What we eat, what we breathe: a collaborative fight for better breathing

2026: ERS Barcelona

ERS KOLS

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The session was an impactful demonstration of how our eating influences both the air we breathe, and how healthily we breathe. It covered all from the impact of diet, malnutrition and obesity and its influence on respiratory health of the individual, to the societal impact of food production and agriculture on ambient air and use of slash-and-burn agriculture.  

It was also made clear that the total exposome, i.e. the sum of all exposures, must be taken into account.

What’s on your 30 tonne lifespan plate?

Raphaëlle Varrasco, France, underlined why diet should be considered a major component to improve respiratory and planetary health. Each person on earth is expected to eat an average of five elephants (30 tons) of food during her lifespan. It is widely accepted that for example an anti-inflammatory diet high in antioxidants and fibre helps regulate the immune system, modulates the gut microbiota, and reduces oxidative stress to the cells. Positive effects on respiratory health have been demonstrated, both in asthma and COPD.¹ Generally, and probably to no one´s surprise, a healthy plant-based diet with low proportion of ultra-processed food is recommended.

The particulate matter of agriculture

From the next speaker, Lidwien Smit, The Netherlands, we learned how global food systems contribute to climate change and influence the exposome for all of us. It is estimated that 30% of all greenhouse gas emissions are related to global food systems,² also affecting atmospheric aerosol loading, availability of freshwater, and the introduction of novel entities such as pesticides and antimicrobials. Agriculture has been shown to sign responsible to more than half of all release of PM_2.5, ammonia and nitric oxides, all with well documented impact on respiratory health. There is much to win here: If agricultural emissions would be reduced by 50%, a reduction in mortality caused by PM_2.5 of 19% is predicted.³

Climate change will contribute to more undernutrition and poverty.

Obianuju Ozoh, Nigeria, presented the consequences under- and malnutrition can have on respiratory health. She showed studies demonstrating malnutrition to occur in 20-50% of children in Uganda.⁴ Also, uncontrolled asthma is the norm, occurring in 80% of patients, and mortality due to asthma is three times the numbers seen in the UK.⁵ Due to cooking over wood- or charcoal fires, the way food is prepared directly adds to the exposome and amplifies incidences of COPD and respiratory symptoms.⁶

Malnutrition can affect lung health before birth: the fetal lung development in utero is dependent on vitamin A and D, and even after birth, sufficient levels of vitamin C, omega-3 fatty acids amongst other factors impacts the lung health trajectory of the babies, influencing the lifelong susceptibility to asthma.⁷ Malnutrition in pregnancy also increases the risk for preterm birth associated with the development of asthma, higher airway resistance, poorer lung function, and an increase in respiratory compliance.

The consequences of undernutrition were prominent when following up on survivors from the Chinese famine in 1959-62. When exposed in utero, a higher incidences of asthma was seen later in life. If exposed during school age, a higher likelihood to develop COPD was described.⁸ No impact on lung health was detected in those in preschool at the time of the famine, possibly due to an opportunity to catch-up in lung growth in this phase of lung development.

Exercise:

helps preserve muscle mass, improves exercise capacity and may contribute to better respiratory disease-specific outcomes.⁹

Rethinking obesity in respiratory disease

Felipe Machado, Belgium, asked the audience to rethink obesity in respiratory disease: Excess adiposity, fat distribution, body composition, and clinical severity need to be considered to better characterise obesity in chronic respiratory disease. Obesity and sarcopenic obesity are associated with poorer physical function and may identify a more clinically impaired phenotype of persons living with disease. Exercise is part of obesity management since it supports fat loss, helps preserve muscle mass, improves exercise capacity, and may contribute to better respiratory disease-specific outcomes.⁹

Weight loss has also been shown to improve symptoms from COPD in obese persons.¹⁰ This was also notable for a New York fire fighter, who shared his perspective in a prerecorded patient testimony. He had developed asthma after breathing in what he called “toxic air and dust” after the attacks on the world trade centres in 2001. Losing weight by choosing food that is “healthy rather than tasty” and exercising led to improvements in his lung health- incremental when they occur, but profound in hindsight. The patient underlined that the good relationship and personal connection with his treating physician was crucial for his improvement in respiratory symptoms. “My physician made it his personal objective to make me feel better.”

24280-09.09.2026