Breathless Pune Part 5 | Long-term exposure even to ‘moderate’ air leads to chronic heart, lung, kidney issues: Expert

Dr Sundeep Salvi, Chair of Chronic Respiratory Diseases, Global Burden of Disease-India, who is the lead author in both studies, said that 10 years ago, their findings suggested that 50 per cent of patients across the country visit a doctor for a respiratory problem, with the paediatric age group accounting for 65 per cent. Concern over these trends has led to plans for a nationwide study, he said.

In an interview with The Indian Express, Dr Salvi, who is also the director of Pulmocare Research and Education (PURE) foundation in Pune, recalled how air quality had improved dramatically during the Covid-19 shutdown and the number of hospital visits for lung and heart-related conditions had reduced significantly.

“Now they are back to what they were doing before the COVID-19 pandemic – highlighting the tremendous effect of man-made air pollution on our own health,” Dr Salvi said, adding that there was a need for more research on the issue.

According to experts, air quality has deteriorated over a decade in Pune, and the number of good air days has reduced, but how safe are ‘moderate air’ days and who is most vulnerable?

Dr Sundeep Salvi: If we take into account the World Health Organization’s (WHO) standards of clean air, we are all living in a highly polluted environment without even realising it. The bigger worry is it is not getting better. With fewer number of so-called ‘good air’ days, the situation is growing worse. Even ‘moderate air’ days have been shown to be associated with adverse health effects. The most vulnerable are newborns, schoolgoing children, the elderly and those with underlying lung or heart diseases.

What pollutants (PM2.5, PM10, NO₂, ozone, etc) are most harmful to the lungs? How do they affect different age groups?

Dr Sundeep Salvi: Particulate matter less than 10 microns (PM10) enter the lungs, get deposited in the windpipes and cause toxic damage. PM2.5 are even smaller (2.5 microns) and not only enter into the deeper portions of the lung, but also into the blood circulation from where they get deposited in other organs of the body.

Ozone is formed from nitrogen oxides (primary source is motor vehicular air pollutants) by the action of sunlight (hence called secondary air pollutant). It is present in industrial cities with high numbers of motor vehicles and plenty of sunlight. PM10, ozone and NO2 affect only the nose, throat and windpipes, while PM2.5 affects the gas exchange portion of the lungs and other body organs.

How does long-term exposure to polluted air differ from short-term spikes in terms of respiratory damage?

Dr Sundeep Salvi: Long-term exposure to polluted air, even if it is moderate, causes slow damage to the lungs, heart, blood vessels and brain, and leads to the development of various chronic lung diseases, heart disease and inflammation in the blood vessels, giving rise to stroke and kidney damage. Respiratory tract infections (including pneumonia, tuberculosis), asthma, Chronic Obstructive Pulmonary Disease (COPD), ischemic heart disease, diabetes and chronic kidney disease are the common diseases associated with long-term exposure to air pollutants.

Short-term spikes exacerbate existing disease states and lead to hospitalisations and deaths among such people. Short-term spikes, such as those that occur during Diwali, can lead to the development of new asthma in children. If the exposure is significant, it can cause permanent damage to the lungs, windpipes and the gas exchange portion.

We continue to see a rise in asthma, COPD and heart disease visits in our city, and the poor quality of air we breathe is a significant contributor to this. Winter is the worst, not only because we burn a lot of substances to keep ourselves warm, but also because the cold air is heavy, does not move much and, therefore, traps air pollutants in the city for a prolonged time.

What is the way forward?

Dr Sundeep Salvi: We need to protect ourselves from the harmful effects of air pollutants that we experience in our cities. Apart from advocating with the government for taking active measures to help reduce the quantum of air pollutants, it is our responsibility to plant trees wherever possible. Even those living in apartments must grow indoor plants, either in their balconies or inside the rooms. They play a significant role in absorbing many of the air pollutants that come from outside.

Wearing a mask whenever going out, like we did during COVID times, will help reduce our exposure. Adequate hydration and consumption of vegetables (cauliflower, cabbage, broccoli, green leafy vegetables) and fruits (at least two different fruits every day) will significantly enhance our lung defence against these pollutants. Regular exercise and simple breathing exercises will build our lungs and hearts efficiently.