Rates of chronic obstructive pulmonary disease (COPD)—including emphysema and chronic bronchitis—as well as lung cancer are increasing sharply among people living with HIV. In fact, the risk of these serious, sometimes fatal, lung diseases appears to be even higher among HIV-positive people compared with people not infected with the virus.

High rates of smoking may account for the higher risk. Some studies suggest people living with HIV are twice as likely to smoke compared with people not infected with the virus. But research also suggests that HIV disease itself increases the likelihood of lung disease, most likely because of immune system inflammation from responding to the ever-present virus. Whereas COPD usually affects HIV-negative men and women in their 50s and 60s, it is being diagnosed in people living with HIV at considerably younger ages.

Here we take a look at some ways to reduce the risk of lung disease and help keep your lungs healthy. For those who have been diagnosed with COPD, lung cancer or another serious respiratory problem, these tips are equally valid.

Smoking Cessation. The best thing you can do for your lungs is to stop smoking (or never start!). Smoking is the underlying cause of most cases of COPD. Quitting smoking can help preserve remaining lung function and has a positive effect on many other aspects of your health. Click here for tips and tricks on how to quick smoking.

Aerobic Exercise. Walking, running, cycling, swimming, dancing and similar exercise—in or out of a gym—help your lungs and heart work at full capacity. Aerobic exercise, also called cardiovascular exercise, improves your body’s oxygen consumption and is great for your lungs. Do something you enjoy. You won’t stick with it if you’re bored. Vary your activities to keep things interesting

Nutrition. Eating a nutritious diet is good for overall health. It increases energy and concentration, strengthens skin, hair, teeth, bones and muscles and helps in many other ways. Dietary habits and nutritional status also seem to influence lung function and the likelihood of developing lung disease, including lung cancer. Many studies have associated better lung function and lower development of chronic lung disease with the intake of high antioxidant and anti-inflammatory nutrients. These nutrients are in fresh fruits, vegetables and fish. One study of nonsmokers and smokers with no history of respiratory disease found that eating a diet that included a lot of fresh fruit was significantly related to improved lung function.

Since advanced COPD can lead to decreased appetite, weight loss and wasting, it’s particularly important to develop nutritious eating habits. When you experience appetite loss, the very idea of eating—nutritiously or not—can be overwhelming. Talking about it with your health care provider and seeing a dietician can help. So can eating small portions of nutritious foods throughout the day.

Immunizations. Talk with your doctor about getting regular immunizations, particularly the pneumococcal and influenza vaccines. Just one dose of the pneumococcal vaccine is recommended for most people. It prevents pneumococcal bacteria infection, which can cause pneumonia that adversely affects the lungs; complications include a bad cough, chest pain, difficulty breathing, increased respiration and the inability to get enough oxygen.

Protect yourself against seasonal flu by getting the flu vaccine every year. The common flu further stresses your lungs, not to mention putting you out of commission for days.

Preventive Medications (Prophylaxis). People with an impaired immune system—such as those with HIV—risk developing opportunistic infections (OIs), some of which affect the respiratory system. To keep from getting these OIs, it’s important to take prophylactic medications, depending on your CD4 count.

Pneumocystis pneumonia (PCP) is an example of an OI that requires prophylaxis to avoid lung damage (among other considerable problems). If your CD4 count is below 200, taking TMP/SMX (Bactrim or Septra) protects against PCP and some respiratory bacterial infections (as well as toxoplasmosis). Some people can’t use TMP/SMX because of an allergic reaction, in which case dapsone is the next most highly recommended medication. If you have a history of PCP, whatever your CD4 count, it’s best to continue taking TMP/SMX as part of your regimen.

Last Revised: January 18, 2016