Pulmonary diseases are often chronic conditions that can be controlled but never fully cured. As with any chronic disease, maintaining a healthy lifestyle is critical in improving one’s quality of life. This article summarizes the lifestyle interventions I recommend for all of my patients. Please remember to consult with your doctors on how best to incorporate these lifestyle changes into your life.

• Incorporate 30 minutes of aerobic exercise 6 out of 7 days of the week. Yes, exercise is difficult, especially for chronic lung disease patients who already have trouble breathing. However, the lack of exercise in combination with chronic lung disease leads to a downward spiral. Lack of exercise results in deconditioning, or being out of physical shape, which further limits a patient’s functional capacity. Simple exercises I recommend include walking sessions for my older patients and jogging, biking, or elliptical workouts for my younger patients. As a bonus, incorporate an additional 10-15 minutes of weight-lifting anaerobic exercises to improve bone strength and minimize risk of osteoporosis. Pulmonary rehabilitation is a program designed for patients with chronic lung disease that incorporates exercise and breathing techniques. If you feel a structured exercise program would be beneficial, consider asking your physician about referral to a local pulmonary rehabilitation program.

• Maintain a diet high in fruits, vegetables, whole grains, healthy fats, and lean proteins and aim for a goal body mass index under 25. Obesity does not cause lung disease by itself but leads to compression of the diaphragm and chest cavity which reduces lung expansion during inspiration. During acute infections, such as COVID-19, obesity increases the body’s inflammatory effect which can lead to more severe illness. Losing weight and eating healthy is not easy as highly processed junk foods are so easily accessible. I ask my patients to set small goals to achieve sustained long-term success. To start, I have my patients aim for 5 servings of fruits and vegetables a day, gradually increasing to a goal of 9 servings. Nutritionists, dieticians, and weight management specialists can be especially helpful for certain patients.
• Stop smoking, vaping, and using illicit drugs including marijuana. This recommendation is obvious and applies to all of my patients. Cigarette smoking is one of the most harmful activities for the lungs and the primary cause of lung disease including COPD, emphysema, bronchiolitis, and lung cancer. There’s never a bad time to speak with your doctors about therapies and medications that can help with smoking cessation. On a similar note, it’s important to avoid allergens, occupational exposures, pollution, chemicals, and foods that worsen your pulmonary symptoms. This is especially applicable to patients with asthma who have known exposures that trigger worsening asthma symptoms.
• Average 7-8 hours of sleep every night, and consider getting tested for obstructive sleep apnea. Sleep deprivation can cause short-term and long-term consequences. Acute consequences include increased stress, mood disturbances, memory impairment, and cognitive slowing. Chronic consequences include increased risk of hypertension, cardiac disease, diabetes, and obesity, all of which will lead to poorer health. Simple interventions to improve sleep hygiene include keeping a consistent schedule, stopping electronic use at least 30 minutes before bedtime, reducing alcohol consumption, limiting afternoon caffeine intake, avoiding late night dinners, increasing daytime exercise, and optimizing the bedroom setting. If you consistently get 7-8 hours of sleep nightly but continue to experience daytime sleepiness, please ask your physician about getting tested for obstructive sleep apnea. Untreated obstructive sleep apnea increases the risk of heart disease, stroke, and motor vehicle accidents, and various treatment options are available.

• Minimize the risk of chronic gastric aspiration by going to sleep no earlier than 3 hours after completing dinner. This recommendation is especially important for older patients with pulmonary fibrosis. It’s postulated that one cause of pulmonary fibrosis is chronic aspiration of gastric material into the lungs. These aspiration episodes are often “silent” in that they can occur without a patient’s knowledge. Going to sleep three hours after dinner allows more time for the transit of gastric or stomach content into the small intestines for further digestion. Consider also elevating the head of bed with Styrofoam wedges under the mattress if you continue to experience reflux symptoms at night.
• Consider incorporating mind and body practices into your daily routine. These practices include yoga, meditation, pursed-lip breathing techniques, diaphragmatic exercises, Qigong, and Tai Chi. There is limited data proving the benefit of these therapies for patients with chronic lung disease. However, most physicians and pulmonologists would agree a trial of these exercises through a local gym or a pulmonary rehab program are worth pursuing. Meditation has been shown to improve anxiety, depression, and fatigue especially in COPD patients. I personally practice meditation and find it the easiest and most practical for patients to add.
• Consider the addition of vitamin supplements. Please note this point is more a personal opinion rather than a guideline-based recommendation as there is minimal data supporting the benefits of supplements in patients with pulmonary diseases. That said, I do recommend 1 multivitamin tablet, 1 omega-3 fish oil tablet, and 1 calcium/vitamin D tablet daily. I find this to be an affordable regimen with some scientific evidence. Vitamin D promotes bone health and strengthens the immune system. Omega-3 fish oil improves cardiac health and increases HDL or “good cholesterol” levels. A daily multivitamin can provide key vitamins or minerals that may be missing from one’s diet. I have limited knowledge of herbal supplements and recommend speaking with an integrative medicine physician before regular use. Notably, these supplements can interact with prescribed medications and are not as regulated as prescribed medications. It’s also important to know that herbal supplements can be expensive with unproven benefits. As always, please consult with your physician before using vitamins on a daily basis.

Following these recommendations improves the health of my patients and can help you, too, if you suffer from chronic lung disease. Be sure to check with your own care providers to make sure they fit into your personal regimen.

References

• Uptodate.com
• Global Strategy for Asthma Management and Prevention 2020
• Thoracic.org
• Sleepfoundation.org