Air pollution exposure is widely recognised as having a range of health effects in healthy individuals, however, it is especially harmful for people suffering from respiratory illnesses like asthma and Chronic obstructive pulmonary disease (COPD).
India has 55.3 million COPD patients (more than 25% of the global cases) and 37.9 million asthmatics (more than 10% of the global figure) as per the Global burden of Disease study. India also has 11 of the top most polluted cities in the world. So what kind of health risk does air pollution present for people dealing with these pulmonary diseases?
What is Asthma?
Asthma is an inflammatory disease of the airways in the lungs. It leads to difficulty in breathing and can make some physical activities challenging or even impossible. Asthma causes the airways in your lungs to get swollen or inflamed, making them extra sensitive to certain things that you may be exposed to every day, or asthma "triggers".
A trigger could be a dip in the weather, or dust, chemicals, smoke and pet dander. Breathing in a trigger makes the insides of your airways swell even more, narrowing the space for the air to move in and out of the lungs. The muscles that wrap around your airways also can tighten, making breathing even harder. This is known as an asthma flare up episode or asthma "attack."
What is COPD?
Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory lung disease that causes obstructed airflow to the lungs. Symptoms of COPD include difficulty in breathing, cough, increased mucus (sputum) production and wheezing.
Differences between Asthma and COPD
COPD is a general term that depicts progressive respiratory conditions like chronic bronchitis and emphysema. COPD is usually seen in older patients and is characterised by decreased airflow over time as well as inflammation of the tissues that line the airway. While Asthma is often genetic and mostly seen in younger children and adults.
Smoking and air pollution exposure are the biggest causes of COPD. According to Mayo Clinic, 20 to 30 percent of people who smoke on a regular basis develop COPD. Asthma attacks or exacerbations are usually caused by environmental triggers like dust mites, pollen, mold, respiratory infections, pet dander, physical activity, cold air, smoke, etc.
Studies show air pollution disproportionately affects people with Asthma/COPD
People with chronic respiratory diseases such as chronic obstructive pulmonary disease (COPD) and asthma are especially vulnerable to the detrimental effects of air pollutants. Air pollution can induce the acute exacerbation of COPD and onset of asthma, and increase the respiratory morbidity and mortality.
COPD and Air pollution
COPD, which is a lung condition that causes narrowing of airways, is triggered by constant exposure to air pollution. “Air pollution negatively impacts the lungs, and is especially harmful to people already living with COPD,” explained Dr Arvind Kate, Pulmonologist at Zen Multispeciality Hospital. The Chronic Obstructive Pulmonary Disease tends to majorly impact people with damaged lungs. The pollutants in the air which trigger respiratory infections can lead to COPD attacks as well.
A recent article about a study published in American Journal of Respiratory and Critical Care Medicine suggests that long-term exposure to fine particulate matter is associated with increased risk for cardiovascular mortality among adults with COPD.
Another study published in the environmental research and public health journal, provides evidence of associations between even short-term exposure to PM2.5 and increased hospital admissions for COPD patients.
According to an article in the Lancet Journal, looking at the DALYs (disability-adjusted life-years) due to COPD in India in 2016, 53·7% were attributable to air pollution, more than twice due to tobacco use (25.4%) which is usually considered as the primary cause of COPD.
Asthma and Air pollution
Air pollution can make asthma symptoms worse and trigger asthma attacks. Children with asthma are especially vulnerable to air pollution. In a study of ten European cities, 14% of the cases of incident asthma in children and 15% of all exacerbations of childhood asthma were attributed to exposure to pollutants related to road traffic.
A study by researchers from Johns Hopkins University found that children exposed to outdoor coarse particulate matter (PM10-2.5), were more likely to develop asthma and need emergency room or hospital treatment for it. Coarse PM can come from roadway particles such as brake and tire wear, and mixtures of road dust and metals. This finding is significant because, while researchers have generally found that exposure to fine particulate matter (PM2.5) is associated with the development of asthma and other respiratory and cardiovascular diseases. Coarse particulate matter was thought to be less harmful, in part because the larger particle size prevents penetration deep into the lungs. However, coarse PM can deposit into the airways, and recent research suggests that short-term exposure may be associated with cardiovascular and respiratory disease.
An article by aafa.org refers to a study that shows that air pollution can significantly worsen asthma symptoms. A study of young campers with moderate to severe asthma showed they were 40 percent more likely to have acute asthma episodes on high pollution summer days than on days with average pollution levels.
Source: The Weather Channel
Onset of Asthma
More and more studies are showing that exposure to pollutants is associated not only with exacerbations but possibly even the onset of asthma. A recent study suggests that air pollutants suppress genes that regulate the immune system’s ability to differentiate an allergen from a dangerous foreign substance, such as a virus or bacteria. The immune system then goes into action, setting up an inflammatory response whether the substance is harmful or not, which leads to asthma.
Another article by American Academy of Allergy Asthma and Immunology (AAAAI) refers to research that shows that prenatal exposure to air pollution has been shown to increase the risk of wheezing and asthma development in children. This finding was found to be true whether or not the expectant mother had asthma herself.
What can help Asthmatics and COPD patients in reducing the adverse health impact of air pollution?
Get rid of the allergens:
Control dust mites
Vacuum once or twice a week
Prevent pet dander
Prevent pollen from getting inside by keeping windows and doors closed
Do not smoke and discourage other family members too from smoking indoors as the smoke can stay around in indoor environments for long periods and lead to attacks.
Manage humidity in the house to avoid mold growth:
Use exhaust fans or keep windows open
Install a dehumidifier for your home
Select houseplants that absorb moisture from the air, such as Boston ferns.
Fix all leaks and other causes of dampness in the house
Ensure use of exhaust fans while doing moisture creating activities like taking hot showers and boiling water on the stove.
Store harmful products like everyday household staples, including paints and solvents, cleaners and disinfectants, pesticides and air fresheners in a shed that is not attached to your home.
Avoid using scented candles or odor-hiding fragrances
Install CERTIFIED asthma & allergy friendly air filters (do not use air cleaners that emit ozone)
Asthmatics, as per many studies, can benefit a lot from exercising in controlled conditions. Exercise for asthma improves heart and lung fitness, and improves quality of life. Check out these 8 Exercises That Are Safe For People With Asthma. Give this Airveda blog a read to know the guidelines for exercising in heavily polluted areas.
Finally invest in an air quality monitoring system to manage air quality in the house and ensure it stays within prescribed limits. It can help you with:
Knowing when you need to turn your purifier on.
It helps you know if your purifier needs filter changes.
Check air quality outdoors so that you can step out when air quality is good.
Understand trends during the day so that you can optimize your workout/walk time as well as the time when your kids are going to the playground for the best air quality during the day. Learn more here.
Our mission at Airveda is to help people breathe well and live well. As part of this we are working hard to enable features for people with asthma and COPD to better manage their condition. The Airveda App allows you to
Monitor outdoor air quality to help you manage your exercise time outdoors when air quality is good/satisfactory or moderate. If it is poor/very poor or extreme, choose to exercise indoors. When stepping outdoors, do check air quality outdoors and wear an N95 or N99 mask if air quality is poor or worse. We show data from all the Govt monitors across India and thousands around the world, along with Airveda monitors set up in various cities to help you make these decisions.
Monitor symptoms and Peak flow data regularly to understand how well controlled your asthma is. The app provides reminders to remind you to monitor your symptoms and measure your peak flow numbers and notifies you when it may be time for a doctor visit. Also this data is extremely valuable for your next pulmonologist visit and enables them to give you better treatment and adjust medication based on how well controlled your asthma is.
Upload your PFT reports and understand your airway score and lung score and nature of your condition plus see trends of your PFT reports over time. Most patients struggle to understand what their PFT report means and how their lung capacity and airway health is improving or deteriorating over time. Uploading your PFTs regularly on the Airveda app can enable you to understand these trends and take appropriate action.
Set up inhaler reminders. One of the biggest causes of asthma and COPD exacerbations is lack of adherence to prescribed medication. Inhaler reminders can ensure that you never forget to take your medication on time!