Synopsis: Air pollution is blamed for one of every eight deaths worldwide, including 200,000 in the US each year. A noted lung physician discusses some of the diseases smog can cause and ways to keep your lungs safe.

Host: Nancy Benson. Guest: Dr. Steven Nathan, Director, Advanced Lung Disease and Lung Transplant Program, Inova Fairfax Hospital, Falls Church, VA

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Air Pollution and Lung Safety

NANCY BENSON: You probably know air pollution affects your health, but you may not realize just how big an impact it can have.  The world health organization links air pollution to one in eight deaths worldwide, including about 200 thousand in the US per year. Still, most of us take for granted the impact air pollution has on our lungs.

STEVEN NATHAN: If you look at all the different kinds of lung diseases, all of them are associated with worsening based on levels of air pollution.  There might even be some causation as well with regards to the effects of air pollution on the lungs.

BENSON: That’s Dr. Steven Nathan, director of the advanced lung disease and lung transplant program at Inova Fairfax Hospital in Falls Church, Virginia.

NATHAN: You can get a disease like Chronic Obstructive Pulmonary Disease if you are exposed to enough air pollution.  Thankfully, it is not seen here in the US, but more in third world countries.  Even in the absence of smoking there can be enough [pollution] to cause significant COPD.  If you look at many other diseases, from asthma to interstitial lung disease, the main one being idiopathic pulmonary fibrosis, all of these diseases appear to be impacted by air pollution.

BENSON: Nathan says most people he comes across don’t know that where their home is located can determine how healthy their lungs are.

NATHAN: There was actually an interesting study that I mention out of Europe from a couple of years ago. What they did in this particular study is they mapped patients’ addresses to major highways.  What they showed was that those patients who lived closest to the major highways had worse outcomes, greater incidence of chronic rejection and more mortality associated with this.  So, whatever disease has been looked at previously has been found to be associated with worse outcomes with regards to exposure to air pollution.

BENSON: It’s true that air pollution can introduce us to chemicals that cause things like heart disease and liver toxicity. Still, Nathan says our lungs should be the primary concern when discussing air pollution because they’re directly exposed to the environment.  Everyday, we breathe countless potentially harmful air particles.  Nathan came up with an acronym to make these particles easier to remember- CREP.  C-R-E-P.

NATHAN: What CREP stands for is Circulating Respiratory aErosolized Particles.  There’s a lot of CREP in the air that we all breathe in that can affect our lungs and ultimately our health.

BENSON: It’s important for people with lung conditions to stay inside when air pollution warnings are in effect.  Even indoors, though, Nathan says precautions need to be taken to ensure the air is safe.

NATHAN: [By] maintaining a clean house and making sure that [you don’t have] elevated levels of radon, which can occur in some basements, at least you have more control of what is happening in your own internal environment.

BENSON: Nathan says that obviously, even people with no documented lung conditions should protect themselves from air pollution, too.  This way, they can try to prevent the onset of such diseases.

NATHAN: You’re not protected if you have normal lungs.  I did mention patients with various diseases because there’s more evidence.  But there have been studies that looked at lung growth in children and compared those children, growing up in areas that are more polluted, versus areas that are less polluted, and the amount of lung growth you get in a more polluted area is less.

BENSON: And it’s not just a risk for children. Living in a polluted area is comparably dangerous for adults.  Nathan says air pollution can have effects similar to those of smoking cigarettes.

NATHAN: What’s been shown is if you live in a more polluted area your loss of lung function after the age of around 25 or 30 is greater than if you live in a less polluted area.  So in a lot of ways it does function like cigarette smoking.

BENSON: Some of the most prevalent air pollutants are lead, carbon monoxide, sulfur dioxide, ozone, and mixtures of gases coming from car exhausts and electric utilities. These pollutants can lead to lung disease, lung cancer, and one disease Nathan is particularly concerned about, Idiopathic Pulmonary Fibrosis.

NATHAN: Idiopathic Pulmonary Fibrosis, or IPF, is a form of chronic progressive scarring of the lungs.  The “idiopathic” means we don’t know what causes it, “pulmonary” is lungs, and “fibrosis” means scarring.  It truly is an underappreciated condition.  It tends to occur in elderly folks, but can certainly occur in folks as young as 50 years old.  Males tend to be more affected than females.  There is a link with smoking, though not quite as strong as the one we have with COPD.  About 70% of patients have been smokers or are current smokers.

BENSON: Experts estimate there are somewhere between 100 thousand and 200 thousand cases of IPF in America at any one time. Nathan says many cases are misdiagnosed because the main symptom, a gradually increasing shortness of breath, is also a symptom of more common diseases like COPD.  Even though IPF isn’t as prevalent as various types of cancers, the disease is incredibly lethal.

NATHAN: The only cancers that have more total deaths in the US than IPF are breast cancer and lung cancer.  If you take other more common cancers like prostate cancer, cervical cancer, uterine cancer, leukemia; there are more deaths from IPF than any one of those.

BENSON: Fortunately, developments to help those suffering from IPF have arrived.  As recently as last year, the only real treatment for IPF was a lung transplant. But since only about 25 percent of patients are healthy enough to have a transplant, there was little doctors could do for most patients in spite of having a diagnosis.  Now; however, doctors have more treatment options.

NATHAN: There are two drugs.  One is called nintedanib.  The other one is called pirfenidone.  They were both approved in the US in mid-October of last year based on clinical studies that showed they both work to slow the deterioration in lung function.  What they do is slow down the progression of disease in patients with IPF.  Neither of these drugs are a cure.  They don’t reverse the disease or restore lung function.  Once the lung function is lost, its lost forever.  At least thus far, we don’t have anything that can reverse the pulmonary fibrosis that does exist.  That’s why it’s also important to be aware of this condition because the earlier the diagnosis is made, the earlier the patient is placed on one of these therapies and the more likely they’ll preserve their lung function for longer.

BENSON: Just as important as treating the disease is preventing it in the first place.  Experts say one of the best things you can do for your lung health is some good old-fashioned cardiovascular exercise.  Maybe just try to go for that 3 mile run closer to parks and forests than factories and busy roads.

Our writer this week is Evan Rook. Our production directors are Sean Waldron and Nick Hofstra. I’m Nancy Benson.

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