World Lung Day is ob­served an­nu­al­ly on Sep­tem­ber 25, and this year’s theme, “Healthy Lungs, Healthy Life,” re­minds us that any dis­ease or im­pair­ment of these or­gans could have life-al­ter­ing con­se­quences.

Air car­ries oxy­gen but, un­for­tu­nate­ly, may al­so have thick plumes of cig­a­rette smoke, vape aerosols, ex­haust fumes, Sa­ha­ran dust, mould spores, in­dus­tri­al chem­i­cals, vi­ral par­ti­cles, ash­es from bush fires and the fine in­vis­i­ble pol­lu­tion that lurks in the air­ways.

Of course, dis­or­ders of the lungs are po­lit­i­cal, oc­cu­pa­tion­al, en­vi­ron­men­tal and so­cial. A child with asth­ma liv­ing near heavy traf­fic or a dump­site does not breathe the same air as one in a breezy, green neigh­bour­hood. A welder, quar­ry work­er, con­struc­tion labour­er, dou­bles ven­dor near the road, hair­dress­er ex­posed to chem­i­cals, farmer us­ing pes­ti­cides or clean­er in­hal­ing strong fumes may car­ry their work­place home in their lungs.

Asth­ma is one of the com­mon­est res­pi­ra­to­ry con­di­tions. Asth­ma is an in­flam­ma­to­ry dis­or­der of the breath­ing tubes which may present with a per­sis­tent cough, chest tight­ness, breath­less­ness and wheez­ing. Trig­gers in­clude dust, vi­ral in­fec­tions, ex­er­cise, smoke, per­fume, cold air, stress, mould, pets and weath­er changes. A good asth­ma plan re­duces in­flam­ma­tion, avoids pre­cip­i­tants, pre­vents ex­ac­er­ba­tions and teach­es pa­tients what to do be­fore a life-threat­en­ing episode.

If some­one is us­ing a re­liev­er or “blue” in­haler re­peat­ed­ly, wak­ing at night with cough or wheeze, miss­ing school or work, or vis­it­ing emer­gency de­part­ments for neb­u­li­sa­tions, their asth­ma is un­con­trolled. Some fa­tal “brit­tle” asth­ma at­tacks oc­cur in peo­ple who ap­peared well un­til there was a sud­den de­te­ri­o­ra­tion.

COPD (chron­ic ob­struc­tive pul­monary dis­ease) is an­oth­er ma­jor lung con­di­tion that is of­ten linked to smok­ing. Oc­cu­pa­tion­al dusts, air pol­lu­tion and re­cur­rent child­hood res­pi­ra­to­ry in­fec­tions have al­so been im­pli­cat­ed. COPD is pro­gres­sive air­way dis­ease, of­ten with cough, spu­tum, wheeze, ex­er­cise lim­i­ta­tion and re­cur­rent ad­mis­sions to hos­pi­tal. Many pa­tients tell me that they are not short of breath be­cause they stopped ex­er­cis­ing! Smok­ing ces­sa­tion strate­gies are un­der-utilised in re­source-poor de­vel­op­ing coun­tries and va­p­ing is not a safe al­ter­na­tive.

Pneu­mo­nia can be fa­tal in old­er adults, peo­ple with di­a­betes, kid­ney dis­ease, heart dis­ease, can­cer, HIV, chron­ic lung com­pli­ca­tions and those with weak­ened im­mune sys­tems. Tu­ber­cu­lo­sis has surged in a post-COVID era, so a cough last­ing more than two or three weeks, es­pe­cial­ly with fever, night sweats, weight loss, blood-stained spu­tum or known ex­po­sure, war­rants a physi­cian’s eval­u­a­tion.

The ex­tra­or­di­nary mor­tal­i­ty rate in this coun­try from COVID cru­el­ly ex­posed the so­cioe­co­nom­ic in­equities that haunt health­care. In­fluen­za and res­pi­ra­to­ry syn­cy­tial virus (RSV) can al­so be fa­tal in vul­ner­a­ble in­di­vid­u­als. Closed, crowd­ed, close-con­tact set­tings are petri dish­es for mi­crobes, and vac­ci­na­tion is one of the most prac­ti­cal ways to pro­tect our lungs. High-qual­i­ty masks like N95 (not use­less cloth masks or old T-shirts as we were once told by layper­sons) should be con­sid­ered in cer­tain set­tings.

Lung can­cer is a lead­ing cause of death world­wide and smok­ing ac­counts for the ma­jor­i­ty of cas­es. Oc­cu­pa­tion­al ex­po­sure to dan­ger­ous chem­i­cals, as­bestos and sec­ond-hand smoke are ad­di­tion­al risk fac­tors. Per­sis­tent cough, bloody spu­tum, un­ex­plained weight loss, chest pain, hoarse­ness, re­cur­rent pneu­mo­nia in the same area or wors­en­ing breath­less­ness are red flags.

Ob­struc­tive sleep ap­noea caus­es oxy­gen dips, snor­ing and strain on the heart and blood ves­sels. The per­son may have day­time som­no­lence, headaches, in­sulin re­sis­tance, re­sis­tant hy­per­ten­sion and rhythm ab­nor­mal­i­ties of the heart. Dick­ens may have recog­nised this health chal­lenge long be­fore doc­tors. In The Pick­wick Pa­pers, the char­ac­ter Joe, the “fat boy,” had all the symp­toms and the old term “Pick­wick­ian syn­drome” was coined.

“Clean air” means to­bac­co con­trol, an­ti-va­p­ing poli­cies for young peo­ple, re­duc­tion of in­dus­tri­al emis­sions, leg­is­la­tion on traf­fic pol­lu­tion, safe work­places, fil­ters, treat­ing mould, im­prov­ing ven­ti­la­tion in schools and pub­lic build­ings. Walk­ing, pul­monary re­ha­bil­i­ta­tion, breath­ing ex­er­cis­es, strength train­ing and grad­ual con­di­tion­ing can change lives.

Seek ur­gent care for se­vere breath­less­ness, blue lips, con­fu­sion, chest pain, cough­ing blood, faint­ing, in­abil­i­ty to speak in full sen­tences, se­vere wheeze not im­prov­ing with treat­ment, oxy­gen lev­els falling if you use a pulse oxime­ter or drowsi­ness.

World Lung Day re­minds us that breath­ing is a shared re­spon­si­bil­i­ty. How­ev­er, a so­ci­ety that tol­er­ates dirty air will pay in asth­ma clin­ics, can­cer wards, emer­gency de­part­ments and fu­ner­al homes.

Clean air is a ba­sic hu­man right. On World Lung Day, take one slow breath in the great out­doors and no­tice the mir­a­cle.