Things that may help with COPD and Asthma.

This is not medical advice I am posting this for educational and informational purposes.

There are many causes of COPD such as smoking , breathing in excess particles, vaccine injury esepcially the Covid vaccines. Things that can caused increased fibroid build up such as infection can cause COPD this is why COPD rates on higher in those with Lyme disease. They heal from it you need to get away from what is causing it or correct the health issues causing it.

Many of these things will help with asthma also because they reduce inflammation and histamines. Oxidative stress is a major cause of chronic illness including COPD.

http://erj.ersjournals.com/content/39/6/1368

Excess Oxidative stress leads to chronic illness there is a test to see if you have excess oxidative stress. If you do not get it resolved you cannot heal.

https://www.sciencedirect.com/science/article/pii/S0009898103004534

There are other test that can help identify which areas of the anti-oxidant system are working and which may not be working. This can help identify the sources of high ROS levels or other toxins produced in the body from oxidative stress.

https://drjockers.com/oxidative-stress-test/

So far this is what they know about asthma and allergies. I have looked at many studies on allergies and asthma and I do not know why they do not see it but in all the studies the cytokines they mention are stimulated by inflammation. Which indicates there is a problem that needs addressed and asthma is a symptom not the cause. It seems the thing to do now days though is to look at the symptoms and not the cause. What has happened to science that has caused them to become blind to the whole picture? They only look at symptoms and how to treat them instead of trying to find the cause.  I compare that to having a flat tire. The air continually leaks out. Instead of trying to find why the air leaks out you try to figure out how to prevent the air leaking out without addressing the cause. Wouldn’t it be easier to find the cause of the leaking air and repair it if possible?

https://www.atsjournals.org/doi/full/10.1164/ajrccm.164.supplement_1.2103024

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5800381/

When someone does figure out what the problem is they seem to go to extremes to solve the problem. Instead of looking for the cause of the inflammation they try to figure out how to prevent the inflammation. As with the flat tire, would it not be easier to find the cause like maybe a leaky valve stem or a nail in the tire and patch the tire or replace the valve stem. There are many causes of inflammation, heavy metals, an imbalance in Omega 3 and Omega 6 fatty acids. Diets are too high in Omega 6 now days and Omega 3 levels need to be higher then Omega 6.  Over consumption of processed sugar causes inflammation. Infection can cause inflammation. Also it can be caused by vaccine injury that causes a T cell imbalance. The list of causes goes on and on.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5698748/

https://www.achooallergy.com/learning/chronic-inflammation-chronic-disease/

Those who use inhaled steroids are at greater risk for pneumonia.

https://www.sciencedaily.com/releases/2007/07/070716132725.htm

Things that can cause COPD.

https://www.wellnessresources.com/news/copd-protecting-the-lung-mitochondria-and-microbiome

Many get misdiagnosed with COPD

http://www.domorewithoxygen.com/bid/299769/Research-Suggests-COPD-Misdiagnosed-in-40-Percent-of-Patients

https://patient.info/health/bronchiectasis-leaflet

Lyme can be mistaken for COPD

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2898701/

The lungs have the ability to regenerate.

https://www.sciencedaily.com/releases/2014/11/141112132105.htm

Antitrypson and COPD

http://www.sciencedirect.com/science/article/pii/S0954611111000515

Lactoferrin helps COPD. Trypase is high in those with liver fribrosis and COPD. Lactoferrin is a trypase inhibitor.

http://www.atsjournals.org/doi/full/10.1164/ajrccm.156.2.9607012

https://www.atsjournals.org/doi/full/10.1164/ajrccm.156.2.9607012

It is also an ACE inhibitor.

http://pubs.rsc.org/en/Content/ArticleLanding/2015/FO/C5FO00580A#!divAbstract

NAC helps COPD

http://err.ersjournals.com/content/24/137/451.long

We need cholesterol for healthy lungs.

https://www.sciencedaily.com/releases/2017/06/170601095333.htm

TH17 imbalance cause lung inflammation. I covered balancing TH17 in my post on the immune system. High TH17 levels are an indication of inflammation and mast cell activation syndrome.

http://www.annualreviews.org/doi/abs/10.1146/annurev-pathol-011110-130318

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5353957/

https://www.ncbi.nlm.nih.gov/pubmed/27373322

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2995967/

Substance P causes inflammation in the lungs. There are a few naturals that reduce it. http://www.alliedacademies.org/articles/effect-of-tripterygium-wilfordii-on-lpsinduced-acute-lung-injury-andquantitative-determination-of-its-active-constituents.html

Vaccinations can cause lung inflammation which can lead to COPD.

http://jvi.asm.org/content/77/18/9831.short

https://www.ncbi.nlm.nih.gov/pubmed/6335351

https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1365-2796.2010.02285.x

http://erj.ersjournals.com/content/41/2/474.long

COPD can be caused by a B Cells

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5142126/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4595676/

Early stage COPD have low B cell count and later stage COPD have higher B Cell counts.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5142126/

How to increase or decrease B cells.

https://www.selfhacked.com/blog/intro-natural-killer-cells-increase-decrease/

Green tea suppresses B cells but should not be used everyday. Studies have shown if used everyday it will raise histamine levels.

http://www.annclinlabsci.org/content/40/2/135.full

There is evidence that COPD is an autoimmune disorder.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4897000/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4226027/

Leptin is increased in the lungs of those with COPD

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3947045/

Many with COPD have metabolic issues that need addressed.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4171881/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3376391/

There are natural things you can do that will help.

https://www.betternutrition.com/ask-the-naturopath/drug-free-solutions-symptoms-chronic-obstructive-pulmonary-disease

https://lunginstitute.com/blog/6-natural-treatments-for-copd/

https://www.hindawi.com/journals/mi/2016/2348968/

Vitamin A has been shown to dramatically improve the health of the lungs in those with COPD.

https://www.healthy-holistic-living.com/common-plant-compound-found-reverse-lung-damage-associated-copd.html

I find it strange that those who have COPD have the same cytokine issues as those who are vaccine injured.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4010626/

Vitamin D deficiency is prevalent in COPD.

https://respiratory-research.biomedcentral.com/articles/10.1186/1465-9921-12-31

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4802087/

Methods of increasing oxygen levels.

http://www.myhdiet.com/healthnews/ampm/14-ways-give-oxygen-rich-blood/

Serrapeptase helps with mucous clearance. Serrapeptase also helps the body break down and remove scar tissue and calcium deposites.

https://www.ncbi.nlm.nih.gov/pubmed/?term=serrapeptase+copd

Propolis has been found to stimulate lung repair in mice.

https://www.ncbi.nlm.nih.gov/pubmed/28886998

Those with COPD have excess oxidative stress. So finding the cause and correcting it is a must. It can be caused by infections, toxins, or even stress itself.

https://www.ncbi.nlm.nih.gov/pubmed/11977322

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3628643/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3376391/

Gensing helps with COPD .

https://www.ncbi.nlm.nih.gov/pubmed/12814035

Iodized charcoal helps with COPD.

http://www.resmedjournal.com/article/S0954-6111(14)00106-1/fulltext

L-carnitine helps with muscle fatigue.

https://www.ncbi.nlm.nih.gov/pubmed/16612469

Aerobic exercise helps.

https://www.ncbi.nlm.nih.gov/pubmed/27358285

Resveratrol helps with COPD by reducing inflammation.

https://www.ncbi.nlm.nih.gov/pubmed/14586044

https://www.ncbi.nlm.nih.gov/pubmed/18264679

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1746526/

Quercitin also helps by reducing inflammation.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4838123/

https://link.springer.com/article/10.1007%2Fs10637-008-9114-7

Inflammation can effect the whole body not just the lungs.

https://www.livescience.com/52344-inflammation.html

There are many other naturals that help with COPD in a variety of ways.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3936423/

Spirulina helps by reducing oxidative stress. But should not be used if you have sulfation issues. Address the sulfation issues first, which could also be the cause of COPD.

https://www.ncbi.nlm.nih.gov/pubmed/25685791

https://www.ncbi.nlm.nih.gov/pubmed/28182098

Probiotics may help to reduce COPD symptoms.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5626249/

https://www.ncbi.nlm.nih.gov/pubmed/25256637

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4674690/

There are many similarities between COPD and IBD showing the importance in gut help in order to heal.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5016372/

A lack of certain gut bacteria makes us prone to fungal infection and has been found to be prevalent in those with COPD.

https://mrmjournal.biomedcentral.com/articles/10.1186/2049-6958-8-59

There is an association between our gut bacteria and our lung health.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4674690/

Taurine helps restore mitochondrial function in the lungs.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5692577/

Pycogenol helps with COPD by suppressing the fibrin response.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5527150/

Rooibos helps because it is a bronchial dilator.

http://www.greenmedinfo.com/article/rooibos-tea-may-have-therapeutic-potential-treating-congestive-respiratory-ailments-due-its

Those with COPD have high oxidative stress levels.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3628643/

Plantain herb helps with COPD by reducing ROS.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3924996/

Lobelia helps fight fungul infections which those whith COPD are prone to. Must be used cautiously. There is an alkaloid similar to nicotine only it is not addictive but just as you can overdose on nicotine you can also overdose on lobelia. Many have used it to quit smoking.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5611621/

It also helps with nicotine addiction.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3725992/

Those with COPD often times have CBS issues. This effects the sulfite levels in the body. When they are high we develop inflammation and our cell will not have the ability to function properly. I have posted on sulfation.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3822510/

Metabolic issues that cause CBS issues.

https://metabolichealing.com/cbs-mutations-regulations-new-observations-insights/

https://genomeinterpretation.org/content/CBS

Reducing oxalates has been shown to reduce COPD

https://www.ncbi.nlm.nih.gov/pubmed/17526194

https://drjockers.com/could-you-benefit-from-a-low-oxalate-diet/

High oxalates can be cause by sulfation issues.

http://www.lowoxalate.info/research.html

There are things that help the lungs to repair

https://lunginstitute.com/blog/recipes-for-lung-detox/

https://theheartysoul.com/best-herbs-for-lung-health/

https://www.sciencedaily.com/releases/2014/11/141112132105.htm

RAGE is increased in COPD natural ACE inhibitors may helps.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3504985/

ACE contribute to fibrosis.

https://www.ncbi.nlm.nih.gov/pubmed/29202450

Some natural Ace inhibitors.

https://www.ncbi.nlm.nih.gov/pubmed/27655074

Celery seed helps COPD.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4080197/

There are many natural ACE inhibitors.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3896793/

Gouda Cheese is an ACE inhibitor.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4976624/

Sunflower seeds are ACE inhibitors.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5622016/

Black Rice is an ACE inhibitor.

https://www.researchgate.net/publication/241096489_Phenolic_compounds_in_raw_and_cooked_rice_Oryza_sativa_L_and_their_inhibitory_effect_on_the_activity_of_angiotensin_I-converting_enzyme

Rice Bran is an ACE inhibitor.

http://www.sciencedirect.com/science/article/pii/S0023643816305333

Tuna is an ACE inhibitor.

https://www.ncbi.nlm.nih.gov/pubmed/2614645

Seems a number of fish have ACE inhibiting properties.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2866476/

Peas are ace inhibitors.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4163438/

Pomegranate is an ACE inhibitor.

https://www.ncbi.nlm.nih.gov/pubmed/11500191

Lactoferrin is an ACE inhibitor

https://www.ncbi.nlm.nih.gov/pubmed/26130265

Good article on COPD.

https://www.wellnessresources.com/news/copd-protecting-the-lung-mitochondria-and-microbiome

Melatonin helps reduce COPD symptoms.

https://www.ncbi.nlm.nih.gov/pubmed/25388990

Black Sativa helps the lungs heal. Black Sativa is amazing it helps many things heal.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3642442/

I have posted on acidosis, if you have acidosis you will have brain fog, tunnel vision, depression and will feel tired often. It can damage the lungs and many other things in the body.

https://www.merckmanuals.com/home/hormonal-and-metabolic-disorders/acid-base-balance/acidosis

Magnesium has been found to be low in those with COPD. So has vitamin D.

https://www.ncbi.nlm.nih.gov/pubmed/11977322

https://academic.oup.com/advances/article/7/1/25/4524034

Cat’s Claw helps with COPD.

https://www.sciencedirect.com/science/article/pii/S0378874117334566?via%3Dihub

Insulin resistance is common in COPD, this is a sign of metabolic issues that need addressed.

https://thorax.bmj.com/content/64/10/830

http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0186708

Olive leaf extract helps with insulin resistance.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3596374/

Breathing exercises that help.

https://www.copdfoundation.org/Learn-More/I-am-a-Person-with-COPD/Breathing-Techniques.aspx

https://www.normalbreathing.com/learn-8-diaphragmatic-breathing.php

Didn’t get to research this lung disorder much , it is when someone is coughing up too much mucous.

https://patient.info/health/bronchiectasis-leaflet

C-reactive protein may be high in those who are ill. It can dramatically negatively impact our health so we need to work on reducing inflammation, which means we need to address the cause whether it is toxins, infection, stress, nutrient deficiencies or metabolic issues.

https://www.healthline.com/health/c-reactive-protein#high-crp-levels

https://translational-medicine.biomedcentral.com/articles/10.1186/s12967-018-1381-2

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4897000/

I believe the clinical trials failed when they tried to reduce inflammation in COPD patients is because they where treating the symptoms and not the cause of the inflammation which is a common theme in allopathic medicine. They cannot distinguish the symptoms from the cause. They view the symptoms as the cause.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4010626/

Naturals have been shown to be effective against inflammation in COPD

https://www.hindawi.com/journals/mi/2016/2348968/

Those with COPD are at risk for type 2 diabetes which indicates a metabolic issue and excess oxidative stress.

https://cardiab.biomedcentral.com/articles/10.1186/1475-2840-11-132

There are infections that can cause lung issues. If not diagnose in time it can result in death. I did a post on the immune system. There are ways to keep it healthy and strong.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4309303/

Infections can be the cause of COPD

https://www.tandfonline.com/doi/abs/10.3109/15412555.2013.814625?journalCode=icop20

A ketogenic diet seems to help COPD but I do not recommend staying on it and those with type 1 diabetes should not fast or try a ketogenic diet.

https://copdathlete.com/copd-news/copd-bio-hacking/

Diosmetin found in the white part of citrus fruit helps with COPD.

https://www.sciencedirect.com/science/article/pii/S0024320516302442?via%3Dihub

Thunder God vine has been shown to help with COPD.

http://www.alliedacademies.org/articles/effect-of-tripterygium-wilfordii-on-lpsinduced-acute-lung-injury-andquantitative-determination-of-its-active-constituents.html

resveratrol found in grape seed extract and genistein help with COPD.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4838123/

Purslane helps with asthma.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5316266/

They test for Nitric Oxide in the breath of those with asthma. This should set alarms off in their heads that there is excess nitrosative stress. I have posted on this. This indicates a problem that needs addressed but allopathic medicine only looks at the symptoms they do not look for the cause. Makes me believe they do not want to cure people. There is no money in a healthy patient. A healthy patient is a lost customer.

https://www.gpnotebook.co.uk/simplepage.cfm?ID=x20140421075131216972

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1906415/

Inhibiting PAI-1 helps reduce the fibrosis in COPD.

Other methods of reducing fibrosis.

https://www.frontiersin.org/articles/10.3389/fphar.2017.00318/full

http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0148969

Pine Bark Extract helps with fiborsis.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5527150/

Carnitine helps increase endurance in COPD.

http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0100-879X2006000400006&lng=en&nrm=iso&tlng=en

Muscle strengthening helps with COPD.

http://journals.sagepub.com/doi/abs/10.1177/1742395316657399?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dpubmed

Celery helps with memory impairment caused by oxygen deprivation.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4080197/

If endothelians are high it can cause lung issues.

https://www.selfhacked.com/blog/endothelins/?utm_source=ActiveCampaign&utm_medium=email&utm_content=The+Latest+From+SelfHacked&utm_campaign=Jan282018+Newsletter

High HSP90 levels contribute to COPD. I am posting on HSP.

http://erj.ersjournals.com/content/51/2/1700386.long

Hawthorne leaves and berries have many health benefits they also help reduce lung inflammation.

https://link.springer.com/article/10.1007%2Fs10753-014-9863-8

It also helps regulate the antioxidant response.

https://onlinelibrary.wiley.com/doi/abs/10.1002/ptr.5035

https://link.springer.com/article/10.1007%2Fs12010-013-0667-3

https://journals.lww.com/cardiovascularpharm/Abstract/2013/08000/Effects_of_Selected_Bioactive_Natural_Products_on.1.aspx

Beta glucan protects from fibrosis which is found in COPD and NAFLD.

https://www.europeanreview.org/article/8816

Whey protein increases strength and muscle mass.

http://www.mdpi.com/2072-6643/10/5/563

Elevated Angiotensin Converting Enzyme is high in COPD. Inflammation can cause high ACE levels.

https://insight.jci.org/articles/view/91923

https://thorax.bmj.com/content/58/7/556

https://bmjopenrespres.bmj.com/content/4/1/e000165

ACE inhibitors have been shown to improve the outcome in those with COPD. There are many natural ACE inhibitors that I have posted about in my hypertension post.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3724277/

Thiocyanate deficiency can cause COPD, this can be cause by metabolic issues especially those involved with cholesterol and sulfation. I have posted on thiols and sulfation.

http://www.pnas.org/content/106/48/20515.long

We do not want to get too much thiocyanate because it can interfere with iodine.

http://renegadehealth.com/blog/2016/10/21/are-you-the-unwary-victim-of-thiocyanates

NAD+ may help with COPD but I would do it in moderation.

http://www.iosrjournals.org/iosr-jpbs/papers/Vol10-issue3/Version-4/O010348688.pdf

https://benthamopen.com/contents/pdf/TOIJ/TOIJ-2-42.pdf

http://www.anti-agingfirewalls.com/2014/11/11/nad-an-emerging-framework-for-life-extension-part-1-the-nad-world-2/

Nrf2 is a target for COPD. I have posted on the Nrf2 in my post on oxidative stress.

https://www.nrf2.com/reversal-persistent-fibrosis-aging-targeting-nox4-nrf2-redox-imbalance-sciencemag-org/

Trelahose reduces oxidative stress by regulating Nrf2/keap1 pathway.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5730428/

Gut bacteria and COPD

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4674690/

Ginseng helps with COPD by reducing oxidative stress.

https://www.sciencedirect.com/science/article/pii/S0965229914001344

The lungs can regenerate.

https://www.nature.com/articles/nature13903

Things we inhale cause COPD by raising the warning signaling hormone Cathepsin B which causes inflammation.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2834784/

There are natural Cathepsin inhibitors but have not found studies on their effectiveness.

https://www.sciencedirect.com/science/article/pii/B9780444637499000062

https://www.omicsonline.org/open-access/cathepsin-b-inhibitors-for-targeted-cancer-therapy-1948-5956.1000302.php?aid=32883

Vaccine injury can cause COPD

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5337467/

Lipoxin reduces inflammation which should help with COPD. I have not had a chance to research how to increase lipoxin.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4598198/

Grape Seed extract prevents airway inflammation.

https://www.ncbi.nlm.nih.gov/pubmed/25920255

Antitrypsin deficiency causes COPD. Raw egg whites and Lima beans inhibit trypsin but I do not know if it will help , I could not find research on humans. There are studies on mice showing the effectiveness of beans that contain trypsin inhibitors being effective. There also also studies showing the trypsin inhibitors fight cancer.

http://err.ersjournals.com/content/24/135/52

https://www.sciencedirect.com/science/article/pii/S0271531715002808

https://www.hindawi.com/journals/bmri/2010/219793/

Lysinuric protein intolerance can cause COPD. This causes high ammonia levels. I did a post on proteinuria it should help with this.

https://ghr.nlm.nih.gov/condition/lysinuric-protein-intolerance

Those with COPD have a cholecystiokinin deficiency. This is a sign of inhibited macrophagy.

https://www.hindawi.com/journals/mi/2018/1309746/

Snail1 involvement in COPD also pointing to an issues with macrophagy.

https://www.ncbi.nlm.nih.gov/pubmed/?term=snail1+copd

Macrophagy issue also cause lipogenesis issues.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6108423/

https://respiratory-research.biomedcentral.com/articles/10.1186/s12931-017-0560-7

Glycolysis issues and in indication of inhibited macrophay and sure enough those with COPD have glycolysis issues.

https://onlinelibrary.wiley.com/doi/abs/10.1002/ibd.21388

Lysosomal issues are a sign of inhibited macrophagy.

http://erj.ersjournals.com/content/50/suppl_61/OA507

Covid vaccines COPD

https://pubmed.ncbi.nlm.nih.gov/34580010/

https://pubmed.ncbi.nlm.nih.gov/35355663/

https://pubmed.ncbi.nlm.nih.gov/35223425/

https://thorax.bmj.com/content/77/1/9

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