Living close to heavy traffic areas can place you at a higher risk for abnormal lung function and asthma.
Smoking is the culprit of chronic obstructive lung disease – everybody knows that. Except when it isn't. While smoking remains the – the combined term for emphysema, bronchitis and some forms of asthma – about one-quarter of people affected are nonsmokers. Some have a . And for others, environmental factors play a role.
"There's very strong evidence that if you're exposed to vapors, dust, gas and fumes at the workplace, then you have increased risk of COPD – independent of smoking," says Dr. John Balmes, a professor with the University of California–San Francisco medical school and at the UC–Berkeley School of Public Health.
Never Smoked – Have COPD
Vlady Rozenbaum, 74, founder of the advocacy group COPD-Alert, was raised in the harsh cold of a Siberian mining town. Retired Judge Valerie Chang, 57, grew up in balmy Honolulu. Chang and Rozenbaum are both nonsmokers. Yet both have COPD.
Rozenbaum's mother was a heavy smoker, and he's pretty sure she smoked during pregnancy. Chang's closest exposure to secondhand smoke was when she worked in the library as a law clerk one summer and people dropped in to smoke, sending her off to the cleaner air of the open atrium.
Both had lung conditions as children. Chang says she had "very mild, well-controlled asthma" as a girl. Rozenbaum's problems were more severe: He suffered from frequent respiratory infections, including pneumonia, and at one point was hospitalized and critically ill. He eventually developed bronchiectasis, a condition in which the airways are abnormally enlarged. Despite successful surgery, the condition later evolved into emphysema.
X-Factors
Chang's case is more mysterious. "I was diagnosed with COPD at 42, which is fairly young, and I had no risk factors," she says. So far, Chang has undergone genetic testing five times, to no avail. Experts still haven't figured out the cause, she says: "I'm one of those enigmas."
"Twenty-five percent of people in the United States who have evidence of COPD have never smoked," says Dr. David Mannino, a professor and chair of preventive medicine and environmental health at the University of Kentucky. "It's a big problem." A number of factors go into developing COPD, including early-life respiratory infections, exposure to occupational dusts and family history of emphysema, says Mannino, former chief science officer for the Centers for Disease Control and Prevention's Air Pollution and Respiratory Health Branch.
Many COPD patients have had asthma for years, he says. One challenge for doctors can be they have – or it might be both.
Urban and Rural Risks
Environment pollutants aren't usually the major and COPD, but they can make lung conditions worse, says Dr. Robert Wise, a professor of medicine at the Johns Hopkins University School of Medicine.
Urban areas have traditionally been thought of as particularly unhealthy, Wise says. For one thing, "the closer you live to traffic, the more likely you are to have abnormal lung function and a risk for asthma." But, he says, recent evidence suggests rural environments, where people are exposed to agricultural air particles, like hay mold, also have a significant effect on asthma.
In some parts of the United States, families who cook indoors with wood- or coal-burning stoves in poorly ventilated homes are at added risk for respiratory conditions.
"Outside of the United States, high levels of exposures to particulates, particularly from cooking what we call 'biomass fuels' – which includes things like grass and straw and animal dung – appears to be a major contributor to chronic lung disease," Wise says.
Workplace Connection
About 15 percent of COPD cases can be attributed to a person's occupation, according to the . Coal mine and silica dust are known risks. Rubber, plastics, leather manufacturing, construction utilities and textile manufacturing industries raise disease risk, according to NIOSH.
Smoke exposure is another work hazard, Balmes says. "Modern firefighters wear self-contained breathing apparatus equipment, and they're protected when they have that on," he says. But after a fire is "out," smoldering continues even as firefighters have removed protective gear. "They're actually inhaling potentially worse stuff than when you're actually fighting a fire," he says.
Diesel exhaust fumes are also a danger, Balmes says, whether you're working at a rail yard or as a truck driver. Over time, he says, continual irritation and inflammation from these types of hazards lead to airway scarring, obstructed air flow obstruction and reduced lung function – hallmarks of COPD.
Chemical Concerns
Industrial cleaning solutions are another problem, Mannino says. "Cleaning fluids are notorious for being irritants to the respiratory tract," he says. At least one study has found that people who work in cleaning jobs, like janitors, have higher levels of respiratory disease.
Manicurists in can be exposed to the same chemicals as factory workers, Mannino notes, but without similar monitoring or regulations. Surgical-type facial masks "are probably completely ineffective" protection, he says. Instead, effective prevention would likely involve some type of industrial hood. "You need to remove the exposure – those chemicals – from your breathing space," he says.
There are no recommendations for preventive screenings, such as pulmonary function tests or lung CT scans, for workers in high-risk occupations, Mannino says, although he thinks there should be.
Pollution Protection
Wise says it's "critical" to pay more attention to air pollution. For all the efforts made to control , he says, evidence suggests federal ozone standards "are still too high and need to come down." Meanwhile, he says, indoor air pollution has been made worse from efforts to increase energy efficiency by closing off houses and reducing ventilation.
What can you do on an individual level to protect yourself and your family? If feasible, Balmes suggests choosing to live in an area where the air quality is as clean as possible. You can check any U.S. location by plugging the ZIP code into the report card from the American Lung Association.
If you live in a problem area, Balmes says, pay attention to air quality alerts and avoid going outdoors on particularly bad days. You also can buy air filtration devices for your home to reduce particle exposure. If you work in a high-risk occupation, wear protective respiratory gear – which your employer should provide. And don't overlook the basics of lung health: not smoking and avoiding secondhand smoke.
COPD Frontlines
"I always thought of emphysema and COPD as something only smokers got," says Chang, the former judge. So when she learned of her diagnosis 15 years ago, "it was really hard to reconcile." Now, as founder and executive director of the Hawaii COPD Coalition, her advocacy skills come in handy for around the third-leading cause of death in the United States. "COPD is so misunderstood," Chang says. "It's not given the respect it deserves."