Inhale. Exhale. You breathe in and out 15 to 25 times a minute, more when exercising and less when asleep. More than 22,000 breaths a day – that’s 8000 to 9000 litres of air. With each breath, oxygen travels through your bloodstream, fuelling your 37 trillion cells. Your lungs, quite simply, are keeping you alive. You don’t have to think about breathing, because your body’s autonomic nervous system controls it. If you hold your breath, your body will override this action, forcing you to release the breath and start breathing again. The automatic act of breathing is something you may only be aware of when it’s impaired or restricted.
Recent research by Lung Foundation Australia found just over half of Australians (around 53 per cent) rarely, or ever, think about the health of their lungs. Yet more than seven million Australians (roughly one in four), and more than 700,000 New Zealanders have a chronic respiratory disease. The Asthma and Respiratory Foundation New Zealand points out that these estimates are conservative – they don’t take into account the unknown numbers of people who are living with an undiagnosed respiratory condition.
Research is one of the most effective ways to improve the prevention, detection, treatment and management of lung disease. Yet despite its prevalence, this issue struggles to attract the same level of research funding as that of breast, prostate and heart disease. Although respiratory disease impacts roughly 25 per cent of Australians, it receives only 7.5 per cent of government research funding. Part of the problem is stigma – lung disease is often thought of as a smoker’s disease.
Not just smokers
Lung Foundation Australia CEO Heather Allan believes it’s important for people to know that it can affect anyone.
“We all have a picture in our mind of someone who has lung disease, but, in reality, lung disease doesn’t discriminate,” says Allan. “It affects the young, old,
male, female, smokers, former smokers and non-smokers.
“It may surprise people to learn that one in three women who have lung cancer are non-smokers while one in five people with the chronic lung disease COPD [chronic obstructive pulmonary disease] have never smoked.”
To increase awareness of lung disease and to get people thinking and talking about their lungs, Lung Foundation Australia recently launched the “Just One Breath” campaign, fronted by Australian Olympic gold medallist Cathy Freeman, who has herself battled asthma for most of her life.
Lung disease commonly goes undiagnosed, as people are unaware of its symptoms. One of the primary aims of “Just One Breath” is to teach people to recognise the early symptoms of possible lung disease. It encourages anyone who’s even slightly concerned to take the two-minute online Lung Health Checklist.
“A key symptom to watch out for with lung disease is breathlessness on exertion, more than someone else your own age,” says Jennifer Alison, Professor of Respiratory Physiotherapy at the University of Sydney. “People shouldn’t just assume that it is normal to get more breathless during activities as they age.”
Symptoms tend to creep up slowly, and people automatically adjust their activities to accommodate or reduce symptoms rather than getting help. “Many people minimise the symptom by avoiding exercise, which makes them breathless, hence the importance of exercise. If you have trouble exercising due to shortness of breath, you should have it seen to,” advises associate professor Gregory King from The Woolcock Institute of Medical Research. Other symptoms to look out for include a cough that lasts more than three weeks, wheezing, chest tightness, increased mucus production and coughing up blood.
The health of our lungs does naturally deteriorate. Professor Alison explains, “As we age we lose elasticity in our tissues (get ‘saggy skin’). The same thing happens in the lungs. This means that as we age the lungs become more ‘floppy’ and we lose lung capacity. The consequence of this is that in our mid-40s when we are lying down, some of the lung is not used/open, and in our mid-60s, when we are sitting some of our lung is not used/open.”
But this certainly doesn’t mean that you can’t keep your lungs healthy well into your 80s and 90s. “It is important as we age to stay active, which means we take deeper breaths and expand the lungs regularly. Very elderly people who are very sedentary should take big deep breaths and be encouraged to move to avoid lung problems,” says Alison.
The Age of Exercise
The importance of exercise both for healthy people wanting to look after their lungs, and for those suffering with lung disease, can’t be overstated. “Exercise is by far the best physiotherapy for your lungs,” explains professor King. “In lung disease, exercise is universally beneficial for relief of symptoms, improving quality of life and reducing attacks of breathlessness. The concept of using exercise as a form of treatment has been rigorously studied and implemented by specialist exercise physiotherapists in pulmonary [lung] rehabilitation departments.”
Professor Alison explains that regular exercise is important for those with lung disease, despite it not intuitively feeling natural. “For people with lung disease, the sensation of breathlessness can mean that people reduce their activity/exercise, which leads to deconditioning. When the muscles are deconditioned they don’t use oxygen very effectively and more carbon dioxide is produced during exercise. It is the carbon dioxide level that drives our breathing, and the more carbon dioxide produced during exercise, the more this stimulates faster and deeper breaths. For people who have lung disease, the aim is to provide an exercise-training programme so muscles become ‘fitter’ and use oxygen more efficiently, which reduces the amount of carbon dioxide produced. This leads to a lower breathing rate and depth during exercise, which reduces the sensation of breathlessness during exercise.”
Regular exercise is also important for maintaining a healthy weight. One theory is that the excess fat associated with obesity increases inflammation in the body, which may affect the lungs. Carrying extra weight can strain the lungs, increase the effort of breathing, and reduce lung capacity. “In very obese people, the lower part of the lungs become ‘squashed’ and some parts may collapse,” explains Alison. Alongside exercise, a dietician can help with individualised dietary advice.
Other than weight control, there is interest into how dietary factors may affect lung health. Although the impact of diet needs further study, accredited practising dietitians Jenna Obeid and Christie Emsley suggest some healthy approaches: “A high intake of fruit, vegetables and fish; low salt intake; restricted intake of trans-fats, foods rich in antioxidants, foods rich in magnesium (nuts, cereals, seeds, carrots, spinach and seafood); and an adequate intake of essential omega-3 fatty acids (found in oily fish, shellfish, soy and leafy vegetables).” This way of eating is in line with an anti-inflammatory diet, and may help to manage airway inflammation, which has been linked to lung diseases such as COPD and asthma.
There has been evidence to suggest a possible link between a diet rich in cured meats – hot dogs, deli meats, bacon – and COPD. “The results of current scientific studies that have already been conducted show that people eating large quantities of cured meats could potentially increase risk of developing COPD or increase risk of COPD exacerbation,” explains Obeid. However, she stresses that future studies will help to conclude whether or not this is actually the case.
But there is no doubt not smoking is the most important way to keep lungs healthy. Smoking exposes the lungs to cancer-causing chemicals and damages their cleaning and repair system by destroying the cilla (tiny hairs) that line them. This allows germs and chemicals from cigarette smoke to remain in the lungs increasing the risk of disease. As well as second-hand smoke, there’s mounting evidence that third-hand smoke could be harmful. The good news is the lungs of an ex-smoker can fully recover, as long as no real structural damage has occurred. “The earlier you stop, the more likely you will benefit from quitting and the greater the long-term benefit,” explains professor King.
It’s also important to protect the lungs from harmful airborne particles. Asthma and Respiratory Foundation NZ advises we should: make our homes smoke-free, use an electric or flued gas heater, limit the use of strong-smelling cleaners and sprays, dust with a damp cloth, vacuum regularly and air the house regularly.
The simple fact is when you can’t breathe, nothing else matters.