14 ways to keep your lungs healthy

“Everyone reaches maximum lung growth around age 25 to 30, and after that it starts to decline,” Ian Hall, a professor of molecular medicine at the University of Nottingham, says. So here’s what you need to do to protect these vital organs.

1. Quit smoking

Several recent news stories have predicted dire consequences for the hospitality industry should the government implement measures to curb outdoor smoking. Yet despite existing legislation, the habit is still responsible for killing as many as 80,000 people a year in the UK and it places a huge burden on the health system.

Smoking is a common cause of cancer and a group of lung conditions collectively known as chronic obstructive pulmonary disease (COPD).

COPD, which affects more than a million people in the UK, includes emphysema — damage to the air sacs in the lungs, which the Hollywood film director David Lynch recently revealed he’d been diagnosed with after “many years of smoking” — and chronic bronchitis, long-term inflammation of the airways. It usually presents with shortness of breath when exercising.

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A 2020 study published in the medical journal Jama did find that people with small airways relative to the size of their lungs may have a lower breathing capacity and, consequently, an increased risk of COPD — even if they don’t smoke or have any other risk factors. Smokers, however, are 12 to 13 times more likely to die as a result of it than non-smokers.

The damage caused by COPD is permanent, but some treatments may help to slow its progression, including the use of prescription medicines and inhalers. A study published in May in The New England Journal of Medicine found that dupilumab significantly improved lung function of smokers and ex-smokers aged 40-85 with the disease. Last week the drug was approved for use in the UK privately (it is currently availableon the NHS for the treatment of severe asthma, eczema and rhinosinusitis in adults).

Although COPD can’t be cured or reversed, according to a study published in 2020 in the journal Nature, the risk of developing lung diseases diminishes once people stop smoking, as healthy cells replace some tobacco-damaged ones. Quitting is more successful when an attempt is supported by talking therapies and medication such as nicotine replacement therapy.

2. Don’t start vaping

“Vaping is a fairly recent phenomenon so we haven’t conducted studies over an extended period,” Hall says. “But I’d find it difficult to believe that vaping won’t have long-term consequences on lung health. There are already short-term studies showing detrimental effects.”

In a recent study, scientists at University College London (UCL) analysed samples of cheek cells from vape users and compared them with those of cigarette smokers, and found that both groups had similar changes to the DNA. Hall also warns about the potential risks of passive vaping. “There’s not been much research on passive vaping, but there could be dangers, in the same way that there are dangers associated with passive smoking,” he says.

3. Go for lung cancer screening if you’re eligible

“Nobody thinks twice about having their blood pressure checked, but it’s not the same when it comes to our respiratory health,” Hall says.

Last year the government announced the national rollout of a targeted lung health check programme in England for people aged 55 to 74 who are at increased risk of lung cancer. “While screening is principally about lung cancer, it has the opportunity to improve respiratory health in the UK,” says John Hurst, a professor of respiratory medicine at UCL. “Even if a patient hasn’t got lung cancer, we’re also able to identify those who are at high risk for COPD or other conditions from that same CT scan.”

The fitter you are, the more likely you are to spot early signs of lung issues

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4. Exercise matters

Children who are fitter and whose fitness improves during childhood and adolescence have better lung function as young adults, according to a large study published in the European Respiratory Journal in 2018. But once you hit your thirties, “you’re not going to get further lung growth in middle age just because you take up exercise,” Hall says “What you really want to do is make sure you’re generally fit and hopefully reduce the rate of decline in lung function.”

Hurst agrees, saying: “You’re not expanding your lung capacity by exercise. It’s about making the most of what lung capacity you have to maintain your cardiovascular fitness.”

Hurst advises following NHS exercise guidelines, which differ depending on your age. For 19 to 64-year-olds, this amounts to at least 150 minutes of moderate intensity activity a week or 75 minutes of vigorous intensity activity a week.

Pulmonary rehabilitation classes, which have proven highly effective for those with COPD, feature exercise sessions that focus on body weight exercises such as wall pushes and sit-to-stand that “strengthen the major muscle groups that people with COPD need on a day to day basis, such as the quads and the shoulder girdle”, Hurst says.

One additional benefit of exercise, he says, is that the fitter you are, the more likely you are to spot early signs of lung issues.

5. Check the outdoor air quality before going for a run

Outdoor air pollution in the UK is responsible for about 10 to 15 per cent of lung cancers in people who have never smoked, affecting about 6,000 people each year.

Hall says: “When outdoor air quality is poor I suggest that asthmatics avoid going for a run or other strenuous activity which would increase exposure due to elevated respiratory rates during exercise. Avoiding areas of worst air quality also makes sense if that’s feasible.” For example, choose a park over a busy road.

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The Department for the Environment’s air website — uk-air.defra.gov.uk — provides a daily pollution forecast and “several cities in the UK regularly breach air pollution guidelines”, Hall says.

6. Adjust your diet

A recent study which analysed data from approximately 96,000 people in the US found that a diet comprising 40 per cent ultra-processed foods was associated with a 10 per cent higher risk of death from chronic respiratory diseases and a 26 per cent increased risk of death from COPD.

Meanwhile, excess weight gained during the adult years may speed up lung “ageing”, according to a large, multi-country study from 2020, published in the journal Thorax. For two decades, researchers followed more than 3,000 adults recruited at ages 20 to 44. For most, weight-gain over time was associated with an acceleration in natural lung capacity decline.

Gabriela Prado Peralta, a researcher at the Barcelona Institute of Global Health and the study’s co-author, says that this is because chest and abdomen fat mass limits room for the lungs to expand during inhalation, while adipose tissue, where fat accumulates, is a source of inflammation that can damage lung tissue and reduce airway diameter.

Dr Andrew Whittamore, clinical lead at Asthma + Lung UK, says that proteins such as meat, beans and eggs maintain your muscles, including your chest muscles, helping your ribs expand as you breathe. For those with asthma, foods high in sulphites and histamines can trigger or exacerbate symptoms, he says. “Sulphites are used in some processed meats like sausages and burgers, in pickled foods and vinegar, dried fruits, and vegetable and fruit jams,” he says. “Fizzy drinks, fruit juice concentrates like squash, cordials, and vegetable juices can also contain sulphites.”

7. Use your extractor fan

“Living in an environment which is poorly ventilated will drive an increased risk of lung disease or poor asthma control,” Hall says. Asthma + Lung UK advises using an extractor fan in the kitchen and bathroom to prevent damp and mould. If drying washing inside, use a tumble dryer or make sure the room is well ventilated.

Dehumidifiers can also help to prevent condensation but, paradoxically, they can sometimes make the air too dry, exacerbating symptoms for asthmatics. A good dehumidifier will allow you to set a well-balanced humidity level.

8. Think twice about using wood-burning stoves

Wood burning in homes produces more small particle pollution than all road traffic in the UK, according to government data from 2022. The data showed that fine particles of 2.5 microns or less in diameter (PM2.5) produced by wood burning rose by a third from 2010 to 2020, when it reached 13,900 tonnes a year. “Even ‘eco design’ stoves emit 450 times more air pollution than gas boilers,” says Dr Neil Rowland, a senior research fellow based at Queen’s Business School, Belfast, who investigates the health effects of ambient air pollution. Studies have shown that the smoke enters neighbouring homes too.

A US study published last year in the journal Environmental International found that the presence of an indoor wood stove or fireplace in the home increases women’s risk of developing lung cancer by 43 per cent compared with those that do not use wood heating.

9. Handle cleaning products with care

Products containing bleach or ammonia are of particular concern. A 2017 study from Harvard University and the French National Institute of Health and Medical Research found that using bleach-based products once a week could increase a person’s chance of developing COPD by nearly a third.

Breathing in high levels of chemicals known as volatile organic compounds, such as acetone (found in paints and nail polish remover) and xylene (found in high-strength cleaning solvents) can harm the lungs too. Hall also says to beware of scented air fresheners, which “some people find trigger respiratory symptoms, especially in those with asthma”.

10. Air purifiers may not be that useful

A recent study found that high efficiency particulate air filters were associated with improved clinical outcomes in children with uncontrolled asthma who were exposed to traffic-related airborne particles. “There are some studies which show that air purifiers reduce exposure to PM2.5 and also allergens, which could benefit people with asthma,” Hall says. However, they only work in relatively small spaces, and if you move away from the air purifier your exposure returns to normal, he adds. “I’m not aware of any good data showing air purifiers improve respiratory health more generally — the evidence is very weak.”

11. Sing in the shower

Singing can help people with lung conditions, including asthma, feel less short of breath and more in control of their breathing, according to Asthma + Lung UK. A study by Chinese researchers in 2022 revealed that singing not only improved the respiratory muscles in people with stable COPD, but it improved their quality of life. Just chiming a long note helps to fully empty the lungs. Apparently taking up the harmonica is also helpful. For years, the harmonica has been used by people with COPD to ease pressure on their lungs. It is believed that playing the instrument opens the lungs because it involves slowly breathing in and out through the nose while keeping the lips pursed.

12. Wear proper protection in dusty environments

The importance of wearing the correct safety equipment was highlighted recently when eight cases of the long-term lung disease silicosis were identified by doctors in Britain, which were linked directly to the inhalation of artificial stone dust among workers who cut kitchen worktops to size.

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Another risk of working in dusty environments is pulmonary fibrosis (PF), a disease that causes scarring in the lungs. The prognosis for some forms of PF is the same, if not worse, than it is for lung cancer, warns Hall. “Most masks won’t actually exclude fine particles in the air, although they can reduce exposure to larger particles — so routinely wearing standard surgical masks, if PM2.5 levels are high, is unlikely to be of benefit.”

13. Get vaccinated

Those who have COPD are at increased risk of serious consequences of viral infections such as flu. So, as well as getting the Covid vaccine they should get the flu jab, Hurst says. The one-off pneumococcal vaccine, which helps protect against serious complications of infection with pneumococcus, a common cause of pneumonia, is also recommended for people with COPD. It has been demonstrated to decrease the incidence of pneumonia and exacerbations in COPD patients, according to a 2017 Cochrane review of 12 trials.

14. Consider monoclonals

For people with severe asthma, Hurst and Hall are proponents of new drugs called monoclonals. Monoclonal antibodies can treat some types of severe asthma by helping to stop body processes that lead to lung inflammation caused by allergies or by high levels of a cell in the body called an eosinophil. Hall hails monoclonals as transformative. “I’ve had patients who went from having 10 to 15 admissions to hospital, and perhaps a couple of admissions to intensive care in a year to having either no admissions or very few, after starting on these drugs.”

The red flags for COPD

Nearly one in four people surveyed with COPD waited more than five years to be diagnosed, so it’s important to be aware of these red flags.

1. A persistent cough with phlegm is a warning sign for COPD — even though some people dismiss it as “smoker’s cough” or an allergy. “The way that I would think about a patient presenting with a cough is whether it is new or changed, how long it’s been going on for, whether there’s phlegm and whether there’s blood in the phlegm or other ‘alert’ symptoms such as weight loss, which could be a sign of lung cancer,” Hurst says. “A cough which has changed, such as coughing up mucus or coughing at night, particularly in someone who smokes, should be taken seriously.” Investigating a chronic cough at an early stage could also pick up people with early pulmonary fibrosis or undiagnosed asthma, Hall says.
2. Frequent chest infections may be due to asthma or COPD. “Repeated chest infections that require antibiotics should prompt further investigation — certainly in somebody who has risk factors like tobacco smoke exposure,” Hurst says.
3. Breathlessness. “People accept breathlessness as part of the normal ageing process when they shouldn’t,” Hall says. A 2021 review of nine studies found that respiratory disease was the main underlying condition for breathlessness in the general population, accounting for 40-57 per cent of cases.

If you have any of these symptoms, your GP may test the efficiency of your lungs using a spirometer. But this isn’t a foolproof test, warns Hall. “The problem with spirometry is it’s not super-sensitive at picking up early lung disease.So you’ve got to have a reasonable amount of lung damage before you start to get abnormal results.”