All of the patients we have seen with idiopathic obstructive emphysema have given a history of many years of cigarette smoking. This observation has been strengthened by published reports1-3 relating emphysema and smoking. Other articles relate bronchitis4-7 and wheezing attacks ("smoker's respiratory syndrome")8 to smoking, and it is apparent from the respective definitions that emphysema is included in these studies. Smokers also suffer higher death rates from noncancerous pulmonary disease than do nonsmokers.9 In a search for a consistent definition for emphysema, we have found none better than Laennec's original observation 10: The general signs of this malady are somewhat uncertain; dyspnea is the chief characteristic and it is one of those varieties which we confuse under the name of asthma... all of the patients in whom I have discovered this affection were subject to habitual cough. I have met with patients who have declared that they had neither habitual