Progress in pulmonary medicine over the past few decades has been remarkable. In 1965 in the United States, 42 percent of the population were smokers, and today the rate of cigarette smoking is less than 14 percent and falling.299 With declining smoking rates, a myriad of diseases should begin to abate, including lung cancer and COPD, heart disease, strokes, and many other types of cancers. This has, in fact, started to happen in earnest: in 2020, the biggest-ever single-year drop in cancer mortality was reported, 2.2 percent over 2016–2017, which was driven largely by an almost 5 percent decline in lung cancer.300
The medical advances in treating other lung diseases are no less notable. A CF patient in 1950 could expect to live a few years, while today life expectancy on average is forty-seven years.301 The incidence of tuberculosis in America has never been lower. Cases of fatal asthma are way down, and finally there is a drug that has been shown to improve outcomes for those with idiopathic pulmonary fibrosis. The quality of our air in the United States has improved over the decades, despite a recent decline, with significant drops in all levels of pollutants.
Nonetheless, the threats to our breath are not taken seriously enough in many instances, and crises remain commonplace, from the recent devastating fires in California, the Amazon rainforest, and Australia, to vaping-related illnesses that have killed dozens, to the emergence of strange infections such as COVID-19. Only when we begin to understand all the many elements of the breath, and how they influence our well-being, can we address new crises in an effective fashion. The atmosphere of the Earth is perfectly fitted in its ability to sustain life, and vigilance to all aspects of our lung health is needed to ensure our future here on this planet, let alone on any others.
Fortunately, the future of pulmonary medicine looks bright, and at times resembles a science fiction novel. Personalized medicine has evolved to the point where lung cancer patients can undergo genetic analyses, which in turn can inform physicians of the best medicines to address their needs. With the promise of genetic manipulation, the day will come when a patient will walk into the clinic with cystic fibrosis and walk out a few hours later without any disease. The potential of stem cells, harvested from a person’s own blood, will no doubt help us grow whole organs for transplant. A vaccine for tuberculosis could come any day, rendering the need for medications obsolete. Every pulmonary disease now has a horizon that was once unthinkable in its promise.
The health of our lungs in the absence of disease rests not in a pill or an injection, but in ensuring above all a healthy environment for our breath. Despite regression in this country at the federal level, many countries throughout the world are committed to lowering toxic greenhouse gases and lowering emissions from cars and power plants. Businesses are anticipating the future as well, with many auto companies formulating plans to abandon gasoline-powered cars over the next few decades and opting for cleaner options such as electric and even hydrogen-powered cars. Individual states in the US are not waiting for leadership from Washington, DC, to emerge, but instead are formulating their own plans for improving the environment. California wants 40 percent lower greenhouse gas emissions by 2030, compared to 1990 levels, and 80 percent lower by 2050.302 People and governments at the local level understand the crisis of our atmosphere.
Worldwide, a healthy breath is going to ultimately depend on our being able to generate power without toxicity. Wind, solar, and geothermal sources of energy hold promise to reduce our reliance on fossil fuels. Fusion reactions can produce a great deal of energy with no carbon emissions and minimal toxic waste, and this technology has seen recent advances. A civilization freed from toxic fuel can be realized.
At a personal level, practicing common sense is always the best way to preserve healthy lung function. This includes avoiding tobacco smoke, ensuring your work and home environments have clean air, and cultivating an exercise, yoga, or other fitness plan. Individually, we must also actively support strong environmental protection and fight climate-change deniers. The stories in this book have shown us what science can achieve. The future is bright if we stick to the scientific principles of cause and effect and dedicated observation. For the health of our lungs and our bodies, and the future of our species and our planet, we must.
299. Centers for Disease Control and Prevention, “Current Cigarette Smoking Among Adults in the United States,” CDC website, https://www.cdc.gov/tobacco/data_statistics/fact_sheets/adult_data/cig_smoking/index.htm.
300. Stacy Simon, “Facts & Figures 2020 Reports Largest One-year Drop in Cancer Mortality,” American Cancer Society, January 8, 2020.
301. Bruce C. Marshall, “Survival Trending Upward But What Does This Really Mean?” Cystic Fibrosis Foundation, CF Community Blog, November 16, 2017, https://www.cff.org/CF-Community-Blog/Posts/2017/Survival-Trending-Upward-but-What-Does-This-Really-Mean/.
302. State of California, “Climate Change Programs,” California Air Resources Board website, https://www.arb.ca.gov/cc/cc.htm.