Jefferson doctor on why lung health is more important than ever and what you can do to improve yours | 5 Questions
Michael J. Stephen experiences as a lung specialist, author and then a COVID-19 patient, took on a new dimension this year.
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As Michael J. Stephen stood in line at the grocery store, after picking up dinner and a beer, he felt a little odd. A little weak. Tired. He figured it was due to months of long shifts taking care of COVID-19 patients.
It would be a long time before he opened that bottle of beer.
Stephen, associate professor of medicine at the Jane and Leonard Korman Respiratory Institute in Thomas Jefferson University’s Sidney Kimmel College, had contracted the coronavirus. Then his wife and his two children were infected, although none of them had to be hospitalized, as he was.
Meanwhile, Stephen had been putting the finishing touches on his book, Breath Taking: The Power, Fragility, and Future of our Extraordinary Lungs, which was published in January. Suddenly, his experiences as a lung specialist, author and then a COVID-19 patient, took on a new dimension.
We asked him recently about those extraordinary organs, our lungs.
Tell us how miraculous our lungs are.
A large part of my book is celebrating how the lungs are a wondrous organ. They are the only major organ in constant communication with the atmosphere, and their dual missions of gas exchange while keeping everything else potentially noxious out is a marvel of nature.
Our resting ventilation, or air moved per minute, is about five liters, but this can be increased to an astonishing 20 or even 30 liters as needed during exertion. Within the lung itself, there are over 500 million alveoli, beautiful grapelike clusters that do the work of gas exchange. Bringing the air to the alveoli is the job of the conducting airways, which if placed on end, would cover 1,500 miles. Inside, tiny hair like cilia beat constantly to sweep out debris, while immune cells patrol to ingest and neutralize bacteria and other invaders.
They are the organ that defines our birth, where they must turn on in an instant to extract oxygen. They also define the end of our life with our final exhalation. They are a source of control and insight, with Siddartha Gautama, known as the Buddha, correctly stating in the fifth century BCE that the only path to wisdom is through a dedicated focus on the breath.
You say our lung health has been ignored. How so?
A main reason lung disease has been ignored comes back to the perception that the lungs are a dirty place. We have known for centuries that diseases can pass from lung to lung through the air. An example is tuberculosis, which has killed more in the history of humanity than any other infection, and whose only real reservoir is the human lung. So when people cough, we instinctively move away. Scare genes have been implanted in us regarding our lungs. They are a place of illness.
Another big reason they have been ignored is that we can’t see the atmosphere, so when we pollute it by burning coal or fossil fuels, it goes unrecognized. Huge benefits have come to civilization from energy production, but today we don’t have to accept this trade-off. We have the knowledge now to transition to clean and renewable energy sources. We have proven there can be tremendous return in our health by cleaning up our air while sacrificing nothing economically.
The end result of this is that we have several acute crises of the breath, namely COVID-19, forest fires, and vaping illness, as well as chronic crises of the breath with massive increases in asthma, COPD, and lung cancer over the past 50 years.
What has COVID-19 taught us about our lungs?
To be a little controversial, COVID-19 has taught us very little about the lungs we didn’t already know. At the beginning of the COVID-19 crisis, we tried to treat it as this very unique disease, and we threw out a lot of what we knew about medicine.
Some said we needed to put people on ventilators early, while others advocated for later. Many postulated that the lungs of a COVID-19 patient acted different physiologically once they were put on a ventilator, and new strategies were needed. All of this ended up being false.
» READ MORE: Hospital coronavirus treatment has changed. Here’s what it looks like now in Philadelphia hospitals.
We see now that we should treat it the same as any other pneumonia, that you are put on a ventilator when a patient gets tired, and their physiology on the ventilator is exactly the same as other pneumonias.
There are, of course, unique aspects to the virus. It is not just a lung disease, but also an inflammatory one of the blood vessels. But in a rush to treat, we gave patients drugs like hydroxychloroquine, which did no good. Here again, we come back to the lesson: Don’t use a medicine unless you have good data. If anything, COVID-19 taught us not to throw out time-honored knowledge just because you don’t understand something.
What can people do right now to take better care of their lungs?
I believe that many of the normal processes of aging that occur can be reversed or mitigated. We see this in the amazing things in sports people are doing at older ages. The lungs are a tricky case, though, as beginning at age 30 there is a normal slow decline in lung function that we cannot do anything about (stem cells may change this). The airways of the lungs become a little floppier, while the alveoli and lung tissue become a little stiffer.
But there’s a lot more that goes into effective breathing and delivery of oxygen to our cells, and we can work to overcome this slow decline. The muscles of our chest and our diaphragm make up the pump function of our breathing, and with exercises like weight work, swimming, or yoga, these can be strengthened tremendously. General cardiac fitness also helps us efficiently deliver oxygen, as does keeping an appropriate hemoglobin level.
In order to absolutely mitigate the decline in lung function that occurs normally, avoiding any noxious pollutants, toxins, and allergens is important both at home, in the local outdoor environment, and at work. The American Lung Association website is a wealth of information about all of this.
After treating people with COVID-19, you were infected yourself. How did that change your perspective on the disease or on the practice of medicine?
My experience getting ill with COVID-19 radically changed my approach to medicine, and it gave me insights into what patients who come into the hospital need.
After two months of working with COVID-19 patients, I came down with severe COVID-19. After two weeks of high fevers and profound muscle aches, I ended up in the hospital with pneumonia and blood clots. I had never been ill like this before, so for me to experience life on the other end of the stethoscope was humbling in a good way.
Everybody in the hospital was so patient and caring. I came in vulnerable, feeling like I had let everybody in my life down. But the people in the hospital passed no judgment; they just worked hard to get me better.
On a personal level, being hospitalized amplified the importance of the human touch, of listening to your patient and their story, to being hopeful and upbeat. I felt tremendous guilt as I also passed along the virus to my wife and two young children. Fortunately, we all recovered and can talk about a happy ending. With this, I saw there is mercy in the world. I am determined now to bring that approach I experienced in the hospital to other people.