INTERVIEW

Americans are "ignorant" about lung health — at their own peril

Lung health expert MeiLan Han explains why the lungs are an "incredible," under-appreciated organ

By Mary Elizabeth Williams

Published November 13, 2021 2:00PM (EST)

Chest X-Ray (Getty Images/Fotosearch)
Chest X-Ray (Getty Images/Fotosearch)

There are endless books to be found about your heart health. There's plenty of literature on your gut. And don't even get me started on your brain.

But our lungs tend to be neglected as a topic of interest, even in the midst of multiple ongoing respiratory crises, from cancer to COVID to asthma.

But Dr. MeiLan K. Han can help us close that health literacy gap. A professor of medicine in the Division of Pulmonary and Critical Care at the University of Michigan, she is the author of "Breathing Lessons: A Doctor's Guide to Lung Health." It's at once an intriguing inside view of the respiratory system and a compelling case for the interconnectedness of our bodies and our environments. 

Salon spoke to Han recently about what we don't know about every breath we take, and what's really "raging" in your lungs when you contract COVID. 

This conversation has been condensed and edited for clarity. 

How did you approach this subject, knowing that we are so ignorant as a population about lung health?

I do a lot of lung research, and many of my colleagues around the world and I were realizing that if we really want to cure chronic lung diseases, we have to be starting much earlier. We can't just focus on the patients that already have problems, because patients get diagnosed so late. We have to start trying to find people in the community who have early lung damage and try to study them better. This is something that just hasn't been done before, and we don't know a lot.

In the book, for instance, I talk about how we got to know about heart disease. Much of it has to do with these really landmark studies like Framingham, which studied an entire population over the life course. They were able to develop all this, get all this great information. We just have never had anything like that for the lung. There's still so much we don't know. This was all swirling in the background when the pandemic hit.

Then it just became this perfect storm of having a massive respiratory pandemic. There's still being so much we don't know about how to treat and prevent lung disease. It's not that we don't know anything. Of course, we've got a lot of good things we can do. We've learned a lot about how to treat patients, for instance with COVID, during the pandemic. But to me, the pandemic itself provides this opportunity to help people understand that the health of their lungs is something that occurs over the life course. We shouldn't be thinking only about our lungs at the point that they start to fail.


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Let's start at the very beginning of that story, and that first breath we take when we're born.

It's important to remember that so much of lung development occurs even before birth. Even in the womb, we are breathing. We're obviously not breathing oxygen, but we are exercising our lungs and we're pulling in amniotic fluid into the lungs. That act of pulling in the amniotic fluid into the lungs helps the lungs to develop. If that doesn't happen, normally that is one of the first hits that the lungs can take in terms of abnormal development.

One of the key messages that I wanted to get out to women in particular and families is that there's so much we need to do to protect the respiratory health of our children before they're even born. Things like exposure to air pollution and secondhand smoke can all ultimately damage the developing of newborn's lungs.

But when we get to that first moment, there's just this incredible breath once babies are born. There's this physiologic transformation that occurs where oxygen, instead of being delivered via the umbilical cord from mom, is all of a sudden delivered through the lungs. There's this massive shift where the body closes down certain routes of blood flow and has to open up new ones to allow oxygenated blood to get to the body from the lungs. It seems very simple, right? When children are born, yeah, they're crying, it's all great. We forget that they weren't actually really breathing in the womb and that this is suddenly a very new thing. The body has to go through this massive evolution within, seconds to change the way it exchanges oxygen and carbon dioxide.

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There are some numbers that you pull in this book that really shocked me. Twenty percent of mothers are smoking in the first three months of pregnancy, ten percent are still smoking in the last three. Forty percent of kids are exposed to secondhand smoke.

We have to remember that we live in a global society. There is huge amounts of variation in terms of smoking prevalence, particularly among women in different parts of the world and the different things that children are going to be exposed to, whether they're living in Bangladesh or Rio de Janeiro or Sweden. I'm included in this group of middle class America, and we take certain things for granted. As a global society, that there is huge variation in the kinds things that young children are exposed to.

There are some things that we don't even think about. For instance, I grew up in Idaho. It was very common in the winter there, to heat homes with wooden stoves. That's just the way that we heated our home in the winter. There's increasing evidence that things like wood burning stoves can cause quite indoor air pollution that can be really damaging to the lungs. There's newer, cleaner stoves that are now available. I am sure that that stove that we had at home, that I was growing up with, did not meet those standards.

I wanted to raise awareness that even if you don't have smokers in the home, other kinds of dangers maybe can be at home.

I live in a neighborhood that has an extremely high childhood asthma rate. What is happening particularly in urban centers around asthma is very disturbing. I also think about my friends in California and other parts of the country, what is happening with climate change and with fires. It feels very out of our control. What do you think we, as citizens of the world, might be able to do protect ourselves?

Unfortunately, the risks are increasing due to air pollution, due to climate change. We've got more dust in the air, we've got more particulate matter in the air. Some of the particulate matter from some of those wildfires out west have made it all the way to Michigan, where I live. The dangers are real and the dangers are going up. From a global perspective, I think this is why we have to support measures, from a government policy level, to try to reduce air pollution. We know that for instance, pollution in urban areas does make asthma much worse for children — for instance that live in the heart of New York City.

One of the interesting things that we saw during the pandemic is a drop in certain respiratory flareups for patients with chronic respiratory conditions. Some of this is probably related to reduced transmission of viruses from everyone wearing masks. But I suspect some of it's also due to fewer people driving and a lot less air pollution, at least for certain parts of lockdown.

I can try to be part of community action to improve the air quality, but there may be at a certain point, only so much I can do. So what else can I do?

In the book I talk about measures to try to within the home. There are certainly things that you can do, like using low VOC paints and having your carpets aired out before new carpets are installed. There's just a lot of kind of simple tips. You can run air filters in a home. Even thinking about where, if possible, we live. Whether you live near a freeway. We should, as a society, not be building schools near freeways or high traffic areas because kids will be outside playing. There's definitely evidence to suggest that children, their lung function is impacted by being in proximity to a freeway.

There may be some simple things like that you can control, and then monitoring the air quality in your area. If you have a particularly sensitive child, just potentially not having to play as much outdoors on bad air quality days. There is some of this that is within our control.

The real seriousness of lung cancer and the impact that it has as a public health crisis doesn't get the amount of attention and funding for research that it should. Talk to me about the dangers, particularly in this country.

More women die of lung cancer than they do of breast cancer every year. Not that breast cancer isn't an important problem. I'm grateful for all the research that's going into it. But part of the problem is that lung cancer suffers from a significant amount of stigma. As a society, we have decided that, well, you caused your own problem therefore it's less important to us. We have to realize that a reasonable percentage of lung cancer actually occurs in non-smokers, particularly in women. You cannot just say, "This is your fault." Furthermore, there are very few conditions that do not have some component of environmental exposures and behaviors and genetics.

We still treat cardiovascular disease, despite diet. We still treat liver disease despite, again, diet and alcohol consumption. We cannot as a society afford to accept caring for and funding diseases based on the public's perceived level to which an individual has contributed to the problem. That's just not helpful and it's not going to help us move forward. It's not going to save lives. Of course, awareness about smoking cessation is important, but even if everyone stops smoking, that's not going to solve the lung cancer problem.

It is a huge problem. We need more cures. We need better cures. Fortunately, there have been some newer treatments for lung cancer that have come out within the last couple of years. Medicare has, at least in the United States started funding for lung cancer screening. We do now have good evidence to suggest that in patients that are at high risk for lung cancer, that getting annual CT scans can help detect cancers earlier. This is the kind of research we need, but I completely agree with you. Just going back to that fact that I said, things like breast cancer get so much attention, people don't even realize more women are dying of lung cancer.

I want to also ask you about where we are now in terms of lung health. The vaping thing is very scary. What do you say to people who say it's not as dangerous? Tell me what you're seeing in terms of public health.

There is so much about vaping that absolutely terrifies me. At least with cigarettes we generally knew what was in them. We have this history of experience of what typically happens when you smoke, both in terms of acute and long term exposures. But the issue with vape liquids and e-cigarettes is that there's been so little regulation that the number of compounds in anyone product can vary widely from product to product.

There are all sorts of harmful compounds, carcinogens and things that get even worse when they start to burn. There's absolutely no reason to think that vaping is a "safe alternative." Even when we look at the nicotine itself, the concentrations of nicotine in these type liquids are so high. Also it's not like with a cigarette, where you could measure by the pack.

It's much different when people have these liquid pods or whatever of varying sizes. Trying to figure out how much nicotine you're actually getting is difficult to control and even measure. I have an eight year old and vaping scares the hell out of me.

Before the pandemic hit, we were seeing children dying, even needing lung transplants from e valley. They ultimately thought perhaps that was related to vitamin E that was in the vaping liquid. Who knows what the next thing's going to be, that somebody's going to decide to add to the vaping liquid?

We don't know because it's never been tested as a vaporized, inhaled product. That's going to cause something else. We're also starting to accumulate that the longer term data on the health effects has been more difficult to accumulate. I have one patient, for instance, that was a world class athlete who now has severe lung disease just from a very short vaping exposure.

We've written a lot of things about what happens when you have COVID and what it feels like inside your body and what the effects are. For you as an observer, is there something that you feel that we journalists are getting wrong?

There's a really powerful picture in the book where I show what COVID looks like in the lungs, the particles. I don't think people realize that when you contract COVID, even if you are asymptomatic, your lungs are literally coated in millions of viral particles. That's been for patients that are asymptomatic or have minimal symptoms, have a bit of a cough. When we get imaging studies and we do CAT scans, we see all sorts of abnormalities.

I don't think people realize just the sheer amount of viral load, some of the subtle things going behind the scenes in the lungs and the war that's actually ravaging, raging in the lungs. Even in a patient that doesn't even know they were infected. That is in part of why it's so highly transmissible. You're generating millions of viral particles that are sitting in your respiratory tract that you can then pass on to other people that aren't going to fight the fight as well.

The other general misconception that frustrates the heck out of me is that the general public thinks, "If I'm not old and I don't have a chronic condition, I'll be okay."

I was just up in our ICU a few weeks ago and we have a 30-something year-old that we're trying to get off the ventilator. They've been on the ventilator for months due to COVID. We have children that have been in the hospital with COVID, and that unfortunately seems to be becoming more and more common. I think, misconception number one is just that if I am young and otherwise healthy, it doesn't matter.

America is all about personal freedoms. I get that, and I love America and I'm proud to be an American. At the same time, I think, unfortunately, we're taking a very selfish approach to vaccination where most of us look at our own personal risks and what we perceive as our own personal risk benefit calculation for the vaccine.

Many have chosen to forego vaccination. I just think what people forget is that it's really a societal responsibility, because even if you don't get sick, you could transmit it to someone else and they could die.

You can really hurt other people, even the people you love.

And then not even know you did it. The thing for me about vaccinations that's frustrating is that there's been so much discussion about the personal viewpoint, and less discussion about how the role that we play in the greater good of our communities.

If you could tell me one single thing that I could be doing to change my prospects for my lung health, what do you think that would be? An action that is a positive thing that you think people maybe aren't doing or don't know about.

The most important thing but not exciting answer is, limit your exposure to smoke. Assuming you're not smoking and you aren't around someone with smoke, believe it or not, as boring as it sounds, it's exercise. We talk about exercise for heart health all the time. The thing that we're learning about lung health is that the peak lung function achieved in early years may be determined by exercise and that that can ultimately impact your life course of lung health. People that maintain or even increase their fitness levels over time are going to have the healthiest lungs going into later adulthood.

That's really important to say. And also to remind people that smoking weed is still smoking.

Yes. When I say to not inhale anything, I mean anything. A lot of patients ask me about marijuana use, and the only thing I tell them is, just don't smoke it.

More lung health stories: 


Mary Elizabeth Williams

Mary Elizabeth Williams is a senior writer for Salon and author of "A Series of Catastrophes & Miracles."

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