Book Review – Breathing Lessons

Breathing Lessons: A Doctors Guide To Lung Health

• Author: MeiLan K. Han MD
• ISBN 978–0–393–8 6662–9
• Published by: WW Norton and company
• Review by Professor Joanna Porter

 

This small volume, just 154 pages, gives a superb overview of the lungs and breathing.  The author is a practicing respiratory physician from America and a national spokesperson for the American Lung Association. Breathing Lessons is beautifully written, easy to read and packed with up-to-date information and peppered with personal vignettes from the author’s clinical practice.

The book is divided into six parts.

How the lungs work – This first part describes the structure of the lungs and how they work. Not only does Dr Han discuss the mechanics of breathing, and what happens when this goes wrong, but she also introduces the idea of using our breathing to change our lives. Although our breaths are involuntary, what happens when we consciously breathe slowly and deeply? Can we reduce our stress, improve our mood, and change our lives?

Immune response – The next section deals with the immune response and the role of the respiratory system, which begins at the nose, in preventing infection, and what happens when these defences are breached. Dr Han talks us through the various pathogens: viruses including SARS, MERS and SARS-CoV-2- the virus responsible for COVID-19, bacteria, and fungi. She also mentions mycobacterium tuberculosis (M.tb.)  and other mycobacteria. Dr Han touches elegantly on the symptoms of these respiratory symptoms but also the potential treatments and approaches to prevention, including the all-important vaccinations.

Protection – The third part of the book deals with protecting your lungs, starting long before birth, throughout childhood, and as an adult. The message is common sense: have a healthy lifestyle and do not ignore chronic symptoms cough, sputum, wheeze, breathlessness. Don’t wait!

How to diagnose – For me, section four was a fascinating insight into the way a chest physician thinks. Dr Han emphasizes the importance of taking a good history at the medical interview to get to the bottom of the problem. Then comes the physical exam followed by important tests, such as lung function, chest X-rays, CT scans and bronchoscopy. The text is peppered with personal stories, and she makes a strong point that, no matter how good the diagnostic tests are, they’re only as good as the physicians interpreting them. We need high quality tests and experienced physicians. I was surprised that Dr Han does not address the growing use of artificial intelligence (AI) to interpret images and even perform investigations such as biopsies. The majority view is that good AI will outperform even the most experienced clinicians, but will AI really replace the experienced clinician who can consider the patient’s entire clinical picture’? Watch this space as Breathing Matters’ research attempts to answer this important question.

Chronic lung conditions – Chapter five is a short guide to the main chronic lung diseases starting with airways diseases and asthma.  The discussion about cystic fibrosis (CF) is up to date and fascinating. Of course, at Breathing Matters we have a special interest in: i) bronchiectasis, which was mentioned as part of the CF section but did not have its own section; and ii) interstitial lung diseases or the diffuse parenchymal lung diseases – for which Dr Han provides a very good concise easy to understand review. However, sarcoidosis, a very important and relatively common ILD, is just mentioned in passing. The treatment information for ILD is hot off the press and includes antifibrotics and even the recent approval of Nintedanib/Ofev for scleroderma associated and other progressive fibrotic (PF)-ILDs.  In fact, Ofev has only become NICE-approved and available on the NHS for PF-ILD since April 2022, so this is very current.

The way forward – Chapter six is a call to arms to make lung health a higher priority. Dr Han argues for: i) widespread use of spirometry for screening and monitoring of lung health as is the case for blood pressure monitoring – something we are addressing at Breathing Matters in our home spirometry project in ILD; ii) improved air quality, and iii) an increase in NIH (American equivalent of our NIHR/UKRI government funding bodies) spending into lung disease. Historically, chronic lung diseases have been less well funded as they are linked to smoking in the public’s eye, even though the majority of chronic lung disease occurs in non-smokers. This is exactly where Breathing Matters can help by raising public awareness of these diseases and acting as a patient advocate. Finally, Dr Han presents a new model of venture philanthropy with a moving description of how a charity worked with a drug company to develop novel approaches to find drugs for rare diseases, in this case cystic fibrosis.

In summary, an excellent book covering a lot about the lungs and breathing.  However, a Breathing Matters supporter looking for in depth information on, for example, bronchiectasis or sarcoidosis might be disappointed.  But for anyone looking for an overview of the lungs and breathing in general, to set the foundations for more in-depth reading, I would highly recommend.