What could cause me to get emphysema if i have never smoked?

Number of things: Most notably, alpha-1-antitrypsin deficiency, an inherited disease. Also, environmental or occupational exposures. Second-hand smoke is also possible though by a longer stretch. Sometimes, normal chest x-rays of healthy young people are overread as emphysema. Hope this helps.

Other forms: Exposure to other toxins including wood fires etc can also lead to COPD and there are some genetic syndromes that also predispose patients to COPD without or with a minimal smoking history - a pulmonologist can help evaluate these. Furthermore chronic poorly controlled asthma or other bronchiolitis can also eventually cause irreversible obstructive lung disease.

Enzyme deficiency...: There is a form of emphysema that is caused by deficiency of an enzyme called alpha-1-anti trypsin. If you are deficient in this enzyme, you will develop emphysema at a younger age and it can occur without a smoking history. If you have this disorder, smoking will further accelerate the process. Treatment includes replacement of the deficient enzyme. It is diagnosed via a blood test.

Genetic form...: There is a genetic form of emphysema called alpha-1-anti trypsin deficiency. It is caused by the absence of an enzyme, alpha-1-anti trypsin. Patients typically develop emphysema at an earlier age and a smoking history is not necessary but smoking accelerates the process. Treatment includes enzyme replacement and it is diagnosed by a blood test.