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Breath Taking: The Power, Fragility, and Future of Our Extraordinary Lungs
From an expert in pulmonary medicine, the story of our extraordinary lungs, the organ that both explains our origins and holds the keys to our future as a species
We take an average of 7.5 million breaths a year and some 600 million in our lifetime, and what goes on in our body each time oxygen is taken in and carbon dioxide expelled is nothing short of miraculous. "Our lungs are the lynchpin between our bodies and the outside world," writes Dr. Michael Stephen. And yet, we take our lungs for granted until we're incapacitated and suddenly confronted with their vital importance.
In Breath Taking, pulmonologist Michael Stephen takes us on a journey to shed original and much-needed light on our neglected and extraordinary lungs, at a most critical societal moment. He relates the history of oxygen on Earth and the evolutionary origins of breathing, and explores the healing power of breath and its spiritual potential. He explains in lay terms the links our lungs have with our immune system and with society at large. And he offers illuminating chronicles of pulmonary research and discovery--from Galen in the ancient world to pioneers of lung transplant--and poignant human stories of resilience and recovery--from the frantic attempts to engage his own son's lungs at birth to patients he treats for cystic fibrosis today.
Despite great advances in science, our lungs are ever more threatened. Asthma is more prevalent than ever; rising stress levels make our lungs vulnerable to disease; and COVID-19 has revealed that vulnerability in historic ways. In this time, Breath Taking offers inspiration and hope to millions whose lungs are affected and vital perspective to us all.
We take an average of 7.5 million breaths a year and some 600 million in our lifetime, and what goes on in our body each time oxygen is taken in and carbon dioxide expelled is nothing short of miraculous. "Our lungs are the lynchpin between our bodies and the outside world," writes Dr. Michael Stephen. And yet, we take our lungs for granted until we're incapacitated and suddenly confronted with their vital importance.
In Breath Taking, pulmonologist Michael Stephen takes us on a journey to shed original and much-needed light on our neglected and extraordinary lungs, at a most critical societal moment. He relates the history of oxygen on Earth and the evolutionary origins of breathing, and explores the healing power of breath and its spiritual potential. He explains in lay terms the links our lungs have with our immune system and with society at large. And he offers illuminating chronicles of pulmonary research and discovery--from Galen in the ancient world to pioneers of lung transplant--and poignant human stories of resilience and recovery--from the frantic attempts to engage his own son's lungs at birth to patients he treats for cystic fibrosis today.
Despite great advances in science, our lungs are ever more threatened. Asthma is more prevalent than ever; rising stress levels make our lungs vulnerable to disease; and COVID-19 has revealed that vulnerability in historic ways. In this time, Breath Taking offers inspiration and hope to millions whose lungs are affected and vital perspective to us all.
311 pages, Paperback
Published January 18, 2022
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January 8, 2021
This book explores the crucial role of breathing in human existence, discussing evidence of how breathing practices can contribute to healing of numerous illnesses, investigating the range of threats -- from pollution to smoking to toxic dust -- that can threaten our ability to breath, and examining a number of diseases that can disturb a person’s breathing. This book is primarily a popular science look at pulmonary medicine. Unlike other breath-related books that I’ve reviewed, this book is mostly about what can go wrong with our lungs and what medical science is doing to combat these threats. The story of how breathwork and changing breathing patterns can improve health and well-being is addressed, but that’s not the book’s central focus. The book uses plenty of stories (e.g. case studies) and what I call “fun facts” to keep the reading from becoming too dry or clinical for a neophyte reader.
The book consists of fifteen chapters. The first two chapters provide basic background information to help understand how the Earth happens to have the oxygen-laden air necessary for our type of life (Ch. 1) and how the lungs exploit that air in fueling our bodily activities (Ch. 2.) Chapter thee explores how breathing begins in newborn babies, explaining that the lungs are the only major organ that doesn’t start working until we are out in the world, and lung inflation doesn’t always go smoothly. The fourth chapter discusses how breathwork (including -- but not limited to -- yogic pranayama) has been shown to improve health for those experiencing a range of conditions, including: depression, addiction, PTSD, and pain, as well as how breath and meditational practices contribute to better health, generally.
Chapter five investigates the intersection of the respiratory and immune systems, explaining how autoimmune conditions, allergies, and asthma come to be. In chapter six, the author discusses one of the most common and widespread diseases in the world, tuberculosis (TB,) a disease which not only threatens the lives of many, but also sits dormant in a huge portion of the population.
Chapters seven through nine each deal with hazardous materials that are inhaled into the lungs. The first of these chapters is about smoking, and it focuses on the question of how nicotine acts in the body to create intense addictions – as well as what has and hasn’t worked to help people break said addiction. Chapter eight is about pollution. (As resident of a city of twelve million people, I found this to be a particularly disturbing chapter because air pollution is a hazard that is too easy to be blind to if one doesn’t suffer from respiratory problems.) Chapter nine investigates a range of breathable hazards including smoke, dust, and asbestos, and it does so through the lens of the rescue and cleanup at the World Trade Center after the dual collapse of the twin towers on 9-11, an event which released all sorts of toxic material into the air, hazards for which most responders were ill-equipped.
Chapter ten through twelve are about ailments that may or may not be linked to environmental causes like the ones mentioned in the paragraph above. The first of these is idiopathic pulmonary fibrosis, which, by definition, is a condition that arises from an unknown cause, an ailment which involves a stiffening and thickening of lung tissue (which must be thin and supple to allow gas exchange and the expansion and contraction of the breath cycle.) Chapter eleven focuses on lung cancer, which is often due to an inhaled hazard (most notably, smoking,) but not necessarily. While the other chapters of the book focus on breathing as a process by which we take in oxygen and expel carbon dioxide, chapter twelve turns to a different role played by breath, one that is crucial to the activities of our species, breath as a means to control the voice.
Chapter 13 describes the process and challenges of lung transplant. As mentioned in the discussion of pulmonary fibrosis, lung tissue is rather delicate material, and so it was no easy task to transplant it. Furthermore, because the lungs are a point at which the external world (air) contacts the body’s internal systems the challenges are even greater than for those organs that are hermetically sealed within bodily tissues.
The last two chapters focus on cystic fibrosis (CF.) Chapter fourteen explores the nature of the disease and the slow, but promising, path towards treating it. CF is a genetic condition in which the lack of a single amino acid wreaks havoc on the ability of cells to process minerals. The last chapter tells the story of two cases of CF. The first story – involving a ten-year-old whose family had to struggle against a policy that essentially locked their child out of the lung transplant list – is particularly engrossing.
As someone who practices breathwork, I found this book to be interesting and insightful. While it is heavily focused on pulmonary medicine, it does offer insights that will be beneficial to those who are not afflicted by respiratory ailments. If one wants to know more about medicine as it pertains to respiration, this is definitely an interesting and readable choice. However, even if one is infatuated with breath more generally, I believe you’ll find in this volume a great deal of beneficial food-for-thought.
The book consists of fifteen chapters. The first two chapters provide basic background information to help understand how the Earth happens to have the oxygen-laden air necessary for our type of life (Ch. 1) and how the lungs exploit that air in fueling our bodily activities (Ch. 2.) Chapter thee explores how breathing begins in newborn babies, explaining that the lungs are the only major organ that doesn’t start working until we are out in the world, and lung inflation doesn’t always go smoothly. The fourth chapter discusses how breathwork (including -- but not limited to -- yogic pranayama) has been shown to improve health for those experiencing a range of conditions, including: depression, addiction, PTSD, and pain, as well as how breath and meditational practices contribute to better health, generally.
Chapter five investigates the intersection of the respiratory and immune systems, explaining how autoimmune conditions, allergies, and asthma come to be. In chapter six, the author discusses one of the most common and widespread diseases in the world, tuberculosis (TB,) a disease which not only threatens the lives of many, but also sits dormant in a huge portion of the population.
Chapters seven through nine each deal with hazardous materials that are inhaled into the lungs. The first of these chapters is about smoking, and it focuses on the question of how nicotine acts in the body to create intense addictions – as well as what has and hasn’t worked to help people break said addiction. Chapter eight is about pollution. (As resident of a city of twelve million people, I found this to be a particularly disturbing chapter because air pollution is a hazard that is too easy to be blind to if one doesn’t suffer from respiratory problems.) Chapter nine investigates a range of breathable hazards including smoke, dust, and asbestos, and it does so through the lens of the rescue and cleanup at the World Trade Center after the dual collapse of the twin towers on 9-11, an event which released all sorts of toxic material into the air, hazards for which most responders were ill-equipped.
Chapter ten through twelve are about ailments that may or may not be linked to environmental causes like the ones mentioned in the paragraph above. The first of these is idiopathic pulmonary fibrosis, which, by definition, is a condition that arises from an unknown cause, an ailment which involves a stiffening and thickening of lung tissue (which must be thin and supple to allow gas exchange and the expansion and contraction of the breath cycle.) Chapter eleven focuses on lung cancer, which is often due to an inhaled hazard (most notably, smoking,) but not necessarily. While the other chapters of the book focus on breathing as a process by which we take in oxygen and expel carbon dioxide, chapter twelve turns to a different role played by breath, one that is crucial to the activities of our species, breath as a means to control the voice.
Chapter 13 describes the process and challenges of lung transplant. As mentioned in the discussion of pulmonary fibrosis, lung tissue is rather delicate material, and so it was no easy task to transplant it. Furthermore, because the lungs are a point at which the external world (air) contacts the body’s internal systems the challenges are even greater than for those organs that are hermetically sealed within bodily tissues.
The last two chapters focus on cystic fibrosis (CF.) Chapter fourteen explores the nature of the disease and the slow, but promising, path towards treating it. CF is a genetic condition in which the lack of a single amino acid wreaks havoc on the ability of cells to process minerals. The last chapter tells the story of two cases of CF. The first story – involving a ten-year-old whose family had to struggle against a policy that essentially locked their child out of the lung transplant list – is particularly engrossing.
As someone who practices breathwork, I found this book to be interesting and insightful. While it is heavily focused on pulmonary medicine, it does offer insights that will be beneficial to those who are not afflicted by respiratory ailments. If one wants to know more about medicine as it pertains to respiration, this is definitely an interesting and readable choice. However, even if one is infatuated with breath more generally, I believe you’ll find in this volume a great deal of beneficial food-for-thought.
October 18, 2020
Good Information On Facts, But Get A Second Opinion On Recommendations. This is a book about the origins and history of lung medicine, by a doc specializing in lung medicine. And because of that very nature, on facts it is quite remarkable. Stephen details everything from the evolution of the lung to the various ailments of it, focusing the last couple of chapters on Cystic Fibrosis in particular, and does so in a very understandable manner. Ultimately this is a prime example of the Flight Director Principle though, where one should absolutely listen to subject matter experts *on their subjects*... and consider the implications on other systems - particularly in conjunction with experts on those other systems - when this particular subject matter expert makes recommendations that impact other systems. And that is where getting a second opinion will be most useful in this particular tale, as many of Stephen's recommendations outside of lung medicine specifically could very likely be problematic at best. Still, only a single star deduction as largely your mileage is going to vary there based more on how you feel about his particular recommendations in those realms. Truly and enlightening read, and very much recommended.
July 18, 2021
The blurb from Sanjay Gupta MD on the cover of Breath Taking says it all:
This richly detailed, engrossing work will have you appreciating the majesty of one of our most vital organs. COVID-19 has taught us all how vulnerable our lungs are and the more we know about them the better we can protect them. Intimately written, with the authority of a pulmonologist but the lyricism of a captivating narrator, Breath Taking reveals surprising notes about our origins, collective human experience, and future on this planet.A member of my family works in lung transplantation. Thanks to Michael J. Stephen, I now understand so much more about the caring and compassion required of the transplant team, as well as the clinical complexity, challenges, and opportunities for innovation facing them. My hat was already off to them, but now I am waving it vigorously and shouting Hurrah!
February 25, 2021
This is an excellent book that taught me a great deal about a subject that I knew nothing about. The importance of the lungs and respiration to life is obvious, but this book really opened my eyes to the ways the lungs are connected to every aspect of life, both the biological as well as the spiritual. I did not expect this book to be the page turner that it turned out to be and I am quite glad that I picked it up.
May 11, 2023
love lungs
May 25, 2021
Very informative and seemingly comprehensive, but I would have preferred there to be more of a connection between the stories. I'm not sure why some patients were featured, since they weren't obviously connected to the author.
> In inland bodies of fresh water, the temperature can vary widely, as can the amounts of nutrients and minerals. The summer and winter also produce very different living conditions in freshwater environments, which often host very different species depending on the season. By contrast, the ocean environment is exceptionally stable.
> when we hyperventilate at rest without an increase in CO2 production, as can happen during a panic attack. Here one is blowing off too much CO2 and acid, and our pH climbs to dangerous levels, which is why one may be told to breath into a paper bag to inhale the expelled CO2, restoring needed acid to the blood
> if an engineer was designing a breathing machine, the functions of gas exchange and air movement would be separated. Birds have such a system. With each breath they take, air moves into air sacs, which are large, easily distensible organs in which no gas exchange takes place. This air then gets shunted to a separate area for gas exchange, termed air capillaries. There, because there is no need for the gas exchange units to bend when a breath occurs, the distance between the air and the blood vessels is incredibly thin, much less than the one third of a micron in mammals, making the exchange even easier. A final difference is that air movement in the bird lung goes around in a circle, much as blood does, so birds get fresh air with both inspiration and expiration
> Dr. Clements imagined that something within the lung must be lowering surface tension so dramatically as to overcome the effect of size on pressure. He correctly postulated it was a soap-like foam, which exerted a dispersal effect as its molecules became more concentrated and the area became smaller, and lost this effect when the lung expanded and pulled the soap like foam molecules apart. The effect of this soap-like foam lowering surface tension would be more important than lung size in calculating pressure if it was a powerful substance (which it was, and is). John Clements later named this substance surfactant
> If the history of civilization is surveyed in its entirety, no other infectious disease has killed more people than TB, over one billion in the last two hundred years alone.100 And it continues to kill more than one million people worldwide each year.
> The researchers’ conclusion was that seals brought TB to the Americas, picking it up from Africa and then swimming across the Atlantic and spreading it to those who hunted them along the coastline of South America.
> up to 90 percent of residents in certain cities got infected. For a time in nineteenth-century Europe and America, TB accounted for one out of every four deaths. During this two-hundred-year period, TB became known as the “white plague,” due to its slow-acting way of sucking the life, weight, and health out of people, turning a patient from a person into a ghost.
> New York City has historically been on the front line of the TB epidemic in the United States. This was never more true than in the late nineteenth century, when TB was the leading killer in the city, claiming ten thousand lives every year
> In 1900, there were 280 deaths per 100,000 people per year. By 1920, deaths were down to 126 per 100,000, and by 1940 the number was 49, less than 25 percent of the 1900 level. This was all without the use of any antibiotics.
> TB grows slowly. Compared to a typical bacterium such as streptococcus, which divides every thirty minutes, TB’s doubling time is sixteen to twenty hours. Cultures for normal bacteria are usually held for a few days. For tuberculosis, because it grows so slowly, one has to wait eight weeks for a definitive answer on a culture.
> Today, a typical course of treatment for a bacterial pneumonia from streptococcus is five to seven days, usually with a single drug. For tuberculosis, the typical course is six to nine months, with multiple drugs being the standard. Recent attempts at shortening this time to even four months have failed.
> this kind of rapid lethal progression occurs only in a small minority of patients. But what is strange about TB is that it has the ability to cause a minor initial infection that can be contained, but not completely killed, by the macrophage and then go dormant for years, or even decades. Tuberculosis goes into hiding in some patients, probably deep in the lymph nodes of the chest. It is likely transported to the lymph nodes by the macrophage, which ingest TB but is then unable to completely kill it.
> The disease is raging out of control in many countries. Absolute numbers of cases are staggering in countries like South Africa, where in 2019 the incidence was 520 per 100,000; in the Philippines it was 554. Resistance has also become more of an issue, with multi-drug resistance rampant in countries like Kazakhstan, Ukraine, and Russia.
> Duke’s aggressive advertising paid off. Acquiring money and market share, he bought out four of his competitors and in 1890 merged them into the American Tobacco Company. He also saw potential overseas and formed the British American Tobacco Company to expand into the European market, taking advantage of his one-size-fits-all product, easily recognized and branded as Duke Cigarettes. Duke became extraordinarily rich and in 1924 gave away some of his money to the then-small Trinity College in Durham, North Carolina. In return for his gift of $100 million, the leaders of the college honored Duke by renaming the institution after him.
> Many of the receptors in the VTA are, not surprisingly, acetylcholine receptors, and there are several different types, some called nicotinic acetylcholine receptors because nicotine can also bind there, creating an imposter safety signal. So rather than a high, nicotine creates a sense of well-being that all is good and safe in the world.
> The half-life of nicotine is about two hours, so over the course of a day, smokers are in a constant battle to maintain steady levels. In the morning the brain is more desperate, after eight hours without its fix.
> In an average year, air pollution causes 6.5 million premature deaths, more than 90 percent of them in developing countries. All forms of pollution contribute to one out of every six deaths worldwide; in the most affected countries, this number increases to one out of four deaths
> lower respiratory tract infections are the number one cause of mortality in children under five years of age, accounting for some 570,000 deaths each year.
> In Great Britain, the matter reached a tipping point in December 1952 with the Great Smog of London. For five days, a thick toxic cloud hung in the air, and the city endured a pollution like none of the previous “pea-soupers.”
> Russia still mines about a million tons of asbestos every year, with hundreds of thousands of workers dependent on the asbestos industry for their livelihood. Worldwide, some two million tons are mined every year.
> in August 2018, researchers discovered a pulmonary cell called the ionocyte, which may transform our understanding of how the lung hydrates itself.
> Over half of lung cancer patients present with metastatic disease. One year one’s chest X-ray can be completely clear, and then twelve months later a doctor is explaining that the pain in one’s chest is from a mass in the lung and the cancer may have metastasized to one’s spine and brain
> Kidney transplant recipients enjoy a five- and ten-year survival rate of approximately 80 and 60 percent, while the outcomes for both liver and heart transplants are both about 75 and 57 percent, respectively. Comparatively, the five- and ten-year survival rates for a lung transplant are 55 and 34 percent
> The next big leap forward with protein modulator therapy came in 2019, with the published results of Trikafta, a pill that contains three protein modulators, all working in synergy. The study, published in the New England Journal of Medicine, showed an average increase of 14 percent in lung function, over three times the result seen with Symdeko. Just as important, with its superior efficacy, the drug is powerful enough to work on many of those CF patients with mutations that caused more severe defects in the protein. With FDA approval of Trikafta in October 2019, the percentage of CF patients eligible jumped from 55 percent to almost 95 percent.
> in 2015, amazed everybody in attendance by announcing at the invocation that the estimated average lifespan for a patient born with CF had jumped from forty-one years to forty-seven years in the previous year
> Cystic fibrosis patients make too much mucus, which gets stuck deep in the lungs, providing a fertile breeding ground for bacteria. Infections and lung destruction follow in a mutually reinforcing cycle of dysfunction.
> patients inhale multiple medications every day to break up the mucus. After taking the medicines, they must expectorate the secretions, either with vigorous coughing or with chest physical therapy, in which a parent pounds on the child’s back to agitate the mucus and move it out of the airways. The work is intense and usually requires an hour in the morning and another hour at night, even with the advent of protein modulators
> Given the overall poor outcomes and ubiquity of complications, transplanting lungs is a high-wire act compared to transplanting other organs. Assessing a patient’s likelihood of dying soon from their lung disease versus their ability to live after a transplant was considered impossible. Thus, the original system of getting in line and waiting for new lungs remained until 2005, long after it had been abandoned in liver and kidney transplants
> liver and kidney formulas can be more accurate because their absolute numbers are so much larger that statisticians have more data to work with. Fortunately, the Lung Allocation Score system worked, despite its potential flaws. The number of deaths on the waiting list plummeted in the years after the new system was implemented, from an average of more than four hundred to two hundred per year. Almost as important, there was no big change in one-year mortality, or even five-year mortality
> A CF patient in 1950 could expect to live a few years, while today life expectancy on average is forty-seven years
> In inland bodies of fresh water, the temperature can vary widely, as can the amounts of nutrients and minerals. The summer and winter also produce very different living conditions in freshwater environments, which often host very different species depending on the season. By contrast, the ocean environment is exceptionally stable.
> when we hyperventilate at rest without an increase in CO2 production, as can happen during a panic attack. Here one is blowing off too much CO2 and acid, and our pH climbs to dangerous levels, which is why one may be told to breath into a paper bag to inhale the expelled CO2, restoring needed acid to the blood
> if an engineer was designing a breathing machine, the functions of gas exchange and air movement would be separated. Birds have such a system. With each breath they take, air moves into air sacs, which are large, easily distensible organs in which no gas exchange takes place. This air then gets shunted to a separate area for gas exchange, termed air capillaries. There, because there is no need for the gas exchange units to bend when a breath occurs, the distance between the air and the blood vessels is incredibly thin, much less than the one third of a micron in mammals, making the exchange even easier. A final difference is that air movement in the bird lung goes around in a circle, much as blood does, so birds get fresh air with both inspiration and expiration
> Dr. Clements imagined that something within the lung must be lowering surface tension so dramatically as to overcome the effect of size on pressure. He correctly postulated it was a soap-like foam, which exerted a dispersal effect as its molecules became more concentrated and the area became smaller, and lost this effect when the lung expanded and pulled the soap like foam molecules apart. The effect of this soap-like foam lowering surface tension would be more important than lung size in calculating pressure if it was a powerful substance (which it was, and is). John Clements later named this substance surfactant
> If the history of civilization is surveyed in its entirety, no other infectious disease has killed more people than TB, over one billion in the last two hundred years alone.100 And it continues to kill more than one million people worldwide each year.
> The researchers’ conclusion was that seals brought TB to the Americas, picking it up from Africa and then swimming across the Atlantic and spreading it to those who hunted them along the coastline of South America.
> up to 90 percent of residents in certain cities got infected. For a time in nineteenth-century Europe and America, TB accounted for one out of every four deaths. During this two-hundred-year period, TB became known as the “white plague,” due to its slow-acting way of sucking the life, weight, and health out of people, turning a patient from a person into a ghost.
> New York City has historically been on the front line of the TB epidemic in the United States. This was never more true than in the late nineteenth century, when TB was the leading killer in the city, claiming ten thousand lives every year
> In 1900, there were 280 deaths per 100,000 people per year. By 1920, deaths were down to 126 per 100,000, and by 1940 the number was 49, less than 25 percent of the 1900 level. This was all without the use of any antibiotics.
> TB grows slowly. Compared to a typical bacterium such as streptococcus, which divides every thirty minutes, TB’s doubling time is sixteen to twenty hours. Cultures for normal bacteria are usually held for a few days. For tuberculosis, because it grows so slowly, one has to wait eight weeks for a definitive answer on a culture.
> Today, a typical course of treatment for a bacterial pneumonia from streptococcus is five to seven days, usually with a single drug. For tuberculosis, the typical course is six to nine months, with multiple drugs being the standard. Recent attempts at shortening this time to even four months have failed.
> this kind of rapid lethal progression occurs only in a small minority of patients. But what is strange about TB is that it has the ability to cause a minor initial infection that can be contained, but not completely killed, by the macrophage and then go dormant for years, or even decades. Tuberculosis goes into hiding in some patients, probably deep in the lymph nodes of the chest. It is likely transported to the lymph nodes by the macrophage, which ingest TB but is then unable to completely kill it.
> The disease is raging out of control in many countries. Absolute numbers of cases are staggering in countries like South Africa, where in 2019 the incidence was 520 per 100,000; in the Philippines it was 554. Resistance has also become more of an issue, with multi-drug resistance rampant in countries like Kazakhstan, Ukraine, and Russia.
> Duke’s aggressive advertising paid off. Acquiring money and market share, he bought out four of his competitors and in 1890 merged them into the American Tobacco Company. He also saw potential overseas and formed the British American Tobacco Company to expand into the European market, taking advantage of his one-size-fits-all product, easily recognized and branded as Duke Cigarettes. Duke became extraordinarily rich and in 1924 gave away some of his money to the then-small Trinity College in Durham, North Carolina. In return for his gift of $100 million, the leaders of the college honored Duke by renaming the institution after him.
> Many of the receptors in the VTA are, not surprisingly, acetylcholine receptors, and there are several different types, some called nicotinic acetylcholine receptors because nicotine can also bind there, creating an imposter safety signal. So rather than a high, nicotine creates a sense of well-being that all is good and safe in the world.
> The half-life of nicotine is about two hours, so over the course of a day, smokers are in a constant battle to maintain steady levels. In the morning the brain is more desperate, after eight hours without its fix.
> In an average year, air pollution causes 6.5 million premature deaths, more than 90 percent of them in developing countries. All forms of pollution contribute to one out of every six deaths worldwide; in the most affected countries, this number increases to one out of four deaths
> lower respiratory tract infections are the number one cause of mortality in children under five years of age, accounting for some 570,000 deaths each year.
> In Great Britain, the matter reached a tipping point in December 1952 with the Great Smog of London. For five days, a thick toxic cloud hung in the air, and the city endured a pollution like none of the previous “pea-soupers.”
> Russia still mines about a million tons of asbestos every year, with hundreds of thousands of workers dependent on the asbestos industry for their livelihood. Worldwide, some two million tons are mined every year.
> in August 2018, researchers discovered a pulmonary cell called the ionocyte, which may transform our understanding of how the lung hydrates itself.
> Over half of lung cancer patients present with metastatic disease. One year one’s chest X-ray can be completely clear, and then twelve months later a doctor is explaining that the pain in one’s chest is from a mass in the lung and the cancer may have metastasized to one’s spine and brain
> Kidney transplant recipients enjoy a five- and ten-year survival rate of approximately 80 and 60 percent, while the outcomes for both liver and heart transplants are both about 75 and 57 percent, respectively. Comparatively, the five- and ten-year survival rates for a lung transplant are 55 and 34 percent
> The next big leap forward with protein modulator therapy came in 2019, with the published results of Trikafta, a pill that contains three protein modulators, all working in synergy. The study, published in the New England Journal of Medicine, showed an average increase of 14 percent in lung function, over three times the result seen with Symdeko. Just as important, with its superior efficacy, the drug is powerful enough to work on many of those CF patients with mutations that caused more severe defects in the protein. With FDA approval of Trikafta in October 2019, the percentage of CF patients eligible jumped from 55 percent to almost 95 percent.
> in 2015, amazed everybody in attendance by announcing at the invocation that the estimated average lifespan for a patient born with CF had jumped from forty-one years to forty-seven years in the previous year
> Cystic fibrosis patients make too much mucus, which gets stuck deep in the lungs, providing a fertile breeding ground for bacteria. Infections and lung destruction follow in a mutually reinforcing cycle of dysfunction.
> patients inhale multiple medications every day to break up the mucus. After taking the medicines, they must expectorate the secretions, either with vigorous coughing or with chest physical therapy, in which a parent pounds on the child’s back to agitate the mucus and move it out of the airways. The work is intense and usually requires an hour in the morning and another hour at night, even with the advent of protein modulators
> Given the overall poor outcomes and ubiquity of complications, transplanting lungs is a high-wire act compared to transplanting other organs. Assessing a patient’s likelihood of dying soon from their lung disease versus their ability to live after a transplant was considered impossible. Thus, the original system of getting in line and waiting for new lungs remained until 2005, long after it had been abandoned in liver and kidney transplants
> liver and kidney formulas can be more accurate because their absolute numbers are so much larger that statisticians have more data to work with. Fortunately, the Lung Allocation Score system worked, despite its potential flaws. The number of deaths on the waiting list plummeted in the years after the new system was implemented, from an average of more than four hundred to two hundred per year. Almost as important, there was no big change in one-year mortality, or even five-year mortality
> A CF patient in 1950 could expect to live a few years, while today life expectancy on average is forty-seven years
December 16, 2020
I have a bit of an infatuation with the powerhouse of our lungs, although I admit to not knowing near as much as I should. I have had adult-onset asthma for years (which I’ve since learned that, uncontrolled, can cause COPD, not smoking related!). One grandfather died of smoking-related emphysema, the other lung cancer, and my aunt had a double lung transplant due to bronchiectasis. She never smoked or did anything that should impact her lungs so negatively.
This book was… breathtaking. I admit that it took me a bit to get into and fully get engaged. There is a lot of science in this book, but the author does a great job sharing his story as a doctor entrenched in the physiology of our lungs and the life it brings us. He shares history of lungs, those who were conducive to the advancements made, as well as explanations. Anyone who wants to understand the workings of our lungs would benefit from this book. And I think, especially now with viruses attacking our respiratory system, it’s important to understand.
This book was… breathtaking. I admit that it took me a bit to get into and fully get engaged. There is a lot of science in this book, but the author does a great job sharing his story as a doctor entrenched in the physiology of our lungs and the life it brings us. He shares history of lungs, those who were conducive to the advancements made, as well as explanations. Anyone who wants to understand the workings of our lungs would benefit from this book. And I think, especially now with viruses attacking our respiratory system, it’s important to understand.
March 24, 2021
I bought this book as soon as I heard about its existence (thanks to the always amazing NYT book review podcast). As my research is about the law and policy of tobacco control, I have heard a lot of different things about lungs and lung diseases, but I still have many questions. Thus, I was sincerely over-excited at the idea of finally having a scientific yet accessible book on lungs.
The book partially disappointed my expectations, mostly because it is not focused on smoking as much as I would have liked. The chapter on tobacco smoking is good, but I would have liked to hear more about what the author thinks of vaping and marijuana smoking. On this point, all that Stephen does is to quote the opinion of an expert, who claims that tobacco addiction has 'a component of disordered learning' and for this reason 'there is no end in sight to our addictive behaviors' (pages 132-133). Vaping and marijuana smoking are then presented as evidence of this phenomenon, but there is no discussion on whether they are equally or less damaging than tobacco smoking (a very hot debate in tobacco control circles).
In spite of the initial disappointment, I kept reading Stephen's book, and finished most of the chapters. The key reason is that his writing flows very well, and the book is full of a lot of other very fascinating stories about our lungs. One of the parts I most loved is the history of how we have discovered how lungs work - from very old but still surprisingly smart theories made by Galen, to 18th and 19th horrendous experiments of scientists cutting open animals' bodies in front of an audience. Another chapter that I found very inspiring is the one about the power of breath and the science behind mindfulness and yoga-inspired breathing practices. Finally, the chapters on lung cancer, asbestos, PM, and infants' breathing were also very interesting.
The last observation that I would like to make is the timing of the publication of this book. For a book on lungs, January 2021 was an equally good and bad time to be published. Good because the Covid-19 pandemic has obviously increased people's interest and understanding of lung diseases. Bad, however, because the book did not have the time to really take stock of the lessons that this new disease is teaching us. The book was presumably mostly written before the Covid-19 pandemic. Although there are some references to it, it is clear that the book was not structured around it. In this respect, one can only hope that in due time Stephen will write a new edition of the book, focused on the lessons learnt and questions left unanswered by the Covid-19 pandemic.
The book partially disappointed my expectations, mostly because it is not focused on smoking as much as I would have liked. The chapter on tobacco smoking is good, but I would have liked to hear more about what the author thinks of vaping and marijuana smoking. On this point, all that Stephen does is to quote the opinion of an expert, who claims that tobacco addiction has 'a component of disordered learning' and for this reason 'there is no end in sight to our addictive behaviors' (pages 132-133). Vaping and marijuana smoking are then presented as evidence of this phenomenon, but there is no discussion on whether they are equally or less damaging than tobacco smoking (a very hot debate in tobacco control circles).
In spite of the initial disappointment, I kept reading Stephen's book, and finished most of the chapters. The key reason is that his writing flows very well, and the book is full of a lot of other very fascinating stories about our lungs. One of the parts I most loved is the history of how we have discovered how lungs work - from very old but still surprisingly smart theories made by Galen, to 18th and 19th horrendous experiments of scientists cutting open animals' bodies in front of an audience. Another chapter that I found very inspiring is the one about the power of breath and the science behind mindfulness and yoga-inspired breathing practices. Finally, the chapters on lung cancer, asbestos, PM, and infants' breathing were also very interesting.
The last observation that I would like to make is the timing of the publication of this book. For a book on lungs, January 2021 was an equally good and bad time to be published. Good because the Covid-19 pandemic has obviously increased people's interest and understanding of lung diseases. Bad, however, because the book did not have the time to really take stock of the lessons that this new disease is teaching us. The book was presumably mostly written before the Covid-19 pandemic. Although there are some references to it, it is clear that the book was not structured around it. In this respect, one can only hope that in due time Stephen will write a new edition of the book, focused on the lessons learnt and questions left unanswered by the Covid-19 pandemic.
February 26, 2021
Wide-ranging in scope: a pre-prehistory of how we ended up with free oxygen in our atmosphere; leading to a prehistory of how animals evolved lungs; then a history of how/when we learned what we know about breathing and the lungs; and an overwhelming catalog of lung pathologies, including cases from the author's own practice. Side detours into comparative anatomy (bird lungs are really cool!), the politics of clean air, the greed of scummy tobacco companies and profit-driven big pharma. Enjoyable but in a detached sort of way: very easy to put down for a while. Informative in places but, having just finished it, I'm struggling to recall anything I really learned (except for bird lungs. Those are cool.)
Written before COVID, with three pages hastily added at publication time (around April 2020) so there's absolutely nothing useful or interesting about it. Too bad, but hey, it might mean a revised second edition in a few years.
Written before COVID, with three pages hastily added at publication time (around April 2020) so there's absolutely nothing useful or interesting about it. Too bad, but hey, it might mean a revised second edition in a few years.
October 21, 2024
I’m into the lungs now, and this book did a good job of blending scientific information with anecdotal stories. A couple of tidbits that left me thinking.. the lungs are among the ‘newest’ organs evolutionarily. Birds have a totally different respiratory system that has separate compartments for oxygen and carbon dioxide. Childbirth is so difficult for the infant lungs.
January 29, 2022
Talk about your deep dive! This book has everything you ever wanted to know about the lungs and much more. Short version: you need lungs! They are a miracle of engineering but lots can go wrong with them. Take care of your precious lungs!
January 25, 2022
Good book on human lungs, how lungs evolved, how they work in humans and covers problems that people can experience with unhealthy lungs.
June 6, 2024
There's some intersting bits in this book, but the author drones on so long before he gets to his points that I lost interest several times in mid-chapters.
May 5, 2025
As someone who got a double lung transplant and is a nurse, reading more about the lungs from an evidence-based perspective was awesome. So glad I read this!
March 14, 2021
Interesting book. Discusses topics from air pollution, development of medications, specific disease topics, and meditation/mindfulness. Each chapter is fairly different and the ending seemed abrupt. I enjoyed the historical aspect enough to finish the narrative.
March 8, 2021
Perfectly fine, if unmemorable. The book is wide-ranging in scope, but reads like a series of mediocre essays on a loose theme. The thread between them is hard to find. The writing is okay. This will stay on the bookshelf because I do appreciate it as a potential reference (and because none of the content stuck well enough in my head to feel like I could remember it without huge prompts).
April 7, 2021
In terms of single subject science books, Breath Taking delivers a bevy of medical knowledge about our indispensable breathing apparatus and the many dangers and afflictions that befall this organ. It’s so useful to have a book written by a doctor in the field of their chosen topic as opposed to a pop science book filled with some borderline quackery (I’m talking about a book like ‘Breath’). Taking on all aspects of the function and use of the respiratory system, Breath Taking goes from A to Z on why organisms evolved to breathe and spends much time going over many of the breathing related issues that are all to unfortunate such as TB, CF, cancer, and environmental impacts. This is all in an approachable way easily understood from those without a medical background. He even does cover some of the more esoteric aspects of our breath but in a way that’s grounded in evidence and not superstition or anecdotal evidence. It’s too bad that a book like ‘Breath’ can be a small hit while this one will likely not get as much coverage, but that seems to be the way things work in our world unfortunately.
Read
July 17, 2024 Breathtaking can’t be called a work of literature but at least to me it came across as a good survey for the neophyte to the lung. The writer, a pulmonologist, conveys a lot of good, simple, information most of which I suppose is accurate. The footnotes really help back that up. I followed up reading some of those studies. Yet, I’m still struck by statements like “the lungs are the only organ we can control” because I guess it depends what you mean by “organ”. I for sure have quite a bit of control over, for example, my reproductive and excretory areas, which I would call organs. Also he needed a better editor because Puccini did not compose Traviata; although Violetta certainly has arias that Breathtaking develops. Mimi probably too but I don’t like Puccini.
The problem seems to be that, overall, lung science is stuck and you will not recover from lung injury no matter how good the hospital. There’s a positive spin to it, exercise the lung. I’ve seen this in my neck of the woods. One friend who taught at Macondo U, the Chief Priest of a secret society I only know about because my family member got drafted, practices yoga and dance like every day. He looks 20 years younger than his actual age. Yet another friend, a former swimmer at Macondo U, who just by swimming necessarily focused on his breath, started doing cirque du soleil like workouts in grad school, climbed to the second stage or whatever it is of the Himalayas, no training, first try, and he looks 20 but he’s 30.
Thus, Breathtaking’s advice makes sense: Breathe deep, clean air. The rest becomes bullet points for liberal policies that basically protect the lung. The societal conclusion is to ban smoke. To have an EPA and regulation. To stay away from grills. He doesn’t say that but basically your grillmeister dad has already got lung injury. Smoke is the insult.
The problem seems to be that, overall, lung science is stuck and you will not recover from lung injury no matter how good the hospital. There’s a positive spin to it, exercise the lung. I’ve seen this in my neck of the woods. One friend who taught at Macondo U, the Chief Priest of a secret society I only know about because my family member got drafted, practices yoga and dance like every day. He looks 20 years younger than his actual age. Yet another friend, a former swimmer at Macondo U, who just by swimming necessarily focused on his breath, started doing cirque du soleil like workouts in grad school, climbed to the second stage or whatever it is of the Himalayas, no training, first try, and he looks 20 but he’s 30.
Thus, Breathtaking’s advice makes sense: Breathe deep, clean air. The rest becomes bullet points for liberal policies that basically protect the lung. The societal conclusion is to ban smoke. To have an EPA and regulation. To stay away from grills. He doesn’t say that but basically your grillmeister dad has already got lung injury. Smoke is the insult.
April 11, 2021
Breathing is miraculous, says Dr. Michael J. Stephen, author of Breath Taking: The Power, Fragility, and Future of Our Extraordinary Lungs. Dr. Joseph states that we take more than 15,000 breaths a day with an organ structured of lacy membranes that is both powerful and fragile.
Early in the book, pulmonologist Stephen reminds us that “our lungs are the linchpin between our bodies and the outside world,” a fact he experienced first hand in the frantic attempt to engage his own son’s lungs at birth. He explains the links our lungs have with our immune system and with society at large, characterizing the lungs as a Petri dish for transmitting deadly diseases like Covid-19.
The book highlights our global connectivity, noting that “the trees in Yosemite National Park are reliant on nutrients in China’s Gobi Desert that have caught a ride on the east-west jet stream, traveling some six thousand miles.” His research includes references to the ancient Greek Galen, who demonstrated how the heart interacts with the lungs to sustain life and moves to pioneers in lung transplants in our time. Numerous case studies provide insight into the effectiveness of recently developed pharmaceuticals as well.
Naturally, as a physician, the author expounds on the persistence of asthma, COPD, the threats of e-cigarettes and other pollutants, but also offers hope with research that has resulted in amazing treatments for various diseases like cystic fibrosis. Most of the details are discussed in lay terms, but I was tempted to skip over a few of the technical passages. Yet, as one reviewer exclaimed, “ Dr. Stephen’s book “weaves together science, history, philosophy, religion, and clinical vignettes” that captivate the reader. I agree with a five-star review.
Early in the book, pulmonologist Stephen reminds us that “our lungs are the linchpin between our bodies and the outside world,” a fact he experienced first hand in the frantic attempt to engage his own son’s lungs at birth. He explains the links our lungs have with our immune system and with society at large, characterizing the lungs as a Petri dish for transmitting deadly diseases like Covid-19.
The book highlights our global connectivity, noting that “the trees in Yosemite National Park are reliant on nutrients in China’s Gobi Desert that have caught a ride on the east-west jet stream, traveling some six thousand miles.” His research includes references to the ancient Greek Galen, who demonstrated how the heart interacts with the lungs to sustain life and moves to pioneers in lung transplants in our time. Numerous case studies provide insight into the effectiveness of recently developed pharmaceuticals as well.
Naturally, as a physician, the author expounds on the persistence of asthma, COPD, the threats of e-cigarettes and other pollutants, but also offers hope with research that has resulted in amazing treatments for various diseases like cystic fibrosis. Most of the details are discussed in lay terms, but I was tempted to skip over a few of the technical passages. Yet, as one reviewer exclaimed, “ Dr. Stephen’s book “weaves together science, history, philosophy, religion, and clinical vignettes” that captivate the reader. I agree with a five-star review.
April 20, 2022
“Paradoxically, all the new [lung] knowledge is showing us not how far we’ve come, but how much further we have to go”.
Ah yes, no better time than the (pandemic) present to read about lungs. Alas, it’s not all gloom. Breath Taking is pulmonologist Michael Stephen’s tribute to an underfunded and ignored organ. And yet, he argues, lungs are bellwethers for societal function.
In Part 1, The Past, we explore how oxygen shaped Earth’s species and ancient civilizations’ perceptions of a mysterious life force. The Present delves into our immune systems and threats like climate change and nicotine. Can our cells adapt to environmental harm or is the onus on us to undo the damage? Part 3, The Future, considers these potential solutions. Personalized medicine, gene therapy, and lung transplants are improving – but is this enough? Finally, Stephen discusses his work in cystic fibrosis.
Though the chapters are slightly disjointed, Stephen’s writing is easily digestible. Medical concepts are clearly explained, as are their relevance to humankind’s future. I’m eager to see if an updated version is in the works; Stephen published Breath Taking in early 2021and no doubt the coronavirus has changed the course of respiratory medicine.
May 14, 2021
This book was SO much better than I anticipated! I didn't have any particular personal interest in the topic of our lungs and breathing, I was just mildly curious. Well, in my honest opinion, I don't think it would be possible to write a better book about it.
All throughout the book, I was completely engaged. Dr. Stephen's writing is so clear and accessible and interesting. His passion for the breath and lungs, and his compassion for the people that he treats and learns from, radiates off the pages. He gets the balance of historical information, science, and supporting personal stories just right. He gets the amount of detail right. I always felt like I was learning and yet never had to struggle to understand anything -- not a single sentence. Sooooo refreshing for someone with such specialized knowledge to be able to share it so effectively!
Thanks to GoodReads and the publisher for the opportunity to win my copy.
All throughout the book, I was completely engaged. Dr. Stephen's writing is so clear and accessible and interesting. His passion for the breath and lungs, and his compassion for the people that he treats and learns from, radiates off the pages. He gets the balance of historical information, science, and supporting personal stories just right. He gets the amount of detail right. I always felt like I was learning and yet never had to struggle to understand anything -- not a single sentence. Sooooo refreshing for someone with such specialized knowledge to be able to share it so effectively!
Thanks to GoodReads and the publisher for the opportunity to win my copy.
July 7, 2021
Stephen, director of the Adult Cystic Fibrosis Center in Philadelphia, takes us on a tour of this organ which often doesn't get the love it deserves, neither from owners or from society at large.
The book is broken up into sections, covering the physiology of the lung and how it works down to the cellular level, how oxygen came to be in our atmosphere, and the health benefits of focusing on our own breath. Later, he focuses on specific diseases and challenges to our lungs, like tuberculosis and nicotine use. Finally, he discusses new developments in treating diseases like idiopathic pulmonary fibrosis, lung cancers and cystic fibrosis (his medical specialty).
This book is a thoughtful tour around this organ that we use 15,000 times a day, often not thinking about it -- until it stops working for us. You won't take your lungs -- or anyone else's -- for granted after reading it.
The book is broken up into sections, covering the physiology of the lung and how it works down to the cellular level, how oxygen came to be in our atmosphere, and the health benefits of focusing on our own breath. Later, he focuses on specific diseases and challenges to our lungs, like tuberculosis and nicotine use. Finally, he discusses new developments in treating diseases like idiopathic pulmonary fibrosis, lung cancers and cystic fibrosis (his medical specialty).
This book is a thoughtful tour around this organ that we use 15,000 times a day, often not thinking about it -- until it stops working for us. You won't take your lungs -- or anyone else's -- for granted after reading it.
October 9, 2021
As a pre-respiratory therapy student I greatly enjoyed this book and how he explained things so well. The writing was very accessible and I learned a lot!
Top three things you should do/not do to help improve our quality of breathing and living:
-Don’t smoke or vape/quit doing so
-look into electric or hybrid options when purchasing a new car (also just support improvements to combat global warming and/or pollution)
-develop a simple exercise routine.
We have made amazing strides in medicine and air quality and can continue to do so!
My only issue with the book was the multiple chapters on Cystic Fibrosis, while I understood that’s his specialty, it just got a little repetitive compared to the rest of the book
Top three things you should do/not do to help improve our quality of breathing and living:
-Don’t smoke or vape/quit doing so
-look into electric or hybrid options when purchasing a new car (also just support improvements to combat global warming and/or pollution)
-develop a simple exercise routine.
We have made amazing strides in medicine and air quality and can continue to do so!
My only issue with the book was the multiple chapters on Cystic Fibrosis, while I understood that’s his specialty, it just got a little repetitive compared to the rest of the book
July 21, 2021
An excellent overview of lung function and lung disease. The perfect gift for friends and family who think that apple cider vinegar cures every cough. This book was written at the very beginning of the COVID-19 pandemic, but it can inform any reader of the physiology of breathing and lung health. The style is friendly, down to earth, and doesn't drown us in technicalities. Still, it will be a great challenge for anyone with a Master's in Business or Elementary Education who already thinks they know all there is to know about science--but has never read a book on science in their life.
For the rest of us who enjoy reading about science, health, and medicine, I highly recommend it.
For the rest of us who enjoy reading about science, health, and medicine, I highly recommend it.
October 30, 2020
This is great science writing by an expert
I loved this book. Dr. Stephen tells a great story about the lungs. The science is clearly explained in a conversational tone and with emotion appropriate to the subject matter. He incorporates patients and his own experiences as a pulmonologist into the story, which to me, creates a closer bond between author and reader. I recommend this book for anyone interested in science or medicine.
Disclosure: I received an advance reader copy of this book via Netgalley for review purposes.
I loved this book. Dr. Stephen tells a great story about the lungs. The science is clearly explained in a conversational tone and with emotion appropriate to the subject matter. He incorporates patients and his own experiences as a pulmonologist into the story, which to me, creates a closer bond between author and reader. I recommend this book for anyone interested in science or medicine.
Disclosure: I received an advance reader copy of this book via Netgalley for review purposes.
May 29, 2021
Vastly informative and entertaining, I found this a fascinating read. Dr. Stephen does a great job of illuminating complex medical concepts in layman’s terms, made real with human examples and ties to historical myth and religion. I especially enjoyed the diversity of stories both scientists/doctors and patients. Dr. Stephen seemed to intentionally highlight achievements and experiences of females and people of color, groups often overlooked or unrecognized in medicine. I learned so much about the lungs, and am grateful for this read!
May 21, 2022
I got a little nervous at first that this was going to be really really science-y. But, as it went on, I realized the first couple of chapters were level setting my fundamental understanding of the lungs so I could better understand the series of essays about the lungs that were to follow. The rest of the book was an interesting look at genetics and our environment and how both that can do a NUMBER on the lungs and how it is a minor miracle that these very seemingly fragile organs are such powerhouses and resilient.
Inhale. Exhale. And repeat. I feel grateful to be able to breathe.
Inhale. Exhale. And repeat. I feel grateful to be able to breathe.
June 3, 2024
A very good book on lungs and lung health. The author writes well, covering topics like asthma, TB, air pollution, and cystic fibrosis. Still, as interesting as the content was, it didn't have that pull some books have on me to keep reading. Using an example of a book in the same category, I just wanted to keep reading James Nestor's book "Breath." That being said, the author does his research and writes with competency and compassion. I appreciated this book on pulmonary health, which I feel is not talked about so often, yet such a critical part of our health!
March 11, 2021
Solid science book by a pulmonary expert. The intricacies how our lungs work or don’t makes one marvel at the incredible synchronicity between the structures, systems, physics, and chemistry.
Fascinating explanation about the existence of birds in the Himalayas and explaining how their bodies separate gas exchange and ventilation.
Again like Nestor’s breath, his chapter on the extraordinary healing power of breadth across cultures, disciplines, and diseases.
Fascinating explanation about the existence of birds in the Himalayas and explaining how their bodies separate gas exchange and ventilation.
Again like Nestor’s breath, his chapter on the extraordinary healing power of breadth across cultures, disciplines, and diseases.
April 22, 2021
3.5 stars
Like most people, I don’t think much about my lungs. This book taught me a lot about how amazing our lungs are and how many discoveries and breakthroughs have helped people with lung diseases to live longer lives. I loved the personal stories, but I struggled with some of the scientific explanations. Overall, interesting, touching, and informative.
Thanks to NetGalley and the publisher for the arc.
Like most people, I don’t think much about my lungs. This book taught me a lot about how amazing our lungs are and how many discoveries and breakthroughs have helped people with lung diseases to live longer lives. I loved the personal stories, but I struggled with some of the scientific explanations. Overall, interesting, touching, and informative.
Thanks to NetGalley and the publisher for the arc.
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