Ep 168: How to best protect our lungs from poor air quality? With Dr Irina Dralyuk, Pediatric Pulmonologist

In this conversation, pediatric pulmonologist Dr. Irina Dralyuk discusses the importance of lung health, especially in light of recent fires affecting air quality in Los Angeles. She explains the significance of air quality indices (AQI), and its limitations.  She reviews the use of air purifiers and masks, to protect lung health, particularly for vulnerable populations such as children with pre-existing conditions.  She emphasizes the importance of post-exposure care, the role of vitamins and homeopathic remedies, and the impact of nutrition on lung health. Dr Dralyuk also addresses exercise considerations during times of poor air quality, school safety measures, and the current trends in pediatric respiratory issues. She concludes with an optimistic outlook on lung healing and recovery, reassuring parents about the resilience of the lungs and the body's ability to heal itself.

Dr Jessica Hochman is a board certified pediatrician, mom to three children, and she is very passionate about the health and well being of children. Most of her educational videos are targeted towards general pediatric topics and presented in an easy to understand manner.

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The information presented in Ask Dr Jessica is for general educational purposes only. She does not diagnose medical conditions or formulate treatment plans for specific individuals. If you have a concern about your child's health, be sure to call your child's health care provider.

Transcript

Unknown: 0:00

Hi everybody. I'm Dr Jessica Hochman, pediatrician and mom of three. On this podcast, I like to talk about various pediatric health topics, sharing my knowledge, not only as a doctor, but also as a parent. Ultimately, my hope is that when it comes to your children's health, you feel more confident, worry less, and enjoy your parenting experience as much as possible. If you live in Los Angeles, or you're listening to the news about Los Angeles, you're probably wondering about the air quality after the recent wildfires, parents are asking, Is it safe for my child to go outside? Is it safe to send them to school? What can we do to protect the air in our homes? Well, to help answer these questions, I'm joined by Dr Irina dreyluke, a pediatric pulmonologist, and she specializes in lung health in children. In this episode, she gives practical guidance to keep your family safe. We'll talk about air purifiers, masking, yes, masking, school safety, outdoor exercise, and how to keep our lungs healthy in general. So if you, like myself, are wondering how to navigate air quality concerns, this episode is for you. Thank you so much, Dr Irina druke for taking the time to come on the podcast now, let's get into it. Dr Irina dreyluke, thank you so much for being on the podcast. I'm so excited to hear what you have to say, and I so appreciate your time. Thank you so much for having me. This is really exciting. So tell everybody. What do you do for work? Excellent. So I'm a pediatric pulmonologist. I work at Cedar Sinai Medical Center. I'm part of gear and children's. I've been here for a few years now. I've been running the department. Now I do have a partner, which is exciting. So now we're sharing the department. But basically, my job entails taking care of kids with any and all sort of breathing problems that could just be, you know, mild asthma. It could be interstitial lung disease, chronic issues, things like cystic fibrosis, ciliary dyskinesia. Might have a kid who just comes in, used to be a healthy kid, oh, and now has a real bad pneumonia, and they need help kind of figuring out what to do going forward if they're still lingering symptoms. And basically, at the end of the day, my job is to help kids breathe easier. So I'm so excited to talk to you. Of course, I want to talk to you. I hear the most wonderful things about you from the community, and also in light of the recent fires happening. We both live in Los Angeles, we have been inundated with questions from parents curious about what to do, how to protect their children's lungs, how to protect their lungs. They're not sure what what to make of the air quality and how worried to be. So I'm so excited to talk to you so that we can get some guidance on on how to handle this recent situation. Sure. Thank you. I think that's a great question, kind of a great area to talk about right now. Obviously very relevant. This is sort of an unusual situation. La, historically has never been a place with amazing air quality, but right now is a particularly special time, and I think first I would say to parents, don't freak out like it's going to be okay, because really, we've dealt with poor things before, both just in LA on planet Earth, this too will pass, and the air quality will be better eventually. Right now, it is important to take it seriously. So what I'm seeing is some folks get very anxious and very worried and in a sense, like it's helpful, but it's also not necessary, right? There are things that we'll talk about that people can do to help prevent bad things from happening to the lungs. But then I also see folks that are not taking it seriously enough, which I think is the more important group to address. Like, I do want folks to pay attention the air right now is not good, right? And we look at this air quality index like it's sort of the only thing that matters, and then people really go by the AQI, like it's the Bible, like, oh well, it's 25 but it doesn't mean a whole lot. So one thing I want people to do is step away from this AQI. Is there a guidance for what to do in terms of the air quality right now and like, how to go about their daily business? And Dr Irina, can you also explain what the AQI is? Because I know before this point, I had looked and referenced the AQI to see how fresh and how clean the air was. You know, I can easily access it on my Apple phone, on the weather app, you can scroll down and see the AQI. Can you explain when is it useful and why is it not so useful? Right now? Yeah, definitely. So it's this air quality index, right that basically talks about particular matter in the air, and it looks at certain types of pollution particles that are picked up. And it's a measure. It's just a measure. It's a metric. It's a way to, like, the same way we measure our weight, we can measure, you know, certain pollutants in the air. And it's used around the year in all parts of the world to see, like, how safe is the air for breathing. So on a random month in LA, I might look at it to see, like, is this a good time for my kid to go outside and play? Or maybe, I think right now it's not so great, you know, and normally it's kind of a useful measure to just get an idea, like, is the air clean? That's sort of how we think about it, right right now, not useful. The reason being is, these fires are not normal fires. It's not just like we had one little fire, a couple of trees burned down. The problem with these fires is, not only are they really expensive, but a lot of. Stuff has burned like, we can't really know what has burned, right? There's probably a fair bit of plastic in all the homes, in all the buildings, there's a lot of hazardous materials we worry about, things like lead that's being burnt up in some of the older homes, right? So there are a lot of substances where the particles being burned and released into the air are not adding to that score, and so that AQI is no longer reflective of the true nature and the quality of the air that we're inhaling. So I might say 25 but you're inhaling things that could cause me down the road, right, 30 years in the future. That's not very reassuring. But again, I don't want people to freak out like there are things we could do right, and they're, they're measures we could take to prevent this exposure from being so dangerous. So just to recap what you said so far, this is very helpful. Don't look at the AQI, but know there are things that we can do to protect ourselves. Yes, we just, I mean, a lot of it is really common sense with the understanding that the AQI is not going to be our guiding measure of how we know what to do and when to do it, because right now it's not an accurate metric on what are we actually breathing in? Right? Makes sense. So then the question is, what do we use? And that's where it gets hazy. Kind of pun intended, I guess. But there are few things, and none of them are mathematical. Unfortunately, the AQI is nice for anybody who likes numbers. I love numbers. So to me, a metric with numbers is the best, because then, you know, I could normally tell you, if you look at Wikipedia or any breakdown of the AQI, it'll tell you zero to 50. You're in the green zone. Everybody knows green is go. My three year old will tell you green is go, right. Yellow you gotta, like, pause, which is like, 50 to 100 and so on and so forth, right? So people are like, Oh, it's only 80. That's not so bad. It's in the yellow zone. No does not apply right now for me, right now, 40 and above is like, I just think of it as the Red Zone going forward, because I don't know what I'm breathing. I don't want to breathe it. So if we're 40 and above, I don't want to go outside. And if I do, I'm certainly putting on my n 95 right? I don't want to breathe in plastic. And I agree with you. I like to know metrics. Something simple, tell me, when can I go outside? When can I want to run safely? And I agree that it's very tricky right now that we don't have those clear metrics. Yeah, but I do know there's other factors at play, right? It must be. It must matter how close you are to the fires, how long it's been since the fires have burned, when they've been put out. And so that's also confusing to me, because I'm not sure how to advise patients. On that front, I'm not sure if you, if you have any advice, yeah, I've got endless advice. I've been giving it all day and the day before and the day before. Wait first, tell everybody, by the way, how many news interviews have you done this week? I think, like, Well, between last week and this week, I think we're at like, 12 or something like that. Thank you. Thank you for being here. For sure, it's been, you know, oddly fun, because normally it's like a story here and there and then, like, I've had days where I do four stories or five stories, but all of these things are important, because I think people have these questions, right, and there is no clear guidance, and a lot of different practitioners are coming at it kind of in a different way, because everybody thinks about it in a different way, like, Okay, what's practical, what's sensible, you know? But also, when I see what other pulmonologists are recommending, we all seem to be much more in the conservative boat. And they think it's because what we see is lung disease. And we know that the pathway from a healthy person to lung disease, it's it could unfortunately be a little shorter than we'd like it to be. Okay, I've had, I'll tell you this story, and it's not like, it's not like it's not meant to scare people. It's just meant to kind of give people an understanding of what can happen with the lungs. Right? Lungs are great. They're very important. I've had a kid, a very healthy young person, who was 14 when they were exposed to a fire outside of their school. It was a fire in a building in a life. This is all a life. And this kid, this child, ended up getting really, really sick. They ended up in the hospital for many, many days, and this person needed oxygen and steroids for weeks, weeks, even now, when this person is now in college, they're now thriving, and they still have what I would consider symptoms of chronic lung disease, like they will forever be my patient as a lung person, they still need medications and support, and they can't do certain things that other kids can do. Just to ask a couple more questions about this particular kid, did they have baseline lung issues? Did they deal with asthma beforehand? And How close were they to the fire? They were close so they did not have any pre existing respiratory history. This was a healthy young person. They were athletic, they were active. They were doing martial arts, all this other stuff, and then they had this yucky exposure that, like, triggered some kind of a weird response and caused this diagnosis called usual interstitial pneumonia, which is very unusual in a pediatric patient, right? Like, very unusual. Took a lot of work to figure out that this was potentially, just literally due to this fire exposure, smoke exposure. So smoke exposure can unearth these weird reactions in human beings. So like, out of, you know, 1000s of kids, most of them will go on and be completely fine, good. That's reassuring for everybody but me or the mom of that kid who happened to have the one kid who had this, like, is it auto immune? We still don't know. They didn't have any auto. And markers that showed up, but they now have chronic lung disease because of this event, right? It sounds like when it comes to being close to fire, close to ashes, always better to be safe than sorry. Why not for sure? For sure? Well, definitely, definitely better safe than sorry, because it has the potential to cause permanent, long, lasting damage to our lungs. Will it for most people? No? Will it for one person? Here and there? Maybe. And it's worth it on a personal level to not take that risk within reasonable parameters. Like we don't need to all basically stay in our house for the next six years. But there are basic common things we could do, like wear our masks, like stay inside for a couple of weeks while it's the worst. Like, if somebody has a house or they're staying close to where the fires have been or are still burning, those are areas where we don't want to go outside and do jumping jacks, you know, right now, indoors, only indoors, right? Because it's safer. Like, there's just no reason to not wait for a couple of weeks. Let's wait until the fires are out. Let's wait until the smoke dies down. You know, I'm not asking for months and months, but a couple of weeks to me is not unreasonable. Any of my friends will know this when I say this, but I love to hike. I love to be outdoors, and definitely, since the fires, I have been exercising indoors when I exercise and I miss my hikes. But it's not worth it right now, it's not. It's not worth it for your lungs, because if you think about it, why do we go outside? Why do we breathe fresh air? Because it's good for us, right? Your lungs are happy. They like it. But right now, if you do that, they're not going to be happy. We're going to cause damage to our lining. And one of the things that you know at the very beginning of these fires that was really troublesome is the particular matter, the size of these molecules from these fires is very, very small, 2.5 pm, which is much smaller than most of the junk that we're going to breathe in, into our lungs. And so it what the problem with that is it's going to travel further down into the little branches of our airway, or what's called the distal airway, the peripheral airway. It's in that part of the airway is also much thinner, much more friable, vulnerable to damage. So it's going to then cause damage to the part of the lung that's more difficult to repair. It's not nice for the lung. We want to avoid this, right? And so that's another reason to wear an 95 because it goes down to a 2.5 versus like a regular COVID mask, which doesn't but it's also great reason to just avoid exposure, right? So right now, going on a hike or going for a run, the things that are meant to help our health and to build our lung health, they're going to do the opposite, right? So it makes sense, right now, until the particular matter improves, until we have less bad stuff to inhale, to just do the exercises inside. You know? Okay, so, so all this makes sense, but I do have some follow up questions to what you're saying. So, so the first I appreciate this actionable advice. I agree, staying inside, and I would add, keeping your doors closed, keeping your windows closed, and if you have a HEPA filter, right? That's recommended as well, to run a filter in the house. I love air purifiers right now. That's probably like, the best thing I can recommend if you if, like, somebody listens to this or anything that I've talked about or read, if they get nothing else, air purifier, just like, invest in a nice, decent, little air purifier, you know, look at square footage that it covers. Find one that's within a reasonable price range. Like, you don't all, like, not everybody has to have a Dyson for $1,500 right? I'm sure it'd be nice, but I just have a regular little lap for, like, 1900 square feet, and it does the job, you know. And my house is fine. If somebody has a huge house, and they might need a couple of extra ones for smaller rooms or, like, if there's a kid that's very sick and they're really worried, get a little individual one for that room too. I think air purifiers right now, truly, in LA are all the rage. Okay, so if you're listening and you're gonna take one piece of advice from this interview, make sure and get yourself an air purifier. It doesn't matter how expensive it is, just make sure that it covers the square footage that you need. Thank you so much for clarifying that, because I do see advertisements for a variety of HEPA filters that really range in price, and so it can be tricky when you want to make sure you're doing the right thing. So that's very helpful. And then the other advice that I've been giving to families is to make sure to change the filters in their homes as well. Yes, love that. That's a brilliant one. I think that's like, probably one of the best things and the easiest things, because some folks will go for years without changing their filters, and you're supposed to do it like, you know, technically, every four to six months. Right now, everybody should probably just go ahead and change their filters, unless they just did it right before the fires. So love that one. That one's perfect. Now, my next question has to do with masks. You brought up masking as a as a important precaution to take when you're outside. I know when people hear about masks, there's such a variety of responses. I think a lot of people, I don't know, they're tired of it after COVID, or they have mixed feelings of it after COVID. And then for me, personally, I find wearing and 95 uncomfortable. They're hard for me to tolerate for too long. So in terms of general recommendation, are there some groups of people that definitely should wear a mask, like, for, for example, kids that have asthma, the elderly? Are there certain groups that you think very strongly should wear, well fitted and 95 mass? Yes, absolutely. That's that's like the question of the day, right? Because, I mean, everybody I think has mask fatigue. I. I would be lying to if I said I didn't. With that being said, I like my lungs. So here's my mask. Okay, this one my husband got from, and that's you like your we like your lungs. Yes, that's true. So like, when you ask me a little sarcastic part of me, of like, which patient groups and like people with lungs, you know, but it's a little more nuanced than that. So like, for me, actually, I have slight reactive airways, and when the fires first started, I was running around without a mask, kind of doing my thing. You know, I walk into the house and my husband's like, can you please go shower and take off your scrubs, because he's a lot more germaphobic than I will ever be. But now I'm, you know, getting that way with the particles. I'll tell you why. Like, day two, I was sitting on the couch and I started coughing, and I just couldn't stop, and I couldn't catch my breath, and my throat was burning, and it just, it just wasn't fun. Since then, I've gotten smarter. So then I started wearing this nice, cute little k 95 I think, from Home Depot, religiously, right when I go outside, even if it's from my car to the house to, like, bring in groceries, and the AQI is 20. I don't care. I don't want to have that episode again. Now, for patients, it's more difficult to try and convince people who don't have that personal experience of misery, from a respiratory standpoint, to where their kid, or have a kid who doesn't want to wear anything, right, pants, less alone a mask that would be my child, so like, who needs to wear the masks, all right? Folks that are obviously still in areas where the fires are burning, those are good candidates for masks. I don't care if they have a respiratory condition. Um, folks with that don't, please wear a mask. Like, just for the love of God, just, just put on a mask. Right? If that one is easy, I think that one should be easy. Even if you have mild, persistent asthma, or anybody who's ever had an inhaler, just put on the mask. It's not that like, it's really not that serious. This is also where I lack a little empathy. It's a mask. Like, yes, they're uncomfortable. I find them uncomfortable too. As a doctor, they have been uncomfortable since I started medical school. My lungs not having them that would be more uncomfortable to me or like having decreased lung function, very uncomfortable, I promise you, more uncomfortable than wearing a mask. But going back to your question, of my favorite groups, so anybody with pre existing lung conditions, emphysema, COPD stuff, right? Anybody with lung cancer, stat stuff, anybody with a trait like the obvious thing, cystic fibrosis, ciliary dyskinesia, babies, like babies who are premature, for example, and now they're three or four or five and they still have lingering chronic lung issues. Those are some of my patients, but I will tell you, those parents are usually really easy because they have the experience of protecting their kids lungs and their lung health. So these are folks who will have trained their kids to keep their mask on. I don't struggle with those parents, but that's not my tough group. It's the folks where the kids are generally healthy, or the adults that are generally healthy and they're not used to having to think about how to stay that way, right? They just take it for granted that we're going to stay healthy. So for those groups, that's going to be tough for me to convince them, like, hey, I want you to do this thing that's very inconvenient, but they're also not my top concern group. The top concern would be immunocompromised folks, you know, neuromuscular disease folks, because they're going to have a harder time doing airway clearance. So basically, that's a lot of patience. And it's not just asthmatics, it's a lot of other folks. I mean, I think this is a helpful reminder, honestly, for myself included, because as you said, a lot of us have mass fatigue. I still have a mark on the top of my nose from wearing it at 95 every day at work for a year and a half. But I think you hit the nail on the head for me when you said, Why not take precaution? Because who wants to have lung issues after this is all over? So if this is just a short period of time, it's just a couple of weeks get through this period until the fires have long been gone, and the air is clear. It makes a lot of sense to be on the safe side. Yeah, I think so. I mean, granted, you know, when you see a lot of nails, you tend to like as a hammer, right? Everything is a nail. So I see lung disease like, that's what I do every day I come to work, and that's a lot of days, because I don't take a lot of vacation. We have a lot of sick kids. All I see is lung disease, and I know how we get there. And it's not, it's not it's not hard to acquire lung disease, unfortunately, and bad air quality is one of the ways to get here. So like, if we're in this situation, how do we get through this in the smartest way possible? We do the easiest things, like the the lowest hanging fruit kind of thing, which is a mask, right? A mask and an air purifier are fantastic combination to get us through these next few weeks and get us to the other side, where then we're not struggling with some of these long term effects. Because if we don't do anything, if we just go on about our business right now, we go back outside. We go back to eating lunch outside at school, we go back to having PE at school. We start doing our jogs and our runs and our jumping jacks outside. What's going to happen is a good number of those people will have significant inflammation, and they will have significant issues from all the debris that's landing in their lower airway. They're going to have irritation of their lungs, and then they're going to have chronic lung issues, and they're going to kind of send their kids to me, and then my adult colleagues are going to be overwhelmed with the number of adults that are now having reactive airway symptoms. And we're going to run out of symbiosis. What's going to happen? And we don't want that? No, no, no. I think I prescribed that like candy. And the thing that people might want to think about is the way to treat severe inflammation is steroids, usually. So for folks who don't want to do things, let's again, weigh like the pros and cons, wearing a mask, getting steroids. I would rather wear a mask. I don't want I've never had steroids. I've never taken steroids thing up, well, except for the inhaled kind. But like systemic steroids, I've never had a tablet of prednisone in my body, and I don't really want to have to get to that point, right? Like, drugs are not fun. They're they're a necessity in a situation where we really don't have other choices. So to me, like preventing the progression of lung disease is worth it, whether it's a mask, an air purifier, staying indoors, kind of getting through the next few weeks, we do have things at our disposal. So that's that's a good thing, right? Like, it's great. We have all these kind of easy things that we could do to prevent more badness, like, right now, we already have enough sad stuff to deal with. People's homes being burned down, schools, there's a lot to deal with. If we can at least protect our lungs on the other side, then we can fix the stuff. Right? Like, people will have support to buy new homes, replace their clothes. Like, yes, valuable sometimes are not replaced. But these are things different, right? I can't replace lung health for people, you know what's interesting for myself, I was out of town for the weekend during the fires. Like many Angelinos, we got out of town for the weekend, and I could tell. I thought maybe it was psychological, but I don't think so. But as soon as I got home and I was in the valley where I live, a certain area of Los Angeles, I felt a little bit of a light headache. I felt it in my chest a little bit. And so I do think there's something in the air that's not the same as it was before. So why not keep precautions for sure, for sure, there's no reason not to. So okay, so apart from the mass and the filters, is there anything else that we should do, for example, when I come home from being outside, should I take a shower? Should I use nasal saline? Should I gargle? Is there anything else that I should do to clean my body after being exposed to outdoor particles. Those are all really good ideas. I think you're not going to go wrong with any of the things you said, right? If you're going to shower, you're going to remove any sort of residue or anything on your skin, your hair, any kind of sinus rinse is always a good idea. That'll help clean your nose if you're feeling symptomatic, right? If you're having little bit of sniffles or anything really, you can always do a little Flonase, just to help with that. You can do gargle. You can really do anything that will help you clean out, you know, your sinuses. You could do a neti pot. You could do humidifier. I think those are really helpful. I've recommended a lot of my families use humidifiers. They are super dry. So those are kind of nice. What about other homeopathic products, like one that's been going around a lot has been to take vitamin C or to take NAC. NAC. Do you have any thoughts on those products? Yeah, sure. Well, vitamin C, to me, is actually very allopathic too. You know, I think I feed my kid lots of food with vitamin C. So I love vitamin C. I think it's very helpful. And also just in conjunction with that iron, because they work hand in hand. So just whether it's spinach or liver, I really don't care. It just depends on people's dietary preferences. So vitamin C all day, every day, right? Because we want to support our immunity. NAC. I don't have any like, pros or cons. I don't use it personally. I have not seen it sort of looked at positively or negatively in the allopathic community. I can research it and get back to you, but I don't have, like, personal feelings about it one way or the other. Is there anything that you would recommend to promote lung health? Sure. Well, yes, absolutely. But you also triggered my memory of, like, one thing that's like, I wouldn't even call it homeopathic. I guess it's more Ayurvedic related that I like. I don't personally love it, because when it just tastes good, I'll tell you what it is in a second, and it helps me. But that's anecdotal, and like the entirety of India, like every Indian friend I've had, which is half my colleagues, as soon as I mentioned, like turmeric milk, they go, Oh, my God, my mom made that for me as a kid, right? So do I recommend it? Yes, because it's delicious, and you just can't go wrong with turmeric milk. Okay? This is, like, my one very non allopathic medical advice, you know, piece of advice is, you take milk of whatever type, right? You add some turmeric in there, you add a pinch of black salt, and then whatever sweetener, like I use honey, you can use agave, whatever, and you, you know, you just, you could, like, boil it in a little teapot for a while, and you get golden milk, or turmeric milk, and that's very delicious and healthy. And a lot of people will tell you, and I believe it, but again, it's not like research in the kind of science that I practice. So I have a hard time being like as a medical like, MD, I'm not recommending it from that. I'm recommending it as a person. Do you know what I mean? 100% I love it. I actually, I relate to you all the way. There's the there's the evidence based medical advice that I give, and then there's the advice that I give as a mom, as a person, something that feels like it could be a good thing to do, why not? For sure, like honey and tea and lemon. That's like a classic. Again, I don't, I haven't done research on it. I haven't seen tons of articles published like, you know, in PubMed on honey and lemon. But do I recommend it? Yes, every single. Should I have? I tell them, if you can drink warm water or tea or honey in your tea, or, you know, eat your honey and lemon, I think that's like the best combo. So between the honey and lemon and tea plus the turmeric milk, I think you have a couple of kind of natural remedies there that I think are great. Ginger is always a good thing. So ginger tea, I think again, one of those kind of life hacks that a lot of cultures have used, and I love all things ginger. Yes, Ginger shows great, anti inflammatory properties. Taste good. Why not exactly, we could put it in our golden milk. Yes, that's right, you can put it in everything. I think you can just ginger and garlic. I mean, I could go on about like, the garlic, the onion. I think food is medicine. So kind of stepping away from my biomedical background, I really believe strongly, and maybe it's part of biomedicine, but I believe food is a big part of how we can keep our bodies healthy and strong, and lungs are part of that, right? So if we eat a bunch of junk food that will affect our lungs, versus having a very vibrant platter of fruits and vegetables and grains and nuts and kind of healthy fats, those are really going to help us fight off infection, bad air, just keep ourselves healthy. So I recommend lots of colorful things on plates. You know, absolutely yes, yes, yes. We're speaking the same love language here. I totally agree. Oh my gosh, I could like talk. I'm trying to control myself because I love food. I love talking about food and the color of food like I just think it's fascinating, and there's a lot between how our body responds to disease or the potential for disease, and the things we're putting in fermented foods, again, not coming from my biomed background, but just kind of from my life background. I think fermented foods are super important for our health. It helps our gut and our gut helps with our immunity. Well, that's a win. So like, if you like kimchi, if you like natto, if you like really, anything key for fermented foods or the lungs, you know that that's, I think that's where lung health is at right now. Okay, so I love this colorful diet. Get your nutrients from the food that you eat. Your food is your medicine. Don't forget to have the fermented foods. It'll help your lung health. It'll help your gut, and thinking about vitamin C alongside iron to help with absorption. I love all of this. What about exercise? Exercising, having a good aerobic workout? Wouldn't that help the lungs? Or is that not okay to do right now, that's a tricky one. It's a yes and no, I would not probably encourage right now whole lot of like fast paced, hardcore aerobic exercise in areas that have had significant smoke exposure I had, I think it was spectrum news where they asked me about going running on the beach, but they would like what they went running and they saw ash. It was like, Well, no, that's a no go. No running on the beach when there's ash flying around, it's not going to benefit our lungs. So right now, I would go from a more protective kind of approach, because running or aerobic exercise, that's more like, how do we build our lung health forward? Right now, I want to think about, how do we prevent damage to your lung tissue? The best way to do that is not to expose the lungs to more pollution, more damage, right? So I would try and keep it easy and, like, go easy on the lungs and not do a lot of hardcore aerobic exercise indoors or outdoors. If you're in a gym, like, I haven't gone to my gym in the last couple weeks, if you have a gym that's got air purifiers, and, like, they've really taken measures to make sure that the air is very clean, and you feel pretty good about that gym, okay, you can get on the treadmill or kind of do whatever you're going to do. Going to do, and I'll play pickleball, I suppose. But I wouldn't think of that as, like, how am I keeping my lungs healthy right now? It's by playing hardcore sports. No, I would actually, right now just take it easy and wear the mask and, like, focus on that is, how do I prevent lung disease, versus do I need to run an extra mile? Not right now. Let's wait until, like, you know, three weeks down, then we can, like, push our our running and our jumping and all that stuff. But right now, I would say people can take it easy. I appreciate that advice. I needed to hear that. So thank you very much. Is there, like, exercise at home? I just did a bar boot camp class today. It's my addiction, so maybe I need to think twice about it. So thank you, sorry. Sorry the party during this century, being a pulmonologist is really, sometimes super fun, and sometimes, like, I feel like the bad guy, you know, because I tell people to do the non fun things, like, I feel very much like a mom, just like, I'm just momming Everyone, no, but it comes from a really good place. And as you said, this is what you see, and so you're trying to protect people. So I think, I think it's great, I think it's great. I think it's great to hear and you're the person that deals with you're the person that treats issues that come up with the lungs, and you have first hand experience that you don't want anybody that you know or love to deal with it. So I think it's I appreciate hearing about it. Thanks. I appreciate you saying that because it is hard. Like, I definitely get a lot of folks kind of looking at me, like, are you want us to do what? And I feel bad. I don't want to, like, be crunchy, you know, I don't want to make people's lives difficult or miserable. But then I think to all my kids I've had who've had these, like, long lasting lung problems. And I think this is kind of funny. I think to like this one older pulmonologist, when I talked to them a few years back, I thought, God, they're so gloomy. I. And the other day, I was like, oh my god, I'm turning into them. This is terrible. I'm not quite there yet, but you're not there. I'm not there, but I'm like, Man, the more stuff you see, the more you realize, like, no bad things do happen to lungs, you know? So how do we prevent them? That's where it's coming from. Okay? So just to make sure we've, we've, we've covered all the big things right in terms of how to keep your lungs healthy, how to prevent issues from the current fire conditions that we're all exposed to in Los Angeles. Yes, yes. Is there anything that parents should think about or advise their schools when they send their kids to schools? Any anything that schools should take precautions about, that parents should be aware of, that they should bring up to their local schools. Oh my god, yes, that's a big one. And that one today, we actually had a lot of conversations in my clinic with other providers. And then I had a patient come in where the kiddo has asthma, and the school has already gotten back to, like, taking the kids outside for lunch and all this stuff. And so the mom was like, Oh my gosh, I really don't want my kid eating outside and doing all this stuff. I got on the principal, because this stuff means a lot to me. And like, if this kid gets sick, like, I don't want this kid exacerbating right? So I just wanted to make sure we keep this kid safe. But also I wanted to kind of figure out what's happening with the school, and I'm having this is only principal I've talked to, but I'm having a lot of conversations regarding school, and sort of like, what do we do with school with different parents? So for kids like this, anybody with a reactive airway history, I'm asking, please don't have them be sitting outside. I don't really care where they are, unless they're in San Diego, okay, Long Beach. I think I told one family, it's okay. They can go outside for their play time, but like in LA proper, let's just keep these kids inside. No, they cannot go and eat their lunch outside and then put their mask back on. You can. I can't eat through a mask, and neither can a 12 year old. You know what? I mean, it's just silly. People are asking me, like, well, what if they like eat and then put their mask? No, no, that's not an option. So those kids need to have a safe place inside the school with a classroom or a library or some kind of a space that has, ideally, not just filters, but air purifiers. So I know some of the schools have already acquired those. Some have not. So one thing parents can do is ask their schools, what have you done so far to make sure that air quality in your school is safe for our children. What are you doing? Are you keeping the doors closed? Are you keeping the windows closed? Do we have air purifiers? You know? How many square foot are they covering? What kind of HEPA filters or other filters do we have the room that this kid was getting access to, was the multi what is it? The multi something room, multi purpose room. Thank you very good. Yes, there's another part to this word. But my the mom told me, like, there's no filter in there or not, there's no air purifier, and the doors are all open. So it's kind of like pointless. So I asked the school please keep this kid in a room that is appropriate. And the school is really sweet. This this principal was amazing. You know, she's very helpful, very agreeable. She's going to work with the teacher. And I said, also, let the other parents know that I called and, like, I made this recommendation, because it sounds like, from the mom that some of the other parents are calling asking to have their kids sent outside. That's the wrong direction, inside, inside right now. Okay, ask the schools to send your kids inside. That's the better place to be with the doors closed. Okay? We don't want our kids breathing this stuff right now. The kids should be inside right for the next two, three weeks. Yes, the kids are gonna go bad even get in the car, drive down, go to like Newport, and go for a walk on the beach, and then come back to LA, which is very stinky and smelly right now, even if we can't smell it, put your kids indoors, close the doors, you know, lock them. So that would be the school thing, right? One thing that I've noticed that's been very interesting at the beginning of all this, my kids school, which has been amazing, they've sent us updates five times a day on all the things they're doing to keep the kids safe, keeping them inside. I don't know how they do it. So this is an example of a school doing this, right? Where they're doing the things, and they're reaching out to the parents and communicating what they're doing. So I don't even have to think, should I send my kid to school? I trust that what they're doing is good, and I see that it's good enough, even for my very high standards. I've had other parents be like, Oh, my school hasn't really reached out to us with anything. And I'm like, Dude, what are they doing? And they're like, well, we don't really know they're going outside during recess and lunch, like, what about purifiers? Like, anything you know, and they're like, We don't know. Like, you should, you should talk to your school or just keep your kid home. Because if, if what I'm hearing is your school is not communicating with you, they're not doing the things. And I agree, like, if the school has done its due diligence, it's gone through all of their protective sort of gears, and they make sure they've updated their filters, they've changed the things, you know, they've installed air purifiers. They're closing the doors, they're keeping the kid in doors. Then we're good. That's that's a school that's being responsible. Myself, I've gotten emails from a couple of my kids classrooms about what they're doing and how they've updated filters and keeping the doors closed. But you're right. If you haven't gotten an email, or you haven't communicated with your with your child's classroom, it's, it's, I think it's worth just checking in, reaching out, and making sure that they are doing the proper precautions while your kids at school, for sure, for sure, and keeping them indoors. You know. So definitely, my clinic is seeing more volume. I'm dealing. I'm trying to help a lot of people, like by phone or by. You know, through epic, through like our communication within the system, because one, the volume is huge, dozens and dozens of like questions every day, between my cell phone, my email and then my inbox, I'm probably answering like 20 different questions a day about fire related stuff from like 20 different families. Wow. Well, thank you so much for the work that you do and for guiding people and making them feel better. Well, no problem. It's, you know, I think this is a funny time, and I'm really glad you're doing this, because the more pediatricians we can communicate this to, the easier it'll be on the community. Because one thing I can't say, struggle, the one thing that's been a point to address is the pediatricians, I think because they don't see the degree of severity that we do as pulmonologists, they're more likely to be sort of more human in their approach. Like, Well, maybe you don't need to do this. This is a little overkill data. Like, we're okay with, you know, 100 and over AQI, you can go back to school, you can go back to sports. And I'm like, God, please don't, please don't let anybody do anything. But I can't, I, you know, I can't force everybody to just stay indoors. That's also, like, unrealistic. So I think if we can get everybody kind of on the same page about, like, how seriously to take this, it'll actually help the community at large more, because I can't take care of everybody by myself, right? Like the pediatricians are, like the first guard, and then it comes to me once it's worse, I definitely I appreciate your message. I hear it loud and clear, and I'm I actually think it's really helpful to hear because I do agree that prevention is very important. So now I'd like to talk about something optimistic. Tell me about lung healing, because I know, for example, smokers that smoked for many years when they quit, when their lungs are no longer exposed to, you know, bad particles and smoke and carcinogens that they do, the lungs do miraculously heal pretty quickly. Can you speak to that so that parents that are thinking, Oh, my goodness, I haven't my child hasn't worn a mask for a week or two. Have I? Have I caused any damage to their lungs? Tell me about lung healing. And is this expected, sure? So the lungs are pretty magical, you know, with a caveat that sometimes things don't go in the magical direction, but for the most part, lungs really do. The body heals itself very well, like we are designed to heal, and our body wants to heal. So that is beyond miraculous. It's really incredible, kind of like you said with the smokers, right? People can smoke for years, and then if they stop and they they live a healthy life going forward, oftentimes they can actually recover the majority of their lung health. So we think about, like, I think as a pulmonologist, in terms of pulmonary function, right? What is somebody's pulmonary function? We can recover a huge amount of lost function up to a point, right? So it's important to also think, like, two weeks is not going to make a huge difference. So I don't want parents to think like, oh my gosh, my kids lungs are just going to be terrible. They're going to get this horrible lung disease. No, no, we're not. The reality is, most of the kids are going to be totally fine. Okay? The one kid out of 5000 or 20,000 or whatever that's going to potentially have long term effects, that's the kid I worry about. But the majority of patients are going to be okay, especially if they take these precautions and whatever degree of lung damage we're all currently experiencing, like sitting here and probably right now breathing in something I shouldn't, but I also know that, like, I'll be fine. So there's no reason to be sort of like freaking out or, you know, punitive with ourselves or our friends or family members. If people haven't been perfect about masking up or not going outside, these are just, you know, it's kind of like food. Nobody has a perfect eye. Well, maybe some people, but most of us have a muffin here and there, or, like, a piece of chocolate or whatever, you know, right? Yeah, a lot of apple pie that my husband's been making lately because it's delicious. And, like, you know, am I gonna have a perfect body? No, I'm not, but the pie is delicious. But also, like, lungs are the same way you can take a little bit of a hit. You know what? I mean? You don't want to take a huge one. And the funny thing to think about is, where's everybody's threshold? We have a lot more room with our lungs than people recognize. What we don't want to do is get close to the threshold. So unless you're sitting there by like a burning fire and just inhaling all the fumes, or you're just downwind from, like a huge piece of plastic. The reality is, you're not at your threshold, okay, and it's going to be a while before you get there. And it's all cumulative, so over the course of our lives, you have to think about, like, how much time do we have to recover for our lungs right now, with this fire, or all of these fires, there's going to be some degree of damage for all of us who've been in the lake, whether we like it or not, little, moderate, a lot. And then time will go by, and we'll make choices for our lungs, and we'll recover a good amount, if not all, of our lung health. And then something else will happen, and then some kid will be exposed to a vape, and then they'll do more lung damage, and then the parent's going to freak out, and then they're going to quit their vaping, and then they're going to restart, and they're gonna restart, and they're gonna quit again 17 times. Then we'll see you in clinic, right for vaping like associated lung injury, and then, shockingly, that kid will still have normal lungs three years down the road. It is absolutely crazy. Not all the kids, like some of these kids, potentially, will have those outcomes that will make. Them my patient for the next 20 years, but the majority of these kids will actually recover their lung health and be okay. So I do want parents to kind of, like, relax a little bit and do the right things. You know what I mean? Like, I don't want people to relax so much that they go, Oh, it's fine. The lungs will just repair themselves. We don't need to add, like, insult to injury for the lungs, but the amount that we can't control for the lungs will do their job, and the body will do its job. And all the vitamin C you're going to eat from those beautiful oranges, they're going to do their job. And so the lungs will come out, and we will breathe, and all make it, you know, hopefully into our 80s and 90s. So there's a lot to be said for like, the body's natural ability to heal itself with the right choices that a person can make throughout their life, you know. So what I'm hearing from you is basically, do the best you can and have faith that it's all going to work out for the best, for sure, for sure. And then, you know, if you can go to Hawaii, like half my family, you're doing, do that, that's also a good option. I agree with, with all of this, I've definitely been trying to think about making lemonade from lemon. So you have to, I agree, yeah. I mean, look, it could be much worse, like, God forbid, yes, these fires are not so fantastic, right? But worse things have happened to human beings, like worst disasters have happened to human beings. We will get through this. It's already getting better. The fires are under much higher containment. You know, things are going in the right direction. The winds are going in the right direction. They're dying down. So at least it's not getting worse, and that's a huge thing, like it could have gotten worse, but it's not. It's getting better. It will slowly continue to get better, and we just have to kind of make the best choices we can given the resources we have. It's a great reminder that I want to be careful for the next few weeks, and then before I know it, I'll be back resuming my regular hiking, right? Yes, and you can call me and we'll go hiking. I'm supposed to actually go hiking within this so we keep putting it off. So yeah, we're supposed to go hiking. So we can all go hiking. Once this is over, I'll let you guys know where I'm emotionally ready to go on a hike. It'll be fun. Good, fantastic. Thank you so much for your time. Thank you for being here. This is a very timely episode. I know a lot of people really appreciate hearing directly from a pediatric pulmonologist, a kid lung doctor. Not that many of you, so I really appreciate you. You sharing your expertise. Thank you. This was super fun. I really appreciate this opportunity. Thank you for listening, and I hope you enjoyed this week's episode of Ask Dr Jessica also, if you could take a moment and leave a five star review wherever it is. You listen to podcasts, I would greatly appreciate it. It really makes a difference to help this podcast grow. You can also follow me on Instagram at ask Dr Jessica. See you next Monday. You.