We can’t breathe without them, and there are plenty of things that make them work less well. So what can you do to keep your lungs healthy? Pulmonologists weigh in on how to take care of your respiratory system for life.
1. No smoking
“The most important thing is not to smoke,” says Philip Barber, a pulmonologist in Manchester. “Lung cancer kills 35,000 people a year in the UK – more than breast, prostate and colorectal combined. It is not only cancer; lots of diseases are caused by smoking. So the message is: don’t smoke and if you do smoke, try to quit.” If not for yourself, do it for others. “Smoking indoors can cause problems not only to yourself, but secondhand smoke exposure to those around you,” says Pallavi Periwal, a pulmonologist at Southampton General Hospital and author of Make Every Breath Count.
2. Quitting is better than cutting down
“I tell patients that cutting down typically doesn’t work – stopping completely is much better,” says Stefan Marciniak, a pulmonologist at Cambridge University Hospitals and professor of respiratory science at Cambridge University. “If you smoke, you’ve got a 50% chance of dying of smoke. Only 20% of us have a genetic predisposition to get emphysema (smoke-induced lung destruction) from it, though any of us can develop cancer if we smoke, or suffer strokes or heart attacks.” The best thing is to not to start, but stopping at any time is still worth it. “I warn patients that life can change quickly from pootling around, doing your own shopping, doing the gardening, to not being able to walk to the end of the drive, to not being able to get out of the house, to having care workers come to care for you in your home. Stopping at any of those points retains the amount of independence you have and delays the point at which you become more dependent on others.”
3. That applies to smoking cannabis, too
“Cannabis can cause emphysema 20 years faster [than tobacco],” says Marciniak.
4. Vaping is not your friend
“The UK philosophy on vaping is based on an approach called ‘harm reduction’ on the basis that it is ‘safer than smoking’,” says Barber. “That suggests that they are both quite safe but vaping is more safe, which is a bit of a distortion. It is more true to say: ‘Vaping is not proven to be safe, but it is safer than the biggest mass killer on the planet.’” Marciniak adds: “It is not as safe as breathing fresh air.”
5. Be aware of occupational exposure
“There are certain jobs that we think about as being associated with the potential for lung damage, which would be dusty or dirty jobs, such as in construction,” says Han. “There are other occupations where we don’t fully understand what the potential impacts are, like working as a nail or hair technician.” For those working in these kinds of salons, Han recommends considering “better ventilation and trying to use products that are lower in volatile organic compounds (VOCs)”.
6. Travel actively
“Air quality inside cars is generally worse than the outside and exposure to pollution is higher,” says Nick Hopkinson, medical director of Asthma and Lung UK and professor of respiratory medicine at Imperial College, London. “So if you are stuck in traffic, your air quality is bad. It is better to be actively travelling if you can – walking, cycling or using low-emission public transport. If you get rid of cars from the streets, there will be a virtuous cycle where you reduce the amount of air pollution and end up with fitter people. There is good evidence that being physically active has an impact on lung health. The more active you are, the slower the decline in lung function is.”
7. Consider potential damage at every age
“Lung development starts in the womb and growth continues until around the mid-20s,” says MeiLan K Han, professor of medicine at the University of Michigan Health and author of Breathing Lessons: A Doctor’s Guide to Lung Health. “In childhood, there are a few things we worry about, but respiratory infections are a big one, so make sure kids have vaccines. Childhood pneumonia is a major killer of children. Try to minimise air pollution and tobacco exposure.”
We all lose lung function over time, which is considered normal ageing, he says, “but due to a huge variety of factors – environmental exposures, occupational exposure, smoking and respiratory infections – you might have accelerated decline in adulthood. So in the first half of your life you want to maintain that upward trajectory, and after that you want to slow the decline.”
8. Burning wood is problematic
“There is a very close relationship between indoor and outdoor air pollution,” says Hopkinson. “Inhaling particles is bad for us – there’s not really any way around it. Wood-burning stoves are a source of indoor and outdoor air pollution, however efficient the stove is. The evidence is pretty clear that wood burning produces quite a substantial proportion of pollution in towns.” Inside the home, “there is clearly going to be less risk if you have a fire with a tightly sealed door as opposed to an open mesh,” says Marciniak. However, he adds: “If you can smell the fire you are breathing in smoke, which is a bad thing. There are certain things which generate more smoke: wet wood is worse than dry wood; plastic is awful because it generates all sorts of horrible complex derivatives of carbon which are quite carcinogenic.”
9. Sleep problems could indicate a lung problem
“Undiagnosed sleep apnea can affect the oxygenation in your body,” says Periwal, and it can lead to decreased lung function and other respiratory issues. “Often it is missed because people don’t expect sleep to cause a respiratory problem. But if you are not able to sleep through the night, repeatedly waking up, or experiencing excessive daytime sleepiness, these can be symptoms of sleep apnea. So it is important that if you’re having issues with sleep, you should get yourself checked to ensure that your lungs are fine.”
10. If pollution levels are high, consider wearing a mask
“People with cardiovascular and respiratory problems and young children tend to fall ill quite frequently with certain pollutants,” says Periwal. “For them it is best to avoid going outside when there’s an increased level of air pollution. If you do go outside, wear a mask.” She has just visited her parents in Delhi, where pollution is notoriously bad. “My dad has asthma so they always check the outdoor air quality index before they go out, and they use face masks,” she says. “Something is better than nothing, but if you can, get proper anti-pollution masks that will help in distilling out the particulate matter.”
11. It is better to exercise outdoors than not at all
“In most cities, when the pollution isn’t terrible, there is a net benefit to exercising outdoors, if you take into account the negative effects of pollution and the benefits of exercising,” says Marciniak. This doesn’t apply everywhere, though. “If you go to the more polluted countries like India and China, you run out of benefits within the first 15 minutes.”
12. Get out of breath
“There are two kinds of exercise that are beneficial for the lungs,” says Barber. “One is anything that makes you a bit breathless – walking, running or cycling – anything that goes a little bit above normal walking pace, sufficient to exercise your heart and lungs. The other is muscle-strengthening exercise, like squats and sit-ups, which are very important in maintaining strength, especially as we get older. This improves your chances of a good outcome with an operation.” You don’t have to pay to join a gym, he says. “There is a lot online about simple stretching exercises with rubber bands, planking, things like that. There are many things you can do by yourself to build up your muscle strength and make yourself a bit breathless each day. Start off at a very low level and build up on a daily or weekly basis. It is surprising how quickly you get a lot stronger and fitter.”
13. You can’t teach yourself how to breathe better
Don’t listen to what the breathing gurus say. “There are some that would have us believe that vast tracts of the population – without lung or heart disease – are somehow breathing the wrong way, which is nonsense,” says Hopkinson. “For most people the problem is just fitness, not dysfunctional breathing.”
14. Eat a nutritious diet
“Ensure you have antioxidants in your diet in the form of omega-3 fatty acids,” says Periwal. “If you have a balanced diet, it is going to help your lungs, just like anywhere else in the body, especially if you have a diet which is rich in fruits and vegetables. This goes a long way in improving your immunity, which is how you get fewer infections.”
15. Take breathlessness seriously
“People often don’t take breathlessness very seriously and dismiss it as a normal part of getting older,” says Hopkinson, “especially if they have a history of smoking or asthma when they were younger. This allows underlying lung disease to progress without treatment. If you go for a run, you might really work hard with your breathing. But if you’re getting breathless doing normal things, or if it is interfering with what you would do normally, then that’s something that needs to be taken seriously. It can be a sign of lung disease, heart disease, or it may be to do with being unfit. There can be a psychological component as well: being anxious can make breathlessness worse. Don’t ignore it – there are simple lung function tests to check if there is a problem with moving air in and out.”
16. Get vaccinated
“Especially against Covid,” says Periwal, “and if you are eligible, get your flu jab and pneumococcal vaccination. We’ve seen that in people who get Covid after the vaccination, the disease is not as severe and does not require hospitalisation compared to those who aren’t vaccinated.” Pulmonologists are also seeing “people who had very severe Covid in the past when vaccines weren’t around who now have very severe lung scarring. And that is a chronic thing that you will need to live with. So one of the easiest ways to prevent that is to not get such a severe form of Covid. You can’t really prevent a virus from entering you, but what you can do is get vaccinated.”
17. Have a persistent cough checked out
“Most simple chest infections settle within a fortnight,” says Barber. “If you have a cough beyond two or three weeks, it is a sign that there is some continuing pathology keeping it on the boil. In that case you need a GP consultation.”
18. If you have an inhaler, use it properly
“Asthma is on the rise,” says Hopkinson. “The UK has one of the worst asthma outcomes in Europe in terms of how common it is, hospitalisation, and the risk of death.” Pollutants such as cigarette smoke and poor air quality prime the lung to make it more sensitive to allergens. “With asthma, you get inflammation in the lining of the airways which causes swelling and the tube gets narrower. Inhalers can relax the muscle or damp down the inflammation,” says Hopkinson. “For most people, inhalers help them to have little or no symptoms. Anyone with an inhaler should go on to the Asthma and Lung UK website and have a look at the inhaler technique videos, because many people make mistakes using their inhaler, and it is important to make every puff count. If you use an inhaler the wrong way then what comes out of it just ends up in your mouth and you swallow it.”
19. Avoid mould and allergens in the home
“If you have a tendency towards allergies, there is an increased risk that you’ll develop allergies to mould spores in your home,” says Marciniak. “There are some things you can’t easily avoid, like house dust mites, the little creatures that live off the skin we shed in our pillows and mattresses, which a lot of people are allergic to. To get rid of them you can use special vacuum cleaners, and we recommend getting particular bed covers and pillowcases and changing carpets, but it will not eradicate them completely. Some allergens can be avoided: not having a cat if you’re allergic to cats is going to help. And not having mould if you’re allergic to mould is definitely going to help.”
20. Campaign
“The lungs are at the cutting edge of the social determinants of health,” says Hopkinson. “Roughly half the risk of getting lung disease in adult life is established in childhood. Child deprivation and the effects of austerity mean that at the moment children’s lung health is being damaged by living in cold, damp homes, indoor and outdoor air pollution, poor nutrition and not getting access to prompt medical care. We are storing up a generation of children whose lung health is going to be affected by that. Join campaigns on air quality, healthcare and housing. Write to your MP or visit their surgery to talk about clean air, smoking and what policies they are supporting to make sure that no one is forced to live in a cold, damp home.”
