Majority of people do have idea that fresh air is essential to remain healthy. But what is less commonly appreciated is that air pollution is closely associated with chronic lung diseases.
But first let us look at a few uncomfortable truths. Pakistan, India and Bangladesh were among the most polluted countries in the world in 2018, according to studies conducted with the help of US Air Quality Index, while 22 of the 30 most polluted cities are in India. Four of the 10 most polluted cities and towns are in the National Capital Region (Gurugram, Ghaziabad, Faridabad and Noida), while Patna and Lucknow follow closely behind. Faisalabad and Lahore in Pakistan and Hotan in China also appear in the list of top 10 polluted cities in the world.
National Air Quality Index
India launched the National Air Quality Index on Sept 17, 2014, under the Swachh Bharat Abhiyan. For this, the Central Pollution Control Board (CPCB) monitors 262 cities and towns in India to check air pollutants: SO2, oxides of nitrogen, SPM (suspended particulate matter) and respirable suspended particulate matter (SPM). Wind speed and direction, temperature and humidity are also considered. Information about Air Quality is released every week.
Indoor pollution is an important factor because people spend 80-90% of their time indoors. Sources include tobacco smoke (active and passive), cooking and heating appliances (in rural India, cooking on Chulha, apparently used by about 100 million people), biomass fuels (cow dung cake, wood, kerosene), asbestos, pesticides, etc. SPM during cooking in such households can go upto 500-2000 micrograms per cubic meter.
Chronic Obstructive Pulmonary Disease (COPD)
COPD is the second largest killer in India (BMJ Open) – national prevalence is about 3.4%, which soars to 10% in Thiruvananthapuram. There are an estimated 500,000 annual deaths in India from COPD. Recently BOLD study conducted in Pune, Mumbai and Srinagar shows the prevalence in Srinagar could be as high as 16.05%.
The common causes of COPD include chronic exposure to lung irritants such as cigarette smoke, vehicle exhaust fumes, air pollution, chemical factory smoke, etc. This hampers the exchange of oxygen within the lungs and more blood is required to ensure that enough oxygen is supplied to the vital organs. Hence the heart has to pump more blood through the circulatory system, and over the years, it could go into chronic heart failure.
The symptoms and signs include frequent cough and cold, bouts of flu, rapid heartbeat, inattentiveness, short of breath after mild exertion such as talking, and discoloration of lips or finger nails. Pulmonary Function Tests are conducted to assess the nature of respiratory disease. These include chest x-rays, spirometry (to determine severity of disease) and arterial blood gases.
Among the treatment options, besides medical management – which includes antibiotics, steroids, drugs that open the airways (bronchodilators) and oxygen therapy, Non-invasive ventilation may also help the patients to breathe better and improve quality of life.
With the technological developments, now there are portable machines that can offer ventilation non-invasively – via a mask.
It may be administered in an ICU setting or for chronic respiratory failure – where it can be administered in the comfort of one’s home. While there are several pressure modes available – like CPAP mode, the ST Mode – newer modes like intelligent volume assured pressure support (iVAPS) – which offer tailored therapy to the patient.
(Writer is Dr Bhaskar Azad, Clinical Head, ResMed Academy. Views expressed are a personal opinion.)