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On 04 Nov, 2023, Seniors Today hosted their weekly Health Live webinar withDr Aditya Agrawal, a Senior Pulmonologist who spoke on and answered questions about Respiratory Care bearing in mind the falling air quality.
Dr Aditya Agrawal is a leading Consultant Pulmonologist attached to several large hospitals in Mumbai. He is extensively trained in respiratory diseases both in India and the US. His special interests are in difficult-to-treat cough, asthma, bronchitis and lung fibrosis, and runs a specialised clinic for patients with chronic cough. He is a dedicated researcher and a peer influencer in the management of respiratory diseases.
Pollution is not just in the air, it is also in our water, noise pollution with festivals around the corner, soil pollution, radioactive pollution.
Air pollution can be of several types. It can be:
- Primary air pollutants
- Secondary air pollutants
- Through natural sources
- Man made sources- vehicular traffic, factories, etc.
- Indoor air pollution
- Outdoor air pollution
Common air pollutants include particulate matter- particles which are floating about in the air, ground level ozone, carbon monoxide- produced following burning, sulphur dioxide, nitrogen oxide, lead, etc.
Ever since the addition of lead to petroleum has been banned/ stopped, it has been observed that lead has become a less important and less common pollutant.
Air pollution can be of any kind and due to any form- agriculture, desert, vehicular transport- road and sea, factories, cities. And all these gases rise and affect the production of ozone.
Primary pollutants include- carbon dioxide produced by burning fossil fuels.
– nitrogen oxide- exhausts of vehicles, factories, power plants
– sulphur dioxide- produced by the coal which is burnt
– toxic substances such as mercury are also produced
– volatile gases
Indoor pollution can be caused due to something as ordinary as a simple coat of paint which realises volatile compounds which are released into the atmosphere, polluting the indoor air which can keep your indoor contaminated for at least 2-3 months.
Cattle raising produces a large quantity of methane gas, which is also an environmental pollutant.
Solid particles which can be in the form of sand, dust or animal waste.
Many of the animal wastes are burnt in the form of fossil fuel.
Secondary air pollutants are ones which are formed from the primary pollutants. They may occur as a part of a photochemical smog which appears as a brown haze. The photochemical smog is formed when certain pollutants have a chemical reaction in the presence of sunlight. This consists mainly of the ozone.
Ozone in the higher levels of the atmosphere is protective ie it protects the earth from the ultra violet rays but ozone at the level of ground is extremely harmful to humans and other living beings.
When nitrogen oxide and volatile organic compounds combine and react in the presence of sunlight form ozone.
Particle pollution is a respiratory health concern because particle pollution produces respiratory symptoms such as
- Phlegm production
- Acute reversible reduction in the pulmonary function
- Inflammation in the mucosa of the nose, throat and lung
- Bronchial hyperreactivity where in any new product in the bronchus will cause bronchoconstriction. It is an acute reaction
- Increase the risk for respiratory infection
- Increases the number of emergency department visits
- Increase in the number of respiratory disease
Children who grow up in a contaminated or polluted environment are known to have decreased lung function and presence of air pollution is known to retard/ slow down the growth of a growing child.
Air pollution also causes chronic loss of pulmonary function in adults and can also result in early/ premature mortality in patients suffering from chronic lung disease.
Air pollution is a silent killer and can affect almost every organ in the body. It is responsible for millions of deaths each year.
The magnitude of impact of pollution on morbidity and mortality is such that a very large population is affected in terms of decreased lung function, cardiac side effects. Patients with chronic pulmonary disease who are fewer in number have more frequent respiratory symptoms, asthma attacks, bronchitis attacks, increased need for medication. This also leads to frequent visits to the hospital, hospitalisation, lost days at schools for children or at work.
In a smaller population it has also been found that air pollution can cause increased risk of cardiovascular morbidity.
Particle pollution can affect the respiratory system by means of deposition of the particle in the respiratory tract thereby inducing injury or inflammation. The extent of injury depends on the particle size, composition, and dose. Every inflammation increases the responsiveness to the irritant which means once a patient’s respiratory tract is injured or inflamed, it responds/ reacts more easily and aggressively to subsequent irritants.
At a cellular level, the inflammation/ injury can cause death of the cells of the respiratory tract.
It also compromises the integrity of the lung and capillary barrier, thus allowing the host defects to be lowered thereby increasing the body’s susceptibility to infection.
Repeated exposure results in chronic inflammation and injury.
The overall balance between injury and repair is altered because of the exposure to pollution. And this results in progression of the inflammatory disease into a more chronic/ long standing disease.
Particle pollutants can enter the body through the skin, eyes, mouth, nose, etc and can be transported through the blood, lymphatics to different parts of the body including the lungs, cardiovascular system, nervous system, etc.
Effects of acute exposure to air pollutants:
- Increased risk of cough, wheezing, breathlessness
- Emergency department visits
- COPD exacerbation
There have been studies which have shown a relation between long term exposure to particle pollution and long term respiratory effects increased frequency of hospital visits, hospitalisation, mortality. Individuals with a standing history of respiratory disease are at a high risk of future respiratory complications.
Exposure of a pregnant female to pollution can cause:
- Intrauterine growth retardation
- Intrauterine death
- Low birth weight baby
- Pre term birth
Strategies to mitigate the harmful affects of pollution:
- Introduction to the air quality standards
- Efforts to reduce pollution
- Use public transport, switch over to electric vehicles
- Cycle/ walk to nearby places
- Choose cleaner routes
- Wear a mask when you’re outdoors
- Avoid burning
- Ventilate your home well
- Do not smoke- indoor or outdoor