The Covid-19 pandemic has brought lung-related issues to the forefront as the virus primarily affects the lungs, however, India suffers from a massive burden of respiratory conditions. In the severe stage, these can lead to lung fibrosis or scarring of the lungs, due to which the lifespan and quality of life of the patient can be dramatically affected. Up to 15% of patients with Covid went on to develop moderate and up to 5% severe forms of lung disease. Many of them may end up having chronic lung diseases requiring continuous external oxygen support. In select patients with significant lung involvement, lung transplantation may be the only ray of hope. Lung transplantation is a procedure where a section or lobe of a lung, an entire lung, or both lungs are transplanted in a person who is suffering from severely diseased or failing lungs. Over the last several years, lung transplantation has become the standard of care for people suffering from end-stage lung diseases and has been shown to add good quality of years to patients with no hope.

Very recently, a Japanese woman whose lungs suffered severe damage from COVID-19 became the world’s first-ever recipient of a lung transplant from a living donor.

Lung transplantation is typically advised for people suffering from lung conditions that have advanced significantly or continue to progress rapidly despite optimal medical management. Such conditions would include COPD, Bronchiectasis, Interstitial Lung Disease, Severe Pulmonary Hypertension, cystic lung disease, etc. People with chronic lung disease have a progressive condition making them oxygen-dependent over time with limited mobility and poor quality of life. These patients need greater attention and level of care by a dedicated team who are trained in managing these groups of patients. These patients also have poor appetite leading to nutritional depletion and need nutritional support by a dedicated dietician. Pulmonary rehabilitation helps and trains these people to maintain overall good health with mobility.

It is one of the most complex organ transplant surgeries, requires specialized expertise and adherence to proper selection protocol of the donor lung and evaluation of the patient’s health condition. Lung transplants are not for all patients and each patient must be evaluated on a case-to-case basis to determine whether or not a lung transplant is suitable for them. It is often provided as the last solution when other treatment measures such as medications or breathing devices do not work anymore. Some unique cases also call for a heart-lung transplant, a rare procedure where both the patient’s heart and lungs have extensive irreversible damage and need to be replaced to improve their quality of life and survival.

Lung transplantation procedures typically depend on the availability of deceased donor lungs. Finding the right match for organ transplantation surgery is of utmost importance for a successful surgery. Several factors such as blood type, size match, age, the health of the patient and other health conditions, tissue type, pulmonary function tests, etc must be taken into account before a patient is deemed to be suitable for lung transplantation.

The process of sourcing an organ itself is an elaborate process that involves multiple specialties and coordination between different centers and organizations. In the past year, not only has there been an increased need for lung transplants, but the organ donation facilitation process has also developed and become better, which has improved the scope of more needy patients receiving much-needed lung transplant surgery. Organ transplantation often gives a new lease of life to the patients who receive it and the noble act of organ donation, be it deceased or live is one that must be encouraged and supported.

Support from insurance companies and crowd-funding can help patients get access to much-needed lung transplants. Rejection of the donor organ is one of the biggest challenges and risks when it comes to any organ transplant surgery and it is the same case with lung transplants. Post lung transplantation, patients are required to be on lifelong immunosuppressive medications and need to take prophylaxis to prevent secondary infections. As the level of immunosuppression is gradually reduced, the risk of secondary infection also reduces.

Lung transplantation surgery in India is still in its early stages with very few medical facilities and trained doctors available to conduct this kind of surgery. A comprehensive team comprising all specialties under one roof is the need of the hour to address the issues with these patients who are sick and have multiple associated co-morbidities.

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Time and again the message of caution that smoking is injurious to health has been propagated over various mediums of communication. Smoking alone puts an individual at the risk of developing over 50 percent of serious illnesses.  Some of these illnesses can be fatal and others can cause long-term irreversible damage to your health. Second-hand smoking is also as good as direct smoking and exposes individuals to the same health risks as smokers. In fact, the death rate for any kind of smoker is two to three times higher than that for non-smokers. Half of the smokers eventually die as a result of their smoking. Despite these dramatic and proven health risks, there are many people who find it hard to kick the habit and put themselves at a high risk of developing smoking-related diseases.

 Let us explore the top 3 ill effects of smoking:

 1. Lung Cancer: Smoking is the number one risk factor for lung cancer. It doesn’t matter if a person smokes only one cigarette or multiple times a day, or only smokes occasionally, the chances of developing lung cancer increase for sure. Smoking produces more than 4,000 chemicals including carbon dioxide, tars, and nicotine and these are capable of transforming normal cells into cancer cells over time. The cancer risk is directly proportional to the number of cigarettes one smokes every day. People who quit smoking have a lower risk of developing lung cancer, and this risk gradually decreases over time. Do not continue the habit by thinking that you are already too far in. Stopping can slowly reduce and reverse the damage already caused to your body.

 There is a misunderstanding among people that smoking can only lead to mouth cancer. However, smoking can contribute to cancer anywhere in the body and lung cancer is one the most common and dangerous ones caused directly by smoking.  

 Symptoms of Lung cancer will show up only when the disease is in an advanced stage. Some of the symptoms are:

• Bone pain
• Shortness of breath
• Weight loss
• Coughing up blood

 2. Chronic Obstructive Pulmonary Disease (COPD): When we smoke, the airways, air sacs, and the lining of the lungs get damaged. Though long-term exposure to lung irritants can lead to COPD, a common risk factor of it is smoking. The airways lose their ability to stretch and shrink back and the walls between the air sacs are destroyed. In the initial stages, there will be hardly any symptoms or mild symptoms which worsen over time. The symptoms are: 

• Difficulty in breathing
• Wheezing
• Tightness in the breath
• Prolonged cough
• Breathing difficulty 

3. Pneumonia: Our body has a natural defense system against bacteria and viruses. But when you smoke, the body’s defense system gets compromised. With compromised immunity, you are susceptible to any infection. The action of the cilia or hair-like projections in the trachea to sweep fluids and any foreign particles out of the airways gets impaired leading to pneumonia.

 Symptoms of Pneumonia are:

• Fever
• Coughing up mucus
• Chest pain 

Early detection is the key:

Catching the above three diseases in their early stage often allows for a higher likelihood of successful treatment. This is also when the treatment is easy and the body’s response to it will be more favorable. Pneumonia, COPD, and lung cancer are closely related and have similar symptoms. The common culprit of smoking can worsen the symptoms and the impact of these diseases on the body. The lungs, which is the primary organ in the respiratory system, bears the brunt of the attack of such diseases.

 It is also a known fact that COPD is a significant risk factor for lung cancer. That’s the reason why to prevent both the diseases, COPD screening in smokers should be started at the earliest, and quitting smoking should be the first thing to do.

 Why is prevention important?

All the above diseases if not prevented in their early stages can be fatal and a key factor to this is to quit smoking immediately. All those patients who get hospitalized when the symptoms worsen lament over holding on to the unhealthy practice of smoking. It will all be fine until the day your body says it can no longer take smoking and then teach you the smoke-free lesson at the hospital bed in the hardest way possible. Not to forget the cost of treatment and the valuable time you end up losing due to the unhealthy practice. It’s not only the above three diseases, but smoking is also linked to diseases of nearly all the organs of the body.

 Remember that you are not only compromising your health by smoking but are also threatening the lives of people near you, especially children, pregnant women, and the elderly as passive smoking is as harmful as taking the real puff.

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