COPD in Non-Smokers

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 1/4 of those who develop the disease have never smoked.

Risk factors for developing COPD include exposure to toxins, genetic predisposition, and respiratory infections. The condition can cause shortness of breath and coughing, and the effects are generally more noticeable with physical exertion. COPD is typically less severe in non-smokers than in non-smokers.

The diagnostic evaluation of COPD in non-smokers includes chest imaging and pulmonary function tests. If you are a non-smoker with COPD, you may need treatment with inhalers, steroids, or supplemental oxygen. Pulmonary rehabilitation, which includes breathing exercises and physical conditioning, can help as well.

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 non-smokers 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.

Differences in COPD Symptoms Among Never Smokers

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 non-smokers. 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. If you have more than one of these risk factors, that can further raise your likelihood of developing COPD. And if you have had long term or high levels of exposure to risk factors (such as second-hand 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 (during a mother's pregnancy), is associated with an increased risk of developing COPD. It is among the leading causes of the condition in non-smokers.

If you spend a lot of time in an enclosed space that contains cigarette smoke—in your home or in your workplace, for example—you will inhale the fumes into your own lungs.

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—play 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 (the body attacks itself) characterized by inflammation. The inflammation can affect the lungs, increasing the risk of COPD.

Genetics

A 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 non-smokers 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.

Diagnostic Tests

Imaging tests used in the evaluation of COPD include a chest x-ray and chest CT. In general, non-smokers 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 in COPD.

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 non-smoker.

Surveillance for COPD

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

Most treatments for COPD are similar for smokers and for non-smokers. A major goal of COPD treatment for smokers involves smoking cessation. If you are not a smoker, one of the major strategies in your treatment centers around avoiding any toxin exposure—if possible.

Treatments can include bronchodilators, inhalers, anti-inflammatory medication (such as steroids), oxygen supplementation, and respiratory assistance.

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, with 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—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 non-smokers 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

A diagnosis of COPD can be 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 disease. Avoiding the precipitating factor is a key aspect of managing your disease.

If you are still able to maintain physical activity, pulmonary rehabilitation can be the key to maintaining your quality of life and maximizing your physical abilities with COPD.

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