It is most likely that the answer to the mystery of why only a minority of smokers develop COPD is to be found in the field of genetics. Familial aggregation has been reported in COPD [79,80], but it is difficult to exclude confounding factors. In addition, COPD is a disease of middle age — by which time parents or grandparents are rarely still alive, so that it is difficult to conduct classical hereditary studies. It is also likely that many genetic factors interact to increase or decrease the risk of developing COPD. Thus, Mendel's laws of inheritance of 'susceptibility' to cigarette smoke could be ruled out .
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