• What is the mean (+/- SD) age and tobacco history of the patients you treat for COPD or refractory asthma?

• How long/heavy did you smoke?

• What is the spread as far as current/former/never smoking patients you see?

• Do you ever imagine a day when more effective preventative and corrective therapies are developed for these disorders? As you know, 20-25% of diagnosed COPD in 1st world countries occur in never smokers and for those that did smoke, even quitting does not return the rate of lung function decline to that of their healthy cohorts and it certainly does not reverse or regain any lung function that has already been lost.

• How do you try and explain to patients and the general public, that just because they never smoked, or quit smoking, or only smoke marijuana or electronic vaporizers, does not guarantee their safety from the development of chronic airflow limitation later in life?

I have COPD. I quit smoking in my late 20's and was diagnosed a few years later - no I do not have alpha 1. Today it is very mild and manageable though I can feel the decline in my health. But I am certainly not alone in this rapidly increasing disease with no proven effective medical treatment to reduce lung function decline or mortality.

http://bjgp.org/content/65/631/e89

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6146a2.htm

http://www.cdc.gov/nchs/data/databriefs/db181.htm

http://journal.publications.chestnet.org/article.aspx?articleid=1078904

• Will this endless cycle of Pharma re-branding old medications for new patents ever end and give rise to the introduction of novel therapies that address the underlying cellular and molecular pathogenic mechanisms of these disorders and have better potential to ameliorate the relentless decline in lung function (despite smoking cessation many years ago)?