Breathe well, live well

The lung, a “sensitive organ”, under the microscope

As pulmonary consultant Dr Jörg Duftner explains, ‘the lungs are highly sensitive organs.’ So how do we keep them healthy? Medical Director Dr Peter Gartner talks to consulting physician Dr Duftner to find out more about them and respiratory conditions such as COPD and coronavirus.

Gesundheitszentrum Park Igls in Tirol

Jörg Duftner:

  • The lungs are structured like a tree, with the windpipe forming a trunk that bifurcates into two large ‘branches’ or lungs. The air we inhale is transported via the bronchi to the alveoli. These are the ‘leaves’ on the tree where gas exchange takes place. Oxygen is released into the bloodstream and waste CO2 is removed from the blood into the lungs to be breathed out.

Gartner:

  • Modern Mayr Medicine echoes this in that we also use the tree as a symbol, albeit for the gut. Modern Mayr Medicine also understands the relationship between the breath and the abdomen. Breathing works like a set of bellows: we use muscle strength to inflate the lungs and then they contract automatically. The inner organs in the diaphragm – the main muscle of respiration – are connected as if under a dome. If they are too heavy, perhaps due to a high level of body fat or a fatty liver, the effect on the diaphragm can be harmful because it is no longer able to move as freely.

Duftner:

  • On a daily basis, I get to observe the mechanics of breathing: X-rays show me the extent to which a diaphragm moves during respiration, and to what degree it supports the breath. A healthy diaphragm moves 5-6cm, but in some cases it barely moves at all, and is practically fixed to the spot. Patients with this kind of impairment often resort to using accessory respiratory muscles such as those in their shoulders to help. It’s really obvious when you see people leaning on something to catch their breath. Try feeling your breath: place your hand on your abdomen; as you inhale relax the abdomen, allowing it to expand. That way, you’ll take in more air.

Gartner:

  • It works even better when lying down. Abdominal breathing is something we all do when we are asleep. Singers and wind instrument musicians actively use it too.

Duftner:

  • The way I see it, there are four mainstays to maintaining healthy lungs and preventing infection:
  1. The principal cause of lung damage is smoking – active and passive. Smokers have low resistance to all pathogens.
  2. Strength and endurance training are the best forms of respiratory muscle exercise. This also ensures good lung ventilation: pathogens like things warm and cosy, so I advise outdoor exercise every two or three days, even in winter.
  3. Drug treatment is also part of staying healthy, as a protective shield. I’m not necessarily talking about medication, but vaccinations – against flu, pneumonia, whooping cough and now COVID-19 – are important in my view.
  4. Diet. We’ve already mentioned the restriction that excess weight places on the diaphragm. We also know there is a connection between excess weight and asthma, which explains why obese children have such a hugely increased risk of developing it.

Gartner:

  • A cleansed gut also offers protection against infectious diseases. We’re not just talking about excess weight: beneficial food choices and chewing properly are primary factors in ensuring healthy dietary intake. Of course, the tolerability of individual food also plays a role. Add to this the fact that your bronchi love plenty of fluids – which is exactly what Mayr recommends: drinking a lot of water or herbal tea really does promote bronchial health.

Duftner: 

  • The use of FFP2 masks seems to be a fairly contentious topic, but as far as I’m concerned they provide good protection from infectious aerosols – and most people only wear them for a short time, anyway. I recommend that occupational groups where mouth and nose coverings are mandatory should take regular breaks. But I see no cause for concern in terms of harm to the lungs.

Duftner:

  • I’m currently treating several long COVID patients with a variety of symptoms. In isolated cases, we are still seeing spots on the lungs, and some patients have decreased lung function. Others have normal X-rays and lung function yet still report issues, so we have to assume that inflammation processes are still at work. The treatment of choice in these cases is a cortisone spray over a period of weeks, and this has yielded good results. I generally advise against strenuous sporting activity for around two months following COVID.
Gartner:
  • As you would expect, environmental factors affect lung function. The state of our bronchi reflects our environment, and the lungs have an enormous potential to store harmful substances. This can cause problems – such as smoker’s lung – but it doesn’t have to. I see many older patients; mostly their breathing difficulties stem from heart problems.

Gartner:

  • A major symptom to look out for is a fever, by which I mean a temperature of 39°C or more, lasting several days. Most adults have some experience of being ill, so they know their bodies and can recognise the warning signs. When it comes to COVID, I hear a lot of patients say they’ve never experienced anything like it.

Duftner:

  • Too often, people with no history of lung disease are prescribed antibiotics much too soon and with little benefit. Persistent coughs – even in asthmatics or people with allergies – are best treated with conventional steroid inhalers. But if breathing becomes difficult and the mucus you cough up changes colour, I’d recommend going to see your GP.

Duftner:

  • The term COPD stands for chronic obstructive pulmonary disease and describes a range of lung diseases including emphysema and chronic bronchitis. Chronic means that the disease lasts a long time and is always present. Obstructive denotes that the ability to move air in and out of your lungs is blocked. Despite a long anti-smoking campaign, smoking, active and passive, is still the cause of around 80–90% of COPD. To a lesser extent, genetic disorders such as cystic fibrosis, also known as mucoviscidosis, and Alpha-1 antitrypsin deficiency can also lead to COPD.

Gartner:

  • However, coughs can also be caused by reflux.

Duftner: 

  • In fact, reflux is one of the most common diagnoses behind persistent coughs or bronchitis. In prone patients, when stomach contents flow back into their oesophagus, stomach acid can be inhaled, causing them to cough and clear their throats. The PH level in the lower third of the oesophagus is lower, which can result in the urge to cough as a reflex.

Gartner:

  • Modern Mayr Medicine can help with this too. Weakening of the lower oesophageal sphincter muscle is a more common cause of reflux than hiatus hernia, and Mayr therapy considerably increases the tonicity of the sphincter.

Duftner:

  • Pneumonia is an inflammatory condition of the lung, usually caused by a bacterial superinfection. Unfortunately, it is often misdiagnosed even though this serious illness makes patients very unwell. A stethoscope doesn’t always pick it up; in fact, this condition is not medically audible in up to 60% of patients, so a doctor’s trained eye is required. Thankfully, GP care in Austria means that patients are treated by a single doctor over long periods of time, rather than an ever-changing stream of GPs. This makes it easier to make an assessment of a patient’s physical signs.

Duftner:

  • Let me make one thing absolutely clear: lung cancer is very rare in non-smokers. However, exposure to passive smoking is associated with an increased risk of lung cancer. Recommended preventative measures include yearly checks for smokers with a history of smoking 20 cigarettes a day for 20 years. A CT scan can be performed with extremely low radiation exposure and no contrast medium.

Duftner:

  • Bronchial mucous membranes can recover, but there is no cure for emphysema. However, it’s never too late to stop smoking, as you can inhibit the progress of lung damage and the severe loss of function that results from it.

Gartner:

  • The psychosomatic aspect of lung function is also worth alluding to. The three biggest interfaces between us and our environment are our skin, gut and lungs. These organs are the sites of nine out of ten cases of psychosomatic illness. Asthma in children can, for instance, be related to problems in the family.

Duftner:

  • It’s diagnosis by exclusion. Once other reasons have been ruled out, we can deduct that the symptoms are the psyche’s way of signalling ‘this situation is smothering me’. There are some interesting studies involving people with animal hair allergies who experience allergic reactions when shown pictures of cats.

Gartner:

  • That really demonstrates how quickly the body is able to learn, doesn’t it? Finally, I’d like to mention some medication that has both an expectorant and an antioxidant effect. ACC (acetylcysteine) is an extremely effective antioxidant which reduces oxidative stress – a cause of ageing. It is used in holistic medicine as a detoxification aid, although ACC used to only be available in the form of effervescent tablets, which isn’t good for the gut. On our initiative, ACC now comes in capsule form, which is easier on the gut while maintaining its detoxifying and expectorant effects. Detoxing for several weeks while taking one capsule a day is a great way to support the body during periods of increased physical and psychological stress.
Gesundheitszentrum Park Igls in Tirol

Dr. Jörg Duftner studied medicine in his home city of Innsbruck, choosing to specialise in lung disease after qualifying as a GP. He ist being a consultant at Park Igls.