Every breath you take: Understanding air pollution and lung health
The 2020 bushfires and COVID-19 drew a national gasp of attention to the importance of clean air, and an organ central to your health and wellbeing: your lungs.
“The first thing we do when we’re born is inhale. The last thing we do is exhale,” says Dr Noah Greenspan, founder of the Pulmonary Wellness Foundation and the Pulmonary Wellness and Rehabilitation Center in New York. It’s a mostly automatic, unconscious action that happens about 22,000 times a day. “Breathing is a thing you take for granted, until you have a problem,” remarks Greenspan, also the author of Ultimate Pulmonary Wellness published in 2017.
Your daily breath
On a global level our lungs aren’t in good shape. World Health Organisation figures show chronic obstructive pulmonary disorder (COPD) is the third leading cause of death globally. In Western countries, asthma is the most common chronic illness affecting children. Within Australia, lung cancer and COPD (obstruction of the airways caused by chronic bronchitis and/or emphysema) are in the top five causes of mortality.
… air pollution kills about 5 million people each year.
While cigarette smoking is the main risk factor, its association with both diseases leads non-smokers to underestimate their risk. A 2016 study, for example, found 27 per cent of females with COPD had no history of smoking. Accumulating evidence reveals a history of asthma, air pollution, occupational exposures to toxins and dusts, chronic respiratory infections, impaired lung growth in childhood and passive smoking are other key risk factors.
In a 2018 paper, researchers at UCL Respiratory College of London called for greater recognition of COPD. They write: “Chronic respiratory diseases receive little attention and funding in comparison with other major causes of global morbidity and mortality … An estimated 328 million people have COPD worldwide, and in 15 years, COPD is expected to become the leading cause of death.” Importantly, most chronic lung conditions are preventable.
Getting to know your respiratory system
Breathing issues during the Australian 2020 bushfires drew attention to the health of our lungs. But breathing involves much more than just the lungs, says Dr Greenspan. It encompasses barely thought-of body parts like the diaphragm and epiglottis (the flap in our throat that prevents solids and liquids entering the lungs) and the cilia: hair-like structures throughout our respiratory tract that trap foreign particles. “Contrary to what people believe, breathing is not just a function of the respiratory system and lungs alone,” he says. It’s intimately entwined with our brain, hormones and cardiovascular, nervous, muscular and gastrointestinal systems.
Inside air is often more toxic than what’s outside.
While most people believe the lungs pump air in and out, it’s actually your diaphragm, the muscle that sits between the thorax and abdomen, doing the job, with a little help from accessory muscles in your upper body. But the brain commands all this, dictating the rate of respiration to maintain the body’s needs for homeostasis.
Put simply, your respiratory system is a mechanism for processing air, extracting life-sustaining oxygen for the cells of your body and releasing waste products of cellular chemistry including carbon dioxide.
Inhaled air from the mouth and nose flows through the trachea into the pulmonary organs, down the stem of your trachea into the multitudinous branches of the bronchi and bronchioles, then into the alveoli, the millions of microscopic air sacs where the exchange of gases occurs. One of the most fragile parts of your body, these alveoli are unable to regenerate. Housed in the spongy lobes of your lungs, they’re additionally protected by the ribcage. But, as the only internal organ in direct contact with the air, your lungs are vulnerable to environmental contaminants. Along with the cilia and mucus, defence mechanisms in the respiratory system include macrophages in the alveoli (which engulf foreign substances and move them upwards to the bronchi for expulsion), coughing, sneezing, swallowing and spitting. Tiny particles, however, can bypass this system.
Common respiratory problems
The most common diseases of the airways and lungs are asthma, occupational lung diseases and COPD (chronic bronchitis and/or emphysema), Dr Greenspan says. “Chronic bronchitis is a disease of the large airways. Emphysema is a disease of the small airways and the alveoli. Often, people have a combination of both, because the culprit in many cases is cigarette smoking or exposure to toxins.”
Asthma, chronic bronchitis, emphysema and cystic fibrosis are examples of obstructive respiratory diseases. These involve narrowing of the airways due to inflammation and difficulty with the exhalation phase of breathing. Such people often have a higher lung volume, which causes hyper-inflated lungs, Dr Greenspan explains.
Those with a restrictive respiratory illness have problems with the inhalation phase, and a lower lung volume caused by restriction upon the lungs expanding. Pulmonary fibrosis, asbestosis, silicosis and interstitial lung disease are examples.
… a diet high in vegetables, fruit, some fish and whole grains reduces the risk of lung function decline, asthma attacks and COPD.
“Whether you have a problem with inhalation or exhalation it manifests in the same way, which is shortness of breath, the primary symptom of all respiratory disease,” he says. Other common symptoms of respiratory problems include coughing, wheezing, decreased physical activity tolerance and hypoxia (inadequate oxygen at tissue level).
What’s ailing our lungs?
“There’s a lot of reasons why people can develop lung diseases,” Dr Greenspan explains. This includes microbial infections, environmental factors, autoimmune or neurological causes, genetics, injury and co-morbid conditions. Predictably, one of the worst things for your lungs is smoking. This includes vaping, he says.
According to Our World in Data, air pollution kills about 5 million people each year.
Solid particles and liquid droplets invisible to our eyes and smaller than 10 micrometres (0.10mm) in diameter, known as PM10, can be inhaled into your lungs. Ultra-fine particles less than 2.5 micrometres (PM2.5) are respirable, meaning they can penetrate deeper into the lungs and enter the bloodstream.
The biggest contributors to PM2.5 are emissions from industry and manufacturing, the burning of fossil fuels and wood, transportation and natural causes like dust storms and bushfires. People in certain professions, like mining, construction, farming, the plastics industry and textile work are particularly at risk. Such pollutants can in turn react with sunlight to cause ground-level ozone, a toxin to your lungs.
Such tiny particles are associated with significant health risks including respiratory problems. Given this, regulations exist in Australia and many other countries to monitor the concentration of particles less than PM10 in outdoor air.
Cleaning up your indoor air
Inside air is often more toxic than what’s outside. Common indoor contaminants, according to the Environmental Protection Agency, include ground-level ozone, car exhaust, gas and wood-burning stoves or heaters, central heating and cooling, asbestos, pesticide, mould and VOCs (volatile organic compounds) from flooring, upholstery, paint, cabinetry, plastics and furniture made of pressed wood products. Malfunctioning appliances can also release pollution. In office environments, photocopier fumes and ultra-fine particles in printing are common air contaminants.
… positive emotions can positively affect our lungs, reduce symptoms and prevent disease …
Hygiene, scent and cleaning products may also lace indoor air. A 20-year study of over 6000 people published in the Journal of Respiratory and Critical Care Medicine in 2018 found that over the long term using cleaning products at least once a week caused lung function decline in women similar to smoking 20 cigarettes a day.
Keep your indoor sanctum as natural and chemical-free as possible. The Department of Health site recommends avoiding unflued gas appliances and wood-fired stoves and heaters, as these produce carbon monoxide and nitrogen dioxide. If you do use them, follow the recommendations on their site. They also suggest using the exhaust fan when cooking with gas and limiting candles and incense.
Good ventilation, cleaning and vacuuming with a HEPA filter can go a long way. Regularly air-dry your home and use exhaust fans to help reduce moisture, as it can lead to mould.
If you’re an asthmatic, avoid lung irritants and allergens building up in the home. According to Safe Work NSW, over 400 substances are known to cause an allergic asthmatic response, including animals, dust, pollen, smoke, fumes and VOCs.
An air purifier can help. Research shows that, to a degree, they can clear particles in indoor air. A Chinese study published in 2015 in the Journal of the American College of Cardiology found air purifiers reduced PM2.5 concentrations in student dorms by 57 per cent. According to CHOICE, HEPA filtration, which traps fine particles down to 0.3 micrometres (this includes smoke) is the most important feature for an air purifier.
On a diet and lifestyle level there’s lots more we can do to improve our lung function. “Pulmonary function peaks at about age 20. Typically, we will lose about a half to 1 per cent lung function per year, depending on what we do with it,” Dr Greenspan says. As a clinical specialist with over 25 years’ experience in cardiopulmonary physical therapy and rehabilitation, he emphasises that it’s possible for even those with a progressive respiratory disease to reduce their symptoms, improve their range of activity and live longer.
Exercise and physical therapies
One of the best things you can do for your lungs is exercise regularly. Unfortunately, people with breathing issues typically avoid activity because of the discomfort it causes. It’s the worst thing you can do for your lungs, Dr Greenspan says. The whole body becomes conditioned to underperformance. “Patients become less efficient at using oxygen, and then they become shorter of breath at lower levels of activity, and the cycle continues. It’s a downward spiral known as the dyspnoea cycle.”
On the upside, “In the same way that you can spiral downhill by inactivity you can spiral up the hill again,” he says. “Exercise is super-important because how your body uses oxygen is based on three main functions: how good your lungs are at moving air in and out; how good your heart is at pumping blood; how good your muscles are at extracting oxygen from the blood and how efficient they are using oxygen. All three get better with exercise. When we talk about cardio, we’re really talking about the cardiopulmonary system. They’re taught and treated as different systems, but the heart and lungs are like yin and yang. They’re super-connected, physically and physiologically.”
Many people mistakenly think they can strengthen the lungs, he says. “It’s an organ. You can strengthen the muscles of respiration but you can’t strengthen the lungs themselves.” In fact, in people with chronic breathing difficulties, the muscles of the neck, shoulders, upper chest and back tend to get painful from overuse. Dr Greenspan teaches more effective breathing techniques to quiet them. He also puts his patients on a boot camp of flexibility, balance and strength training. Any activity that increases heart rate and muscle strength is useful, including yoga, tai chi, walking and aerobics.
If you’re overweight, trimming down can also make a significant difference to your breathing. “Fat is not our friend,” Dr Greenspan says. “It’s an inert, extra weight we have to carry around. Imagine if I said, here’s two bowling balls, carry these around all day. You’d be exhausted; you’d be short of breath; you’d be tired; you’d be fatigued.” Mid-section, abdominal weight is the worst kind. “Every time you want to take a breath and elevate the ribcage your diagram has to work that much harder against that extra weight,” he explains.
Being underweight, on the other hand, can result from living with a chronic respiratory condition. “When you’re working hard to breathe, you’re burning a lot of calories. Their lungs can be too large or space in the thoraco-abdominal cavities can become smaller, therefore they feel fuller.”
While mucus is part of your respiratory system’s natural defence mechanism for removing contaminants, overproduction is common in people with lung problems. Too much can cause shortness of breath, decrease our ability to oxygenate the blood and become a breeding ground for infection, he says. It’s hard to expel mucus submerged deep in your lungs because your coughing mechanism only works in the larger airways, he explains. “If I have a ketchup bottle I can shake it around, but unless I put it in the right position no ketchup is going to come out.” Gravity can drain mucus into the large airways, the reason many people cough in the morning. Dr Greenspan recommends postural drainage, percussion (cupping), controlled coughing, specific breathing and huffing exercises and other techniques to clear the airways. There are also devices that can help.
Avoiding infection and triggers
Preventing infections is particularly vital for those with chronic respiratory diseases. Infections can exacerbate symptoms, speed the progression of disease and take longer to heal than in someone healthy, says Dr Greenspan.
It’s things like handwashing, using antibacterial wipes, not fiddling with your face (pathogens can enter our bodies through the mucous membranes of the eyes, nose and mouth) and avoiding situations likely to harbour a lot of germs — “everything you’ve heard about avoiding coronavirus,” he says.
Fortifying your immune system with sufficient rest, sleep and sunlight and avoiding allergens and other respiratory triggers is also important. For example, cold can trigger bronchoconstriction and hot, humid weather makes the air feel thicker and more difficult to breathe. He suggests covering your nose and mouth with a scarf in cold weather. On hot, humid days get out in the morning and evening.
The lung microbiome
According to a 2019 article in The Lancet, changes in the balance of microorganisms within the lung are involved in the pathogenesis and progression of many lung diseases. In fact, asthma is viewed by some as a form of dysbiosis (imbalanced microbial communities).
Nurture your microbiome with probiotic foods, those containing beneficial bacteria species, like yoghurt and fermented foods. Favourable bacteria, in turn, flourish on a diverse diet and prebiotic fibres found in chicory root, onions, garlic, leeks, Jerusalem artichokes, oats, nuts, lentils and other foods. Avoid foods like sugar and refined flour products that cause pathogenic species to flourish. Be mindful of things that kill beneficial microorganisms, like antibiotics, pesticides, alcohol, cigarettes, stress, artificial sweeteners or cleaning chemicals.
“While there is a tremendous wealth of knowledge about nutrition in the management of conditions like cardiovascular disease, diabetes and obesity, far less is understood about the role of nutrition as it relates to pulmonary health and wellness,” Dr Greenspan laments in Ultimate Pulmonary Wellness.
Certain foods and eating big meals can actually make you more short of breath, he says. Pressure in the abdominal cavity caused by liquids, solids or gases increases pressure in the chest cavity. And vice versa. It also creates resistance against the diaphragm’s downward contractions and pushes the lungs up, another impediment to breathing.
Those suffering respiratory illness should avoid large meals and gas-producing food and drinks like carbonated beverages, consume smaller more frequent meals and eat slowly. Think quality over quantity; consume nutrient-dense foods, he says. Follow a diet low in carbs, moderate in protein and high in healthy fats. It’s a formula based on the “respiratory quotient”, a ratio of carbon dioxide produced in the body by different foods. “Carbohydrates produce the most CO2 per gram of all the nutrients,” Dr Greenspan explains. “Carbohydrate is 1.0 on the respiratory quotient, protein is 0.8, and fat is 0.7. That high carbohydrate meal will spill carbon dioxide into your blood and send a signal to you to breath and expel it.” Another advantage of “good” fats — they possess anti-inflammatory properties.
Avoid food allergens, caffeine and alcohol. He says alcohol is a nervous system depressant which impedes breathing. Hold back on the salt shaker too. “Salt increases fluid retention, which increases the workload on the heart, increases blood pressure and generally overloads the cardiopulmonary system.” And stay hydrated: “Dehydration can affect blood pressure and cardiac output, and it could make your secretions very hard and thick.”
He advises those taking steroid medications like inhalers to consume enough dietary calcium to combat their bone-depleting effects.
In the book, Natural Therapies for Emphysema and COPD, naturopath Robert Green additionally recommends avoiding dairy foods, red meat, wheat, fried food, junk food high in trans fats, and sugar — these can be mucous-forming and pro-inflammatory in the body. Sugar also suppresses the immune system.
Supporting such advice, studies show a diet high in vegetables, fruit, some fish and whole grains reduces the risk of lung function decline, asthma attacks and COPD.
Therapeutic foods and herbs
Increase your intake of foods and herbs that boost immunity, reduce inflammation and free radical damage, and prevent proliferation of harmful bacteria and viral species and fungi like candida and mould.
Green suggests daily consumption of raw foods and homemade juices to obtain concentrated nutrients, antioxidants (which prevent free radical damage) and enzymes destroyed by cooking. Specific helpful foods include leafy greens and orange-coloured fruit and veg, a rich source of vitamin A and beta-carotene important to the health of the respiratory tract mucous membranes. Leafy greens are also rich in chlorophyll, which detoxifies blood. Papaya and pineapple contain digestive enzymes and anti-inflammatory activity. They also break down mucus.
The spice and herb cabinet is another source of help for the respiratory system. Ginger and turmeric have well-studied anti-inflammatory powers. Green recommends chilli, horseradish, onion, mustard and garlic (a potent natural antimicrobial when taken raw). Chilli stimulates circulation and expectoration (coughing up phlegm) and onion breaks down mucus. Thyme is an antimicrobial specific to the respiratory system.
Beyond the pantry, Green also recommends echinacea, which boosts immunity, oregano oil for its antimicrobial abilities and liquorice root, a natural anti-inflammatory.
Before taking herbal medicines, consult an expert to discuss any potential interactions with your medications.
Helpful supplements, according to Green, include bromelain (which breaks down mucous), immune enhancers like zinc, antioxidants including grapefruit seed extract, selenium, quercetin, vitamin A and E, and anti-inflammatory fish and plant oils. Magnesium, which relaxes the smooth muscle of the lungs, and vitamin C, an immune booster, antioxidant and anti-inflammatory, are particularly useful.
According to experts on the subject, most of us don’t breathe efficiently. Breathing techniques to rectify this mostly centre around slower, deeper, abdominal breathing.
Naturopath and breathing educator Mim Beim says we should breathe through our nose. This filters and warms the air prior to it hitting the lungs, particularly important for asthmatics.
Beim cured her own asthma using the Buteyko breathing method, which focuses on gentle nasal-breathing, activating the diaphragm and reducing the breathing rate with breath control exercises and relaxation. According to Beim, this switches on the parasympathetic nervous system (associated with rest) and increases oxygen delivery to the cells of the body.
Emotions like stress, anxiety and depression are super-impactful on the lungs, Dr Greenspan says. Conversely, he notes, “Few things are more stressful than not being able to breathe. Having a lung disease diagnosis creates anxiety of itself, and the fight–flight response makes you breathe faster. It does the opposite of what you need.” It’s a cycle of anxiety and breathlessness that can lead people with lung issues to limit their activity. Negative emotions can also be the true cause of breathing difficulties.
Being educated about your health can help alleviate anxiety. He also recommends mindfulness meditation, breathing exercises, positive thinking, exercise, social support, counselling and self-nurturing practices and hobbies.
The flip side of the emotional link to breathing is that positive emotions can positively affect our lungs, reduce symptoms and prevent disease, Dr Greenspan says. “Light breathes light, positive breathes positive.”