‘Where do you stay and where do you commute to?’ is one of the first questions that Dr Paritosh Baghel, senior consultant, internal medicine, SL Raheja Hospital, Mahim, Mumbai, asks those seeking treatment for respiratory conditions. Construction work, redevelopment of the neighbourhood and traffic have made the lives of those who meet him difficult, and he sometimes suggests some of them make a temporary shift to an area less plagued by these problems.
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Dr Baghel recalls the time when a 50-year-old woman from Mumbai, who had developed an acute cough, was worried about what was happening to her lungs. She was given anti-allergic medicines. But she also decided to relocate temporarily to another area in the city to escape the pollution.
“There are multiple such cases where people come with symptoms of shortness of breath, cough and allergic rhinitis. There could be upper respiratory tract symptoms like blocked nose, watery nose and increased lacrimation [secretion of tears],” adds Dr Baghel. There could also be lower respiratory symptoms such as chest tightness.
According to the World Health Organization, in 2019, 99 per cent of the world’s population was living in places where the WHO air quality guidelines levels were not met.
An AQI (air quality index) ranging from 0-100 is said to be good, 100-200 moderate, 200-300 poor, 300-400 very poor and 400-500 severe. In the second week of December (2022), Delhi’s AQI had crossed 300, leading to concerns.
One of the major concerns is the fine particulate matter in the air or PM 2.5. Dr Vinod Chavhan, consultant, pulmonology, Kokilaben Dhirubhai Ambani Hospital, Navi Mumbai, explains that PM 2.5 refers to fine inhalable particles that usually have diameters of 2.5mm and smaller. “These particles travel deeply into the lungs through the respiratory tract. Nowadays, the levels of PM 2.5 are increasing due to increasing vehicle usage. A way to avoid this is by limiting strenuous outdoor activity in areas with higher amounts of traffic,” says Dr Chavhan.
According to the WHO, what pollutes the air are high levels of carbon monoxide, ozone, nitrogen dioxide and sulphur dioxide, apart from PM2.5.
The lungs are constantly exposed to high levels of air pollution and hence the worst affected, says Dr Rahul Chandola, associate director, heart and lung transplant specialist, Max Healthcare, New Delhi. It is more harmful than cigarette smoke, says Dr Chandola.
He adds that when one is outdoors, he/she is exposed to high levels of harmful pollutants which enter the lungs. “Worst affected will be persons with underlying lung diseases, co-morbidities such as COPD, pulmonary fibrosis [lung tissues damaged and scarred] and post-covid fibrosis,” says Dr Chandola.
What air pollution can do
Air pollution can harm a person in multiple ways and symptoms can appear on the skin, eyes and lungs, says Dr Chavan. “It can cause skin irritation, dermatitis, watering and redness in the eyes. It can cause allergic rhinitis, sinusitis and bronchitis too. It can lead to a lot of respiratory complaints like breathlessness, recurrent attacks of asthma and worsening of COPD. At present, there is no direct correlation between any other major illnesses like cancer,” says Dr Chavhan.
Know the symptoms
Dr Chavhan adds the typical symptoms should not be ignored. “Most common symptoms include cough, sneezing, hemoptysis [blood in the sputum] and breathlessness. Many a time, coughs are very mild and the affected person does not give them much importance. Any kind of cough which has been present for two to three weeks should be reported immediately,” he says
According to Dr Chandola, symptoms such as shortness of breath, feeling uneasy and a drop in oxygen saturation level (SPO2) below 90 per cent are alarming. However, SPO2 is not the only criterion; a clinical examination has to be done for a proper diagnosis.
In mid-December, a 76-year-old was admitted to a local hospital in Haridwar when he developed shortness of breath. While he maintained an SPO2 level of 94 per cent and seemed to be recovering, his oxygen saturation levels plummeted below 90 per cent, all of a sudden. He required oxygen support and was brought to Delhi’s Max Hospital, Saketh.
Dr Chandola who treated him says that the elderly are particularly vulnerable to developing air pollution-related respiratory issues, mainly during winter. He adds that during such a time, the symptoms of COPD and reactive airway disease (when the airways overreact to the allergens and swell) can take a turn for worse.
Why pollution heightens during winter
Respiratory and cardiac illnesses are common during winter, explains Dr Chandola. “Airways get exposed to the cold air and become more reactive. On top of that, pollutants create havoc. It’s a combination of the season and pollutants,” he says, adding that those with allergies are the worst affected. Fireworks during Diwali also add the pollution.
Clinical diagnosis of air pollution is tough but very indicative, says Dr Baghel.
How to prevent exposure to air pollution
According to Dr Chavhan, one of the key ways to prevent exposure to pollution is to avoid its creation in the first place. “Adjusting one’s life based on the AQI of a city is tough and not possible for everyone. However, wearing masks or a cloth that covers the nose and mouth to prevent inhalation of pollution will help. A way to avoid creating more pollution is by servicing vehicles regularly and ensuring regular pollution control checks,” says Dr Chavhan.
When the air pollution levels are high, one must avoid exercising outdoors, jogging and walking especially in the mornings, when there is heavy smog (smoke + fog), says Dr Baghel. He suggests exercising indoors at the time of high AQI. Dr Baghel adds that using masks is an excellent way to safeguard oneself from air pollution.
Dr Chavhan suggests wearing N95 masks instead of the ones made from cloth; N95 masks protect people from harmful bacteria and viruses in the air, apart from filtering over 95 per cent of all particulates including ones that are 0.3 microns.
Dr Chandola advises the use of the spirometer (a device that measures the airflow) to improve lung capacity.
Takeaways
Doctors suggest simple and practical ways to protect oneself from the dangers of air pollution:
- Stay indoors as much as possible and hydrate yourself
- Restrain from burning items. Fine particles from smoke can be a health hazard
- Use air purifiers at home, to keep the air clean. Change the filters at regular intervals
- Don’t smoke indoors; encourage yourself and others not to smoke
- Eat immunity-boosting fruits, vegetables and legumes
- Support green initiatives and support causes that genuinely help combat climate change
