Lung Health Awareness Month

Blog post by: Dr SA Makate

Determinants of Lung Health – Mic series 1

As part of Lung Health Awareness Month, SM Chestclinic brings you this instalment of the microphone series and blog posts.

We all know that we need to ensure our lung health in order to live long and abundant lives, reaching our individual highest potential. Beyond not smoking and avoiding pollutants, have you ever wondered what determines good lung outcomes? It might surprise you!

1. Firstly, where you are born and where you currently live

Where you are is not only a geographical accident, but it literally can determine whether your lungs stay healthy or whether you are at a higher risk of lung complications.  For example, those of us living in more urbanised areas, with industrialisation are more likely to be exposed to more pollutants than those in more rural areas. In the same breath, other exposures to certain animals in more rural settings can lead to very common lung conditions like Hydatid Lung Disease, which is the infection of the lung tissue with the Echinococcus Parasite, commonly found in rural settings.

By virtue of being in sub-Saharan Africa, we find ourselves still living in a part of the world that still has a high TB prevalence compared to the rest of the western world. If you use public transport/ spaces, you are also exposed. Because of this, more of our loved ones also live with the chronic complications after successfully treating TB.

2. When you are born (premature vs term)

Circumstances and complications around your birth and delivery can also set the trajectory of your lung health in motion. Usually, our lungs are ready to take on the world and the many triggers once we are fully matured in the womb. But if you are born premature, not only will you have less lung breathing units called alveoli, but the literal size of your lungs will be smaller, and their elasticity and resilience will be reduced. This means your little one is set to face a world full of viruses and pollutants with lungs that are immature and that required deliberate care such as good nutrition for growth, vaccinations, treatment of infections in time and avoidance of harmful pollutants.

3. Who your parents are

It’s true, we can’t choose them, but they influence our own lung health and even the lung health of our children. Research shows that if your parents were smokers, your children will have lower lung functions even if you yourself were never a smoker… Wild right. If you are raising your children in a household with smokers, they will have lower lung functions than children raised with parents that are non -smokers. Procedures like tonsillectomies and other minor procedures can be complicated by exposure to passive smoke inhalation with children getting laryngospasms on sleep induction with anaesthetic medication.

More frequent hospitalisation with chest complaints and more difficult control of chronic lung conditions such as asthma due to passive smoke exposure. It’s important to remember, passive exposure is not only during the actual process of smoking, but the chemicals linger on our skin and clothes. Unless you take a bath or shower and change clothes after smoking, you are still exposing your loved to secondary smoke exposure.

4. Exposure to harmful behaviours such as vapes and e-cigarettes

With social media marketing and boom of direct-to-consumer advertising, the use of e-cigarettes, vapes and under waterpipe smoking devices commonly called “hubbly-bubbly” has been put forth as less dangerous than traditional cigarettes. This is far from the truth as chemicals used in combustion of these chemicals can lead to an entity called vaping associated lung injury. It’s an inflammatory lung disease than can develop rapidly and lead to permanent lung damage.

5. Access to all levels of health care

In a country like ours, most people will have access to basic primary health care. Hopefully. But some children are born in areas where access to specialist services to diagnose, treat or manage more specialized lung conditions is limited. This will result in delayed or missed diagnosis. Less extensive management plans and certain scenarios have devastating consequences.

References:

Nigro M, Laska IF, Traversi L, Simonetta E, Polverino E. Epidemiology of bronchiectasis. Eur Respir Rev. 2024 Oct 9;33(174):240091. doi: 10.1183/16000617.0091-2024. PMID: 39384303; PMCID: PMC11462313.

McCready C, Haider S, Little F, Nicol MP, Workman L, Gray DM, Granell R, Stein DJ, Custovic A, Zar HJ. Early childhood wheezing phenotypes and determinants in a South African birth cohort: longitudinal analysis of the Drakenstein Child Health Study. Lancet Child Adolesc Health. 2023 Feb;7(2):127-135. doi: 10.1016/S2352-4642(22)00304-2. Epub 2022 Nov 23. PMID: 36435180; PMCID: PMC9870786.

Gray D, Willemse L, Visagie A, Czövek D, Nduru P, Vanker A, Stein DJ, Koen N, Sly PD, Hantos Z, Hall GL, Zar HJ. Determinants of early-life lung function in African infants. Thorax. 2017 May;72(5):445-450. doi: 10.1136/thoraxjnl-2015-207401. Epub 2016 Nov 17. PMID: 27856821; PMCID: PMC5520243.

Münzel T, Hahad O, Kuntic M, Keaney JF, Deanfield JE, Daiber A. Effects of tobacco cigarettes, e-cigarettes, and waterpipe smoking on endothelial function and clinical outcomes. Eur Heart J. 2020 Nov 1;41(41):4057-4070. doi: 10.1093/eurheartj/ehaa460. PMID: 32585699; PMCID: PMC7454514.