Honolulu attorney Robert Kessner barely survived the chronic obstructive pulmonary disease that resulted from 40 years of filling his lungs with nicotine and other toxic chemicals found in cigarettes.

Since being diagnosed with early stages of COPD in 2008, the 70-year-old’s breathing gradually worsened over the years to the point that he could no longer function normally. In the fall of 2018, he developed pneumonia and was given weeks to months to live.

Kessner had stopped smoking in 2010, but his lungs were never the same due to the progressive disease that obstructs airflow, making it harder to breath. COPD includes emphysema, or damaged lung tissue that absorbs less oxygen into the blood; chronic bronchitis, which increases mucus and inflammation; and irreversible asthma, which may not respond to typical medications.

“I absolutely could not breath without an oxygen machine. I could not go to altitude. I could not walk without stopping to catch my breath after 10 feet,” he said. “I could just see the end stage of COPD was going to be very, very unpleasant.”

There are 40,800 Hawaii residents living with COPD, according to the American Lung Association.

COPD was an underlying or contributing cause of death in the islands in 723 cases last year compared to 598 10 years ago, according to the state Health Department. The prevalence of COPD in Hawaii is expected to worsen with the aging of thousands of baby boomers who grew up in an era when smoking cigarettes was the societal norm.

“The cultural aspects of smoking was viewed as cool. Hollywood promoted it. There were advertisements. Cigarettes were included in military rations,” said Kessner’s pulmonologist, Dr. Eric Crawley. “It’s unfortunate there’s a stigma on former smokers because at the time there were a lot of societal pressures that encouraged people to smoke.”

The consequences are starting to be seen in the health care system.

“We’ll see a tidal wave of patients with COPD as the population ages,” he said. “As part of normal aging everyone loses some lung function. But the rate of decline is higher (when you have COPD).”

What’s more, people with COPD have a higher risk of developing lung cancer, the No. 1 cancer killer in America, surpassing casualties from breast, prostate and colon cancers combined, he said.

Kessner was one of the fortunate ones to survive the crippling disease.

Upon Crawley’s suggestion, the attorney took a leap of faith, flying to the mainland last December on a $50,000 air ambulance to seek a double lung transplant, a procedure that isn’t done in Hawaii. Within a week, he was at St. Joseph’s Hospital in Phoenix, the fourth-largest lung transplant center in the country. He was not on a waiting list at St. Joseph’s and didn’t have donated organs at the time.

“I knew what the alternative was if I stayed here: ‘Which hospice do I want to go to?’” Kessner said. “I just feel like I’ve got a lot more to do.”

A month later he had a double lung replacement at a cost of $750,000, covered mostly by health insurance. Ten months later, he says he feels “better than I have in 10 years,” working out daily and keeping himself as healthy as possible.

“I feel incredibly blessed. As the baby boomer generation of which I’m apart continues to age … I think there’s going to be a significant increase in COPD deaths and transplant needs,” he said. “I would tell anybody if you’re smoking now … you really don’t want to go through what I did. This vaping thing is horrid. There’s no reason in the world for it.”