As a person goes through life healthy and unburdened, he tends to take the tiny details of living for granted. How he can see and perceive the world clearly and vividly, how easily he can walk from place to place or up and down the stairs, how pleasurably he can eat anything without worry. Until the passage of time takes its toll and age catches up with him, he will most likely overlook his simple fortune of being able to breathe properly.

Breathing is perhaps the single most important action human beings do daily. Eating, drinking, or sleeping all fall under it as it would be literally impossible for a normal person to go five minutes without air. Taking care of the lungs, the organs responsible for this vital function, is necessary for a long and healthy life.

According to data gathered by the World Health Organization, four out of the top 10 causes of death around the world are due to respiratory and pulmonary problems. These 10 causes account for more than half (54%) of the 56.4 million deaths worldwide in 2015, and lung problems account for a major part of them.

“Chronic obstructive pulmonary disease (COPD) claimed 3.2 million lives in 2015, while lung cancer (along with trachea and bronchus cancers) caused 1.7 million deaths,” the World Health Organization reported on its Web site.

“Lower respiratory infections remained the most deadly communicable disease, causing 3.2 million deaths worldwide in 2015. [Meanwhile] tuberculosis killed fewer people during the same period, but is still among the top 10 causes with a death toll of 1.4 million,” the report added.

So how does one take care of his or her lungs? Like any part of the human body, keeping one’s lungs healthy means choosing and maintaining healthy lifestyle choices. The lungs in particular already have a natural defense system designed to protect itself from dirt and unwanted invaders, so all that’s left would be to keep it in good shape.

The American Lung Association (ALA) suggests a number of ways one might do this, but perhaps the most significant method of reducing the risk of lung diseases is the eschewal of smoking.

“Cigarette smoking is the major cause of lung cancer and chronic obstructive pulmonary disease (COPD), which includes chronic bronchitis and emphysema,” the ALA said on its Web site.

“Cigarette smoke can narrow the air passages and make breathing more difficult. It causes chronic inflammation, or swelling in the lung, which can lead to chronic bronchitis. Over time cigarette smoke destroys lung tissue, and may trigger changes that grow into cancer. If you smoke, it’s never too late to benefit from quitting,” it added.

Individuals who smoke regularly and over a long period of time have a greater risk of lung cancer and COPD, which includes emphysema and chronic bronchitis. Even secondhand smoke, which is much harder to avoid, is harmful too.

Contact with air pollution, which can be found indoors as well as outdoors, also need to be minimized. Chemical pollutants, ozone, and radon can cause and worsen lung disease. Sources of these harmful particulates range from construction materials and wood-burning stoves to even air fresheners, pet dander and candles.

The United States Environmental Protection Agency, which keeps up-to-date information on air quality in the US, recommends a three-pronged approach: Eliminate pollution sources, improve indoor ventilation, and use air cleaners to remove particulate matter.

Harmful particles or gases can even be found in simple home activities like cleaning. Cleaning products can contain chemicals like volatile organic compounds, ammonia, and bleach, and one must ensure that he is well-protected when using such products. Always work in a well-ventilated area, and use a dust mask for safe cleaning habits.

Preventive measures

Of course, in an environment devoid of much pollution keeping one’s physical fitness becomes a trivial thing. People who live in the cities, however, do not have much choice. Smoke and pollution are almost everywhere, and it would be nothing short of a miracle to avoid them completely. In these conditions, building a robust defense system would be essential in keeping one’s lungs healthy.

Respiratory infections, even common ones such as cold and flu, can sometimes become serious if not treated properly, and especially so if coupled with other lung problems. Protection and prevention are the key against common threats. Getting the flu shots in time for flu season, or the pneumococcal vaccine for the elderly can be the difference between going disease-free and succumbing to illness.

Further steps can be taken to avoid similar infections, such as frequent hand-washing, avoiding crowds during flu season, getting plenty of rest, eating well and avoiding too much stress. Exercise, especially aerobic exercises, will help maintain cardiorespiratory fitness.

“Aerobic exercise helps improve your lung capacity. Specific breathing exercises can also help improve your lung function. Exercise and breathing techniques are also great for improving your mood and helping you relax,” the ALA said.

Dealing with common lung problems

Due to the common nature of colds and coughs, it can sometimes be hard to know when an illness is serious enough to warrant a visit to the doctor. Filipinos are stubborn at this. Our frugal nature comes at the expense of our own well-being, with many Filipinos refusing to go to a hospital unless their illness is life-threatening. But health should always come first in such situations, and it is absolutely imperative that diseases be treated as soon as possible, for them not to get worse.

“Regular checkups help prevent diseases, even when you are feeling well. This is especially true for lung disease, which sometimes goes undetected until it is serious,” the ALA said.

If your coughs last for more than a few weeks to a month, or if you have a hard time breathing with little or no physical exertion, you should see a doctor. More glaring symptoms like wheezing, coughing up blood or coughing up phlegm for more than a month need to be examined at a hospital as soon as possible.

Easy it may be to overlook, breathing is one the most fundamental functions of the human body. Like the heartbeat, each breath punctuates each moment of our lives, pushing our bodies to go on living. That one is able to breathe freely and without problems is a blessing in itself, a blessing that many do not have. — Bjorn Biel M. Beltran

Sometimes, a dysfunctional heart is to blame for one’s breathlessness. This is the case with pulmonary edema or oedema, a condition where there is excess fluid in the lungs, particularly in the alveoli, or tiny air sacs, causing difficulty breathing.

According to the online health information provider WebMD, “Normally when you take a breath, your lungs fill with air. If you have pulmonary edema, they fill with fluid instead. When that happens, oxygen from the air can’t get from the lungs into the blood where it’s needed.”

The usual source of the problem is a heart problem. Patient, an independent health platform, explains that when the heart fails to pump blood to the body efficiently, the amount of blood that stays in the veins, the tubes that take blood through the lungs to the left side of the heart, increases.

“As the pressure in these blood vessels increases, fluid is pushed into the air spaces (alveoli) in the lungs. This fluid reduces normal oxygen movement through the lungs, which can lead to shortness of breath,” the site said.

But there are cases when pulmonary edema is triggered by other causes. These causes include acute respiratory distress syndrome; exposure to ammonia, chlorine and other toxins; acute kidney injury or chronic kidney disease; near-drowning incidents; viral infections; and being in high altitudes.

A sudden attack of pulmonary edema is called acute pulmonary edema, which, WebMD warns, can be life-threatening. One is advised to seek immediate medical help when one is experiencing any of the following: sudden shortness of breath; trouble breathing with a lot of sweating; bubbly breathing; coughing up pink, frothy spit; blue- or gray-looking skin; lightheadedness; and dizziness.

Chronic pulmonary edema is the type that develops over time. Among the signs and symptoms associated with it are tiredness, weight gain, more breathing problems than usual during physical activities, swollen legs and feet, trouble breathing when lying down and waking up at night with a breathless feeling.

There are several ways in which doctors diagnose pulmonary edema. The most basic steps are examining a patient’s medical history, checking the blood pressure and listening for noises in the lungs or murmurs in the heart using a stethoscope.

Several tests may need to be conducted: a chest X-ray to see signs of abnormalities in the heart and lungs; heart tests — like echocardiogram and electrocardiogram — so that the doctor will know if there are problems with the heart’s muscle and rhythm; and a blood test to check the levels of oxygen, carbon dioxide and salt, and the presence of a substance called natriuretic peptide.

Left untreated, patient notes, the condition may result in the increased pressure in the right side of the heart and cause the right ventricle to fail, and the failure of that ventricle may lead to the fluid swelling of the legs and the tummy, as well as congestion and swelling of the liver.

WebMD says treatment depends on the cause of the pulmonary edema. A diuretic may be prescribed to lower the pressure in the heart and lungs, and several lifestyle changes may be recommended, including consumption of lots of vegetables and fruits, regular exercise, quitting smoking and losing weight.

In a populated city, maintaining healthy lungs can be a challenge. One might make healthy personal choices but external factors and other people’s choices about managing their bodies may contribute to the development of certain diseases. While some can be managed with proper sanitation and use of medical masks, other diseases can be mitigated by not smoking.

“Bronchitis, Tuberculosis (TB) , Pneumonia and smoking-related disease Chronic Obstructive Pulmonary Disease (COPD) are in my opinion  the most common [lung diseases]. These are of multifactorial etiology,” Dr. Nazario A. Macalintal, Jr., Doctor of Pulmonary Medicine at the Makati Medical Center, told BusinessWorld in an e-mail.

Dr. Macalintal shared the factors that can contribute to the development of these diseases such as environmental factors, attitudinal factors and unhealthy choices caused by existing systems.

Each disease affects the lungs differently and exhibits distinct differences.

The Mayo Clinic defines Bronchitis as an inflammation of the lining of the bronchial tubes, which carry air to and from the lungs. People who have bronchitis often exhibit cough up thickened mucus, which can be discolored.

“Tuberculosis, or TB, is a disease caused by a bacteria belonging to a family of mycobacteria. The TB bacteria is airborn and therefore one can get it by simply by inhalation,” Dr. Macalintal explained.

Pneumonia, on the other hand, is  defined by the Mayo Clinic  as an infection that inflames the air sacs in one or both lungs. The air sacs may fill with fluid or pus (purulent material), causing cough with phlegm or pus, fever, chills, and difficulty breathing.

The European Lung Foundation defines COPD as a long-term condition that causes inflammation in the lungs, damaged lung tissue and a narrowing of the airways, making breathing difficult.

Dr. Macalintal shared how environmental factors such as pollution especially from diesel exhaust fumes can harm the lungs. These can be a result of policies that allow for unhealthy practices to thrive such as choosing popularly advertised over-the-counter drugs to self-medicate. “Our system allows so many medicines to be advertised for this and that. Why not allow prescription medicines to have the same but with bold reminder ‘Available in prescription only. See your doctor’,” Dr. Macalintal said.

He added that some of these have not gone through scientific testing. In terms of people’s attitudes, Dr. Macalintal shared two scenarios. He explained that while smoking is one of the main contributors to lung disease, smokers do not often realize its cost. “They have not seen the gargantuan financial impact of getting sick of COPD and always, it is only at the end that they realize the burden,” Dr. Macalintal said.

The second scenario that Dr. Macalintal shared is the general attitude of of Filipinos to wearing face mask when sick. He explained that this “stigma” prevents locals from practicing a habit that will prevent the spread of sickness. “Local people generally don’t wear mask when sick. Cough airflow dynamics show about 8 meters per second transfer of those droplets. That is enough to infect people,” he explained.   

To maintain healthy lungs, Dr. Macalintal recommended having annual medical examinations. It is a “preventative measure,”  he said. “Do not assume that ‘no symptom, no disease’. Learn from others.”

He also advised consulting the doctor if one suspects that he might have a lung disease. He also cautioned that while self-medication might be an easy choice, knowing the root of the problem is still the best solution. “See your doctor. Get examined. Don’t call for prescription. They need to listen to your lungs first. Avoid consulting ‘Dr. Website’. It cannot talk back to you. It is a one-way street,” Dr. Macalintal said. — Sigourney V. Tulfo

Tuberculosis (TB) is one of the top 10 causes of death and the leading infectious disease threat in the world which is responsible for more deaths than HIV (human immunodeficiency virus) and malaria. According to the latest Global Tuberculosis Report published by World Health Organization (WHO), there were an estimated 1.8 million people died from TB in 2015 or an equivalent of over 4,900 TB deaths every day. Over 95% of these cases occurred in low- and middle-income countries.

The report also said that an estimated 10.4 million new TB cases were recorded, which 5.9 million (56%) were among men, 3.5 million (34%) among women and 1.0 million (10%) among children. 60% of the figure was accounted to only six countries namely: China, India, Indonesia, Nigeria, Pakistan and South Africa.

Generally, the number of TB deaths worldwide fell by 22% between 2000 and 2015. In the same period, an estimated 49 million lives were saved through TB diagnosis and treatment. However, the case fatality ratio or the global proportion people with TB who die from disease varied under 5% in a few countries to more than 20% in most countries in the African region. This implies that there are considerable inequalities in access to TB diagnostics and treatment among the countries.

As explained by WHO, TB is caused by bacteria called Mycobacterium tuberculosis that attacks the lungs. It can also spread to the other parts of the body like the brain and spine.

TB is contagious and airborne which means it can be passed from person to person through air. When someone with lung TB coughs, sneezes, or spits, tiny droplets that contain germs are release into the air. Once a person inhales and catches a few of these germs, he or she become infected.

There are two types of TB conditions, the latent TB and the active TB disease. According to WHO, about one-third of the world’s population has latent TB, which means people have been infected by TB bacteria but are not yet ill with the disease and cannot transmit it. However, the infection is still alive in the body and can become active anytime. WHO noted that persons with compromised immune systems, such as people living with HIV, malnutrition or diabetes, or people who use tobacco, have a much higher risk of falling ill.

On the other hand, active TB disease is a condition which germs in the body multiply and make the person suffers from cough with sputum and blood at times, chest pains, weakness, weight loss, fever and night sweats. People with active TB can infect 10 to 15 people through close contact over the course of a year.

TB can be cured with proper treatment. The active TB disease is treated with a standard of six-month course of four antimicrobial drugs with a supervision and support by health worker or trained volunteer. As for WHO, “Without such support, treatment adherence can be difficult and the disease can spread. The vast majority of TB cases can be cured when medicines are provided and taken properly.”

In 2035, reducing tuberculosis death cases by 95% and TB incidence rate by 90% are among the targets of WHO under its “End TB Strategy”. In addition, it aims to ensure that no family is burdened with catastrophic expenses due to TB. It may be an uphill battle to reach these targets, but WHO has assured that significant strides are made by setting specific targets every period. — Mark Louis F. Ferrolino