I was deep in thought at the store, flipping through my binder of coupons and trying to stretch our grocery money, when my phone rang. It was my husband, and he was gasping for air.
“You need to come home. I can’t breathe.”
I abandoned my cart, apologized to the cashier and ran to my car. On the way home, I called our son and told him to meet us there so we could take his dad to the emergency room. My husband had never experienced anything like this. I knew it wasn’t something for a walk-in clinic.
He had started smoking as a teenager. He tried many times to quit. Sometimes he stopped for days or months, but he always returned to it. Additionally, he spent over three decades working in a factory, inhaling dust, fumes and chemicals. The combined damage had been building quietly inside his lungs for years.
At the ER, they took him in right away and started a nebulizer treatment. It took two rounds before he could finally breathe normally. During intake, the nurse asked whether he smoked. As soon as he said yes, the tone shifted. No one asked about his decades of chemical exposure. No imaging, no blood work, no spirometry. Just a stethoscope to his back and a contemptuous look.
“You shouldn’t have smoked,” a nurse told him sharply. “This is what happens when people smoke.”
The doctor diagnosed him with chronic obstructive pulmonary disease—COPD—and gave him a prescription for a daily inhaler and a rescue inhaler. We were sent home after the doctor told him to quit smoking.
On the way home, he broke down and began to cry. The ER had made him feel like he deserved what was happening to him.
I wish I could tell you this kind of judgment is rare. It isn’t. People who smoke—and those who used to smoke—often describe being dismissed or chided when they receive diagnoses like COPD or lung cancer.
Research has documented this pattern: People living with COPD report that stigma often comes directly from health care providers. Many say they are treated as if they are to blame for their suffering and therefore have less of a right to compassionate care.
For my husband, the stigma hit immediately. On the way home, he broke down and began to cry. He apologized repeatedly for “ruining our lives.” The ER had made him feel like he deserved what was happening to him.
The ER staff didn’t offer counseling, medication to help him quit smoking, a quit-smoking referral, or even basic information about COPD. So I Googled COPD myself. I found out how it is actually diagnosed: through spirometry, chest imaging and sometimes further testing to rule out heart disease or lung cancer. The COPD Foundation explains that these tests are necessary to confirm the diagnosis and guide treatment. None of that was offered to him.
My husband quit smoking cold turkey after that ER visit. It was difficult; emotionally, physically and psychologically. He was scared, grieving, ashamed, and dealing with withdrawal. All I could do was support him, because the health care system hadn’t even tried.
Years passed before a doctor finally revisited his diagnosis and ordered the tests he should have received on day one. He had pulmonary function tests, a CT scan to rule out lung cancer, and a stress test for his heart. We were relieved that the results showed COPD and not lung cancer. But COPD has devastated his health, his independence, and our family’s plans. It is not a minor diagnosis, just the one that wouldn’t kill him immediately.
The “what if” will always haunt me. Lung cancer often causes no symptoms early on. The Mayo Clinic notes that lung cancer and COPD can have some of the same symptoms as they progress, and early detection of lung cancer is crucial. If my husband’s shortness of breath had been something else, the ER’s assumptions could have been deadly.
November 19 is World COPD Day. But this year, something cruelly ironic is unfolding at the same time.
It’s been 10 years now. COPD has reshaped every part of our lives. We used to dream of buying a motorhome and traveling to sprint car races around the country. We don’t go to races anymore because he can’t climb the grandstands, and the dust from the track can trigger an exacerbation. Heat and humidity make breathing significantly harder. Since the COVID-19 pandemic, we live with even more heightened caution. I quarantine away from home if I’ve been exposed to someone sick. He rarely leaves the house.
His world has shrunk to what his lungs will allow. He tinkers around the house, but only for short stretches before he must rest. We run air filters in every room. He loves being outdoors, but pollen, wildfire smoke, humidity and even mowing the lawn can leave him struggling to breathe. The disease progresses slowly, slower because he quit smoking, but progressing nonetheless.
This is the reality for millions of families. COPD is a significant cause of long-term disability, affecting an estimated 392 million people. It is also the fourth leading cause of death worldwide, costing 3.5 million lives each year.
November is COPD Awareness Month and November 19 is World COPD Day—a time when the global public-health community is supposed to focus on improving diagnosis, treatment and compassion.
But this year, something cruelly ironic is unfolding at the same time. Global health leaders are currently in Geneva for the World Health Organization’s Framework Convention on Tobacco Control COP11—a meeting widely known for opposing tobacco harm reduction tools that help millions of people who smoke to move away from combustion.
Experts from around the world have urged the WHO to correct course, pointing out that almost all of the harm from smoking comes from smoke, not nicotine, and that wider substitution of safer nicotine products would dramatically reduce smoking-related disease.
My husband’s life, like the lives of all people who smoke, is worth more than a lecture.
But misinformation persists, especially in medicine.
Rutgers University found that a staggering 80 percent of doctors believe nicotine causes cancer, and 81 percent believe it causes COPD. A global survey of 15,000 physicians in 11 countries found the same pattern: 74 percent believe nicotine causes lung cancer and 76 percent believe nicotine causes COPD.
These beliefs are not supported by scientific evidence. They are rooted in decades-old messaging that conflates nicotine with smoking, and they have real consequences. If clinicians think nicotine itself causes COPD, they may avoid recommending effective ways to help people move away from combustion.
For people living with COPD, these misperceptions are dangerous. Switching completely from smoking to vaping has been shown to reduce exacerbations and improve symptoms. Studies have found persistent improvements in quality of life and lung function among patients with COPD who switched.
People with COPD do not deserve lectures. They deserve care. Many have lived with poverty, workplace hazards, air pollution, limited health care access, or genetic vulnerabilities. When smoking is involved, it is part of a complex story, not a moral failure. Stigma drives people away from health care, delays diagnosis, undermines quit attempts, and deepens suffering.
As I look at my husband—alive, still here, still fighting for breath—I think about all the people who never got the chance he had, because stigma stood between them and proper medical attention.
As we mark World COPD Day, we must confront stigma, misinformation and the harms they cause. And the people making global policy decisions must be reminded that people who use nicotine are human beings with the right to respect, accurate information and options that reduce harm.
My husband’s life, like the lives of all people who smoke, is worth more than a lecture.
