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How Delhi pollution is taking a toll on fit people too: Teacher couldn’t breathe although she had no asthma, allergy or flu

Weeks of coughing, wheezing, blocked noses, acute sinusitis and bronchitis --- it’s a crazy cocktail out there

5 min readUpdated: Dec 18, 2025 03:19 PM IST

PM2.5 and PM10 can sit on the lining of nasal and sinus chambers easily, irritating and inflaming them. (File)

A 40-year-old school teacher walked into the OPD, distraught, listless and breathless. She had had three weeks of persistent nose block, with thick nasal discharge, facial heaviness and a wet cough which had begun as dry bouts. Yet she had no past history of asthma, sinusitis episodes, allergies, infection or cough and cold. In fact, she had never had major respiratory issues at all. And yet there she was, hardly able to breathe and needed steroid nasal sprays and nebulisers, as if she were an asthma patient.

Initially, she thought she had just been infected by the seasonal flu virus and her fever was indeed gone in a day. But then she tested negative for the flu. Her stuffiness persisted despite taking anti-allergens and antihistamines. What’s more, she was wheezing like an asthmatic, the first sign that she was having trouble breathing because of blocked or narrowed airways. She said the wheezing would increase in the mornings and the evenings. She would have sudden bouts of dry cough, which lasted well over a minute, straining her back and shoulder muscles that had made them stiff and painful. But for all the discomfort, her chest scans were absolutely clear, so it was not pneumonia. The problem lay in her sinuses and bronchial tubes. This was clearly environment-induced. So, I asked her how much time she spent outdoors. And she told me she would use public transport, either a bus or a cab, to travel from Delhi to the school in Gurugram where she worked, passing high-traffic roads.

How pollution causes sinusitis

Her X-ray showed bilateral sinusitis. It means her sinuses were inflamed. Sinuses are air-filled spaces in the skull, located behind the forehead, nasal bones, cheeks and eyes. Mucus drains out through them. Even air is able to flow through the sinuses. So when their linings are inflamed, air flow is restricted and mucus builds up, leading to nasal congestion and pain. In her case, the inflammation, constant nasal drips and phlegm had gone down to the lining of her bronchial tubes which carry air to and from the lungs. That’s why she was coughing up thickened mucus. Since she had no signs of microbial infection and was exposed to severe pollution, she was suffering from what we call acute sinusitis with reactive bronchitis. This can happen to anybody without a history of respiratory infection, triggered by external elements like smoke, toxic gases, vehicular emissions and dust.

What are symptoms of sinusitis with reactive bronchitis?

Since all the airways become irritated and inflamed, with a lot of mucus being generated, symptoms include chest tightness, blocked or runny nose, headache, swelling, pain or tenderness around cheeks and forehead. This is usually accompanied by coughing spasms, shortness of breath, wheezing or a whistling sound while breathing. Such is the discomfort that patients end up breathing through the mouth, drying it completely. That’s why we tell patients to sip water in between.

How pollutants block sinuses

PM2.5 and PM10 can sit on the lining of nasal and sinus chambers easily, irritating and inflaming them. PM10 tends to deposit in the upper airways, causing swelling and excess mucus that can block sinus drainage, while PM2.5 penetrates deeper and induces stronger inflammatory response. Both types of particles damage the tiny hair-like structures in these cavities which move the mucus out. That’s why mucus and pathogens accumulate, triggering an infection. The resulting sinus blockage results in persistent inflammation.

What about treatment and prevention?

Since my patient had already been struggling with her condition for three weeks, we first cleared the blockage with nasal washes, steroid nasal sprays and nebulisation for two weeks. We gave her limited antibiotics to prevent secondary infection. Her condition improved in a week. Her cough took an additional two to three weeks to settle. Her recovery took almost a month, showing that air pollution can complicate sinusitis and bronchitis in people who have never had respiratory issues. Imagine what pollution can do to people with compromised lung conditions.

As prevention, do not step outdoors in peak pollution season without the N95 mask, use regular nasal washes to prevent pollutants from sitting inside the cavities, ventilate spaces with an exhaust to ensure circulation, place air purifiers with HEPA filters near pollution entry points. Clean the filters every two weeks. If acute sinusitis-bronchitis happens season after season, then it can become chronic. Treat it aggressively. Be vigilant about children, elderly, those with existing respiratory stress and commuters.

(Dr Tickoo is Director, Internal Medicine, Max Healthcare)