THIS PROGRAM IS FUNDED IN PART BY GRANTS FROM THE FOUNDATION FOR A HEALTHY KENTUCKY AND THE KENTUCKY MEDICAL ASSOCIATION.

GREW A GRANT FROM THE ANTHEM FOUNDATION.

>> NOT BEING ABLE TO BREATHE IS ONE OF THE MOST HORRIBLE EXPERIENCES A AMERICAN CAN HAVE.

>> Renee: CHRONIC OBSTRUCTIVE PULMONARY DISEASE, C.O.P.D., IS A MAJOR CAUSE OF DEATH IN KENTUCKY AND OFTEN GOES UNDIAGNOSED IN ITS EARLY STAGES FOR THOSE LIVING WITH C.O.P.D., SIMPLE ACTIVITIES OF DAILY LIFE CAN BE A STRUGGLE ASTHMA, ANOTHER CONDITION OF THE AIRWAVES CAN BE DEBILITATING IF NOT PROPERLY CONTROLLED.

IN THIS PROGRAM, WE TALK TO EXPERTS AND PATIENTS ABOUT THESE TWO COMMON CONDITIONS AND TRAVEL TO EASTERN KENTUCKY TO LEARN ABOUT A NOVEL RESEARCH STUDY CALLED THE MOUNTAIN AIR PROJECT.

THIS PROGRAM IS PART OF OUR SERIES "FIGHTING TO BREATHE" WHERE WE EXAMINE THE UNDER TOLD STORY OF LUNG DISEASE IN KENTUCKY, INCLUDING LUNG CANCER, C.O.P.D.

AND ASTHMA.

EXPLORE THE LATEST ADVANCEMENTS IN TREATMENTS AND MEET HEALTHCARE PROVIDERS AND ADVOCATES ACROSS THE STATE FOR WORKING TIRELESSLY TO HELP US ALL BREATHE EASIER.

>> WELCOME TO ANOTHER INSTALLMENT OF FIGHTING TO BREATHE, KET'S THREE PART SERIES ON LUNG DISEASE IN KENTUCKY.

I'M RENEE SHAW.

IN THIS EPISODE WE FOCUS ON CHRONIC OBSTRUCTIVE PULMONARY DISEASE C.O.P.D.

AND ASTHMA, TWO OF THE MOST COMMON LUNG CONDITIONS.

BOTH ISSUES ARE OFTEN MISDIAGNOSED AND CAN GREATLY IMPACTS ONE'S QUALITY OF LIFE IF NOT RECOGNIZED AND MANAGED.

WE BEGIN WITH ASTHMA.

Dr. WAYNE TUCKSON, HOST OF KENTUCKY HEALTH INTERVIEWS ONE OF THE PIONEERS OF ASTHMA TREATMENT IN THE REGION.

>> GOING OUT THERE EVERY THREE OR FOUR WEEKS.

>> HE IS THE FOUNDER AND CHIEF MEDICAL OFFICER OF FAMILY ALLERGY AND ASTHMA.

I ASKED HIM TO DESCRIBE THE MECHANICS OF BREATHING AND ASTHMA AND TO SHARE THE LATEST ADVANCEMENTS IN ASTHMA TREATMENTS.

JIM, WE ALL KNOW THAT BREATHING ISY ESSENTIAL AND ONE OF THE THINGS WE TAKE FOR GRANTED.

IF YOU WOULD TAKE ME THROUGH THE PROCESS OF BREATHING.

WHAT IS GOING ON, THE MECHANICS AND THE LEVEL OF THE LUNGS?

>> OBVIOUSLY WE NEED OXYGEN TO LIVE THE LUNG'S MAIN FUNCTIONS IS TO EXCHANGE GASES.

AS WE BREATHE, WE TAKE IN AIR DOWN TO OUR BRONCHIAL TUBES AND YOU WANT TO THINK OF AS AS AN UPSIDE DOWN TREE.

THE TRACHEA IS LIKE THE TRUNK, GOES DOWN TO THE AIRWAYS THAT ARE SMALLER AND SMALLER LIKE BRANCHES ON A TREE UNTIL YOU GET DOWN TO THE SMALL AIR SACKS.

IF YOU SPREAD THEM OUT, THERE ARE MILLIONS, ABOUT THE EQUIVALENT OF A TENNIS COURT IN SIZE AND THAT'S WHERE THE AIR EXCHANGE TAKES PLACE.

BLOOD FLOW IN THE LUNGS AND THE RED BLOOD CELLS PICK UP THE OXYGEN THAT DIFFUSES ACROSS THE SURFACE OF THE AVEOLI AND RELEASES THE CARBON DIOXIDE AS OUR CELLS METABOLIZE VARIOUS THINGS AND THAT'S RELEASED BACK OUT INTO THE AIR WAY.

AND SO THIS EXCHANGE IS WHAT, YOU KNOW, GIVES US LIFE.

>> WHAT IS ASTHMA?

HOW IS THE BEST WAY TO DESCRIBE THIS TO ME.

>> ASTHMA IS A CHRONIC DISEASE OF THE AIRWAYS.

IT'S NOT OF THE AVALEOILI.

IT'S IN THE WEAR WAYS.

IT'S TYPICALLY OCCURRING IN CHILDHOOD INHERTED DISORDER THAT WE ARE BORN WITH THE TENDENCY TO HAVE ASTHMA.

ONE OUT OF 10 PEOPLE HAVE DEVELOP SOME SIGNS OF ASTHMA IN THEIR LIFE TYPE.

IF YOU HAVE ASTHMA, YOU HAVE AIR WAY OBSTRUCTION.

THREE DIFFERENT THINGS HAPPENING ONE ONE IS SWELLING OF THE AIR WAY AND JUST GETS SMALLER FROM THE INFLAMMATION AND SECOND IS INCREASED MUCOUS PRODUCTION AND THAT CAN GET TO BE REAL THICK, TENACIOUS AND CAUSE OBSTRUCTION IN THE AIR WAY AND THE FINAL THING THAT HAPPENS, MICROSOFT PEOPLE ARE FAMILIAR WITH THE IDEA THAT ASTHMA CAUSES BRONCHIAL SPASM WHERE YOU GET A SPASM IN THE AIR WAY FROM THE MUSCLES THAT SURROUND THE AIR WAY AND THAT WILL RESTRICT EVEN FURTHER THE AIR FLOW.

SO THE OTHER TWO THINGS MAY BE MORE CHRONIC AND THE BRONCO SPASM COMES AND GOES.

>> I WANT TO COME BACK TO SOMETHING YOU SAID EARLIER.

THE INHERITABLE NATURE OF ASTHMA.

I MUST ADMIT, I THOUGHT IT WAS AN ACQUIRED PROBLEM IN THINKING ABOUT ENVIRONMENTAL OR ALLERGIC REACTIONS GIVING RISE TO ASTHMA.

>> ACTUALLY YOU ARE RIGHT.

IT'S ACTUALLY BOTH.

SO WE ARE BORN WITH THE GENETICS SOMETHING WE CALLED GENETIC PLASTICKIVITY, OUR GENES RESPOND TO VARIOUS THINGS IN OUR ENVIRONMENT.

SO THE ENVIRONMENTAL TRIGGERS CAN ACTUALLY CHANGE GENETIC RESPONSE.

AND ACTUALLY, AMAZINGLY ENOUGH, THERE HAVE BEEN STUDIES THAT SHOW YOU CAN LOOK AT GRANDMOTHERS OF CHILDREN WITH ASTHMA, IF THEY'RE SMOKERS, THERE WOULD BE A HIGHER INSTANCE OF ASTHMA NOT BECAUSE OF EXPOSURE BUT GENETIC CHANGES IN THE SEQUENCE OF GENETICS FROM THE GRANDMOTHER TO THE MOTHER TO THE CHILD.

AND THE OTHER THING THAT HAPPENS IN THE INDIVIDUAL, IF YOU HAD THIS GENETIC TENDENCY TO BE TO HAVE ASTHMA, AND YOU HAVE DIFFERENT TYPES OF EXPOSURE, THERE ARE CERTAIN ALLERGEN LIKE DUST MITE, COCKROACH, MICE EXPOSURE AND THIS HAS TO DO AGAIN WE CANS POSE YOURS IN EARLY CHILDHOOD AND CHILDREN IN POVERTY MAYBE WITH SUBSTANDARD HOUSING.

THAT EXPOSURE KICKS THE GENETICS IN AND LEADS TO THE ASTHMATIC RESPONSES.

ALLERGY PLAYS A ROLE.

ABOUT 80% OF INDIVIDUALS WHO HAVE ASTHMA HAVE SOME DEGREE OF ALLERGY THAT TRIGGERS THIS.

THEN YOU HAVE ENVIRONMENTAL MORE POLLUTION LIKE CIGARETTE SMOKE, DIESEL, SO ALL THIS PLAYS A ROLE IN THIS FIND OF AFFECTING THE UNDERLYING GENETICS THE DEVELOPMENT OF THE DISEASE.

>> WHAT IS THE WAY THAT YOU GO ABOUT MAKING THE DIAGNOSIS AND WHAT ARE THE THINGS THAT GET CONFUSED.

>> ABOUT ONE THIRD OF ASTHMA IS UNDIAGNOSED OR UNDER DIAGNOSES AND THAT HAS TO DO WITH RECOGNITION AND HOW THE PATIENTS THEMSELVES ACCESS THEIR MEDICAL CARE.

A LOT OF TIMES THEY'RE GOING TO URGENT CARE OR THEY'RE GETTING EMERGENCY ROOM VISITS FOR THEIR ACUTE EXACERBATIONS THEY HAVE AND THEY THEMSELVES DON'T REALIZE THAT THEY NEED TO GET INTO A SITUATION WHERE THEY HAVE CONTINUITY OF CARE.

THAT'S VERY IMPORTANT FOR ANY CHRONIC ILLNESS WHETHER IT'S ASTHMA OR DIABETES: ONCE WE ESTABLISH THAT THEY PROBABLY HAVE ASTHMA, ONE OF THE THINGS WE DO IS LUNG FUNCTION TESTING AND WE CAN DO A BASELINE LUNG FUNCTION AND USE A BRONCO DILATOR WHICH IS THE MEDICATIONS THAT GIVE YOU QUICK AREY LEAF AND THEN A SECOND LUNG FUNCTION ABOUT 20 MINUTES AFTER THE FIRST AND WE LOOK FOR IMPROVEMENT.

IF THEY DON'T IMPROVE, YOU MAY OR MAY NOT HAVE ASTHMA.

>> YOU HAVE BEEN AT THE TREATMENT OF ASTHMA FOR A PRETTY LONG TIME,.

>> A COUPLE OF YEARS.

>> THREE.

>> AT LEAST.

WHAT HAVE YOU SEEN THAT HAS CHANGED FROM THE VERY BEGINNING WHEN WERE YOU STARTING YOUR JOURNEY WITH ASTHMA TO NOW.

>> THE BIG DEVELOPMENT IN THE LAST 20 YEARS PRIMARILY THE LAST FIVE OR SIX, WE HAVE WHAT WE CALL BIOLOGICS WHICH ARE MONOCLONAL ANTIBODIES THAT TARGET CERTAIN PATHWAYS THAT LEAD TO ASTHMA.

SO WE ARE NOW BACK DOWN TO TREATING THE UNDER LYING, YOU KNOW, PATHWAYS AND OF COURSE THE OTHER THING THAT WE USE IN TREATMENT IS ALLERGY SHOTS.

HAVE BEEN AROUND A LONG TIME.

WE BELIEVE IT BETTER.

IT HAS BEEN REFINED AND WE CAN TREAT THE TRIGGERS THAT ARE ALEDGER-- ALLERGIC AND THAT CAN BE A DRAMATIC EFFECT.

SO THAT COMBINATION OF DIFFERENT TREATMENTS CAN HAVE A BIG IMPACT.

>> TYE ADAMS IS A WALKING TESTIMONIAL FOR THE EFFECTIVENESS OF THESE NEW ADVANCEMENTS IN ALLERGY AND ASTHMA TREATMENT.

UNDER HIS CARE, HE RECEIVES IMMUNOTHERAPY TO TREAT ALLERGIES AND BIOLOGICS TO TREAT THE UNDERLYING PATS WAYS.

>> TWO FLIGHTS OF STEPS AND I WAS COMPLETELY OUT OF BREATH.

IT GETS YOU DOWN PHYSICALLY AND MENTALLY AND YOU KNOW, YOU START TO QUESTION EVERYTHING AND NOT IN A HEALTHY WAY I HAVE BEEN FORTUNATE THROUGH ANOTHER DOCTOR TO GET A REFERRAL AND COME INTO THE PRACTICE AND IT MADE A HUGE DIFFERENCE IN MY LIFE AND WE REALLY WANTED TO UNDERSTAND WHY INSTEAD OF JUST TREATING THE SYMPTOMS WE WANTED TO UNDERSTAND WHERE IT WAS COMING FROM AND HE HELPED ME UNDERSTAND THAT.

>> HOW HAVE YOU BEEN DOING?

>> REALLY GOOD.

WE GOT THROUGH AUGUST AND INTO THE FALL AND DIDN'T HAVE THE GOLDEN ROD TRAUMA.

>> IMMUNOTHERAPY HAS WORKED THAT OUT AS THE OTHER TWO BIOLOGICS.

>> WE HAVE TREATMENTS LIKE YOU EXPERIENCED THAT CAN TURN YOUR LIFE AROUND AND NORMALIZE IT.

>> WE ARE ACTIVE AND LIKE TO DO STUFF AND BEFORE I WAS VIRTUALLY CIRCLE LING THE DRAIN.

>> USING YOUR CRYSTAL BALL, WHAT DO YOU SEE THE NEW FRONTIER FOR ASTHMA AND ASTHMA TREATMENT.

>> I THINK THE BIOLOGICS HAVE OFFERED A BIG JUMP IN THE RIGHT DIRECTION.

WE HAVE BEEN ABLE TO IMPROVE, I MENTIONED EARLIER IMMUNOTHERAPY FOR ALLERGY.

BETTER IDENTIFICATION OF ALLERGIES AND ANYTHING ON THE ENVIRONMENTAL SIDE THAT WE CAN DO TO HELP REDUCE TRIGGERS AND EXPOSURE TO THING THAT WILL, YOU KNOW, DRIGGER ASTHMA AND MAKE THE GENETICS WHICH IN EARLY CHILDHOOD CAN MAKE A BIG DIFFERENCE.

>> THANK YOU VERY MUCH FOR ALL YOU ARE DOING FOR ALLERGY AND FOR BEING WITH US TODAY.

>> THANKS A LOT ENJOY BEING HERE.

>> Renee: IF YOU EXPERIENCE ANY OF THE SYMPTOMS OF ASTHMA, WHEEZING, COUGHING, TIGHTNESS IN THE CHEST, DIFFICULTY BREATHING, BE SURE TO SEE AN ASTHMA SPECIALIST FOR DIAGNOSIS AND TREATMENT.

NOW ON TO CHRONIC OBSTRUCTIVE PULMONARY DISEASE OR C.O.P.D.

STAY WITH US AS Dr. CHAITANYA MANDAPAKALA EXPLAINS THE DIFFERENCE BETWEEN ASTHMA AND C.O.P.D.

AND WE LIFT A PULMONARY REHAB CENTER THAT IS HELPING PATIENTS LIVE FULL LIVES DESPITE THIS CONDITION.

>> SO ASTHMA IS A DISEASE THAT YOU GET A TRIGGER AND YOUR LUNGS CLOSE DOWN SAYING I DON'T WANT THIS ALLERGEN OR TRIGGER COMING IN AND HAVE YOU TROUBLE BREATHING.

THE TRIGGER GOES AWAY.

YOUR BREATHING GOES BACK TO NORMAL C.O.P.D.

ON THE OTHER HAND, OVER TIME IT BUILDS UP AND ONCE IT BUILDS UP, IT IS NOT EASY TO BRING IT BACK BECAUSE ONCE THE TUBES GET NATTLED AND ONCE YOU HAVE C.O.P.D., IT DOES NOT REVERSE.

IT DOES NOT EVER GO AWAY.

SOY SMOKING TOBACCO IS THE MOST COMMON THING EVERYONE TALKS ABOUT AND IT IS REAL.

IT IS REAL THAT IT CAUSES ISSUES ANY OTHER KIND OF VAPING CAUSES C.O.P.D.

AS WELL, SMOKING MARIJUANA CAN CAUSE C.O.P.D.

AS WELL.

AND THEN WHEN IT COMES TO THE GENERAL POLLUTANTS PER SE, YOU KNOW, WE GET THESE THINGS LIKE TODAY IS A BAD DAY FOR AIR QUALITY AND THINGS LIKE THAT ALL OF THOSE THINGS IMPACT OUR PATIENTS IN FACT, WHEN SOMEBODY HAS C.O.P.D., A HOT HUMID DAY CAN MAKE THEM SO SHORT OF BREATH, IT CAN PUT THEM IN THE HOSPITAL.

>> Renee: AT ST. ELIZABETH HOSPITAL IN EDGEWOOD STAFF AT THE PULMONARY REHAB CENTER TREAT A VARIETY OF LUNG DISEASES BUT THE MOST PREVALENT BY FAR IS C.O.P.D.

>> I'M HANGING IN THERE.

>> IN 2016 I WAS DIAGNOSED WITH C.O.P.D.

WHICH IN MY CASE IS EMPHYSEMA.

I FOUND IT VERY DIFFICULT TO BREATHE AT THAT TIME.

AND WHEN I MADE AN APPOINTMENT WITH THE PUM PULMONOLOGIST HE CONFIRMED THE DIAGNOSIS AND PUT ME ON INHALERS THAT IT WAS SUGGESTED I MIGHT WANT TO COME TO PULMONARY REHAB.

INITIALLY I DIDN'T WANT TO BECAUSE I LOOKED IN THE DOOR AND SAW A BUNCH OF OLD PEOPLE AND CAME TO THE CONCLUSION THAT I'M ONE OF THEM DOUGH I DECIDED TO GO AHEAD AND DO IT.

>> WHEN WE LOOK AT A PATIENT WHO HAS PROBLEMS AND HAS C.O.P.D.

TYPICALLY JUST NORMAL THINGS, GETTING UP OUT OF BED IN THE MORNING IS A STRUGGLE.

WALKING DOWN THE HALL IS A STRUGGLE.

STEPS ARE A HUGE STRUGGLE.

THEY'RE JUST AFRAID, TOO BECAUSE WHEN YOU FEEL LIKE YOU CAN'T CATCH YOUR BREATH, THAT'S THE WORST FEELING IN THE WORLD.

>> HAVE I TO SAY I LOVE THIS CERTAINLY.

SOME GIRLS ARE MADE FROM SUGAR AND SPICE, KENTUCKY GIRLS ARE MADE FROM BOURBON AND ICE.

I GO GOT TO SAY I LIKE THAT.

>> WE TRY TO MAKE IT AS EASY AS POSSIBLE WE HAVE PATIENTED THAT HAVE BEEN COMING TO REHAB FOR YEARS WHO WELCOME ALL THE NEW PATIENTS IN I CAN'T FIX THEM, AS MUCH AS WOULD I LIKE THEM I CAN'T FIX YOU BUT IF YOU FEEL BETTER THAT IS AMS OUR GOAL.

IF YOU CAN GO TO THE GROCERY STORE AND NOT BE SO SHORT OF BREATH OR IF YOU CAN GO FROM YOUR MAIN FLOOR OF YOUR HOUSE UP TO THE SECOND FLOOR AND NOT BE SO SHORT OF BREATH.

>> EXERCISE IS NOT ALWAYS FUN, BUT WE TRY TO MAKE IT AS MUCH FUN AS WE CAN.

>> Renee: THE SECRET BEHIND THE SUCCESS OF PULMONARY REHAB IS SURPRISINGLY SIMPLE.

>> SO INTERESTINGLY, WHAT YOU DO WITH THE REST OF YOUR BODY IMPACTS YOUR LUNGS MORE THAN PEOPLE BELIEVE.

LIKE, FOR EXAMPLE, IF YOU ARE A SEDENTARY PERSON OR OBESE PERSON AND YOUR MUSCLES ARE WEAK, WEAKER MUSCLES DEMAND MORE OXYGEN THAN STRONGER MUSCLES.

SO WITH STRONGER MUSCLES, YOU NEED LESS OXYGEN.

SO A PATIENT WITH MODERATE C.O.P.D.

BUT GOOD MUSCLES MIGHT NOT EVEN FEEL THAT THEY'RE THAT SHORT OF BREATH.

WHERE SOMEONE WITH MILD DROPPED WITH VERY WEAK MUSCLED MIGHT FEEL MORE SHORT OF BREATH.

SO YOU CAN BE A VERY SEVERE C.O.P.D.

PATIENT BUT THEIR STRENGTHENING YOUR MUSCLES IN A PULMONARY REHAB PROGRAM, YOUR SHORTNESS OF BREATH BECOMES MUCH BETTER AND YOU CAN DO MORE IN YOUR DAY AND IMPROVE YOUR QUALITY OF LIFE.

>> WHEN I FIRST CAME HERE, I COULDN'T DO ANYTHING.

I WOULD GET WINDED QUICKLY.

MAYBE JUST A COUPLE OF MINUTES ON THE TREAD MILL NOW CAN I DO IT FOR 20 MINUTES I FIND THAT I'M A WHOLE LOT STRONGER THAN I USED TO BE AND FOR ME, THAT'S KEY TO CONTINUING TO HAVE A FULL LIFE NORMAL BREATHING, SLOW IT DOWN, NICE AND EASY GREAT JOB.

>> Renee: PULMONARY REHAB KEEPS DOWN HOSPITAL READMISSION RATES.

>> AS A HOSPITAL SYSTEM, WE ARE IN OUR HIGH 20s AS FAR AS OUR READMISSION RATES.

WE ARE IN KENTUCKY, BIG TOBACCO STATE, A LOT OF C.O.P.D.

SO THAT DOESN'T HELP.

I WILL TELL YOU THAT OUR PULMONARY REHAB PATIENTS, LESS THAN 5% READMISSION RATE.

SO WE ARE KILLING IT WITH THAT.

WE'RE DOING A GREAT JOB OF MAKING SURE THESE PATIENTS UNDERSTAND THEIR DISEASE, UNDERSTAND THE THINGS THAT THEY NEED TO CHANGE AND DOING THOSE THINGS ON A DAILY BASIS.

>> IT'S MY PET PEEVE IN MANY WAYS BEING A LUNG DOCTOR THAT THE NATIONAL CONVERSATION HAS NOT BEEN MUCH ABOUT C.O.P.D.

WE LIVE IN A COUNTRY WHERE WE ARE PROUD OF THE WORK WE DO WE HAVE A STRONG WORK ETHIC.

SO THESE KINDS OF DISEASES LIKE C.O.P.D.

WHICH CAN PROBLEM YOU OF YOUR WORK DAY OR EVEN BEING INDEPENDENT, LIKE DOING THE THINGS IN YOUR HOUSE ON YOUR OWN, IT PROBS YOU OF THAT KIND OF STUFF.

WE REALLY HAVE TO PAY ATTENTION TO DISEASE IS LIKE C.O.P.D.

>> Renee: DESPITE THE SUCCESS OF PULMONARY REHAB, THE SERVICE IS NOT COVERED BY MEDICAID AND REIMBURSEMENT RATES BY MEDICARE AND PRIVATE INSURERS ARE VERY LOW, MAKING IT LESS ACCESSIBLE TO THOSE WHO MAY NEED IT THE MOST.

IN OUR NEXT SEGMENT, WE TRAVEL TO LETCHER IN HAR HARLIN COUNTIES WHERE RATES OF LUNG DISEASE VASTLY OUTPACE THE REST OF THE STATE TO LEARN ABOUT A STUDY CALLED THE MOUNTAIN AIR PROJECT.

EASTERN KENTUCKY IS KNOWN FOR ITS EXPANSION PANSIVE TREE RINGED MOUNTAINS AND THE LOW LYING AREAS KNOWN AS HOLLERS, WHERE IMMIGRANT FAMILIES FIRST SETTLED AND THEIR DESCENDANTS STAYED FOR GENERATIONS.

IT'S ALSO KNOWN FOR EXCEEDINGLY HIGH RATES OF C.O.P.D.

AND ASTHMA.

TWICE AS HIGH AS THE STATE AVERAGE.

SHARMIN CHAPMAN CRANE WHO LIVES IN LETCHER COUNTY IS ONE OF THE PEOPLE REPRESENTED IN THOSE STATISTICS.

SHE AND OTHER COMMUNITY MEMBERS HAVE BEEN CONCERNED ABOUT AIR QUALITY AND THE POSSIBLE IMPACT OF SURFACE COAL MINING FOR YEARS.

>> I'VE HAD ASTHMA FOR ABOUT 14 YEARS.

AND THAT STARTED WHEN THEY STARTED BLOWING UP BLACK MOUNTAIN ABOVE US.

WHEN THEY WERE DOING MOUNTAIN TON REMOVAL, THEY WOULD SET OFF THESE BLASTS DURING THE DAY AND ALL OF A SUDDEN, THE AIR WAS JUST FILLED WITH SILT IN THE WINTER TIME THE SNOW WOULD BE WHITE ONE MOMENT AND AFTER A BLAST, IT WOULD BE BROWN.

ALARMINGLY HIGH RATES OF RESPIRATORY DISEASE IN EASTERN KENTUCKY BUT WE ALSO HAVE ALARMINGLY HIGH RATE OF SMOKING STILL EVEN NOW.

AND WHICH IS REALLY DISTURBING.

SO THAT'S A LARGE PART OF IT.

BUT THE LEVEL OF C.O.P.D.

IN ASTHMA THAT YOU SEE MAKES YOU THINK, WELL,WHAT ELSE IS GOING ON?

IT'S EVEN BEYOND THE LEVEL THAT JUST SMOKING COULD EXPLAIN IT.

>> Renee: MEANWHILE, RESEARCHERS IN THE COLLEGE OF PUBLIC HEALTH AT THE UNIVERSITY OF KENTUCKY WERE ALSO ASKING THE SAME QUESTIONS.

AFTER MEETING WITH LOCAL COMMUNITY MEMBERS RIGHT ON SHARMIN'S PORCH, THE MOUNTAIN AIR PROJECT WAS BORN.

THE STUDY WOULD EXAMINE THE ENVIRONMENTAL FACTORS CONTRIBUTING TO LUNG DISEASE IN THE REGION.

I SPOKE WITH STEVE BROWNING, ONE OF THE LEAD INVESTIGATORS OF THE MOUNTAIN AIR PROJECT ABOUT HOW THEY CAREFULLY TAILORED THEIR STUDY TO THE REGION.

SO TALK TO US ABOUT THE BASIC DESIGN OF THE STUDY.

GIVE US KIND OF THE MECHANICS OF HOW IT WORKED.

>> IT WAS IMPORTANT FOR US TO SELECT DIFFERENT AREAS WITHIN THE COUNTY SO THAT WE WERE PICKING PEOPLE FROM OUTSIDE OF THE TOWNS AND OUT IN THE MOST RURAL AREAS AND DOWN IN SOME OF THE HOLLERS AND SO WE REALLY KIND OF SEPARATED OUT THE COUNTIES BY THE SMALL GEOGRAPHIC UNITS WE CALLED HOLLERS AND SAMPLED FROM THOSE IN DIFFERENT HOLLERS HAVE LOTS OF MINING OR LESS MINING AND DIVERSITY OF ENVIRONMENTAL EXPOSURES AND WE DID A SURVEY, 970 PEOPLE FROM NEARLY A THOUSAND PEOPLE PARTICIPATED IN THE STUDY AND WE WENT INTO THE HOMES AND WE DID THE 40 MINUTE INTERVIEW YOU IN THE HOMES WE ALSO TOOK SPECTROMETRY, LUNG FUNCTION BECAUSE A LOT OF LUNG DISEASE TENDS TO BE UNDIAGNOSES AND A SUBSAMPLE OF THE HOMES, WE DID A FULL SCALE WORKUP OF EXPOSURE TO PARTICULATES, AIR POLLUTANTS, LOOKED AT MOLD ISSUES AND OTHER ISSUES LIKE THAT SO WE HAD A SENSE OF HOW HOUSING MIGHT IMPACT SOME OF THE RESPIRATORY CONDITIONS AS WELL THE STUDY IMPLORED LOCAL COMMUNITY MEMBERS TO KNOCK ON DOORS AND RECRUIT RESIDENTS.

HAVING A LOCAL PERSON DOING THE RECRUITMENT MADE ALL THE DIFFERENCES.

>> DARLENE WAS OUR ACE RECRUITER AND SHE KNOCKED ON DOORS AND ASKED PEOPLE, SOME WHO KNEW HER AND SOME WHO DIDN'T, IF THEY WANTED TO BE IN A RESEARCH STUDY LOOKING AT RESPIRATORY DISEASE AND 82% OF THEM SAID YES.

IT WAS ASTOUNDING.

THEY KNEW AS WE WORKED WITH THEM WE HAD THEIR INTEREST AT HEART.

WE WEREN'T JUST COLLECTING DATA.

WE WERE OUT THERE TO HELP SO AS WOULD I GO TO HOUSES, I WAS SURPRISED URBAN COUNTIES HOUSE AFTER HOUSE, YES, WE HAVE ASTHMA EVERY DOOR IF THEY DIDN'T, THEY KNEW SOMEBODY WHO DID THEY HAD A FRIEND OR NEIGHBOR OR RELATIVE SUFFERING WITH A RESPIRATORY DISEASE.

>> Renee: FOR THE RESEARCHERS AT U.K., THE FOCUS ON HOLLERS YIELDED SOME NOVEL RESULTS IN THE STUDY TALK ABOUT THE FINDINGS AND WHAT IS SO IMPORTANT ABOUT THE DEEP DIVE AND HOW THEY'RE IMPACTED BY THEIR PROXIMITY TO ROADS, ET CETERA OR HOW THE AIR MAY BE TRAPPED INTO THEIR ENVIRONMENTS?

>> YEAH, THIS WAS A LITTLE BIT UNEXPECTED FOR US BECAUSE, YOU KNOW, IN LOOKING AT THE ASSOCIATION, PARTICULARLY BETWEEN ROAD DENSITY AND THESE HOLLERS, HOW MUCH ROADWAY EXPOSURE THEY HAD.

WE FOUND REALLY STRONG ASSOCIATIONS, PARTICULARLY WITH CURRENT ASTHMA.

SO PEOPLE THAT LIVED IN GEOGRAPHIC AREAS THAT HAD A LOT OF ROADS, A LOT OF TRAFFIC AND THEY WERE VERY NEAR THE HIGHWAY, HAD ASTHMA RISKS THAT WERE TWO OR MORE TIMES HIGHER THAN THOSE THAT WERE LESS SO AND WE TYPICALLY DON'T THINK OF RURAL AREAS AS BEING OR HAVING AIR POLLUTION TYPE OF PROBLEMS.

BUT WE THINK GEOGRAPHY IN THE HOLLERS THE WAY THE AIR MOVES AND THE MEASUREMENTS ON AIR PARTICULATES IS SOME TRAPPING OF HIGHER LEVELS OF PARTICULATES AROUND THERE.

THERE MAY BE NOVEL EXPOSURES FROM COAL TRUCKS GOING DOWN THE ROAD AND OTHER THINGS AND THIS MAY BE SOME OF THE RISKS WE SEE.

THE OTHER ISSUE WE FOUND WAS PUBLIC HOUSING AND MULTIFAMILY HOUSING UNITS SHOWED AN INCREASE RISK WITH ASTHMA AND THAT MAY VERY WELL BE RELATED TO THAT HOUSING STOCK, WOO ILL THEY'RE MAINTAINED WE KNOW THERE IS A LOT OF MOLD AND MILDEW AND SOMETIMES DANDER AND CLUTTER AND THINGS THAT CREATE HIGH INDOOR AIR POLLUTANT DEVELOPS.

>> Renee: WHAT DID YOU LEARN ABOUT THE HOOF ALL IMPACT OF COAL MINING?

>> FOR US AT LEAST WITHIN OUR DATA, WE STILL SEE OCCUPATIONAL EFFECT OF THE MEN IN OUR STUDY.

30% OF THE MEN THAT PARTICIPATED IN OUR STUDY HAD WORKED IN COAL MINES AND ABOUT 10% OF OUR POPULATION OF THE MEN HAD BLACK LUNG DISEASE.

WE THINK THE ENVIRONMENTAL IMPACT FROM COAL MINING, AT LEAST IN OUR PARTICULAR STUDY DID NOT SEE THAT AS STRONG AS SOME OF THE PREVIOUS STUDIES.

>> LET'S TALK ABOUT INDOOR AIR QUALITY.

WHAT ARE SOME OF THE BIGGEST PROBLEMS WHEN IT COMES TO INDOOR AIR QA ULT?

>> THE FACTOR THAT BEST PREDICTS PARTICULATE LEVELS, AIR POLLUTANT LEVELS IN THE HOUSE IS INDOOR SMOKING.

SMOKERS INCREASE SUBSTANTIALLY THE PARTICULATE LEVELS IN THE HOUSE.

SO JUST MOVING TO A ROLE OF SMOKING OUTSIDE WILL HAVE A BIG IMPACT.

FIGURING OUT WAYS TO TO BETTER VENTILATE YOUR HOME.

HAVING FANS THAT RUN CONTINUOUSLY AND THINGS DEHUMIDIFIERS THAT PULL THE MOISTURE OUT OF YOUR HOUSE, THAT WILL LOWER THE PARTICULATE LEVELS IN THE HOME AND THAT USUALLY HAS A BENEFICIAL EFFECT.

>> Renee: DO YOU FIND THAT PEOPLE DO THOSE TYPES OF THINGS.

>> IT'S VERY MUCH A MIXED BAG.

65% OF THE POPULATION OUT THERE HAS SOME SMOKERS IN THE HOME SO IT'S STILL VERY LARGE AND, YOU KNOW, OVERALL ABOUT 30% OF THE FOLKS IN OUR STUDY WERE STILL CURRENT SMOKERS.

SO CIGARETTE SMOKING STILL CREATES A HEALTH RISK FOR RESPIRATORY CONDITIONS REGARDLESS.

BUT IT IS CERTAINLY TRENDING IN THAT DIRECTION AND WE HAVE SEEN PARTICULARLY AMONG YOUNG PEOPLE AND KIDS AND WE HAVE DONE WORK WITH KIDS IN THESE COMMUNITIES, THEY'RE PUSHING THEIR PARENTS TO SMOKE OUTSIDE OR CUT DOWN THE AMOUNT THAT THEY SMOKE AND THAT'S ALL FOR THE GOOD.

>> Renee: CHILD SHALL LEAD THEM, HUH.

>> THAT'S TRUE.

>> Renee: TO ENGAGE YOUNG PEOPLE AROUND THE ISSUE OF RESPIRATORY HEALTH, THE RESEARCHERS AND COMMUNITY ADVISORY BOARD ENCOURAGE LOCAL YOUTH TO TAKE PICTURES OF THINGS IN THEIR ENVIRONMENT THAT COULD IMPACT SOMEONE'S LUNGS, A PROCESS CALLED PHOTOVOICE.

THEY THEN HEAD A HAD A PUBLIC DISPLAY OF THE VOTES.

>> IT WAS AMAZING SOME OF THE PHOTOGRAPHS, YOU CAN LOOK AT AND YOU CAN SEE THAT THEY CHOSE THINGS THAT MOST OF US WOULD NOT HAVE THOUGHT OF.

>> I THINK THE PHOTOGRAPHS HELP LIKE POINT OUT THE ISSUES AND I THINK IT SHOWED, WAS ABLE TO LIKE HELP PEOPLE WHO DON'T REALLY HAVE-- CAN'T REALLY DESCRIBE IT, LIKE THEY TOOK A PICTURE, THIS IS WHY IT'S BAD THIS IS WHAT WE ARE BREATHING IN.

>> Renee: TOO OFTEN RESEARCHERS COME TO AN AREA, GET THEIR DATA AND LEAVE.

BUT THE MOUNTAIN AIR PROJECT HAD AND ACTION COMPONENT AS WELL.

AFTER DISCOVERING THE HIGH RATES OF ASTHMA IN PEOPLE WHO LIVE IN PUBLIC HOUSING THE TEAM SENT VISITING NURSES TO PROVIDE ASTHMA CARE AND EDUCATION TO RESIDENTS.

UTILIZING THE SERVICES OF LOCAL HOUSING NON-PROFITS, PROVIDED HEALTHY HOME INSPECTIONS AND GREEN CLEANING KITS.

>> IT'S, IF YOU LOOK DOWN HERE, IT TELLS YOU ITS ABILITY TO GET ALLERGENS.

>> IT TEAMS LIKE ONE OF THE BIGGEST THINGS WE LEARNED DO YOU REMEMBER WITH OUR WORK IS THAT EDUCATION IS IMPORTANT.

NOT JUST FIXING A PROBLEM.

WE COULD SHOW AND TELL WHAT THE PROBLEM WAS AND MAYBE HOW TO ELIMINATE BUT THEN THERE WAS EDUCATION THAT HAPPENED.

IT WILL HAPPEN AGAIN.

THERE WILL BE ANOTHER LEAK AND NOT TO LET THAT GO AND CREATE MOLD AND MILDEW AND IF YOU SEE MOLD OR MILL MILDEW, IT HAS TO BE TAKEN CARE OF QUICKLY.

THE EDUCATION ASPECT IS ONE OF THE SUCCESS GLRS THE MOUNTAIN AIR PROJECT HAS PUBLISHED NUMEROUS PROFESSIONAL PAPERS AND MORE ARE UNDER WAY.

FOR THE WOMEN ON SHARMIN'S FRONT PORCH, MUCH GOOD HAS ALREADY BEEN DONE.

I THINK I HAVE ALWAYS BELIEVED THE ANSWERS TO THE PROBLEMS IN THE COMMUNITY ARE RIGHT THERE IN THE COMMUNITY IF THEY CAN JUST GET MOBILIZED.

BUT I THINK BEFORE THIS I WOULDN'T HAVE THOUGHT RESEARCH IS ONE OF THE IMPORTANT TOOLS FOR MAKING THAT HAPPEN.

>> Renee: THE DATA FROM THE MOUNTAIN AIR PROJECT WILL HELP HEALTH ADVOCATES AND EXPERTS DEVISE STRATEGIES AND PLANS FOR LOWERING THE BURDEN OF LUNG DISEASE IN THE REGION.

THAT'S IT FOR THIS EPISODE OF FIGHTING TO BREATHE.

REMEMBER, THAT ANYONE WITH LUNGS CAN GET LUNG DISEASE.

CLEAN AIR IS ESSENTIAL TO LIFE AND IS SOMETHING WE ALL SHOULD BE FIGHTING FOR BOTH FOR OURSELVES AND OUR FELLOW CITIZENS.

PLEASE VISIT OUR WEBSITE AT ket.org/RESPIRATORY FOR MORE INFORMATION AND TO WATCH AN ARCHIVED VERSION OF THIS PROGRAM.

THANK YOU SO MUCH FOR JOINING US.