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Senior co-author Dr Joel Kaufman, from the University of Washington, said: We were surprised to see how strong air pollutions impact was on the progression of emphysema on lung scans, in the same league as the effects of cigarette smoking, which is by far the best-known cause of emphysema. The professor of environmental and occupational health sciences and epidemiology added: We really need to understand whats causing chronic lung disease, and it appears that air pollution exposures that are common and hard to avoid might be a major contributor. Ground-level ozone is produced when UV light reacts with pollutants from fossil fuels, and the process is accelerated by heatwaves