Tennessee guide to lung health: how to manage common challenges

image of lungs and stethoscope

Lungs are an organ we typically forget about unless there’s a problem. But as Tennesseans, there are several extra things we need to consider when it comes to lung health.

“In Tennessee, we’re more likely to have occupational and geographical exposures that can affect our lungs,” says Dr. Ian Bushell, a family medicine physician and medical director for BlueCross BlueShield of Tennessee.

“In East Tennessee and Southwest Virginia, for example, coal miners may experience black lung disease, which occurs when coal dust is inhaled over time. That causes scarring in the lungs and can impair your ability to breathe. We also need to be on the lookout for radon, a cancer-causing gas that’s emitted by underground rocks, which are common in many parts of Tennessee.”

Here are some crucial things Tennesseans need to know now about lung health.

What are the most common issues people in Tennessee have with lung health?

Dr. Bushell: In Tennessee, the most common challenges are cancer, asthma and COPD.

1. Lung cancer 

Tennessee is one of the top 5 states in the nation for new diagnoses of lung cancer. Tennessee also ranks below average for survival, and for catching lung cancer early among the Black community.

In the U.S., lung cancer is caused most often by smoking. The #2 cause, however, is radon, which is a naturally-occurring radioactive gas. As I mentioned, Tennessee has a high prevalence of radon gas because of the rocky terrain and mountainous air. It takes about 10 years of living somewhere that radon gas exists to increase your lung-cancer risk. If you are a smoker living with radon gas exposure, you’ll have a much higher risk of lung cancer due to the combined effects.

Make sure you test for radon when you buy or rent your house, especially if it has a crawl space or basement that’s open to dirt or rock, if it’s an older home, or if the concrete slab isn’t sealed completely from the ground. The tests can be a little pricey — a couple hundred dollars — but it’s worth it to know you’re not exposing your family to cancer-causing gas. And if you have testing done while buying a home and the result is positive, the seller will typically pay for the necessary ventilation system.

EPA Map of Radon Zones

Tennessee radon zones map

 Zone 1 has the highest radon levels (red) while zone 3 has the lowest (yellow).

2. Asthma 

More than half a million Tennesseans live with asthma, a chronic respiratory condition in which the tubes that carry air to and from your lungs are hyperresponsive. They overreact to stimuli, which causes inflammation, increased mucus production and airflow obstruction.

Asthma is typically diagnosed in young kids and may carry into adulthood. However, if you start experiencing asthma symptoms in your 30s or later, see a doctor as soon as you can.

Asthma guide: Causes, triggers & how COVID-19 factors in


Tennessee has one of the highest rates of chronic obstructive pulmonary disease (COPD) in the country. COPD refers to several diseases that restrict air flow and cause trouble breathing, including emphysema and chronic bronchitis.

Because COPD comes on gradually and worsens over time, many people don’t notice the symptoms until it’s too late, which is why Tennessee also has one of the highest mortality rates from COPD.

What is COPD? A guide to chronic obstructive pulmonary disease + 5 tips to manage it

What symptoms indicate lung problems?

Dr. Bushell: Talk to your provider if you experience:

Noise when you breathe 

While asthma sometimes causes a wheeze — meaning you can hear the air leave your body — breathing should actually be a silent process. If you clear your throat with a simple cough and still hear a noise when you breathe, see your provider.

Chronic cough that persists for several days

A cough, whether it’s productive or not, is not normal. It could be caused by something as simple as allergies or acid reflux, but it’s always better to get it checked early.

Shortness of breath

Shortness of breath happens when you can’t take a deep breath, or when you can’t catch your breath while doing activities you used to do easily. For example, if breathing becomes difficult while climbing stairs, that’s the kind of change it’s worth asking a professional to evaluate.

What should you do if you have these symptoms?

Dr. Bushell: Go to your primary care physician and tell them about it.

I think the biggest thing people need to know is that tests for lung conditions don’t hurt! A doctor can learn so much just by listening to your lungs with a stethoscope and doing noninvasive lab testing.

Most people delay getting simple workups because they’re afraid the results will be something scary. It’s easy for us to deny our own health, but think about it this way: If your child or significant other had these symptoms, what would you do? Follow that advice.

What kinds of lung tests might a provider run?

Dr. Bushell: After a provider listens to your lungs, they might use a:

  • Pulse oximeter, a device that checks blood oxygen by painlessly resting on your fingertip
  • Chest X-ray to ensure you’re clear of any infection
  • CAT scan, especially if you’ve smoked for many years and they need to see all parts of your lungs

Again, none of these tests hurt! The pulse oximeter is actually something you can get online for $10-15 and use at home. Many parents of kids who have asthma have one. If you get one, look for a blood-oxygen level of 95% or higher. If your blood oxygen is lower than 95, your lungs are struggling in some way.

Is there anything people with lung conditions need to be aware of with regard to COVID-19?

Dr. Bushell: Stick to the guidelines: wear a mask, social distance and wash your hands. Get vaccinated for COVID-19, and remember to stay up-to-date on your influenza and pneumonia vaccinations. And if you do test positive for COVID, talk to your doctor about antibody treatment, which may be able to reduce symptoms and is being given in an outpatient setting to people over age 12.

            How vaccines work and what to expect when you get one

If people can only do a few things to improve their lung health, what should they be?

Dr. Bushell: Simple:

  1. If you’re a smoker, get help stopping. It’s a challenge, and it’s a process. Keep trying until it works.
  2. Be aware of your exposures, whether it’s industrial particles at work or radon at home.
  3. Try and get into some regular exercise.

We hear a lot about getting 150 minutes of exercise a week for your heart, but it’s just as important for your lungs. Focus on just moving for 20 minutes a day. Get up and walk around the neighborhood. Go to the mall, do a lap and then stop and shop. It’s all about baby steps. Just start doing more movement than yesterday — you got this!

See more WellTuned articles from Dr. Bushell

Ashley Brantley

Ashley Brantley has been writing about food, culture and health for more than a decade, and has lived in three of Tennessee’s four major cities (Memphis, Nashville and Knoxville).

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Get more information about specific health terms, topics and conditions to better manage your health on bcbst.com. BlueCross BlueShield of Tennessee members can access wellness-related discounts on fitness products, gym memberships, healthy eating and more through Blue365®. BCBST members can also find tools and resources to help improve health and well-being by logging into BlueAccess and going to the Managing Your Health tab.

Filed under: Mind & Body


Ashley Brantley has been writing about food, culture and health for more than a decade, and has lived in three of Tennessee’s four major cities (Memphis, Nashville and Knoxville).