Thanks for your question on HCM. Being a smoker emphysema can occur at any age. And smoking make you more vulnerable to get emphysema at this antitrypsin level. So if you have chest x ray and PFT (Pulmonary Function Test) siggestive of emphysema than you are suffering from it only. No need to search for the cause. Better to start treatment. 1. Smoking cessation should be the atmost priority. 2. Inhaled bronchodilators. 3. Pulmonary rehabilitation with chest physiotherapy and deep breathing exercise. 4. Pulmonary vaccination with pneumococcal and h.influenzae vaccines.