Breath Taking. Michael J. Stephen

The neglect has had serious consequences. Respiratory diseases, which include asthma and COPD, are among the top three leading causes of death both in the United States and worldwide. In America, these lung conditions traditionally trailed heart disease, cancer, and cerebrovascular disease as causes of death; however between 1980 and 2014, according to the Centers for Disease Control and Prevention (CDC), heart disease decreased by 59 percent, stroke by 58 percent, and cancer deaths by 24 percent, while chronic lower respiratory diseases increased by 40 percent.12 The data is even more alarming for the period between 1965 and 1998, during which death rates from COPD increased by an enormous 163 percent, even as all-cause mortality declined by 7 percent.13 In 2008, respiratory diseases in the United States for the first time replaced stroke as the third-deadliest disease, and it has kept that place ever since.

These statistics on the exploding burden of lung disease, dismal as they are, would be welcome in many other countries. Respiratory infections are the leading cause of death in low-income countries, where infants and children under five make up a disproportionate share of the four million deaths each year.14,15 Globally, toxic indoor and outdoor air pollution are an issue for three billion people, and together these problems are responsible for eight million premature deaths each year. Ninety-one percent of people in the world live in places where air quality fails to meet World Health Organization standards.16 All of these statistics point to a significant international health crisis.

      Lung diseases show no signs of abating, nor do the persistent, alarmingly high smoking rates or the worsening air quality driven by climate change and pollution. Even more worrying, crises that pose a threat to the breath and lungs have grabbed headlines recently, from the lethal wildfires in California, the Amazon, and Australia, to the strange respiratory illness from vaping, to of course the devastating 2020-coronavirus outbreak that shut down the global economy and killed hundreds of thousands. These catastrophes show that we have not taken potential threats to our air seriously enough.

      In the face of these challenges, some innovative doctors, scientists, and advocates are working extraordinarily hard to prevent and cure lung diseases. Given what we now know about genetics, biology, and medicine, there is no better time in history to be on the front lines of that fight—or, if you must, to be a patient with lung disease. The stories in this book illustrate the uniqueness of our current moment, showing how we’ve gotten to where we are with the lungs, and also pointing the way to a bright future.

      1. Holy Bible, Job 33:4 (New Revised Standard Version).

      2. Ibid., John 20:22.

      3. Ibid., Gen 2:7.

      4. Julia Wolkoff, “Why Do So Many Egyptian Statues Have Broken Noses?” CNN.com, March 20, 2019, https://www.cnn.com/style/article/egyptian-statues-broken-noses-artsy/index.html.

      5. Thich Nhat Hahn, The Miracle of Mindfulness: An Introduction to the Practice of Meditation (Boston, MA: Beacon Press, 1999), 15.

      6. C. D. O’Malley, F. N. L. Poynter, and K. F. Russell, William Harvey Lectures on the Whole of Anatomy, An Annotated Translation of Prelectiones Anatomiae Universalis (Berkeley: University of California Press, 1961), 204.

      7. Manoj K. Bhasin, Jeffrey A. Dusek, Bei-Hung Chang, et al., “Relaxation Response Induces Temporal Transcriptome Changes in Energy Metabolism, Insulin Secretion and Inflammatory Pathways,” PLOS One 8, no. 5 (May 2013): e62817.

      8. National Institutes of Health, “Cancer Stat Facts: Common Cancer Sites,” National Cancer Institute, Surveillance, Epidemiology, and End Results Program website, accessed July 31, 2019, https://seer.cancer.gov/statfacts/html/common.html.

      9. National Institutes of Health, “Estimates of Funding for Various Research, Condition, and Disease Categories,” NIH website, https://report.nih.gov/categorical_spending.aspx.

      10. David J. Lederer and Fernando J. Martinez, “Idiopathic Pulmonary Fibrosis,” New England Journal of Medicine 378 (May 10, 2018): 1811–1823.

      11. Rein M. G. J. Houben and Peter J. Dodd, “The Global Burden of Latent Tuberculosis Infection: A Re-Estimation Using Mathematical Modelling,” PLOS Medicine 13 (October 25, 2016): e1002152.

      12. Centers for Disease Control and Prevention, “Mortality Trends in the United States, 1900–2015,” CDC website, accessed July 31, 2019, https://www.cdc.gov/nchs/data-visualization/mortality-trends/.

      13. Romaine A. Pauwels and Klaus F. Rabe, “Burden and Clinical Features of Chronic Obstructive Pulmonary Disease (COPD),” Lancet 364, no. 9434 (August 2004): 613–620.

      14. World Health Organization, “The Top 10 Causes of Death,” WHO website, accessed May 8, 2020, https://www.who.int/news-room/fact-sheets/detail/the-top-10-causes-of-death.

      15. Forum of International Respiratory Societies, The Global Impact of Respiratory Disease, 2nd ed. (Sheffield, UK: Sheffield, European Respiratory Society, 2017), 7.

      16. World Health Organization, “Air Pollution,” WHO website, accessed July 31, 2019, https://www.who.int/airpollution/en/.

PART I

      THE PAST: THE LUNGS SHAPED OUR BEGINNINGS, PHYSICALLY AND SPIRITUALLY

      Chapter 1

      Oxygen, Then Existence

      The story of our need for breath goes back many millions of years. As each person’s biological life has a conception, gestation, and early, middle, and late stage, the same is true of Earth itself. Just as an infant coming into the world can flourish only when it has mastered breathing, Earth started flourishing only when some kind of breathing and oxygen use began.

      The Earth has not always had oxygen in its atmosphere. Its early gases would have been toxic to most of the species alive today. But when oxygen first appeared, it changed the world radically. And, remarkably, we didn’t know how oxygen first came to envelop our planet until the 1970s.

The universe, namely all matter that we see before us in the form of stars and planets and everything else contained within their apparent space, is thought to have emerged some fourteen billion years ago. Almost certainly, in the single instant of the Big Bang’s explosion, the entire past and