“Until I feared I would lose it, I never loved to read.
“One does not love breathing.”
Every breath we take is an underappreciated miracle.
As Harper Lee wrote in To Kill a Mockingbird, we seldom appreciate something until we fear its loss.
Just as one does not think of loving breathing until it becomes difficult, so too do we take healthy lungs for granted.
That truth defines the struggle of millions.
Across Malaysia, too many only realise the value of healthy lungs only when they are already damaged.
This World Lung Day (marked every Sept 25), under the global theme “Healthy Lungs, Healthy Life” championed by the Forum of International Respiratory Societies (FIRS), we are reminded that lung health is not merely a medical issue, but a national priority across the globe.
Hitting fast and long
According to the World Health Organization (WHO), chronic respiratory diseases (including asthma, chronic obstructive pulmonary disease or COPD, occupational lung disease, and pulmonary fibrosis), lung infections and lung cancer remain among the leading causes of death and disability worldwide.
Risk factors range from tobacco smoke and air pollution to occupational exposures and repeated childhood respiratory infections.
A recent joint report by WHO and the European Respiratory Society (ERS) estimated that over 81 million people in Europe live with chronic respiratory diseases, and millions more remain undiagnosed.
The story is no different in Asia: many live with lung disease without knowing it, dismissing persistent coughs or breathlessness as minor ailments.
Malaysia is grappling with both acute and chronic threats. COPD alone affects 6.1% of Malaysians – a likely underestimate – and is already among our top causes of poor quality of life.
At the same time, pneumonia has resurged with devastating force.
In 2023, it was Malaysia’s number one cause of death, claiming 18,181 lives and accounting for more than 15% of medically-certified deaths.
This combination of chronic disease and acute infections represents a double burden that exacts a heavy toll on patients, families and the healthcare system.
The consequences extend beyond hospital walls. Respiratory illness means lost workdays, mounting medical costs, strained caregivers and families living in constant anxiety.
At the national level, it translates into reduced productivity and heavier health expenditure.
In an ageing society, these burdens will only intensify if left unchecked.
Main risk factors
Smoking remains the single most important risk factor for COPD, lung cancer and a host of other respiratory diseases – and despite decades of anti-smoking campaigns, the number of smokers remains higher that we would like.
Every cigarette inhaled is a step closer to irreversible lung damage.
Compounding this is the rise of vaping, increasingly embraced by our youth under the guise of being a “safer” alternative.
Yet, evidence is mounting that e-cigarettes are far from harmless: they introduce toxic chemicals into the lungs, disrupt immune responses and may serve as a gateway to nicotine addiction.
There are signs of damage already emerging: chronic bronchitis, asthma flare-ups, and even cardiovascular (heart) issues linked to vaping.
If we are serious about protecting lung health, vaping must be treated with the same urgency and rigour as tobacco: through regulation, education and enforcement.
Healthcare gaps
A holistic approach requires primary care services that are preventive in nature and not reactive.
Public awareness is poor, with many still dismissing breathlessness as “normal ageing” or a chronic cough as “just the weather”.
Access to pulmonary rehabilitation, i.e. programmes combining exercise, education and psychosocial support, is limited to a few hospitals in urban centres.
Yet we know that such programmes improve quality of life, reduce hospital admissions and allow patients to reclaim independence.
For those with very severe disease, the picture is even bleaker.
Palliative care remains heavily skewed toward cancer, leaving patients with chronic lung disease to endure severe breathlessness and anxiety without adequate support.
Outside the clinic, environmental and social factors like haze, traffic pollution, industrial emissions, mould and overcrowded housing, continue eroding our lung health, disproportionately affecting poorer communities already burdened with access issues and avoidable risk.
Call to action
Malaysia must continue to place lung health higher on its health and development agenda.
This begins with early detection.
Primary care clinics must be equipped and trained to identify lung disease earlier, whether through spirometry or structured screening programmes for high-risk groups such as heavy smokers or those exposed to occupational hazards.
The Health Ministry has introduced artificial intelligence-powered lung health screening in some clinics to help detect lung-related disease as part of one of its key efforts in the National Lung Health Initiative 2025-2030.
But diagnosis is only the beginning.
More can be done in addressing issues of medical inflation, particularly when we have to use modern treatment like biologics for better outcomes.
Rehabilitation and long-term support must be scaled up nationwide.
Community-based, and even home-based, pulmonary rehabilitation models could help overcome barriers of distance and cost.
Patients must also be empowered with education on how to use inhalers correctly, how to exercise safely and how to recognise early warning signs.
At the other end of the spectrum, compassionate palliative care should be integrated into chronic lung disease pathways.
A patient with advanced COPD deserves the same dignity, pain relief and psychosocial support as one with cancer.
To ignore this is to condemn thousands to needless suffering.
Beyond the health system, lung health must be recognised as an environmental, social and economic issue.
Stronger enforcement of air quality standards, better urban planning and housing policies that prioritise ventilation and safe indoor environments are all crucial.
Addressing poverty, education and access to care will yield dividends not just for lung health, but also for national well-being as a whole.
Why should we care?
Healthy lungs are the foundation of healthy lives.
They determine how well we withstand infections, how productive we are at work, how active we can remain as we age, and even how long we live.
Weaker lungs equate to a weaker society.
Malaysians are often cognisant of heart disease, diabetes and cancer, but lung health too often slips through the cracks.
We cannot afford to treat it as a secondary concern.
To do so is to invite preventable illness, escalating costs and unnecessary suffering.
Lee’s words capture the heart of the matter.
Breathing is so natural, so constant, that we rarely think about it – until it becomes difficult.
By then, it is often too late.
This World Lung Day, let us not wait for breathlessness to teach us the value of our lungs.
As citizens, we must not only look after our health, but also demand cleaner air, better healthcare and timely attention to symptoms.
As policymakers, we must continue to invest in a national lung health strategy that integrates the environment, healthcare, education and social policy.
Dr Helmy Haja Mydin is a consultant respiratory physician and Social & Economic Research Initiative chairman. For further information, email starhealth@thestar.com.my. The information provided is for educational and communication purposes only. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this column. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.
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