The Vitruvian Protocol

System VIII of XI

Respiratory

Lungs & airways

Why it matters

Lung tissue doesn't regenerate well, so prevention matters more here than in almost any other system. Tobacco smoke is the dominant cause of lung cancer and COPD. Quitting is the single most effective health decision a smoker can make.

The protocol

Protocol 1

Never smoke or vape. If you do, quit with medication plus support

Grade A · Strong evidence
How to do it
  • Set a quit date within the next two weeks.
  • Use a proven medication: varenicline or cytisine (prescription), or combination nicotine replacement (a patch plus a fast-acting gum or lozenge).
  • Add behavioral support, such as a free quitline, an app or counseling. Combined with medication it works better than either alone.
  • Expect setbacks. Most people need several attempts, and each one raises the odds of the next.
Why it works
Smoke paralyzes the cilia that sweep the airways clean, inflames the bronchi, and destroys the walls of the air sacs. After quitting, cilia recover and the rate of lung-function decline slows toward normal.
The evidence
In a large US cohort, smokers lost more than 10 years of life expectancy. Quitting before age 40 cut the excess risk of death from continued smoking by about 90%1. A Cochrane review of 75 trials found that varenicline and cytisine help more people quit for at least 6 months than placebo, and that varenicline beats bupropion and single-form nicotine replacement2.

What to measure

  • Smoking / vaping statusNoneIncluding secondhand smoke at home and work.
  • Spirometry, FEV₁/FVC≥ 0.70Worth testing if you have chronic cough, breathlessness or any smoking history.
  • Lung-cancer screeningIf eligibleAn annual low-dose CT is recommended for people aged 50–80 with 20+ pack-years who smoke or quit within the past 15 years3.

Avoid

  • Secondhand smoke and indoor combustion, such as wood stoves without good ventilation and unvented gas heaters.
  • Hard outdoor exercise on poor-air days (AQI above 150). Move it indoors, or use a HEPA filter at home during wildfire smoke.
  • Occupational dusts and fumes without proper respiratory protection.

Sources

  1. Jha P, Ramasundarahettige C, Landsman V, et al. 21st-century hazards of smoking and benefits of cessation in the United States. N Engl J Med. 2013;368(4):341–350. doi.org/10.1056/NEJMsa1211128
  2. Livingstone-Banks J, Fanshawe TR, Thomas KH, et al. Nicotine receptor partial agonists for smoking cessation. Cochrane Database Syst Rev. 2023;(5):CD006103. doi.org/10.1002/14651858.CD006103.pub8
  3. US Preventive Services Task Force; Krist AH, Davidson KW, Mangione CM, et al. Screening for lung cancer: US Preventive Services Task Force recommendation statement. JAMA. 2021;325(10):962–970. doi.org/10.1001/jama.2021.1117

Educational content, not medical advice. These protocols summarize published evidence for healthy adults; they are not a substitute for care from a clinician who knows your history. Check with one before starting a new exercise program, changing medication, or if you are pregnant or managing a medical condition.