The bill is coming due for the massive increase in smoking among women in the 1950s, 1960s and 1970s, in the form of rising illness among middle-aged women, the New York Times reported Nov. 29.

The death rate from chronic obstructive pulmonary disease (COPD), a lung disorder caused by smoking, has tripled among women between 1980 and 2000, and today more women die of the disease than men. About 85 percent of COPD cases are smoking-related, and symptoms typically show up after age 40.

"Women started smoking in what I call the Virginia Slims era, when they started sponsoring sporting events," said lung specialist Barry J. Make of the National Jewish Medical and Research Center in Denver. "It's now just catching up to them."

Make's colleague, James Crapo, called COPD "the largest uncontrolled epidemic of disease in the United States today." The disease is often mistaken for asthma, experts said, and victims face stigma and ignorance about treatment options. Complications run the gamut from lung infections to pneumonia. Exercise is essential because shortness of breath caused by COPD causes many patients to become inactive, making them even weaker.

"This is a disease where people eventually fade away because they can no longer cope with life," said COPD patient Grace Anne Dorney Koppel. "My God, if you don't have breath, you don't have anything."

About 20 percent of smokers develop COPD and, unfortunately, COPD rates will continue to increase worldwide even if every smoker quit tomorrow, according to researchers. Secondhand smoke also may cause the disease.