondhand Smoke

Secondhand smoke exposure at any time in life, even in utero, is associated with an increased risk of developing COPD. It is among the leading causes of the condition in nonsmokers.

If you spend a lot of time in an enclosed space that contains cigarette smoke—in your home or in your workplace, for example—this is of particular concern.

Pollution

Air pollution has been linked with COPD in never smokers, especially in highly industrialized regions. Indoor air pollution—such as fumes from gasoline, biomass fuel heating, paints, and stains—plays a role as well.

Occupational Exposures

Exposure to coal, silica, industrial waste, gases, dust, and fumes on the job increase your risk of developing COPD. In some cases, the risk of inhaling toxic fumes can be reduced with safety masks and other protective wear, but these strategies are not always effective.

Asthma

Having asthma increases your chances of developing COPD. In fact, asthma chronic obstructive pulmonary disease overlap syndrome (ACOS) is characterized by features of both conditions.

Lung Infections

Recurrent respiratory infections can cause permanent damage to your lungs. Childhood respiratory infections are especially associated with an increased risk of COPD in never smokers.

A history of tuberculosis is also linked with COPD and is a common risk factor in areas of the world where tuberculosis is more prevalent.

Rheumatoid Arthritis

Rheumatoid arthritis is an autoimmune condition (i.e., one where the body attacks itself) characterized by inflammation. The inflammation can affect the lungs, increasing the risk of COPD.

Genetics

A rare genetic condition, alpha-1-antitrypsin deficiency, can lead to emphysema—a type of COPD. It often begins at an early age in both smokers and nonsmokers.

Severe Nutritional Deficits

Factors influencing lung growth in the womb or during early childhood development may increase the risk of COPD. Low birth weight and poverty have both been linked with COPD.

And in adulthood, nutritional deficiencies increase the risk of COPD, especially in combination with other factors, such as secondhand smoke, respiratory illness, and environmental pollutants.

COPD risk factors cause irreversible lung damage. Keep in mind that the risk factors that cause COPD in nonsmokers can worsen COPD in smokers too.

Diagnosis

If you are complaining of a chronic cough or exercise intolerance, your medical team will likely begin a diagnostic evaluation to identify the cause of your problem. COPD is diagnosed with a number of tests, including chest imaging tests, pulmonary function tests, and blood oxygen levels.

If you do not have a history of smoking, your medical team will also consider heart disease and systemic illnesses as possible causes of your symptoms—and your diagnostic evaluation can reflect these other considerations.

Testing

Imaging tests used in the evaluation of COPD include a chest X-ray and chest computed tomography (CT). In general, nonsmokers who have the condition tend to have less significant changes on imaging tests, which reflects a lower severity of the disease.

Pulmonary function tests are breathing tests that assess your respiration with several methods. Some tests measure the amount of air you can inhale (breath in) and exhale (breath out). Your forced vital capacity is a measure of the amount of air you can breathe in, while your forced expiratory volume is a measure of the amount of air you can breathe out.

You may also have your blood gases measured—including oxygen, carbon dioxide, and bicarbonate. The concentration of these gases in your blood helps your medical team assess the efficiency of your respiration, which is a reflection of your lung function.

Inflammatory markers can be changed in COPD as well. Fibrinogen and C-reactive protein tend to be elevated in smokers with COPD. You might not have these changes if you are not a smoker, but they are more likely to be elevated if you have an inflammatory condition like rheumatoid arthritis.

Toxin exposure can cause a variety of effects on the body beyond the respiratory system. Your medical team will want to check tests to identify any other toxin-related health issues that you could have—such as anemia (low blood function) or even cancer—if you have developed COPD as a nonsmoker.

Surveillance

If you work in a setting where your coworkers are prone to developing COPD, you may need to be screened for the condition, even before you develop any symptoms. Depending on your level of risk, your doctor may consider screening tests such as chest X-rays.

If you have early disease, you may need further testing, as well as treatment of your symptoms.

Treatment

While smoking cessation is a major focus of treatment of COPD in smokers, avoiding toxin exposure is at the center of treatment of COPD in nonsmokers. Beyond that, most treatments are the same for both groups.

Prescription Medication

Your doctor may prescribe a bronchodilator, which is a medication that can widen the bronchi (small breathing tubes in your lungs). These medications are typically inhaled and are also often used to treat asthma. They are typically fast-acting and can help you breathe easier if your lungs are inflamed or blocked due to COPD.

Sometimes, long-acting bronchodilators are used in managing COPD. These medications are useful for all people who have COPD, whether they have a history of smoking or not.

Steroids and other anti-inflammatory medications can be beneficial if active inflammation (such as from asthma or rheumatoid arthritis) is worsening your COPD. If you have an ongoing inflammatory reaction to a toxin, anti-inflammatory medication may reduce it. These medications can be taken orally (by mouth) or inhaled.

Oxygen Supplementation and Respiratory Assistance

If your COPD becomes advanced—i.e., it is interfering with your ability to breathe—you may need oxygen therapy. This would require that you use an oxygen tank and that you place a mask or tubes near your nose to breath in the oxygen supply.

You need to be cautious when using oxygen supplementation. Oxygen therapy is not safe if you are around anything flammable, such as a wood-burning stove or industrial chemicals.

Sometimes, mechanical ventilation assistance is needed if your inspiratory muscles become weak. This can happen with late-stage COPD, although it is not as common in nonsmokers as it is with smokers.

Pulmonary Rehabilitation

Exercise can improve your breathing abilities and exercise tolerance. It is often beneficial to work with a respiratory therapist. You may need a plan that includes progressively increasing physical activity, muscle strengthening, and respiratory exercises.

A Word From Verywell

This diagnosis can come as a surprise if you have never smoked because it is usually considered a "smoker's disease." Your individual risk factors play a major role in your risk of developing progressive COPD. Avoiding the precipitating factor is key. If you are still able to maintain physical activity, pulmonary rehabilitation can help maintain your quality of life and maximize your physical abilities with COPD.

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