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Air Pollution Exposure Raises Lung Disease Risk

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Chronic obstructive lung disease is a major cause of death and disability.

Air pollution is one of the most prominent factors in the development of lung disease, accounting for more than 2.1 million deaths worldwide. The highest death rate is in population-dense Asia, where air pollution is particularly high.

Research conducted by scientists at the University of North Carolina and published in the journal Environmental Research Letters blames 75 percent of deaths from air pollution on increases in fine particulate matter in the air. These particles are small enough to penetrate deeply into the lungs, causing declines in lung function and a risk of cancer. The remaining 25 percent of deaths are due to lung damage caused by ozone in the air.

Air pollution causes chronic obstructive pulmonary disease (COPD). Most commonly, the culprit is cigarette smoking and exposure to secondhand smoke.

Less commonly, an inherited disease, alpha-1 antitrypsin deficiency, leads to COPD at a young age by making the lungs more susceptible to damage from any pollutant. And finally asthma, primarily caused by allergies, is a frequent cause of COPD.

To understand how COPD occurs, we first must understand the function of the lungs. With each breath, air moves through large airways called bronchi that divide into thousands of smaller tubes called bronchioles that eventually end in millions of tiny air sacs called alveoli. Here, oxygen easily passes into capillaries, enters red blood cells and is transported throughout the body.

Exposures to pollutants damage the airways of the lung. Irritation of bronchi causes increased production of mucus and an inability to clear it from the lungs. The bronchi and bronchioles become blocked, and alveoli are irrevocably damaged and lose their ability to transfer oxygen from the air to red cells.

As lung function declines, the person breathes more often to maintain normal oxygen levels, and breathing feels harder. Initially, breathlessness occurs with moderate exertion, but eventually the person is breathless all the time.

Excessive production of mucus leads to a chronic cough and an increased risk of infection. As more and more damage to the lungs occur, oxygen levels drop to unacceptably low levels.

This in turn affects the body's metabolism, causes the heart to beat faster, enlarge and eventually fail.

Patients with COPD become dependent on oxygen, find even the most minor movement exhausting, are frequently hospitalized for infections and heart failure and become totally dependent on others.

COPD is a major cause of disability and the third leading cause of death after cancer and heart disease. While there is currently no known way to reverse the disease, there are therapies and lifestyle changes that can help relieve symptoms and slow the rate of progression of COPD. Diagnosis is usually made in middle age or later on the basis of exposure to pollutants (such as cigarette smoke), a chronic cough and shortness of breath. Often a chest X-ray or CT scan will be done to confirm the diagnosis and exclude the possibility of an underlying lung cancer — which is far more common in patients with COPD, irrespective of the cause.

The most important element of therapy is prevention.

Highly effective programs are available to assist with smoking cessation that include medications and, most importantly, support groups. No matter your age, avoid secondhand smoke, dusty environments and fumes that are known to irritate the lungs.

Anyone with impaired lung function must receive annual flu shots and vaccinations for pneumococcal pneumonia. And any infection, either viral or bacterial, is much more serious and often leads to illness severe enough to warrant hospitalization.

Irritation of the lung frequently leads to spasms of bronchi, which aggravates breathlessness and is often associated with wheezing. When spasms are present, bronchodilators may be prescribed. These are often combined with inhaled steroids that reduce spasm and relieve acute attacks of breathlessness. Newer combinations of medications offer the promise of more effective prevention of spasms that, when combined with therapies to assist in clearance of mucus, as well as appropriate physical therapy, can substantially reduce symptoms and the risk of serious infections.

Chronic lung disease remains a worldwide scourge. Even as smoking becomes less prevalent, air pollution remains a serious threat not only to the environment but to the health of everyone.

Dr. David Lipschitz is the author of the book "Breaking the Rules of Aging." To find out more about Dr. David Lipschitz and read features by other Creators Syndicate writers and cartoonists, visit the Creators Syndicate Web page at www.creators.com. More information is available at: drdavidhealth.com.

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