Background: Recent smoking quitters are still affected by their previous smoking years in the form of breathing limitations and alterations. Thoracic spinal manipulation is capable of resolving ventilation inefficiency. Aim: Our aim is to ascertain the impact of thoracic spine high-velocity, low-amplitude manipulation (HVLAM) on ventilatory functions among male smoking quitters. Design: This is a randomized, two-group pre–post-test, controlled study. Setting: Health Units in the 6th of October City, Egypt. Subjects: This study enrolled 54 males aged 35–50 years who were smoking quitters of less than one year and were equally allocated at random into groups A and B. Group A received HVLAM intervention for the thoracic spine along with a conventional physical therapy (CPT) program for the chest in the form of diaphragmatic and pursed-lip breathing exercises, mobility exercises for thoracic spine in the form of foam roll hyper-extension exercise, chest expansion exercise (Open book) and thoracic hyper-extension from kneeling. Group B only received the CPT program. Both groups received sessions twice weekly for 8 weeks. Tools: Participants were evaluated by a computed spirometer to assess ventilatory functions and a 12-item Short Form Health Survey (SF-12) to assess quality of life. Outcome measures were forced vital capacity (FVC), maximum voluntary ventilation (MVV), forced expiratory volume in 1 s (FEV1), physical component summary (PCS), and mental component summary (MCS). Results: Ventilatory functions and the SF-12 survey both improved significantly within both groups. Moreover, groups A and B had significantly increased (P<0.05) FVC, MVV, FEV1, PCS, and MCS post-treatment compared to pre-treatment, with nonsignificant differences between both groups. Moreover, group A showed more improvement in FVC (68.63% vs. 62.69%), MVV (9.46% vs. 8.91%), FEV1 (46.10% vs. 36.21%), PCS (30.39% vs. 29.79%), and MCS (13.67% vs. 12.26%) than Group B. This indicates that both groups showed improvement in ventilatory functions and the SF-12 survey, with group A displaying more percentage of improvement. Conclusion: Thoracic HVLAM did not significantly impact ventilatory functions in male smokers, but it resulted in a higher percentage of improvement. Recommendations: Male smoking quitters should consider incorporating thoracic spine HVLAM with the CPT into their rehabilitation program to improve their ventilatory functions effectively.