How air pollution is affecting chronic airway diseases/COPD in India?

India is reeling under the devastating effects of air pollution. According to a 2018 report published by the Indian Council of Medical Research (ICMR), one in every eight deaths in India is attributable to air pollution. Around 77% of the population breathes air poorer than the safe limit prescribed by the National Ambient Air Quality Standards. The report mentioned that the average life-expectancy of Indians would have been 1.7 years higher if the air in our cities and towns had been cleaner, and the pollution less than the minimal level. It also revealed that Delhi, UP, Bihar, Haryana and Rajasthan are among the worst affected states. The results were based on the population-weighted annual mean of PM 2.5 in micrograms per cubic meter. PM 2.5 is a deadly air pollutant. It is a group of airborne solid and liquid particles ? 2.5 micron in diameter. It infiltrates the lungs and causes chronic respiratory disease. The atmospheric concentrations of PM 2.5 and PM 10 (particulate matter ? 10 micron) are used as standards for measuring air pollution.

Reports on air pollution

Studies have confirmed that the air pollution in India is deteriorating. In 2017, an estimated 12.4 lakh people died due to air pollution- induced health complications, reported a joint study by the Indian Council of Medical Research (ICMR), Public Health Foundation of India (PHFI), Ministry of Health and Family Welfare, and The Lancet. 6.7 lakh out of this perished due to ambient air pollution while 4.8 lakh died due to indoor air pollution. Half the fatalities were in persons below the age of seventy. With India making up 18% of the world’s population, it meant that internationally 26% of the premature deaths caused by air pollution were suffered by Indians, which is an alarming statistic.

A Greenpeace study observed that 3 of the world’s biggest nitrogen oxide emission hotspots were in India. Delhi-NCR, Sonbhadra in UP, Singrauli in MP and Talcher-Angul in Odisha were found to have the highest levels of air pollution in the country. Recently small hill towns like Manali was in news due to increasing air pollutants.

A 2017 World Health Organization (WHO) report revealed just how bad the situation in India was. It stated that 14 of the 15 most polluted cities in the world, based on PM 2.5 levels, were Indian cities. The report based its findings on data collected from over 4000 cities in 100 countries. The final results had Kanpur taking the ignominious lead, followed by Faridabad, Varanasi, Gaya, Patna and Delhi. Here are the 15 cities and their annual PM 2.5 average in 2016 (in micrograms per cubic meter).

  1. Kanpur – 173
  2. Faridabad – 172
  3. Varanasi – 151
  4. Gaya – 149
  5. Patna – 144
  6. Delhi – 143
  7. Lucknow – 138
  8. Agra – 131
  9. Muzaffarpur – 120
  10. Srinagar – 113
  11. Gurgaon – 113
  12. Jaipur – 105
  13. Patiala – 101
  14. Jodhpur – 98
  15. Ali Subah Al-Salem (Kuwait) – 94

Air pollution and its impact on human health

A WHO report declared that in 2016, around 1,01,788 Indian children (54,893 girls and 46,895 boys) below the age of five died prematurely due to air pollution. It is the highest pollution-induced child mortality rate in the world under five years of age. The report also mentioned that one in ten deaths in children in that age bracket in India was on account of air pollution. It drew a direct correlation between air pollution and chronic obstructive pulmonary disease (COPD), childhood cancers, asthma, and reduced lung activity. It also attributed low birth weight to sustained exposure to PM 2.5 pollution during pregnancy.

Air pollution affects all our vital systems. Most notably, it encourages chronic airway diseases like COPD. It attacks our nose, throat and lungs, and leads to debilitating breathing disorders. It also aggravates already existing respiratory diseases like asthma, emphysema and bronchitis.

Polluted air causes lung disease, heart disease, cancers, birth defects, immune dysfunction, neuropsychiatric disorders, hormonal imbalance and hematological disorders. According to the WHO website, ambient air pollution is the reason behind:

  • 29% of all deaths and disease from lung cancer
  • 17% of all deaths and disease from acute lower respiratory infection
  • 24% of all deaths from stroke
  • 25% of all deaths and disease from ischaemic heart disease
  • 43% of all deaths and disease from chronic obstructive pulmonary disease

Here are some of the major respiratory diseases associated with air pollution.

COPD

Air pollution triggers COPD. COPD is a generic term used to describe a group of lung diseases that impeded normal breathing. It congests the lungs and hinders free movement of air. It is characterized by increasing breathlessness. Chronic bronchitis, emphysema and refractory (non-reversible) asthma are common examples of COPD.

Tobacco smoke is a major cause of COPD. Both active smoking and inhalation of secondhand smoke can lead to COPD. It is also caused by prolonged exposure to smoke from polluting cooking fuels like firewood, dung cakes, kerosene and coal. COPD is currently incurable. But, with proper diagnosis, treatment and preventive measures, it can be kept under control.

Asthma

Asthma is a lung disease. It is a condition in which the tissues around the airways become swollen and secrete large amounts of mucus. The swelling and the mucus narrow down the air path, leading to shortness of breath. It makes the patient gasp for air and exerts enormous pressure on the lungs. Asthma can be triggered by a number of factors like cigarette smoke, pollen, dust mites, dust mite feces, insects, insect feces, animal allergens, spores and fine respirable particulate matter.

Bronchitis

Bronchitis is a condition in which the bronchial tube lining becomes inflamed. The lung produces excess mucus which collects in the airways, constricting them and hindering free passage of air. It is characterized by chronic coughing and shortness of breath. Bronchitis can be acute or chronic. Acute bronchitis may last for 2-4 weeks. It is caused by viral infections and exposure to polluted air. Chronic bronchitis can last for months, and sometimes, evens years, if not treated properly. Smoking, whether active or passive, is the biggest cause of bronchitis.

Emphysema

It is a type of COPD in which the alveoli or air sacs at the end of the smallest air passages of the lungs called bronchioles become damaged. It is caused by smoking and sustained exposure to secondhand tobacco smoke. Emphysema prevents the body from getting the oxygen it needs. It disrupts supply of oxygen to key organs, and significantly reduces lung function.  The patient suffers from chronic cough and has difficulty breathing normally.

Preventive action – How to protect yourself from air pollution

Air pollution mask

An air pollution mask is a special respiratory filter, or respirator, worn over the nose and mouth. It prevents fine dust and microbes from entering our body during respiration. It is an effective way to counter the ill-effects of air pollution.

Air pollution masks have ratings which indicate their application. The rating consists of an alphabet and a number. The alphabet tells you if the mask is tolerant to oil and the number tells you what percentage of pollutants the mask can remove.

Respirator Rating Letter Class

N – not resistant to oil

R – resistant to oil

P – oilproof

Respirator Rating Number Class

95 – eliminates 95% of all air pollutants with diameters of 0.3 micron and larger

99 – eliminates 99% of all air pollutants with diameters of 0.3 micron and larger

100 – eliminates 99.97% of all air pollutants with diameters of 0.3 micron and larger.

Types of masks

N95 and N99 are the most common air pollution masks used in cities with high levels of ambient air pollution. N95 removes up to 95% and N99 removes up to 99% non-oily allergens as small as 0.3 micron. Both respirators are effective against fine suspended dust, smog, vehicular emissions, bacteria and viruses. They also prevent the spread of diseases like common cold, swine flu, avian flu and TB.

N100 masks are more effective than N95 and N99. However, they are not readily available and must be specially ordered.

P95 masks are worn in industrial and medical facilities. They are resistant to oil and effective against oil-based impurities. They are used by workers in petrochemical, auto, pharma, chemical, food, paint, paper and textile manufacturing/processing units.

Air purifier

An air purifier removes pollutants from the house air. It is an effective way to control indoor air pollution. Air purifiers use powerful filters like HEPA (High-Efficiency Particulate Arresting) to trap PM 2.5 and PM 10. Some have activated carbon filters to eliminate odors, cooking smells and volatile organic compounds (VOCs). Some use ion generators to rid the air of harmful allergens. UV light is another air purification technique. It neutralizes living microbes by altering their DNA composition, thus stopping them from multiplying.

Air purifiers are good for people with allergies, and respiratory disorders like asthma and bronchitis. They are suitable for kids, pregnant women, and the elderly. They have built-in smart sensors that constantly monitor the indoor pollution level, and adjust the filtration accordingly. They also share live air quality information and have customizable airflow.

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