November is Chronic Obstructive Pulmonary Disease (COPD) Awareness Month. What exactly is COPD? It is a chronic lung disease that makes it very difficult for people to breathe. Air becomes progressively trapped inside the lungs due to excess mucus, scarring and narrowing of the air passages and destruction of the air sacs (emphysema).

Given that COPD affects 16.4 million diagnosed adults and millions more may be undiagnosed, you probably know someone with the condition. But this isn’t the only reason you should care about COPD.

Cigarette smoke exposure is a major cause of COPD, but for years, physicians thought most individuals reach adulthood with a relatively “healthy” pair of lungs and that it was adult exposure alone that led to the majority of lung function loss. Recently, however, we’ve made a rather important discovery. When looking at large populations of individuals over longer periods of time, a significant proportion of individuals never reach adulthood with fully “healthy” lungs to begin with, making them even more vulnerable to the toxic effects of factors such as tobacco smoke exposures during adulthood.

This means that something is going seriously wrong with lung development much earlier for a much larger proportion of the population than we had previously thought. Estimates suggest over 300 million persons around the globe live with COPD. It could be that millions of individuals are having their lung growth impaired somewhere during the prenatal, childhood and adolescent periods.

What exactly is responsible for these accumulated insults to the lungs over time? It is likely a multitude of factors, although the contribution from tobacco smoke is still significant. Roughly 20% of women report cigarette smoking during the three months before pregnancy and 10% of women report cigarette smoking during the last three months of pregnancy. Maternal smoking and second-hand smoke exposure during childhood are known to impact lung development. Studies suggest nicotine exposure during lung development may stimulate too much airway branching, leading to long, tortuous airways that imped airflow. This means that even electronic nicotine delivery devices used during pregnancy would still theoretically pose risks to unborn infants. In addition to second hand smoke exposure, other factors known to impair lung development during childhood include respiratory infections during childhood and exposure to air pollution.

One of the biggest issues we face in trying to understand this as either parents concerned about the lung health of our children or as individuals trying to preserve our own lung health, is the fact that we never perform lung function testing as part of routine care in medicine. While blood pressure is carefully tracked over time among individuals of all ages, as are height and weight, we never perform tests to measure lung health unless patients report symptoms. And even then, often other tests are conducted before lung function is measured. This is an aspect of our healthcare system, I along with many other pulmonary physicians and researchers are trying to rectify. We are working to show that screening for lung disease makes a difference.

In the meantime, however, what does this mean for you and your family? How do you protect yourself and your loved ones? When it comes to your lungs, you need to have the long view in mind. In other words, life is a marathon. At every point along this long journey we call life, you have to be thinking about how to maintain health. For developing fetuses, this means first and foremost reducing exposure to nicotine and tobacco product exposure. Talk to your children about the dangers of vaping and cigarette use. Middle school is a good time to start having these conversations. The American Lung Association has some great resources to jump start conversations with your children about vaping. During childhood, think about air quality within the home and outside of it. The American Lung Association website has some great resources on how to protect the air you breathe. Ensure children have their age appropriate, recommended vaccinations. Some new research suggests peak fitness levels in young adulthood are also associated with lung function later in life, so if you’re not exercising regularly, now is a good time to start. If you or your children are experiencing prolonged shortness of breath or cough, don’t wait to talk to your health care provider about having your lungs evaluated. The bottom line is that it is never too late to begin investing in your respiratory health.

MeiLan Han, MD American Lung Association volunteer spokesperson and author of Breathing Lessons: A Doctor’s Guide to Lung Health.

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