Who benefits from stronger lungs? EVERYONE!

By David Dunaief, M.D.

Until recently, many people thought COVID-19 was like the common cold or maybe like the flu. Now, most of us know somebody directly or indirectly who has been hospitalized with COVID-19. 

While social distancing and handwashing are critical to prevent its spread, strengthening lung function is crucial to preventing its progression to severe disease.

Among those with highest risk for severe COVID-19 are those with chronic obstructive lung diseases such as chronic obstructive pulmonary disease (COPD) and asthma, as well as those who smoke and vape.

What can we do to strengthen our lungs? We can improve lung function with simple lifestyle modifications including exercising, eating a plant-based diet with a focus on fruits and vegetables, expanding lung capacity with an incentive spirometer, and quitting smoking and vaping, which damage the lungs (1). Not only people with compromised lungs will benefit; studies suggest “healthy” people will also benefit.

Why is this important?

This virus starts in the throat but may progress to the lungs attacking the alveoli, small air sacs that allow gas exchange to take place. When this occurs, patients get short of breath and may have to be hospitalized and placed on a ventilator. Two factors influence this: inflammation and fluid in the lungs.

Both asthma and COPD increase inflammation of the airways and the lung’s functional tissue (parenchyma) thus, potentially making these patients more susceptible to severe COVID-19.

Let’s look at the research, taking a three-pronged, or “forked,” approach: diet, incentive spirometry and exercise.

Diet Studies in Asthma

In a randomized controlled trial (gold standard of studies) of asthma patients, results show that after 14 days those who ate a low-antioxidant diet had less lung function compared to those who ate a high-antioxidant diet (2). Researchers measured lung function with one-second forced expiratory volume (FEV1) and predicted forced vital capacity (FVC). Additionally, those who were in the low-antioxidant diet group also had higher inflammation at 14 weeks, as measured using a c-reactive protein (CRP) biomarker. Those who were in the low-antioxidant group also were over two-times more likely to have an asthma exacerbation.

The good news is that the difference in behavior between the high- and low-antioxidant groups was small. The high-antioxidant group had a modest five servings of vegetables and two servings of fruit daily, while the low-antioxidant group ate no more than two servings of vegetables and one serving of fruit daily. Carotenoid supplementation, instead of antioxidant foods, made no difference in inflammation. The authors concluded that an increase in carotenoids from diet have a clinically significant impact on asthma and can be seen in a very short period. 

Diet Studies in COPD

Several studies demonstrate that higher consumption of fiber from plants decreases the risk of COPD in smokers and ex-smokers. Bear with me, because the studies were done with men or women, not both at the same time. In one study of men, for example, results showed that higher fiber intake was associated with significant 48 percent reductions in COPD incidence in smokers and 38 percent incidence reductions in ex-smokers (3). The high-fiber group ate at least 36.8 grams per day, compared to the low-fiber group, which ate less than 23.7 grams per day. Fiber sources were fruits, vegetables and whole grain, essentially a whole foods plant-based diet. The high-fiber group was still below the American Dietetic Association-recommended 38 grams per day. This is within our grasp. 

In another study, women had a highly significant 37 percent decreased risk of COPD among those who consumed at least 2.5 serving of fruit per day compared to those who consumed less than 0.8 servings per day (4).

The highlighted fruits shown to reduce COPD in both men and women included apples, bananas, and pears.

Incentive Spirometry

What is an incentive spirometer? It’s a device that helps expand the lungs by inhaling through a tube and causing a ball or multiple balls to rise. This opens the alveoli and may help you breathe better. 

Incentive spirometry has been used for patients with pneumonia, those who have chest or abdominal surgery and those with asthma or COPD, but it has also been useful for healthy participants (5). 

A small study showed that those who trained with an incentive spirometer for two weeks increased their vital capacity, right and left chest wall motion, and right diaphragm motion. This means it improved lung function and respiratory motion. Participants were 10 non-smoking healthy adults who were instructed to take five sets of five deep breaths twice a day, totaling 50 deep breaths per day. The brands used in the study are easily accessible, such as Teleflex’s Triflo II.

In another small, two-month study of 27 patients with COPD, the incentive spirometer improved blood gasses, such as partial pressure carbon dioxide and oxygen, in COPD patients with exacerbation (6). The authors concluded that it may improve quality of life for COPD patients.  

Exercise Studies 

Exercise can have a direct impact on lung function. In a study involving healthy women ages 65 years and older, results showed that 20 minutes of high-intensity exercise three times a day improved FEV1 and FVC, both indicators of lung function, in as little as 12 weeks (7). Participants began with a 15-minute warm-up, then 20 minutes of high-intensity exercise on a treadmill, followed by 15 minutes of cool-down with stretching.

What is impressive is that it was done in older adults, not those in their twenties and not in elite athletes. Since most of us don’t have access to a treadmill right now, note that any physical exercise will be beneficial. 

We should be working to strengthen our lungs, regardless of COVID-19. However, to potentially reduce our risk of severe COVID-19, this three-pronged approach of lifestyle modifications – diet, exercise and incentive spirometer – may help without expending significant time or expense. As Yogi Berra would say, “When you come to a fork in the road, take it!” There is no time to waste.

References:

(1) Public Health Rep. 2011 Mar-Apr; 126(2): 158-159. (2) Am J Clin Nutr. 2012 Sep;96(3):534-43. (3) Epidemiology Mar 2018;29(2):254-260. (4) Int J Epidemiol Dec 1 2018;47(6);1897-1909. (5) Ann Rehabil Med. Jun 2015;39(3):360-365. (6) Respirology. Jun 2005;10(3):349-53. (7) J Phys Ther Sci. Aug 2017;29(8):1454-1457. 

Dr. Dunaief is a speaker, author and local lifestyle medicine physician focusing on the integration of medicine, nutrition, fitness and stress management. For further information, visit www.medicalcompassmd.com.