What is the cost of diagnosis, treatment for pulmonary diseases

Causes And Symptoms Of Poor Lung Health: Expert Tips To Prevent Asthma, Cancer, COPD In Elders

Maintaining lung health becomes increasingly important to general health as we age. Lung disease affects around 1 in 7 older persons, making it a serious health risk. Among persons 60 years of age and older, chronic respiratory conditions rank as the second most common reason for hospitalisation. Elderly people are more vulnerable to diseases like lung cancer, asthma, and chronic obstructive pulmonary disease (COPD) due to physiological changes brought on by ageing.

Dr Pratibha Dogra, Senior Consultant, Pulmonology and Sleep Medicine Expert, Marengo Asia Hospital, Gurugram, says that older persons must take proactive measures to safeguard and preserve their respiratory health by being aware of these changes.

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Physiological changes in lung function with age

Dr Dogra says that the natural ageing process alters the physiology of the lungs, making breathing harder for senior citizens. Among the significant adjustments are:

Decreased lung expansion: As people age, their bones may become less flexible, leading to a stiffer rib cage and less room for the lungs to expand.

Weaker respiratory muscles: As we age, our breathing muscles, such as the diaphragm, become weaker. Breathing becomes less efficient as a result.

Diminished neurological system response: As we age, our neurological system's capacity to control breathing deteriorates, leading to a reduction in the effectiveness of respiratory function.

Reduced immune function: Lung infections and long-term respiratory illnesses are more common in older persons as their immune systems deteriorate.

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In addition to ageing naturally, prolonged exposure to cigarette smoke, air pollution, and environmental pollutants can further deteriorate lung health in the elderly. Lung cancer, pneumonia, COPD, and bronchial asthma are among the conditions that are common in older people.

Ways to protect ageing lungs

Even though ageing causes a natural decline in lung function, there are various things older generations may do to slow down this process and keep their lungs healthy.

Avoid smoking cigarette 

In older persons, smoking is the primary cause of bronchitis, emphysema, and lung cancer. The effects of secondhand smoke are similar. One of the most crucial things you can do to keep your lungs healthy is to stop smoking or limit your exposure to it. Smoking raises the risk of serious respiratory disorders and accelerates the development of chronic lung diseases. If smoking has already had an impact on someone, removing exposure can help prevent more harm.

Monitor air quality and avoid pollution

Lung illness in the elderly makes them especially vulnerable to air pollution. They can learn whether it's safe to go outside by monitoring the Air Quality Index (AQI), particularly in places where there is a lot of particulate matter or smog. In winter, especially in northern India, air quality can drastically decline, making outdoor activities dangerous for people with respiratory conditions. On days with bad air quality, staying inside can lower your risk of developing respiratory issues.

Improve indoor air quality

Respiratory problems can be exacerbated by indoor contaminants such as mould, pet dander, and chemicals from cleaning supplies. Maintaining interior air quality can be accomplished with the use of air purifiers, better ventilation, and removing indoor pollution sources. This is especially crucial for senior citizens who suffer from respiratory diseases like COPD, asthma, or other ailments.

Stay physically active

It is imperative to engage in regular physical activity to preserve lung function. Simple exercises like swimming or brisk walking might support the strength of the respiratory muscles. Exercises involving deep breathing also strengthen the diaphragm, improving respiratory efficiency. Exercise increases oxygen use in the body and improves cardiorespiratory fitness, which facilitates easier breathing even though it doesn't strengthen the lungs. Moderate exercise can help people with COPD and asthma avoid their symptoms getting worse.

Adopt a healthy diet

Overall lung health is supported by a diet high in fruits, vegetables, and anti-inflammatory foods. Nutrients found in foods like apples, red bell peppers, garlic, ginger, and turmeric improve lung function. Consuming cruciferous vegetables, like broccoli and cauliflower, has been linked to a decreased risk of lung cancer, according to studies. Immune system performance and lung inflammation can both be enhanced by eating a balanced diet.

Get vaccinated

For older persons, especially those with pre-existing lung issues, respiratory infections can be deadly. Pneumococcal and flu shots should be administered annually to avoid infections that exacerbate respiratory conditions. In addition to vaccines, infection prevention measures include proper hygiene, getting adequate sleep, and managing stress.

Also see: Ditch these 8 habits for healthy lungs, lower risk of asthma, lung cancer, tuberculosis, and more

Recognising early warning signs of lung problems

Senior citizens must identify the early indicators of lung issues. A doctor should be consulted if you experience symptoms like a cough that doesn't go away after more than a month, wheezing, coughing up blood, or chest pain that gets worse when you breathe. Severe consequences can be avoided with early identification and treatment.

One essential component of ageing successfully is lung health. Proper diet, exercise, avoidance of pollutants, and early detection of respiratory problems are among the proactive ways older individuals can maintain lung function and enhance their quality of life. Ensuring that lung health receives regular care and attention can help the lungs age as elegantly as the rest of the body.

Disclaimer: This article, including health and fitness advice, only provides generic information. Don't treat it as a substitute for a qualified medical opinion. Always consult a specialist or your health specialist for more information.

Nivedita is a Delhi-based journalist who writes on health, fashion, lifestyle and entertainment. Views expressed are personal.

Vets With Rare Lung Disease Could Get Benefits More Easily Under Proposed Changes, VA Says

Veterans with a rare lung disease could have an easier time collecting Department of Veterans Affairs disability benefits under proposed changes announced by the agency Wednesday.

The ailment, called constrictive bronchiolitis, or CB, is one of the burn pit-related illnesses covered under the PACT Act, the sweeping law passed two years ago that aimed to make it easier for veterans with certain diseases linked to toxic exposure to get VA care and benefits. But veterans with CB have reported still facing unique challenges to getting their benefits approved by the VA.

Now, the department is taking steps to remove the specific challenges veterans with CB face when applying for benefits.

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"These steps are part of our comprehensive efforts to make sure that all those we serve -- including veterans who live with CB and their survivors -- get the benefits they deserve," VA Secretary Denis McDonough wrote in a letter to Senate Veterans Affairs Committee Chairman Jon Tester, D-Mont., released by the department Wednesday.

"Altogether, we are now delivering more care and more benefits to more veterans than ever before, but we will not rest until every veteran and survivor gets the care and benefits they deserve," McDonough added. "That is why today's proposed steps are so important, and that is why we will continue to do everything in our power to support veterans who live with CB and their survivors."

CB, also known as obliterative bronchiolitis or bronchiolitis obliterans, is the narrowing or obstruction of the lungs' smallest airways -- the bronchioles -- by scarring or fibrous tissue. The scarring prevents oxygen exchange between the lungs and the bloodstream, causing extreme fatigue.

Other symptoms include shortness of breath and unexplained wheezing or dry cough in the absence of a cold or allergies.

CB was one of the 23 ailments that the PACT Act classified as presumed to be linked to military service, meaning the burden is no longer on veterans to prove their illness was caused by military service in order to be approved for benefits.

But two specific issues have made it difficult for veterans with CB to collect benefits even after the PACT Act, veterans and experts recently told lawmakers in a roundtable to mark the anniversary of the bill.

First, CB is the only PACT Act respiratory illness that does not have its own diagnostic code in VA disability claims systems. That means the VA must enter a diagnostic code for a similar disease into the system, a practice it says allows the department to still award benefits but which veterans and advocates say fails to recognize the true effect of their condition. Second, it is difficult to diagnose CB, with the only current way to definitively diagnose it being a painful, invasive lung biopsy.

To address those hurdles, the VA is taking steps to add a diagnostic code specifically for CB. The department is also moving to allow two additional medical tests to evaluate those with CB that will "make it easier for veterans to obtain an accurate disability rating," according to McDonough's letter. The tests are maximum oxygen consumption and metabolic equivalents, which respectively measure oxygen and energy usage during exercise.

The changes announced Wednesday are not taking effect immediately. The department must first go through the federal rulemaking process, a sometimes lengthy undertaking that includes soliciting public comment. The proposed rule change will be published in the Federal Register on Thursday, according to a draft published on the agency's website Wednesday.

In April, Tester led 17 other senators in calling on the VA to make the changes similar to those announced Wednesday after a PBS NewsHour story highlighted the issue.

A Senate aide told Military.Com that, while not perfect, the VA's Wednesday announcement was a significant step forward and that Tester will monitor the implementation of the changes.

"Toxic-exposed veterans have waited decades to receive the benefits and health care the PACT Act provides, and it's critical VA is implementing the law the way veterans need and deserve," Tester said in an emailed statement Wednesday. "That means fixing outdated processes standing in the way of veterans and their newly expanded benefits. I'm glad to see the department answering my call to do this for veterans with constrictive bronchiolitis, and I'll keep holding VA accountable to roll out this law the way Congress intended."

Editor's note: This article has been updated to reflect that constrictive bronchiolitis is the only PACT Act respiratory illness without a diagnostic code in VA disability systems and to clarify the effects of not having its own diagnostic code.

Related: Burn Pit Victims with Rare Lung Disease Struggle to Get VA Care and Benefits

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VA Requiring Veterans With Rare Lung Illness To Take Tests That Can Fail To Detect Disease

A proposed rule at the Department of Veterans Affairs to make it easier for veterans with a rare lung condition to qualify for disability benefits is being criticized by some veterans and a pulmonologist because the change requires tests and assessments that often fail to detect the chronic disease. (Stars and Stripes)

WASHINGTON — A proposed rule at the Department of Veterans Affairs to make it easier for veterans with a rare lung condition to qualify for disability benefits is being criticized by some veterans and a pulmonologist because the change requires tests and assessments that often fail to detect the chronic disease.

The lung ailment is called constrictive bronchiolitis, which is a toxic injury from exposure to burn pits, dust storms, jet fuel exhaust and industrial pollutants. Patients with the disorder experience inflammation, emphysema and scarring of the lungs.

Dr. Robert Miller, a scientist and physician at Vanderbilt Medical University who was part of the team that first identified the disease in troops 20 years ago, said the VA will require routine respiratory tests that are unreliable to confirm the diagnosis. The rule change also adds a diagnosis code for constrictive bronchiolitis to process veterans' claims more efficiently.

Some veterans who have been exposed to toxins and developed constrictive bronchiolitis received 0% disability or a very low rating. Miller said he does not expect that to change without the proper testing and criteria.

Jim Raines, 61, of Alabama, a retired Army chief warrant officer, said he has been battling the VA for 12 years for recognition of the disease and how it has impacted his life. His battle continues.

Jim Raines with his daughter, Jenna, in Alabama in 2007 while he was on leave during a two-year deployment to Afghanistan. (Provided by Jim Raines)

Raines had an open lung biopsy that diagnosed him with constrictive bronchiolitis, but the VA did not accept the findings, he said.

"They were only interested in the pulmonary function tests," said Raines, who served in Afghanistan in 2006 and 2007. "They agreed that I had a service-connected condition but then rated me at 0% because the PFT — a catch-all test for lung conditions — was normal."

Some of the service members who Miller treated could no longer meet minimal physical fitness tests because of their breathing problems. Veterans with the incurable condition will still be denied health care and benefits once the VA changes the rule, he said.

''I have seen several patients who received one rating from the [Defense Department] only to have it downgraded by the VA. I have seen patients who have received a rating for constrictive bronchiolitis only to have their rating reduced without explanation," said Miller, who previously conducted research at Fort Campbell, Ky., that looked at disabling respiratory illnesses reported by hundreds of service members returning from deployments in Iraq and Afghanistan.

However, Terrence Hayes, the VA press secretary, said the agency approved 307 veterans for disability compensation of constrictive bronchiolitis since passage of the Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxics Act, also known as the PACT Act.

"I was being bounced around to different VA doctors because my [pulmonary function tests] were showing me as normal," said Cynthia Daniels, who had to quit her job as a police officer after leaving the military because of breathing problems.

Daniels, 46, of Montana, was a former specialist in the Missouri Air National Guard from 2000-06. During deployments to the Middle East, Daniels said she developed wheezing and shortness of breath that did not go away. She described coughing up a black substance from her lungs.

Daniels underwent a lung biopsy in 2014 that showed she has constrictive bronchiolitis. The biopsy found remnants of dust and metal fragments in her airways.

But the VA did not accept the findings as confirmation of the condition. She instead was given pulmonary tests that patients receive during routine medical checkups, which did not flag a problem.

After two years of appeals, Daniels said the VA connected her lung disease to her deployment, and she received a 100% disability rating. Daniels described the appeals process as frustrating and brutal.

Miller has since testified before lawmakers about the need for better medical criteria to support veterans' claims for constrictive bronchiolitis. He told the Senate Veterans' Affairs Committee in 2019 that many service members who deployed to combat zones in Iraq and Afghanistan were exposed to "particulate matter" that damaged their small airways.

Dr. Robert Miller at Vanderbilt Medical University. (Vanderbilt Medical University)

But their symptoms were dismissed by clinicians who misinterpreted initial normal test results for assessing oxygen levels, when a more comprehensive evaluation was needed, he said.

The VA relies on a pulmonary function test to diagnose many respiratory conditions, according to a notice published last week in the Federal Register on the new diagnosis code for constrictive bronchiolitis.

"PFTs are the cornerstone for evaluating respiratory impairment," the notice reads.

But a VA study in 2022 recommended specialized medical teams for testing, diagnosing and treating veterans with the illness. Doctors would determine who might need lung biopsies and who might be eligible for a presumptive diagnosis of deployment-related lung injury.

"In the VA, there is not broad knowledge, understanding or recognition of constrictive bronchiolitis or of the group of service members with this condition," Miller said.

Raines was diagnosed with constrictive bronchiolitis in 2012 after developing a chronic cough and fatigue after a deployment to Afghanistan.

The findings from a lung biopsy determined that Raines had constrictive bronchiolitis, emphysema, blood vessel damage and scarring from pneumonia.

But the VA did not accept the findings for a diagnosis of constrictive bronchiolitis, he said. The VA denied his disability claim in 2012, which he appealed and was turned down.

Raines refiled with the VA in 2016 and was denied again. He appealed again.

In 2023, he was awarded a 10% disability rating, 11 years after the original claim was filed.

He has since sought a higher rating but was turned down again in August.

"They only want to use the tests they have — the PFTs. That is their primary focus. The tests they use will never show anything with this disease," Raines said.

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