BREATHE BETTER TO LIVE LONGER: WHY RESPIRATORY HEALTH SHOULD BE A KEY INDICATOR OF HEALTH STATUS

For many years, medicine viewed the lung primarily as the organ responsible for gas exchange. Today, this perspective appears increasingly limited. The latest scientific evidence indicates that respiratory health is one of the best indicators of the body's overall condition, influencing not only quality of life but also longevity. Indeed, lung function is closely linked to cardiovascular health, metabolism, aging, and even cognitive abilities. Respiratory function as a health biomarker Several epidemiological studies have shown that reduced lung function—even in individuals without a diagnosis of respiratory disease—is associated with an increased risk of: • cardiovascular mortality; • diabetes; • frailty in the elderly; • cognitive decline; • hospitalization. In other words, the lung acts as a sort of "sentinel" for overall health status.

The concept of "lung health" In recent years, the American Thoracic Society (ATS) and the European Respiratory Society (ERS) have promoted the concept of "lung health"—viewing lung health as a state to be preserved throughout one's entire life. It is not simply a matter of avoiding respiratory diseases, but rather of fostering optimal lung function development during childhood and slowing its physiological decline during adulthood. This perspective fundamentally changes the approach to prevention. Respiratory health is built in the early years of life We now know that many adult respiratory diseases originate long before symptoms appear. Factors such as: • prenatal exposure to smoke; • air pollution; • early-life respiratory infections; • prematurity; • childhood asthma; • adverse socioeconomic conditions can influence lung growth and result in reduced functional reserve from an early age. COPD, for instance, is not always the result of a rapid decline in respiratory function; in many cases, it stems from lungs that never reached a normal peak functional level

The Impact of the Environment Climate change and pollution are reshaping the landscape of respiratory medicine. Today, the lungs are constantly exposed to: • fine particulate matter; • ozone; • wildfires; • allergens; • indoor aerosols. Protecting respiratory health therefore requires action not only at the level of the individual patient but also regarding the environment in which they live. The Importance of Early Diagnosis A major challenge is that many respiratory diseases are diagnosed too late. It is estimated that a significant proportion of patients with COPD remain undiagnosed, while many individuals with pulmonary fibrosis or asthma are identified only months or years after the onset of symptoms. Investing in early diagnosis means preserving respiratory function and quality of life. A New Culture of Prevention Respiratory medicine is evolving toward a broader perspective, in which the lung serves as an indicator of overall health. For this reason, it would be beneficial to incorporate respiratory function assessment into prevention programs more frequently—alongside checks for blood pressure, blood sugar, and cholesterol levels. In many cases, a simple spirometry test could become a valuable tool for preventive medicine. As pulmonologists, we are accustomed to intervening once disease is already present. The challenge for the coming years will be different: preserving respiratory health before symptoms appear. The concept of "lung health" encourages us to view the lung not merely as an organ to be treated, but as an asset to be protected throughout one's life. Respiratory health is far more than the mere absence of lung disease. It is an indicator of the body's overall health and a fundamental determinant of longevity. Promoting a culture of respiratory prevention means investing not only in the treatment of COPD, asthma, or pulmonary fibrosis but also in the population's overall well-being.