Your Lungs and the Environment
This article was written by MeiLan Han, MD, MS, COPD Foundation Board Member.
Many of us don’t stop to think about how our environment impacts our lungs. While tobacco smoke contributes to the development of COPD, there are many other environmental factors that contribute both to the development of lung disease and can also make respiratory symptoms worse for those who do have lung disease.
To begin, it is now believed that air pollution not only contributes to the development of COPD but can also make respiratory symptoms worse and trigger exacerbations (also known as flare-ups). Hotter temperatures and drought increase the amount of dust and particle pollution we are exposed to. Wildfires in particular have become a major source of extremely high particle levels, noticeable even hundreds of miles from the fires themselves. Since air pollution can vary significantly on a daily basis, websites such as airnow.gov allow you to look up the Air Quality Index in your area at any given time. On unhealthy air quality days, you may want to stay indoors if possible, while keeping doors, windows, and fireplace dampers shut. Air cleaning devices with high efficiency particulate air (HEPA) filters can provide additional protection. If you must spend time outside, ordinary masks are unfortunately not that helpful for filtering the smaller, more dangerous particles. In these cases, an N-95 type mask is most effective; however, as many now know, these can be uncomfortable to wear and breathe through. When driving on unhealthy air days, another tip is to roll up your windows and operate the recirculate setting for your vehicle’s ventilation system.
We know that air pollution can also come from inside the home. Sources of indoor air pollution include asbestos, paint and cleaning supplies, as well as mold and radon. Strategies to reduce air pollution in the home include trying to use safer products. For instance, “low-VOC” (volatile organic compound) paints are now readily available. Cleaning products unfortunately often contain chemicals harmful to the lungs. Ammonia and bleach can irritate the airways. It is important to never mix bleach or any bleach-containing product with any product containing ammonia. This combination can create a gas which can cause significant breathing problems and even death. The Environmental Protection Agency (EPA) has a list of cleaning products that meet their new "Safer Choice" requirements.
Other tips include having new carpet aired out before installation and making sure the carbon monoxide detectors in your home are working. Radon, the second leading cause of lung cancer, has been found at elevated levels in homes in every state in the U.S., so the only way to know is to test for it. If radon is a problem in your home, mitigation systems can be installed. Also, if you suffer from allergies, keeping the home humidity low and replacing carpets with hard surface flooring can help.
An often overlooked source of indoor air pollution is residential wood-burning stoves. As a child, we used a wood burning stove in the home for winter heating, which was quite commonplace in Idaho where I grew up. In the United States, it is estimated that solid fuel is a primary heating source for more than 2.5 million households. Emissions from wood smoke not only make respiratory symptoms worse, but can also lead to lung function impairments over the long term. If possible, consider upgrading to a clean burning device or consider alternative heating methods. The EPA adopted new, stricter standards so look for devices that meet these new 2020 standards, such as newer wood stove models featuring improved safety and efficiency. However, even gas stoves used for cooking create nitrogen dioxide, which has been associated with increased risk for respiratory symptoms and exacerbations. Using air purifiers with HEPA and carbon filters or replacing gas stoves with electric stoves have been demonstrated to reduce nitrogen dioxide levels in the home.
Finally, another factor to consider is protecting your lungs at work. Roughly 15% of all COPD cases in Western societies have been attributed to occupational exposures. While certain exposures such as asbestos, silica dust, and coal mine dust are notorious for causing lung diseases, a wide variety of occupations are at risk for unclean air. This list includes industries such as farming, woodworking, construction, and taxi driving, as well as hair and nail care services. Hair dressers, for instance, may be exposed to VOC’s found in styling product propellants. Other potentially harmful alcohols are widely used in beauty products. Secondhand tobacco smoke exposure in the work place is another major issue for certain workers which is difficult to control sort of tobacco-free policies within the workplace.
What’s the take home message? If you are doing anything that creates dust or generate aerosols, think about how to reduce your exposure. If the air quality index suggests an unhealthy air day, try to limit outdoor exposure when possible. We all need to become aware of the particles and chemicals in our environment, but this is even more important for individuals with lung disease.
Dr. Han is the author of the book Breathing Lessons, A Doctor’s Guide to Lung Health.