Smita gets frequent colds and has asthma. Every day when she goes to work, she dreads the traffic. Environmental pollution levels in Mumbai and around have risen over the past years, though with new roads and flyovers, traffic has certainly speeded up. However, new constructions continue, and with a booming real estate market, the construction scene will only get busier. And with it will increase the SPM (suspended particulate matter) in the environment. Environmental pollution may not be the cause of Smita’s problems, but most certainly aggravates her underlying disease.
What are asthma and COPD?
Asthma and COPD (chronic obstructive pulmonary disease) are the commonest airway diseases we treat in clinical practice, and easily one of the commonest causes of cough presenting to a lung specialist. A lung specialist would easily be seeing at least half a dozen such patients every day in his practice, if not more. Conservative estimates are that at least 5 to 10 % of our population suffers from asthma, and at least 4 to 5 % of the adult population over 40 years of age, suffers from COPD. Another common problem is allergic rhinitis, manifested by frequent runny nose, nasal discharge, and sneezing. This condition can often exist alone, but can also co-exist in about 30 – 50% of asthmatics, worsening their asthma if left untreated.
In the West there has been a significant reduction of industrial pollution with the use of efficient filters in factory chimneys, and with combustibles like petrol and electricity which pollute less than coal. The main concern today of urban air pollution both in the developed and developing world is automobile-induced pollution. With falling oil prices, expect to see even more cars on the road. The question will remain – how many can our city roads really afford to take?
Though many believe that pollution can cause rhinitis and asthma, the evidence is not so strong. Very polluted cities like New Delhi still have lower levels of asthma, than much less polluted cities in Australia and New Zealand. Sensitisation to pollen and genetics play a role in the latter. Also, pollen sensitisation (interestingly) is more prevalent in areas of truck (but not car) traffic. Either way, particulates from automobile exhaust are significant pollutants, and studies from Pune have shown that diesel is particularly harmful, so too travel by auto rickshaws, as compared to taxis, trains or buses. It’s more likely related to the magnitude of exposure, that too with a large open area directly facing the human body, that makes auto rickshaws the unfortunate, though most certainly the most harmful mode of transport when it comes to exposure to environmental pollution.
But I’m not writing this article to give you a treatise on environmental pollution. Too much has been written on that, and continues to be written. I like to believe in fixing myself before fixing the world. So for all of you patients with lung disease, don’t try to take on the Herculean task of fixing environmental pollution – it’s a close to impossible task for a single individual to do.
The fix-it-yourself remedy
What you could do however is to ensure your local environment at home is at least less polluting. Also, avoid stepping outdoors when warnings of high environmental pollution are prevalent. And finally (what I prefer to recommend always) – treat your underlying lung disease well, so that you suffer (if at all) any effects of environmental pollution, to the least possible extent. If you are an asthmatic, here’s what you should do:
- Check with your doctor if you have intermittent or persistent asthma. If intermittent, you need to take your inhaler only need-based, i.e., only if you have symptoms. If persistent, you need to take a steroid inhaler regularly, depending on how severe it is.
- In some countries the media alerts the population on elevation of environmental pollen counts. Of late in India too, the media has been alerting the population on ambient levels of SO2, nitrous oxides and particulates. This can help asthmatics to be more aware of when they are likely to suffer more symptoms, and especially if they are not on preventive inhalers.
- Always keep a relief inhaler on hand. It is at times impossible to predict when your environment suddenly changes to a more polluted one. Acute wheeze can be precipitated and the inhaler comes in handy.
- Always ask your doctor for an action plan for emergencies. This is usually of a prescription of steroid tablets – life saving in an acute severe asthma attack, and can often avoid a trip to the family doctor in an emergency and hospitalisation too! When travelling abroad this becomes even more important.
- If you enjoy exercising outdoors, try to avoid polluted environments again, and exercising during high vehicular traffic movement. Exercising in cold weather (the cold air between zero to 15 degrees can itself act as a trigger on the airway at 37 degrees) can also precipitate asthma attacks. Hence, important again to use preventive medication regularly, or take a relief medication 15 to 30 minutes before the start of exercise. If you have COPD, then you have even higher chances of suffering the illeffects of environmental pollution. COPD is one of the top 10 killers worldwide, and expected to be the third largest killer of all diseases by 2020. Approximately 500,000 die of this disease every year in India, with very little media attention.
What should a COPD patient do, to avoid attacks of his disease during heightened environmental pollution?
- Stay indoors in cold weather
- Avoid cigarette and beedi smoking – remind patients that one cigarette is too much, and twenty is too little!
- Biomass fuel exposure in India has been shown to be a significant risk factor for COPD. Over two billion people, almost all in developing countries, rely on coal and biomass in the form of wood, dung and crop residues for domestic energy. These materials are typically burnt in simple stoves with incomplete combustion. Consequently, women and young children are exposed to high levels of indoor air pollution every day, resulting in an estimated 1.5 to 2 million premature deaths a year and a high prevalence of COPD. Improving ventilation in these homes, and changing the type of energy source for cooking (especially in these homes), will go a long way in reducing chronic lung disease.
- Needless to say, the patient with COPD also needs to use regular inhaled dilators to improve his symptoms. Unlike asthma, the steroid inhalers are not that effective in COPD.
- Regular physiotherapy also helps patients breathe better, and improves their ability to handle polluted environments better.
- Vaccination is also critical – normal people above the age of 65 years need to be vaccinated for pneumonia. Two vaccines are available, and we normally advise patients with COPD and chronic lung disease to take both. Vaccinating for flu is equally important, as influenza is responsible for significant illness in the elderly patient sub-group. Many patients with heart attacks and stroke have been attacked by flu some days prior. The protective effects of a regular flu shot are therefore significant too.
- Finally, wearing a simple protective mask doesn’t usually help. Personal respirators are far more useful, and one such is the N – 95 mask. Here 95 implies that it filters 95% of fine particles. The 8812 model is considered the best, with 96% of particles above PM 0.5 being blocked. The simple cloth masks are ineffective against particulates, blocking only 28% of the particles.
So to summarise, if you are exposed to environmental pollution (and most certainly if you have lung disease), you have 3 options:
- Stay indoors all the time – not a great option. Who likes to stay indoors all the time when it rains? And if you continue to smoke, it makes no difference anyway!
- Stop smoking, take your preventive medication/vaccines and step out bravely.
- If the going gets really bad (high SPM levels), then step out with a protective mask. Live your life well, and be responsible.
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Dr. Sujeet Rajan
The writer is a Respiratory Physician at Bombay and Bhatia Hospitals in Mumbai.[/column]