There has been little information about the relationship between respiratory symptoms and number of years (duration) of tobacco use, particularly in a population representative of a US state. This is also true with regard to the relationship between duration of tobacco use, respiratory symptoms, and sex. Pack-year history requires the use of two survey questions, whereas years of tobacco use can be estimated by a single question. South Carolina is a US state with a high prevalence of current smoking (21.0% in 2010) and COPD (7.7% in 2011), and a high mortality rate from COPD (68.6 per 100,000 in 2010).16,17 The South Carolina Behavioral Risk Factor Surveillance System (BRFSS), an annual health survey, included state-added questions regarding years of tobacco use and respiratory symptoms in 2012 and provided an opportunity to assess the association of prolonged tobacco use with respiratory symptoms and COPD in a contemporary state population of adult respondents with a smoking history.