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Breathing Easy With Dr. MeiLan Han

TED 58 | Breathing Lessons

Prioritize your health because you can’t function well and fulfill your roles if it is deteriorating. This episode features Dr. MeiLan Han, a pulmonary and critical care specialist, and the author of Breathing Lessons: A Doctor's Guide to Lung Health. Dr. Han will talk about why the lungs are so neglected and how we can all work on improving our own lung health. She will talk about COVID-19, the science behind masks, and exactly what a ventilator does. She also discusses what we can all do to be better lung health advocates for ourselves and our communities. You will definitely be able to breathe easier after this episode!


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Breathing Easy With Dr. MeiLan Han

Please keep in mind that the content of this episode does not constitute medical advice but is purely for the purpose of education. This episode was supported by the National Geographic Society Emergency Fund for Journalists. In this episode, we are talking with Dr. MeiLan Han, a Professor of Medicine and the Chief of Pulmonary and Critical Care at the University of Michigan.

Dr. Han is also a spokesperson for the American Lung Association and the author of, Breathing Lessons: A Doctor's Guide to Lung Health. She received her Medical degree from the University of Washington in Seattle and completed her residency in Internal Medicine and fellowship in Pulmonary and Critical Care Medicine at the University of Michigan. Dr. Han's research is focused on Chronic Obstructive Pulmonary Disease, also known as COPD. Welcome, Dr. Han.

Thank you for having me.

Thank you so much for joining us. The lungs have been top of mind for the last few years, given the COVID pandemic. First, let's talk a little bit about basic lung physiology. Besides the obvious of it keeping us alive, why are the lungs important?

The lungs have been top of mind, and they haven't been. At the beginning of the pandemic, I was getting lots of questions about how the lungs work and mechanical ventilators. People wanted to understand. I had a fun opportunity to do another episode with Freakonomics where we chatted about that. One of the things that have been frustrating to me is that as the pandemic has drawn on, people have tried to move on. We have forgotten about this issue particularly when it comes to addressing the fact that we have eleven million Americans with long-haul COVID. I appreciate the fact that you are focusing on this, and I hope that the audience can take something away that will help them.

Basically speaking, the lungs work by getting air in and out, exchanging oxygen for carbon dioxide. One of the interesting things that people don't realize is that the lungs are a little bit like a rubber band. When the diaphragm contracts, it pulls that rubber band. That's what allows the air to come in, and then you let it go, and then the air is expelled.

Where that physiology gets interesting is when we think about mechanical ventilators, which don't work like that and are pushing air in as opposed to letting it be pulled in passively. One of the things a lot of people don't realize is that mechanical ventilators force air into the lungs. That's what makes it so uncomfortable for many patients who are in ICU and have to breathe that way because we have to sedate them pretty heavily.

The other thing a lot of people don't realize is if you have ever had general surgery, you have probably been on a mechanical ventilator. That's only for super sick people. It's a technique that we use pretty commonly. The other thing to think about when it comes to the lungs that are relevant is the fact that for the lungs to do this amazing job with gas exchange, the red blood cells have to file through a single file and be close to the air. To make that work, the air sacs are paper-thin when you look at them on a microscopic level to allow that to happen. If it fills with a fluid like pneumonia or you have any scarring and causes that paper-thin lining to become thicker or filled with fluid, that's when the lungs fail but it works well when it's perfect.

The other thing that is somewhat interesting to contemplate is that for the lung to do its job, it's not just trying to get air in and do this important gas exchange job for us but at the same time, it's also trying to filter. It's also got allergens, mold, dust, smoke, air pollution, bacteria, and viruses that it's all trying to deal with. It keeps the bad stuff out and gets the good stuff in all at the same time.

While it sounds like it shouldn't be a problem, unfortunately, it has been. Sometimes, the lungs work too well, and you can have a lot of damage accumulate before people know that anything is wrong. We do a bad job at diagnosing lung disease in this country of screening for lung disease. There are a lot of people that have damage that doesn't even know it.

TED 58 | Breathing Lessons
Breathing Lessons: Mechanical ventilators don’t work like our lungs. They actually push air in instead of letting it be pulled in passively. That's why breathing on a mechanical ventilator is so for uncomfortable patients.

You touched on this a little bit. Do you think there's a disconnect between what most people think they know about how our lungs work and function?

Most people think about lung disease as someone, not them. They are like, "No one was ever saying anything to me. I feel like I breathe fine. Lung disease is for other people. It's not me." The fact of the matter is that lung disease was the number one cause of death in the United States in 2021. Even before the pandemic, chronic obstructive pulmonary disease was the third leading cause of death in the US, and pneumonia among children is a major killer worldwide.

The other thing that is fascinating to me is that the more we do studies where we bring people in for lung function testing and CAT scans to look at them, which we wouldn't have done necessarily clinically, we are finding more and more people have what I'm going to call sub-clinical levels of lung injury. It maybe doesn't quite meet the definition but there's something abnormal. The fact that people think that you can smoke forever and not have anything wrong is a myth. Most people who smoke do have some evidence of damage to their lungs. It's just not been looked at or picked up but it goes even deeper than that.

For instance, there was this fascinating study that was done by Harvard. They found that in Oregon, where there was a lot of smoke exposure from wildfires that there were almost an excess 20,000 cases of COVID and an extra 1,000 deaths, which means that this is one place where we could identify a cause of lung injury that probably most of those people didn't even know they had that was then causing them to have increased susceptibility to another virus.

We did this other study at the University of Michigan, where we looked at CT scans of people that ultimately ended up getting lung biopsies for COVID. We found that a whole bunch of them had abnormalities on CT scans that no one had ever told them about before they ever got COVID. There are a lot more people out there that have something wrong or some level of inflammation going on that no one has picked up on but ultimately could have clinical consequences. For the first time, we are seeing that and measuring that because of the pandemic but it has been there all along.

Speaking of lung disease in this other category, what do you think are the three most common lung diseases faced by patients? How can we avoid getting them or exacerbating them besides fewer wildfires?

Off the top of my head, I should pull out some things that I tell you what the three most common ones are. As a clinician, some of the ones that we encounter most commonly would be acute diseases and chronic diseases. Chronic diseases, COPD, asthma, and lung cancer are some of the top ones that we as physicians probably deal with. On a more short-term basis, a lot of things like bronchitis and pneumonia are super common.

Also, what makes the job of being a lung doctor difficult is that there are also a ton of rare things that can cause lung disease. Sometimes, I liken it to being a bit of a detective because you can have stuff going on for long periods of time, and then you are stuck. When I see a patient, I will start with birth. I will also get to the history of asking what you can do to protect yourself. It starts at birth or even before birth. I think about lung development and the need to protect the lungs.

I think about your lung health in three stages. There's the period in the womb, and that's where it matters. We know that moms who are exposed to air pollution can be a problem, as well as moms exposed to nicotine. No matter how that exposure occurs, we know that nicotine can cause the airways of infants to develop abnormally. They become long and torturous, which can predispose kids to asthma and poor lung function. Getting good prenatal care is important.

Being born prematurely can have a significant long-term impact because the lungs are finishing development right at about the time of birth. In boys, that tends to be a bit delayed compared to girls. Technology is advancing on both fronts. We now have our ability to help babies survive earlier but hopefully, also lung protective strategies for infants. It will be interesting to see.

We do a really bad job at diagnosing lung disease in this country. There's probably a lot of people who have damaged lungs and don't even know it.

I saw a patient not too long ago. He's fairly young and was telling me about how hard he was working to keep up with his buddies at basketball. I started asking, "Tell me about your childhood. Were you born early?" All of a sudden, he's like, "I was born early, and I had all problems in the first year of life." It turns out he had significant lung disease but had fallen through the cracks because we don't routinely measure lung function in children. We will check to see if a child's height is off, and we will do all of those things to make sure that kids are developing normally.

There was this study that was published that there are roughly 30 million adults with COPD in the US. Roughly half of the people who developed COPD didn't develop it because of exposure and adulthood but rather had abnormal lung function coming into adulthood, which is shocking. It means that a good percentage of the stuff that we see in adulthood is related to stuff that happened way before adulthood.

As a mom, I think about making sure he has his vaccines and trying to ensure he's in a smoke-free environment. We know kids who have schools near freeways have lower lung function and are more prone to asthma exacerbations. I think about air pollution in the home, things like running the exhaust fan on my stove to change the filters when needed and paying attention to bad air pollution days to watching things like VOCs.

There's all this stuff that we need to be much more conscious of in protecting kids. We then finally get into the stuff with later teen years and adulthood, where we are aware that things like vaping, smoking, and occupational exposures are important. Even there, we think about, "I'm not a coal miner." There are these classically dirty jobs but what about hairdressers? What about nail technicians that are exposed to all sorts of chemicals? We need to broaden our thinking when we think about lung health and lung protective strategies.

I had a patient like this who had strange symptoms for months and was trying to get to the bottom of exposures that he had. He had worked in the Navy and didn't remember things that he had been exposed to. I can see how that can have long-term impacts even far in the future from when you have actual exposure.

You published a book called Breathing Lessons. In your book, you discuss how a simple and inexpensive spirometry test could save many lives, particularly if we begin doing these as young adults. Can you first explain spirometry and then tell us why it's important to potentially consider doing these tests?

Spirometry is a measure of lung function. I did some research for the book. People think everything I wrote in the book, I learned in medical school or wrote it down but there's a lot in there I did not learn either in medical school, residency or fellowship. I had to do some very specific research for the book because I know and understand how to diagnose and treat lung diseases but we don't spend a lot of time as physicians talking about protective strategies or prevention.

I had to change my thinking and do quite a bit of research for the book. One of the things that I was struggling to get my head around for the book was, “Why don't we do more spirometry in this country? Why don't we measure lung function tests? Why is this nobody's recommendation? Why is nobody doing it?” It's not that hard. It doesn't expose anyone to radiation. You don't have to poke anyone. It's harmless from a patient perspective. I went back and did this research.

The forerunner to the modern-day spirometer was invented by a gentleman that was an actuary. He figured out that measuring lung function was associated with mortality. He was using it for his actuary tables. Somehow, we lost that. It was clunky. It was like this inverted bell with tubing and water. It's not like something a doctor could throw in their doctor's bag.

The original blood pressure cuff, when it was first invented, was not combined with a stethoscope as we would perform it now. The combination to combine it with a stethoscope to get both systolic and diastolic happened in the early 1900s. When they put 2 and 2 together like that, suddenly you had this thing that the doctors could put in their bag. They could do it. This is going to sound pathetic but it made doctors look cool. They thought that if they went into some wealthy patron's home and did this, it would distinguish their skillsets.

TED 58 | Breathing Lessons
Breathing Lessons: Sometimes the lungs actually work too well and you can actually have a lot of damage accumulate before you know that anything's wrong.

You have to remember. This concept of evidence-based medicine is very new. We used to practice this way. Measuring lung function did not catch on. Measuring blood pressure did. As time went on, the evidence-based grew. We had studies like Framingham, where they incorporated cardiovascular measures. They were able to prove that if you measure blood pressure, that's associated with strokes and heart attacks, and then we figured out how to prevent it.

We never measured lung function, so we don't have quite as much data and studies to say that if you have it and you intervene, it's going to make a difference, so then nobody wants to recommend it. Everybody should get it but nobody gets it, then we diagnose everybody late, and you can't intervene. It's this vicious cycle that goes keeps going round and round.

I keep thinking about, "How do we break the cycle?" I wish we were getting lung function in kids and young adults or teenagers because we would know if things were veering off track but we aren't doing it. Is it a recommendation? It's not. People need to have a very low threshold to say to their physician, "I'm worried about my lung function because I grew up breathing secondhand smoke. I get episodes of acute bronchitis five times a year that I can't quite recover from. I'm having a hard time keeping up in my exercise class."

The threshold needs to be that low for doctors to check lung pressure because the earlier we can figure out that there's an issue, the earlier we can get people started on the right thing or maybe remove an exposure that somebody didn't know was causing a problem. Unfortunately, birds are sometimes associated with lung disease.

There might be something that you could fix but you are not going to know if we don't check. If you are concerned, ask your doctor, "I would like a breathing test." It's called spirometry. It's easy to get either doctor will have it in their office or you can be referred to a local clinic, a hospital or a satellite where it's done. It takes about half an hour. It's easy. You just blow hard into a tube.

One of the things about spirometry that I also realized when I was writing the book was that lung doctors were apparently very particular because to do spirometry correctly, you have to repeat the maneuver several times. That's why it takes a while because they want to insist that the measure be repeatable. With it being repeatable, that means it's very accurate.

We don't hold blood pressure to that same standard. If you were to get a perfect blood pressure measurement versus supposed to sit down, wait fifteen minutes, and you might check it three times, you take an average of the measurements. You never do that for blood pressure. We use it as a service screening, and then we will keep rechecking it until we feel like we have a good average.

I sometimes wonder whether perfect has been the enemy of good. People are afraid. Sometimes, doctors are afraid to even order it because they are like, "Someone in my office is going to have to spend all this time trying to meet the standards for getting the perfect test," and maybe we would be better off getting a test then at least screen for it, doing it in the office, and then moving somebody onto a certified lab if there's a problem.

Those are all such good points. It speaks to how we practice medicine and how evidence-based medicine is critically important. Using clinical common sense to do what's right for our patients also is important. You convinced me. I want to get some spirometry done for myself.

I never had it done until I had it done as a fellow so that I could understand how the test was done and better interpret it for my patients. If it hadn't been for that, I never would have had it done at all.

We need to really broaden our thinking about lung health and lung protective strategies.

Over the last couple of years, we have focused on the negative and the doom and gloom of the COVID-19 pandemic. However, the pandemic has increased science's understanding of many things that will forever change medicine, public health, and the development of vaccines moving forward. Can you talk about some of these advancements, particularly for pulmonary health?

One of them is how respiratory viruses are transmitted. If you think back to the beginning of the pandemic, do you remember that originally, we were told it's all social distancing, and you don't need to bother wearing a mask? Somewhere in the middle of the pandemic, the public health messaging flipped. All of a sudden, we were being told we’ve got to wear masks.

What happened there was for years, people had been using this somewhat random 0.5-micron cut-off as to the size of a particle and whether it was likely to have what we call aerosol transmission versus droplet transmission. For anything that's a larger particle like a droplet, the thought was you might spray it when you are talking but it's heavy and will fall quickly. If something that's spread by droplets, then that's where social distancing becomes important but anything small that might get "aerosolized," those small particles can hang in the air for quite some time. Those are the kinds of things that we need a mask for.

We originally thought that viruses like SARS-CoV-2 were not spread via aerosols. We thought that they were spread via droplets because of some old literature that, interestingly, a lot of scientists began to question and push, and finally, you couldn't ignore the fact that despite social distancing, a lot of people were getting sick. Something in the math was wrong.

They had to simply accept that viruses like SARS-CoV-2 are transmitted via aerosols, and that changed masks. It is going to change how we think about viruses and the transmission of respiratory viruses for a long time. As for influenza, we thought it was more of droplets as opposed to aerosols. I don't know about you but I'm still wearing a mask at my hospital. I'm not sure that mask is ever leaving.

I probably would wear a mask during flu season before the pandemic and almost always with pediatrics.

It's smart, and because they understand the science involved, we are probably all going to do that. My son's school almost got shut down before the pandemic due to a flu outbreak but we know how to fix that now. Even before the pandemic, when I would go to clean out a dusty garage, I wouldn't think about putting on a mask but now because they are everywhere and I'm thinking about my lung health constantly, I'm much more cognizant and have a much lower threshold of throwing one on if I'm cleaning out the basement, the garage or doing a dusty cleanup job of any sort.

That's true for me too where over the last couple of years, I have been thinking about lung health and ways that we can filter some of those noxious particles out of the air. With wildfires, if it's bad and raining ash, I'm going to be wearing a mask.

Maybe that could be the day you don't do your marathon practice because the data that I showed is that it does cause measurable inflammation. Besides the risk for increased risk of other respiratory infections, we also know that breathing in air pollution gets into the blood vessels and can increase the risk for cardiovascular events. That is one thing that has changed hopefully that people are much more mindful of what you are breathing in and trying to control it or protect themselves in some way.

Another advance that is super exciting is the huge leap forward we have seen with the vaccine technology and antivirals. There are all sorts of companies that are now investigating vaccines for the common cold or the concept that you could give patients at-home test kits that they could test for certain panels of viruses beyond SARS-CoV-2 and could it potentially have an armamentarium of things that could be given pretty quickly to stop it? We knew that there was that for flu a while ago but you have to get it started pretty quickly. There wasn't this energy and investment towards figuring out how do we test people quickly enough that we can make a difference.

TED 58 | Breathing Lessons
Breathing Lessons: Besides the risk for increased risk for respiratory infections, we also know that that air pollution actually gets into the blood vessels and increases the risk for cardiovascular events.

I'm sure you see this in the emergency room all the time. For patients with chronic medical conditions, if they can track what the rest of us might mean a "cold," they can get pretty sick. We are going to see a wider array of vaccines for things like a respiratory syncytial virus in the next few years, which is a huge issue for kids or tests and treatments for "the common cold," which has a big impact on a huge population. To me, that's another exciting advance. The other thing is virtual care. We were working on it before the pandemic. The University of Michigan had this goal of getting 20% to 25% of the visits done virtually within the next year or two. They accomplished it in weeks.

I heard that from a lot of people at a lot of different hospitals where Telemedicine was on the edge of what they were doing but very quickly advanced and now is here to stay.

There are some hopefully, good things that have come out of the pandemic.

Speaking of protecting ourselves, you have talked about building a lung reserve from early childhood to early adulthood and keeping our lungs healthy in our later years. What are some of the top things that parents or young adults can do to protect their long-term lung health?

I talked about a bunch of them already, including vaccinations and protection from indoor and outdoor air pollution. If there are parents reading, vaping has not gone away. This acute lung injury that you can get from vaping is called EVALI. We still have that with us. There are still kids developing severe immediate lung injury, even to the point of requiring lung transplants. The problem is that remains a very unregulated area despite the FDA's lukewarm commitment to fixing it. They were sued by the American Academy of Pediatrics and the American Lung Association to enforce regulation over electronic cigarettes. They have been slow to do so.

It can be extremely insidious. Parents may not even know what the devices look like. It may look like a USB drive sitting on your counter. It's never too early to start talking to your kids about it. Middle school is a good time to start. At least before the pandemic, we had roughly a quarter of our kids experimented with some kind of nicotine product. The scary thing is that they are not regulated. You don't know what extra chemicals are in there. They think it was the vitamin E acetate but who knows what the next vitamin E is going to be that somebody decides some interesting flavor and that they are going to propel or throw in there?

You don't always know how much nicotine you are getting because that's not regulated. The overall concentrations of nicotine are much higher. The addictive potential, particularly for kids, concerns me. As we move into adulthood, there are all occupational exposures that we have to be mindful of. The other thing I did spend some time thinking about with respect to the book is not a defense but, “What can you do that's an offense to protect your lungs?” The best data there is around exercise.

There's this interesting study called CARDIA that was funded by the National Institutes of Health. What they showed was that for young adults between the ages of 25 and 35, their peak aerobic fitness levels at that early adulthood age-predicted lung function later in life. If you could maintain or improve that level of fitness over a lifetime, it also is associated with higher levels of lung function.

What we don't know is it could be lung function in the lungs but it's also influenced by the rib cage and the muscles that surround the chest wall. It could be that these fit individuals have stronger chest walls, so they are able to flow better and do better on the lung function test. There's also some thought that what if exercise is anti-inflammatory and it's helping to combat some of this other stuff that we are constantly exposed to? We don't know.

There is this new study that's kicking off now that is co-funded by the National Institutes of Health and American Lung Association called The Lung Health Cohort. If people are interested, it's enrolling all over the country, and you will get a free CAT scan and a function measurement. We are trying to build some data and understand by recruiting some people who are young and are not ever getting lung function tests done to try that. Follow those people then over a lifetime and try to get a better sense of who has early levels of lung inflammation and what habits, behaviors, diet, etc. are associated with better lung function over a lifetime. I'm hoping we will have more information later. As of now, exercise is one of those proactive things that you can do.

Aerobic fitness levels in early adulthood predicts lung function later in life. If you could maintain or improve that level of fitness over a lifetime, you can achieve higher levels of lung function.

If you think about it, it makes sense. You think about something like runner's high, how it decreases stress and cortisol levels, and how that probably decreases levels of inflammation in the body. I'm looking forward to knowing the results. We will have to have you come back and talk about it.

It's going to take a while to collect the data. As you might imagine, COVID has impacted our ability to do anything particularly research-wise. Everything is delayed and kicking off late but we are hopefully moving in the right direction.

My research is in the same boat. I understand. What are scientists learning about the impact of long COVID on our lungs? This is something that's fairly poorly understood still. What do you expect the long-term effects will be on the population at large?

Long-haul COVID is so diverse. That is the first thing that I will say. We are seeing some people that no matter what you do to try to test them, we are not coming up with much. The lungs look fairly normal. It could be that there's nerve damage, muscle damage, maybe even microvascular damage, damage to small airways, or something that we are not picking up with our current tools. That is a whole sub-segment of patients that are probably frustrated or it could be cardiac effects.

The donors don't understand why they still feel awful and are short of breath. You've got those patients on one end of the spectrum, and then you have patients all the way at the other end of the spectrum who were severely ill were in the ICU or on ventilators. Some of them, their lungs look like patients who have had severe interstitial lung disease. We are seeing the same kind of scarring patterns. It's such a huge variety.

We are also seeing some patients that now have new airway disease. It looks a little bit more like asthma. The other thing we are seeing for patients who were hospitalized for COVID is there's a high rate of rehospitalizations for other things. They get over that first bout, and then they are coming back with some other complications. I have another patient who got through it and then ended up back in the hospital with blood clots. I'm sure you have seen this in emergency rooms where somebody is discharged or seen once and then comes back with a blood clot. We are ordering CAT scans to look for them like crazy.

This particular patient I'm thinking about has had stuttering issues for years now. It took forever to recover from the blood clots. They’ve got fluid around the lungs, and then the next time they get a cold, it sends them into a tailspin. The lungs are more fragile than they were. I was talking to someone else about this before the call. We have still failed to see the level of investment from the government that we are going to need to understand what's going on with patients with long-haul COVID and how to treat them.

This problem pre-existed the pandemic. When patients get sick with COVID, we call that ARDS. It's severe lung inflammation. We didn't have good treatments for ARDS before the pandemic. All doctors know that mechanical ventilation, which we have to use sometimes to save people's lives, is a double-edged sword because, if not used properly, it can cause lung injury due to overinflation and stretching.

We have not seen the level of investment and prioritization. I keep looking at Appropriation Bills, and everyone is coming out with, "We need to be prepared for the next pandemic." I have yet to see a single plan. Why don't we need to better understand how to treat patients with acute lung injury or how to help patients recover? I don't understand why it continues to be a blind spot. It's mind-boggling and baffling to me.

If there's someone out there that is stuck suffering from long-haul COVID, the first thing to do would be to get in to see a lung doctor. Sometimes, the lung doctor is going to be helpful, and sometimes, it may end up being something else, in which case, many centers have what we call a multi-disciplinary COVID clinic where it's not just lung doctors. It might be lung doctors and heart doctors. We see a spike in diabetes. There are so many things that this virus seems to be able to do to certain people that it may require more extensive investigation.

TED 58 | Breathing Lessons
Breathing Lessons: There's just so many things that this virus seems to be able to do to certain people. It may require more extensive investigation.

It requires a lot more intensive investigation. The symptoms of long-haul COVID are so wide-ranging. It's amazing. It's very difficult to pinpoint a diagnosis of exclusion where we know there are other things that are not causing your symptoms, so we are like, "Maybe it's related to this." I completely agree. Speaking of research dollars, in your book, you talk about the fact that COPD and lower respiratory infections are the 3rd and 4th leading causes of death globally but rank 13th and 17th respectively for research grants. Why do you think the money isn't being spent on this research?

It's a huge conglomeration of things but one major contributor is that there has been this assumption for many years that lung disease is someone else's problem and it was their fault. When we think about things like lung cancer and COPD, people automatically associate those with smoking, despite the fact that roughly a quarter of people with COPD never smoked and that lung cancer is the number one cancer killer among women. There is a predominance when you look at who gets lung cancer. There is an imbalance between smokers and non-smokers, such that women who are non-smokers have an increased risk of getting lung cancer compared to men.

I lost a young female colleague who was a non-smoker to lung cancer.

That is so heartbreaking. The problem is if you look at heart disease, some of that is related to too many cheeseburgers but we don't sit around and say, "We are not going to fund heart disease because this is a self-inflicted disease." Patient advocacy groups have a strong ability sometimes to affect things but if you look at who gets certain lung diseases like COPD, it can sometimes tend to be associated with lower socioeconomic status.

Historically, you have people that can't speak up for themselves and don't feel comfortable speaking up for themselves because of stigma. What we are now realizing is that lung health and lung disease are now everybody's problem. This is not just some tiny sub-segment of the population. We have eleven million Americans with long-haul COVID.

I am sure this is not our last respiratory pandemic as much as I wish it were. We can't continue from a funding perspective to ignore it. I have been working hard with organizations like the American Lung Association and the COPD Foundation to see what we can do to impact appropriations. It's mind-boggling to me that it keeps getting ignored.

What is one thing that you think everyone can do to improve lung health?

It comes down to paying attention. Pay attention to what you are breathing, whether you are outside and it's a bad air quality day. If you smell something funny in your home, investigate it or be mindful if something is taking up those. If you are cleaning up a toner spill, some chemical in the home or your dusty garage like me, if you think that there's a chance you should be wearing a mask, put the mask on. Be mindful of your environment.

I like to garden. I would not go into the garden without wearing gloves because it's a pain to get the soil out from underneath my fingernails. I can wash my hands if I do get my hands dirty but there's no easy way of washing the lungs out. I'm sure you have seen this as well. Part of my research has involved taking lungs out from patients once these people died for another reason. We studied the lungs.

What is shocking is even in a "healthy person," how much dirt and particulate matter end up in the lungs that you can physically see looking at a lung in front of you. People would probably be shocked because the lung could break some stuff down but there's a lot it cannot break down. It will sit in your lungs forever. It accumulates. There's no fixing it over time. We've only got one pair. You can't clean them. You've got to think about prevention at all stages of life.

Lung disease is now everybody's problem. It’s not just some tiny sub-segment of the population.

That makes a lot of sense. After this episode, I certainly will be paying much more attention to what I'm breathing. What is one thing you wish everyone knew about COVID-19?

I don't think this is new information but I have a hard time getting the message through about how deadly and capricious it can be. Everyone thinks it's like a bad cold. When you are not in the ER or ICU, it's very easy to shut those messages out and think, "Maybe some random person got sick." It's eye-opening to see the young, otherwise healthy people on ventilators in the ICU. It's not just old people with chronic conditions. That is the majority but it is not all the people. Anybody is at risk of getting sick.

The other eye-opening thing for me is I am on the COVID committee for my son's school. We enacted weekly PCR testing for the entire school. I had a very good sense of how much COVID there is in my son's school because we have been testing weekly for years. We are still picking up cases weekly, so it's not gone. The number of people we are picking up on it on a weekly basis through this screening method that I have is still much higher than where we were at this time in 2021. If you look at those case rates that are published by CDC or New York Times, they are all much lower than what is out there.

People aren't testing because there are a lot of people who are vaccinated or aren't getting picked up. It's good. They are not getting as sick. We are not seeing the huge spike in hospitalizations but we are starting to see, at least at my institution, that hospitalization numbers are starting to tick back up. We don't know what's coming with the additional variants.

As much as I would love to throw up my hands and say, "Goal post. We are done," what I'm seeing is that it's still there. People are still getting sick. Fortunately, the people who are vaccinated are not getting as sick but it's not gone. It's higher, at least in Michigan, than it was this time in 2021. It can be quite deadly for the unvaccinated, no matter how healthy you are. I'm sure you are seeing the same thing.

I see people who are unvaccinated who are much sicker. We still see some cases of people who are vaccinated but they are not imminently being intubated. I agree that it's still here. It's not gone. We should still remain cautious and continue to be aware of what's going on so that we can hopefully prevent ever getting back to where we were at some of the worst parts of the pandemic. Do you have any final words of advice or final thoughts before we wrap this up?

It's a pleasure to get to chat with you. I hope if there's something that people take away from it, it's to be more mindful of not just what they breathe but their own symptoms and have a low threshold of chatting with their doctor about whether they need more testing. Don't let yourself get blown off. The scary thing is that of the patients in the United States that carry a diagnosis of COPD, only 1/3 have undergone appropriate diagnostic testing.

Doctors have a bad habit of making diagnoses of lung disease without doing appropriate diagnostic testing. It is a problem, whether you read my book or not, arming yourself was the goal that I had with writing the book. I want people to be informed because this is a scenario where people are not informed, and doctors are not doing a good enough job. If I could take the information to lay to the public, then people could do what they have the power to protect themselves and their own families. That's what it's about.

Doctors are good at educating each other but not our patients. I love what you are doing with this book. Where can our readers get your book or follow your work?

It's available at pretty much every major book retailer, whatever your favorite one is, whether that's Amazon, Barnes & Noble, Walmart, or Target. You can also follow me on pretty much every social media channel as well as I do have a website,

What are your social media handles?

For Instagram, it's @DrMeiLanHan. I also have a small YouTube channel, which is called Breathing Lessons with Dr. MeiLan Han. My Twitter handle is @MeiLan_Han. I'm also on LinkedIn as well.

Thank you for sharing. Thank you for joining us, and for what you are doing to help educate everyone about lung health.

Thank you so much for having me. It was a real pleasure.

That's it for this episode. If you like what you learn, please give us a rating, comment or subscribe. This episode was supported by the National Geographic Society Emergency Fund for Journalists. Until next time.

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About MeiLan Han

TED 58 | Breathing Lessons

MeiLan K. Han, MD, is professor of medicine and chief of pulmonary and critical care at the University of Michigan, a spokesperson for the American Lung Association and the author of Breathing Lessons: A Doctor's Guide to Lung Health.

She received her medical degree from the University of Washington in Seattle and completed her residency in Internal Medicine and fellowship in Pulmonary and Critical Care Medicine at the University of Michigan. Han directs NIH-sponsored research on chronic obstructive pulmonary disease (COPD).


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