The key message is that physicians should intervene with every patient who smokes: those who want to quit, those who do not, those who have COPD, and those who do not. Indeed, smoking intervention is not a zero sum game because the potential payoffs for cessation are universal. By increasing smoking abstinence, smoking treatment can mitigate, reverse, or arrest virtually all pulmonary conditions, including upper and lower respiratory tract infections, dyspnea, respiratory tract cancers, and compromised pulmonary function, as well as many other medical conditions. Whereas some of the lung parenchymal damage of COPD is irreversible, as noted above, it is clear that cessation can slow the progress of that disease. Moreover, the earlier that physicians intervene in the patient’s smoking career, the better. It is inestimably better to prevent COPD than to try to mitigate it. Smoking directly causes about 80% of COPD deaths each year in the United States (about 93,000 deaths) as well as morbidity and mortality from other smoking-related pulmonary disease. Thus, among the known benefits of smoking cessation, its potential to prevent pulmonary disease and dysfunction may be the greatest.