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So COPD is usually a disease much more commonly seen in patients with smoke exposure, frequent smoking, long history of smoking. You may be wondering why some people that have been heavy smokers in the past don’t have COPD, and there’s some other patients that may have been light smokers or never smokers, happen to have COPD. This in a way boils down to a patient’s underlying genetics and their propensity towards development of lung disease. A slight few patients with heavy smoking history simply have good genetics in which their lungs can tolerate a lot of nauseous cigarette and smoke exposures, while other patients are unfortunately more predisposed and more prone to developing lung disease. One very well-characterized protein deficiency that predisposes to COPD is alpha one antitrypsin deficiency. This disease should be suspected in patients with an early diagnosis of COPD and more limited smoking history.