Explaining Lung Function & Health to Patients

How do you explain lung function — and dysfunction — to your patients?

Breathing Lessons, a book by pulmonologist MeiLan Han, MD, offers clear, patient-friendly explanations of lung function, lung infections, and lung disease that can help patients and their caregivers grapple with topics that might otherwise seem difficult and intimidating. Written in patient-friendly language, the book provides a convenient reference for patients and offers providers a tool for sharing a wealth of information with patients.

Conceived during the pandemic, when the general public was hungry to understand the devastating effects of COVID-19, Breathing Lessons provides an overview of how the lungs work and plain language explanations of the many things that can go wrong. The book also provides helpful information on how to preserve lung health, explaining why this is especially important in-utero and during childhood and young adulthood. There is even a chapter titled “How Pulmonologists Think,” explaining how medical exams, pulmonary function tests, imaging, and bronchoscopy serve as essential tools for assessing lung disease and dysfunction.   

The book is “relevant to anyone who breathes,” says Dr Han, a professor of medicine and Chief of the Division of Pulmonary and Critical Care at the University of Michigan Health in Ann Arbor. Dr Han is also a passionate advocate for lung health on social media, an American Lung Association spokesperson, and a frequent speaker at pulmonology conferences.

The Pandemic as a Teachable Moment

Breathing Lessons was inspired by the COVID-19 pandemic, says Dr Han. Five years ago, the COVID-19 pandemic showed the world the importance of lung health and lung function by highlighting the disastrous consequences of widespread lung failure — a lesson that reverberates today, as many people still suffer from the effects of long COVID.

When the pandemic hit, Han had been a longtime American Lung Association spokesperson. This was “a little bit of a sleepy job” pre-pandemic, she notes, but that changed dramatically in 2020, when many people were frantic to understand how COVID-19 affected the lungs and why ventilators suddenly seemed to be in short supply. “All of a sudden, people had a lot of questions about how the lungs worked and…[we] realized that we really did not have a lot of credible literature for the public.”

As the pandemic progressed, Dr Han did many media interviews, explaining basic facts about breathing, lung function, and ventilators in clear and simple language that was easy for the general public to understand. An editor who heard Dr Han speak realized there was a lack of patient-friendly literature about how the lungs work — and what happens when they don’t work — and approached her about writing a book. “He and I started chatting and we put together an outline for what a book could look like and what I felt people needed to know. That was spring of 2020,” says Dr Han. After that, she said, “I put myself on a really strict writing schedule,” and the book came out in late 2021.

The COVID-19 pandemic “revealed that much of the lay public lack even a basic understanding of how the lungs work or how we might protect our lungs,” Dr Han notes. Although the pandemic has moved into society’s rearview mirror, she hopes that the interest in protecting lung health that was sparked by the pandemic 5 years ago will remain alive and well. “[T]he lungs had been a relatively low priority target for both research funding and public education” prior to the pandemic, Dr Han explains in Breathing Lessons. “We now understand that safeguarding lung health is crucial to our overall health and survival.”  

The COVID-19 pandemic also showed us that “our lungs, generally speaking, were probably not as healthy as we all assumed they were,” says Dr Han. She notes that some of the variability in lung disease severity seen with COVID-19 related to pre-existing lung inflammation that patients may have been unaware of. As an example, she cites a study done in the western United States demonstrating that a greater number of COVID-19 infections and deaths occurred at the same time wildfires were raging in that part of the country.¹ These findings suggest that lungs weakened by wildfire smoke exposure may have been more susceptible to COVID-19 infection, she explains.

Lung Health: a New Concept?

“We know a lot about caring for lung diseases, but less about lung health,” says Dr Han.

Notably, her university is one of 36 sites across the country participating in a first-of-its-kind lung health study involving 4000 healthy participants aged 25 to 35 years. The American Lung Health Cohort Research Study (ClinicalTrials.gov Identifier: NCT04543461), which is expected to complete enrollment next year, seeks to determine how young adults’ lifestyles, environment, and physical activity affect respiratory health, and to understand “just how healthy or unhealthy the lungs of young Americans are,” says Dr Han.

Lung health is just as important as heart health and, like heart health, should be regularly monitored by primary care doctors and patients themselves, Dr Han stresses. Lung disease risks could be mitigated and the occurrence of disease could be identified much earlier — “before significant lung damage has occurred,” she notes — if lung health was monitored in the same way as heart health.

Spirometry as the Fifth Vital Sign

In Breathing Lessons, Dr Han describes lung function measurement via spirometry as a “fifth vital sign” that should be added to the list of 4 major vital signs (body temperature, pulse rate, respiration rate, and blood pressure) checked by primary care physicians. “[E]ven now, when easy-to-use digital spirometers are widely available, many primary care offices do not own a single machine,” Dr Han points out in her book.

Without regular monitoring of lung function, “most lung disease in the United States is picked up relatively late in the course of disease,” says Dr Han in her book. She likens this to trying to prevent erosion “on a plot of land where much soil has already been lost. No matter what you do at this point, the soil is already gone.”

This focus on treating well-established lung diseases rather than monitoring and promoting lung health is deeply ingrained in medicine and medical research. For instance, says Dr Han, “We currently have no therapies to target patients early in the course of COPD [chronic obstructive pulmonary disease] to slow the development of emphysema, which occurs over many years.” Even if we did have such therapies, we would still need better strategies for identifying patients with lung problems earlier, she adds.

Adopting a new focus on lung health and on early diagnosis and treatment of lung diseases “also means that regulatory agencies, such as the Food and Drug Administration [FDA], will need to expand the type of end points they are willing to examine for clinical trials. The FDA has traditionally favored lung function as a primary end point for pulmonary studies. However, even in the setting of significant disease, lung function decline may occur quite slowly.” In order to bring treatments to market that address lung diseases at earlier stages, “other types of clinical trial end points, such as data derived from [computed tomography] scans,” would be needed, says Dr Han.

Lung Health Starts Early in Life

As Dr Han emphatically notes in Breathing Lessons, lung health starts in the womb and must be fostered and protected from that time onward. “[One of the] biggest breakthroughs in our understanding in the last 8 to 10 years has been that we now realize that many chronic adulthood lung diseases actually start in childhood or even in the womb.”

For parents, this means that “even if your child does not have any known lung condition, there’s a lot we need to be thinking about with respect to how we can protect our children and promote lung health.”

Most of the general public is unaware that peak lung function occurs around the age of 25 and can be impaired by a variety of circumstances and conditions that occur before that time. This includes events that occur in-utero, childhood diseases, and lifestyle choices such as vaping and smoking cigarettes or marijuana. “The scary thing is that we don’t ever routinely check lung function,” Dr Han notes.

“As a parent, I take my child into the doctor, and every time we’re there, I see where he is on the growth chart, and I know how we’re doing for height and weight. I get a general assessment, and if there was something grossly off, I would know it,” says Dr Han — unless that something is related to lung function, which is never checked. As a result, she notes, “we have a lot of people going into adulthood who don’t have great lung function, but we never check until there’s a problem later in life.”

She cites an example of a 20-year-old man who came to see her because he had breathing problems playing basketball with friends; he couldn’t keep up and wondered if his vaping habit, which began a few years earlier, was to blame. After digging into his medical history, Dr Han found that the young man was born prematurely and had been on oxygen for his first year of life, but he had somehow gotten lost to follow up. “His lung function was roughly half of normal, and he had no idea,” Dr Han recalls.

“If he had known he was hitting adulthood with half-normal lung function, I’m guessing he would have made different choices about things like vaping,” she notes. “We all might make different choices if we actually knew what our lung function was,” she adds. For this to happen, pediatricians and primary care clinicians would need to monitor patients’ lung function on a regular basis and provide them with more information on lung health during well-visits.

Why put this on primary care clinicians, rather than pulmonologists? “Because people are sick by the time they get to me,” Dr Han notes. Even so, she understands why primary care providers don’t focus on lung health. “There’s just so many things that primary care physicians have to go through,” she acknowledges. They have a “massive checklist” of items they must ask patients about, and lung health and monitoring are not required items on that list.