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Living Well with Chronic Lung Disease:
An Interview with Author Jane Martin

(Editor's note: This article is for informational purposes only. If you think you may suffer from a chronic lung disease - or think you know someone who does - we urge you to consult with your primary care provider for medical advice.)

We all pursue fitness for quality of life, both now and in the future. Eating right, exercising and combating stress can lessen our chances of developing cardiovascular disease and many forms of cancer. Most of us are concerned with our heart health, our colons, our breasts, our prostates... but how many of us really think about our lung health? Of course, nobody wants to get lung cancer and many smokers have quit to avoid it. But there are other, extremely common diseases that affect the respiratory system - diseases that are rarely discussed. Did you know that COPD (Chronic Obstructive Pulmonary Disease) is the fourth largest killer of all the major diseases? We bet you didn't know. But more people are becoming aware of chronic lung diseases - Time magazine had a story on COPD in its April 19, 2004 issue.

(Article continued below.)

Tens of millions of people in the U.S. suffer from chronic lung ailments - many of them undiagnosed. But what exactly is it and what can you do about it? We interviewed Jane Martin, respiratory therapist and author of Breathe Better, Live in Wellness to find out. For more than two decades, Ms. Martin has worked in acute care and outpatient settings, and is very active in not only making people aware of chronic lung disease, but also in creating a supportive atmosphere for those whose lungs are already affected. Her website, Brething Better, Living Well is a marvelous resource for those suffering from chronic lung disease, and those who are in search of more information. Even if you are suffering from a chronic lung disease, or are at risk to develop it, there are ways to retain your quality of life.

What are the most common chronic lung diseases and how do they differ in the ways they affect people's quality of life?

The most common chronic lung disease is COPD (Chronic Obstructive Pulmonary Disease), which is when a person has a combination of at least two of the following: emphysema, chronic bronchitis, and asthmatic bronchitis. About 16 million people in the United States have been diagnosed with COPD and it is estimated, unfortunately, that about that same number have it and are undiagnosed. COPD is the fourth highest cause of death in the U.S. and the only one of the top ten on the rise.

Pulmonary Fibrosis is not as common, but relatively speaking, I see a lot of people with it. Alpha-1 Antitrypsin Deficiency is emphysema that results from a genetic abnormality in the lungs' ability to protect themselves from infection, smoke, or other insults. People with Alpha-1 can already have significant shortness of breath in their 20s, 30s, or 40s. This disorder is highly undiagnosed due to lack of awareness. It is estimated that some 25 million people could be carriers of Alpha-1.

All of these disorders can cause severe limitation in activity, especially in advanced stages, making it difficult to just walk across a room. The time to get help and begin an exercise program is when the disease is mild.

Asthma affects, anywhere from 5 to 10 percent of the population; at least 15 million people have it. Asthma can also be debilitating, causing a decrease in level of activity, missed school and workdays, and coughing fits, especially at night. Over 5,000 people in the U.S. die of asthma each year, almost all of these deaths being preventable. Probably the scariest thing about asthma is that it is frequently not taken seriously enough.

Some people with chronic lung disease require supplemental oxygen, which is very helpful and becoming more convenient, but can still present logistical problems in everyday life.

What are early symptoms that people should see a doctor about?

Early symptoms? What a good question! It would be great if more people heeded their early symptoms! Unfortunately, though, the nature of lung disease is that symptoms are so insidious, and people also ignore a lot of early signs and don't seek help. Here are some indicators for who is at risk for COPD:

  • Are you 45 or older, currently smoke cigarettes or have smoked in the past?
  • Are you 45 or older and have a history of breathing irritants in your environment?
  • Do you sometimes have coughing fits or breathing trouble when exerting?
  • Do you have frequent bouts of bronchitis?
  • Do you cough up mucus or phlegm in the morning?
  • Does asthma, bronchitis, or emphysema run in your family?

If you answered "yes" to any of these questions, you might have COPD. Early symptoms can include a persistent cough, with or without production [of mucus], wheezing, the inability to keep up with other people during activities, and the need to visit the emergency room for help breathing. Ask your doctor about taking a quick, simple spirometry (lung function) test, a simple breathing test that can be done in a clinic or doctor's office. Your doctor checks your blood pressure with each office visit. Why not check lung function once a year in people at risk? Breath Better Live in Wellness Book

We all know about cigarette smokers being more likely to develop lung diseases, but what else can put someone at risk?

All smoke is dangerous; some is more toxic, say industrial smoke. Pot smoke is unfiltered, and therefore very harmful. Who else? People who have lived or worked in hazardous environments, such as being exposed to second hand smoke or other fumes, welding - any irritant that is airborne in small enough particles to be inhaled can cause damage to the lungs. I have had some patients who, for example, have worked for 10 years in metal grinding, 20 years in furniture refinishing, and smoked 2 packs a day. It is a wonder they are still able to breathe at all!

Our lungs put up with an awful lot before they tell us that something is wrong. That's another reason why early detection through technological means, such as pulmonary function testing, is so important. By the time we notice shortness of breath, there is a lot of damage.

How does exercise play a role in the lives of people with chronic lung disease? Wasn't exercise contraindicated in past?

Exercise is extremely important for the person with a chronic lung disease. Muscles that are conditioned require less oxygen than muscles that are out of shape. Yes, it used to be thought that persons with asthma should not exert themselves too much. And I am still seeing patients whose doctors are basically telling them, "You have emphysema and there is nothing that can be done about it. Your activities from now on will be very limited, so just go home and sit." My patients who have stayed fit all their lives, even those with severe lung disease, do so much better than the couch potatoes!

What types of exercise are recommended for people with chronic lung disease?

Aerobic exercise, starting at a very slow pace, if necessary. Weight and resistance training, and stretching for flexibility. Also, upper body exercises encouraging better chest mobility. Pulmonary rehabilitation is a great - and very safe - way to get started.

What types of exercise aren't recommended? Are there certain situations when some exercises are okay and some aren't?

It is not recommended that people with limitations go right into something that is very strenuous with a lot of stopping and starting. Something like basketball or football would probably just not be beneficial. Endurance is the key. Some of my patients are only able to walk at a pace of less than 1.5 MPH, but they can do it for about 20 minutes non-stop, whereas when they started the program, they could barely go three minutes. Many people with asthma have found swimming beneficial because the air in that environment is more humidified, lessening the chance for irritating the bronchial airways with dry air. However, many COPD patients do not tolerate humid air well at all. Much of this "what works best or not" question is answered by the individual after trial and error. And suggestions by respiratory professionals can be very helpful. There is help out there, and I wish that more people knew that!

Is there any reason someone with chronic lung disease could not practice Yoga?

From what I know of it, some of the more advanced techniques might not be helpful for those people with compromised lungs. But many of the basics, inhaling deeply through the nose, and exhaling slowly and controlled through pursed lips with an emphasis on using the diaphragm are the hallmarks of what we call breathing retraining for people with chronic pulmonary disorders. Also, some of the flexibility exercises such as neck stretches and relaxing the shoulders are very helpful. (People with breathing problems often have a lot of tension in their upper body.) Also, flexibility can be limited in this population, so some of the yoga poses would not be possible to achieve. [Ed. note - if you have been diagnosed with a chronic lung disease, and your doctor and/ or respiratory therapist has given you the go-ahead to practice Yoga, make sure you meet with the Yoga instructor beforehand to discuss any limitations you may have. The same goes for working with a personal trainer at a health club.]

Breathing technique does play a part in other forms of exercise, such as Pilates and weight training. How does this affect the ability of someone with chronic lung disease to do them?

Again, abilities vary from person to person, so some people might be able to participate in these things quite successfully. Others may not. I can't stress enough that enrolling in a pulmonary rehab program can be very helpful. There, a respiratory therapist or other health professional specializing in pulmonary issues can observe the patient as he or she learns proper exercise sequence and breathing techniques. For the person with compromised breathing who is interested in exercise, doing so in a safe and monitored environment is essential. The rehab participant can learn what his or her oxygen level is with certain activities and then carry on outside class with a better idea of what is safe. I have had patients who say, for example, "I want to get back to swimming - how should I go about that?" So, although we don't have a pool on our premises, we can give them suggestions and then, at the next session they let us know how it went. Starting slowly, pacing, breathing properly, and knowing your own body are the most important things to remember.

Chronic lung disease is not necessarily the end. People can and do go on to have great lives. Several of them have their stories in your book. Can you give us an example of someone here?

Great question - it definitely does not mean the end of a quality life! On the contrary, many people with lung disease have gained a whole new appreciation for each and every day - each and every breath - and have a very full and rich life.

Several patients come to mind, but one is a young man who has COPD brought on by Alpha-1 Antitrypsin Deficiency, an inherited form of emphysema that is often diagnosed in a person's 30s, 40s, or 50s. A long time smoker, Ken was told at age 34 that he had only 5 years to live if he kept on smoking and didn't seek help for his disease. Fortunately, he quit smoking immediately and without hesitation began pulmonary rehabilitation.

Ken is now highly motivated, working hard to stay as healthy as possible. Moreover, he has become a champion for Alpha-1 awareness. In addition to working at a physical job full time, he bicycles long distances with other Alpha-1 patients and family members to raise money and awareness for lung disease. Ken comes faithfully to rehab twice a week and is an inspiration to his classmates and friends, many of whom are twice his age.

I have many other patients whose stories may not be as dramatic. But when a person begins our program being completely sedentary with essentially no hope for involvement in any activities, and goes to exercising twice a week and getting out into the world again, this makes a huge difference in their existence. It is like they are getting their life back again. It is very rewarding to work in this field.

Here are some links to find out more about chronic lung disease and lung health:

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