If they’re healthy now, you need to keep them that way; if they’re not, there are treatments that can help
By Wendy Haaf
Are you doing everything you can to keep your lungs healthy?
By the time we reach age 55, many of us have been exposed to things that can compromise the health of these miraculous organs, which play a crucial role in helping us remain active. In fact, an estimated one in four Canadians 40 or over will develop chronic obstructive pulmonary disease (COPD, formerly known as emphysema and chronic bronchitis), a condition that commonly goes undiagnosed. Unchecked, it can seriously harm your quality of life and eventually interfere with your ability to carry out even the most mundane everyday tasks.
While it’s impossible to turn back the clock, you still have the power to prevent, or at least slow, any further damage. Here’s how.
Avoid further smoke exposure.
Smoking and second-hand exposure to tobacco smoke is still the No. 1 cause of COPD (workplace exposure to chemicals, dust, and other substances is No. 2), and while you’re still at risk of developing COPD even decades after quitting, stopping is the best thing you can do for your lungs, as well as for your overall health.
“If you recognize early COPD in a smoker and can help him or her quit, you will definitely modify the course of the disease and improve his or her life expectancy,” says Dr. Shawn Aaron, a professor and the chair of the Division of Respirology at the Ottawa Hospital Research Institute and the University of Ottawa.
It’s important to note that other factors may contribute to the development of COPD, such as asthma that’s been poorly controlled or that’s gone undiagnosed. Emerging evidence also suggests that conditions such as rheumatoid arthritis and early-life events that can interfere with proper lung development may also be implicated in the development of COPD.
Second after smoking cessation and avoiding second-hand smoke? “Stay away from dust, all smoke, fumes, and pollution if you can,” Aaron says. For example, if you’re going to spray-paint an item, ensure that the area is well ventilated and that you’re wearing a mask.
Consider replacing your fireplace with a gas insert. According to a 2010 Canadian Lung Association survey, nearly a third of Canadians who are at risk for COPD are exposed to smoke at least monthly via a wood-burning stove or fireplace.
And in light of the imminent change in cannabis legislation, Aaron advises, “If you’re going to consume cannabis, eat it, don’t smoke it.”
Stay alert for symptoms.
Fatigue, shortness of breath with activity (climbing stairs, for example), and persistent wheezing and coughing are all possible symptoms of COPD, and often, people may either dismiss them as something else (allergies, lack of fitness, or age) or (consciously or not) alter activities to minimize such issues. “If people have these problems, they should see their doctor. They might also ask them if they think pulmonary function testing would help,” advises Dr. Andrea Gershon, a respirologist at Sunnybrook Health Sciences Centre and scientist at Sunnybrook Research Institute and the Institute for Clinical Evaluative Sciences in Toronto. Similarly, if you notice that a family member tires easily, breathes more rapidly, or recovers more slowly after activity, you may want to gently suggest that he or she get tested.
Pulmonary function testing is used to diagnose COPD and asthma. The most common type of pulmonary function test used to investigate these conditions is called spirometry. “People are asked to blow into a tube, which allows us to determine if there is airflow obstruction in the lungs,” Gershon explains. (In asthma, the airflow obstruction is reversible, while in COPD, it is not.) While researchers such as Aaron are trying to untangle the reasons that COPD often goes undiagnosed, it’s believed the possible causes include some physicians not recognizing the symptoms of COPD, and problems with access to spirometry, which isn’t as readily available as, say, ultrasounds to diagnose heart failure.
“It’s thanks to studies that use spirometry in swaths of the general population [those that have and have not been diagnosed with COPD] that we know the condition is underdiagnosed. For example, in one such study of about 1,500 Ontario residents, we found 3.7 per cent of people had been correctly diagnosed with COPD and 13.7 per cent had undiagnosed COPD,” Gershon says.
Treat existing lung disease.
Sure, you know asthma can be treated, but if you’re like many people, you don’t know that there are treatments available for COPD, too. (When the Lung Association surveyed a group of people at risk for COPD, nearly 50 per cent said they were unaware of such treatments.)
After smoking cessation, the most powerful tool for preventing the worsening of COPD is “to prevent what we call exacerbations, or flare-ups,” explains Dr. Brian Rowe, the scientific director of the Institute of Circulatory and Respiratory Health at the Canadian Institutes of Health Research (CIHR) and a professor of emergency medicine at the University of Alberta in Edmonton. “Every time you get a flare-up, your lung function declines a bit.” (That’s to say nothing of the symptoms, which can be miserable—some people describe the resulting breathlessness as feeling like drowning.)
So how do you reduce your chances of experiencing exacerbations? Ideally, by following a written action plan that you’ve developed with your care providers during a process that includes education about COPD. “You need to make sure you’re getting influenza and pneumococcal vaccinations to reduce your chances of getting really serious respiratory infections, and to make sure you get on the right medications for your disease,” Rowe says. COPD medications, such as bronchodilators, can’t fix lung damage, but they can improve symptoms such as breathlessness.
An action plan typically includes a list of steps to follow under certain circumstances. For instance, if you’re producing more phlegm than usual, you might increase your dose of a particular medication, and if that fails to work, start taking another medication. This can sometimes prevent flare-ups from worsening: for example, since people with COPD are prone to both viral and bacterial lung infections, which can cause exacerbations, having an antibiotic prescription on hand that you can start taking at the earliest hint of bacterial infections may halt the process before it spirals further downward.
In a recent study involving people with late-stage COPD, a program that incorporated these components with psychological support and telephone follow-ups and troubleshooting led to a 52 per cent drop in emergency department visits and a 64 per cent decline in hospital admissions. Aaron and his colleagues have launched a study probing whether providing a similarly comprehensive intervention at a much earlier stage can change the course of the disease.
One treatment that doesn’t need further study, however, because it’s been proven effective in one trial after another—more effective, in fact, than medication—is a combination of education on self-management and of exercise—specifically, gradually intensifying a group of exercises dubbed “pulmonary rehabilitation.”
“Exercise will not improve the lungs, but when you train the heart and the muscles, the lungs function better, so you don’t have to breathe as hard for a given workload,” explains Dr. Michael Stickland, a professor of respiratory medicine at the University of Alberta and the director of the G.F. MacDonald Centre for Lung Health in Edmonton.
The resulting benefits are manifold. For one thing, Stickland says, “We don’t necessarily understand why, but we know that if you remain physically active, that’s actually one of the best ways to prevent a hospitalization or exacerbation, and it improves survival.” One possible explanation is that exercise has beneficial effects on the immune system, bolstering infection-fighting ability while dialing down damaging inflammation. “Many physicians don’t know about pulmonary rehab—it’s not on their radar—but if we get patients into a pulmonary rehab program within 30 days of hospitalization, we see significant reductions in the risk for being readmitted to hospital,” he says. (Stickland adds that many patients aren’t diagnosed until they show up in Emergency with 50 per cent of predicted lung function and with their fitness level having declined so much that they may not be able to walk 100 metres without resting.)
Perhaps even more important, though, pulmonary rehabilitation improves exercise tolerance, function, and quality of life while reducing symptoms—which can help people resume cherished activities such as dancing with a spouse and playing with a grandchild. “The research shows that when we look at things including breathlessness, quality of life, and exercise tolerance, pulmonary rehabilitation is actually the most effective therapy—it’s better than any medication we can give,” Stickland says. “If you have COPD and remain breathless, ask your doctor to refer you to pulmonary rehabilitation.”
Follow a healthy lifestyle.
“There’s pretty good evidence that nutrition also plays a role in keeping you well,” notes CIHR’s Dr. Rowe. “There are some interesting studies being done that are looking at lung function and diet. What they’re showing is that there’s a pro-inflammatory diet,” he says. The so-called typical North American diet falls into this category, while eating patterns rich in vegetables, fruits, whole grains, legumes, nuts, and fish appear to have the opposite effect. “There’s not yet enough information, but it seems that if you have an inflammatory condition, keeping the level of inflammation down in your body through diet, exercise, air quality, limits on exposure to self-inflicted environmental toxins, and proper sleep is going to be critically important to recovery and to maintaining your health,” he says.
Now that’s advice worth taking, even if you don’t have COPD.