How good is your lung power?

Hello, I am you right lung

Take a deep breath. Inhale long and easy and then, after a heartbeat, exhale long and easy. Do this about 4-5 times. Did you feel your balance right itself, ever so slightly? Yes? Good, because that’s really what I can achieve for you if you fill me up to capacity on a regular basis. Breathing is the key to life and I am happy that it all boils down me. As one of your lungs, I am immodest enough to say that it’s probably me that keeps you going every second of the day. You can stop eating for a while, go thirsty for a few hours and you will survive. But if you don’t breathe for more than a few minutes, it could be the end, my friend. In fact, in many health disciplines and philosophies, breathing right can make all the difference between mediocre and great health.

Let me give you my address

At the top end, I extend to above your collar bone and the 1st rib in the rib cage, reaching the base of your neck. Below, I go up to the level of the space between your 5th and the 6th rib on either side to sit on the diaphragm which separates the thoracic cavity from the abdominal cavity. I am kind of behind your ribs. The liver lies just below the diaphragm under me and the stomach under my co-breather, the left lung.

Each of us occupies one half of the thorax in an airtight compartment and are separated by the mediastinum (which houses the heart and the food pipe).

Having almost the whole of the right half of your chest (or thoracic cavity as it is called) to myself, I count myself lucky in that my partner, the left lung, has to share space with our friend - the heart. I do not believe it minds the arrangement being good friends with the heart, but that does mean that my colleague gets to be smaller in size than me, having to give up some of the space in the left thoracic cavity.

My vital statistics

I am light and porous, a spongy structure who floats in water. I am smooth, shining and very elastic.

I am encased in a fibrous membrane called the pleura, comprising of 2 layers with a thin fluid in between. The fluid serves to reduce friction when me and my partner expand and contract, much like the engine oil in your car, that keeps parts from rubbing against each other..

Between the two of us, we contain 2,400 kms of airways serving 300-500 million alveoli.

What are alveoli: These are small sacs of tissue in me that are very important in the process of respiration. ( More about their function in the next section). The capillaries inside me and my partner the left lung, if opened and laid end to end, would run for 992 kms!The combined area in the alveolar bed (of the area that the alveoli cover) where the blood and the air interface is 70 square metres, the size of one side of a tennis court.

My weight: Each of us weigh between 550 gms to 1 kg or more depending upon whether it is the left or the right lung, the gender of the individual, his or her build and also on how much water we both contain.

As your right lung, I have three lobes.

What is a lobe? Lobes are distinct sections of me separated from each other by deep fissures. There are 2 lobes to the left lung and 3 for me. As I explained earlier, my partner has to make place for the heart so he gets to be a bit downsized..

When you were born, I was soft, spongy and pink, a pristine condition I exulted in. I remained in that happy state till you turned a teenager and on that rather cold winter morning back in the 80s, took up the offer of a smoke from your best buddy at college. It was your first thrill and my first moment of terror. From then to now, your smoking has become my bête noire. If only you could look at me today – I am far from that pink, robust entity. I am distinctly grey, kind of murky and the years have taken a toll on me, as have environmental pollutants like dust, traffic fumes, chemicals in the air, fusty office interiors, etc. I would hate to look into the mirror, if you ask me.

My job description

I am made up of millions of delicate honeycomb-like air sacs at the microscopic level, the alveoli, and you know what they do. Each sac is surrounded by thin capillary network that are branches of the pulmonary artery bringing blood from the heart. The precious oxygen diffuses from the air inside the sacs to the blood in these capillaries and immediately combines with the haemoglobin to form oxyhaemoglobin to be merrily carried away to irrigate the body tissues. Conversely, the CO2 diffuses from the blood into the sacs to be expelled into the atmosphere. So you breathe in oxygen and breathe out CO 2. How cool is that?

The villainous CO2 is not such a rogue after all: Carbon dioxide is usually considered a rascal necessitating elimination from the body with every breath, but the truth is, carbon dioxide stimulates the respiration centre in the brain. Respiration continues only when blood levels of carbon dioxide are maintained at a certain level. For this reason, if one breathes pure 100% oxygen over a prolonged period, the respiratory centre in the brain stem will not be stimulated; the person will stop breathing leading to apnoea and death. Talk of oxygen being the breath of life.

The capillaries repeatedly join together to form the pulmonary vein which takes the blood- freshened by me - back to the heart.

The air is brought to me from the nose and mouth through a system of pipes which progressively get thinner as they go along. Thus the wind pipe or the trachea is quite big in diameter and can be felt in front of the neck as firm but compressible cartilaginous rings if you run your finger below your voice box. The trachea divides into the right and the left bronchi to supply air to me and my partner, the left lung, respectively. Each bronchus divides into bronchioles which get thinner and thinner till each tiny segment ends in a grape-like bunch of air sacs.

I am capable of expanding with every breath , my work made easier by my friend the diaphragm which goes down every time I expand, creating more space and less pressure inside the chest cavity.

With each breath, my partner and I together draw in 500 ml of air. An equal amount is expelled when you breathe out. On an average, people breathe about 16 times a minute, so about 8 litres of air are taken in and 8 litres are thrown out per minute. This figure increases when you are panting, for instance on a treadmill.

Besides the very obvious function of helping you breathe, I also act like a sieve, filtering out from the blood, minute blood clots, germs, cells (including cancerous ones) and air bubbles. How? The air passages in me have minute hairs lining them called cilia, which exhibit continuous sweeping movements and serve to expel dust, soot, pollens and other small foreign bodies from the air passages and filter the air so that it is as clean as possible by the time it reaches the alveolar level. Consider them like automated micro brushes that keep the area clean.

When it gets too cold, or you smoke or have an infection, these micro brushes, or cilia, do not function very well. Which explains why you suffer from problems when I function poorly. This ciliary movement is inhibited by a cold temperature, smoking and by microbes.

The passages or the airways inside me not only warm the inhaled air to the body temperature, but also humidify it. If they did not do this, you would be freezing to pain every time you breathed in cold, dry air that remained cold right into your lungs.

I also help a person maintain the pH balance by eliminating CO2 in case the milieu interior becomes acidic, and in elimination of certain substances like ketone bodies and alcohol. It is this ability of mine that helps traffic cops figure if you have been violating the law by drunk driving. The breathalyzer they use? That analyses what I am spewing out.

Er, what is milieu interior? It refers simply to the internal environment of the body - levels of acidity, blood gases, chemicals, enzymes, hormones.

My wish list

*Do not smoke. Every time you light up, I freak out. My ultimate joy is in being able to keep myself clean and healthy. Need I say more?

*Eat a healthy, well balanced diet.

*Exercise regularly. This gives me a fantastic workout.

*Do deep breathing exercises as in yoga and meditation. Proper breathing has been given a lot of importance in yoga and other oriental health sciences. Pranayama is a separate branch of yoga dealing with concentrating on one’s breathing. Proper breathing is said to improve not only the pulmonary function, but also blood circulation, digestion, endocrine, nervous systems and to invigorate the body as a whole. It is closely associated with meditation and claims to keep most chronic diseases at bay and to promote longevity.

*Take your vaccines, whenever required, especially the flu shot.

*Avoid smoky, dusty, damp places as far as possible, using a mask if it is absolutely essential to visit these locales.

*Wash your hands regularly to avoid getting flu viruses from telephones, door handles and lift buttons.

My nemesis:

If I am stricken, I may groan and moan and make noises, almost literally. I do not believe in suffering silently. I won’t give you a chance to say, “Why didn’t you so?’.

1) Shortness of breath. When a climb up a flight of stairs makes you feel all winded up, and you start to remember the times when you could sprint up and not miss a breath.

2) Cough: It may be a dry cough (smoker’s cough) or he may bring up sputum. Green or yellow sputum is more ominous than the white variety as it signifies infection. Blood with cough is seen in tuberculosis and lung cancer.

3) Wheezing or whistling with each breath signifies that the air tubes have shrunken with a reduced diameter (as in asthma). The narrowing of the air passage causes a sibilant note each time air passes along.

4) Chest pain as in pneumonia or embolism.

5) Rapid breathing, deep breathing, shallow breathing, difficulty in breathing, no breathing.

Some abnormal breathing patterns:

• KUSSMAUL”S PATTERN: A deep regular breath as in acidosis due to diabetes.

• APNOEA: Means cessation of breathing for 2-60 seconds for whatever reason.

• BIOT’s pattern: Several short breaths followed by a long period of apnoea as in raised intracranial tension.

• CHEYENE STOKES: Breathing shows apnoea followed by an equal period of rapid breathing as in brain damage and uraemia.

6) I may be infected by virus, bacteria or fungus. The much dreaded Flu, Pneumonia and Tuberculosis are in this variety of pulmonary diseases.

7) Asthma, emphysema and COPD (chronic obstructive pulmonary disease) are loosely associated with reduced air passage through the conducting tubes.

8) Fluid may accumulate in the chest cavity and compress me, causing pain and breathlessness-Pleural effusion. Pus, air or blood may similarly press me hard- and these are more dangerous than the former.

9) Pulmonary embolism refers to an often sudden blockage of the pulmonary artery by a blood clot which may have migrated from the leg veins. It is a serious condition requiring immediate attention.

10) Lung cancers: I may have a cancerous growth either originating within me or brought to me by the blood stream. Both varieties have poor prognosis.

CHECK LIST: SYMPTOMS TO WATCH OUT FOR

1) Chest pain-sudden or insidious.

2) Breathlessness.

3) Prolonged fever.

4) Cough especially when it brings up sputum and blood.

5) Wheezing or whistling sounds while breathing.

6) Changed breathing pattern.

Cardiac problem such as a silent heart attack in diabetics may present solely as breathing distress without the typical chest pain. Asthma symptoms appearing for the first time in adulthood may signify a cardiac cause and are never to be taken lightly.

SOME RELATIVELY COMMON LUNG CONDITIONS

• Asbestosis

• Asthma

• Bronchiectasis

• Chronic Bronchitis

• COPD ( Chronic Obstructive Pulmonary Disease)

• Cystic Fibrosis

• Emphysema

• Influenza

• Lung Cancer

• Pneumoconiosis (Black Lung Disease)

• Pneumonia

• Sarcoidosis

• Severe Acute Respiratory Syndrome

• Silicosis

• Tuberculosis

• Pneumo-, haemo- and pyothorax.

INVESTIGATIONS I REQUIRE

If you suspect me to be the culprit for any of the above symptoms, you must visit a doctor sooner rather than later. The doctor will take a detailed history and is likely to give you an earful when he learns about your smoking habit.

He will then do a thorough physical examination. He may order blood tests, an X ray examination and PFT (pulmonary function test). The latter involves breathing into a machine which measures the force and volume of your breath.

A CT , MRI or bronchoscopy may rarely be required.

Pulmonary investigations are also required if you are involved in certain professions like mining, asbestos industry, sand blasting, marble, cotton and sugar cane factories.

Me and my partner are so important because replacing us with artificial lungs is impossible. My transplant is possible from cadavers and is often combined with a heart transplant as a combined heart-lung transplant.

If one of my lobes needs to be replaced, it is only possible from living donors.