Air pollution due to smoke from chulha and angithies, metal dust from machines in factories, and dust from stone cutting in Aravalis is leading to poor lung health among people in and around Faridabad. Individuals directly exposed to these pollutants are particularly at risk of severe lung disease, according to experts at Amrita Hospital. Doctors say they are seeing alarmingly poor lung health among people in the region, with many of them coming with advanced stage of lung disease after ignoring symptoms for years.

Women’s health is not given high priority

Said Dr. Arjun Khanna, Head, Dept. of Pulmonary Medicine, Amrita Hospital, Sector-88, Faridabad: “Women in villages in Faridabad and rural areas around Delhi are still cooking food on traditional chulha or angithis, which cause significant smoke pollution. They don’t realize that this smoke is even more dangerous than cigarette smoke and gets inhaled in large quantity daily. Even a few years of daily exposure to chulha smoke causes as much lung damage as someone smoking cigarettes for 30 years. Due to this, we are seeing large number of young women patients in their 30s and 40s suffering from chronic obstructive pulmonary disease (COPD), a condition typically found in elderly cigarette smokers who have been smoking for decades. Many of these women are from well-to-do families in villages, but they still prefer to use chulha that burns wood or animal dung. This is an old kitchen tradition they find hard to break even when cooking gas is available.”

He added: “In India, neither lung disease nor women’s health are given high priority, and people tend to overlook symptoms for years. When exposed to chulha smoke, the situation becomes much worse. Treatment of COPD is not very difficult. Some basic medicines, breathing exercises, and avoiding smoke can make one’s life return to normal, even though the disease cannot be reversed.”

Also Read: Healthy lungs : Very crucial to fight against infectious disease. 

Pollution from industrial activity in the city

Faridabad is the biggest industrial town in Delhi-NCR. Direct exposure to pollution from industrial activity in the city is also causing poor lung health among people. Said Dr. Sourabh Pahuja, Consultant, Dept. of Pulmonary Medicine, Amrita Hospital, Sector-88, Faridabad: “Workers in industries are constantly getting exposed to pollutants and substances they work with, such as metal dust, leading to occupational lung diseases like asbestosis and silicosis. Faridabad falls in the Aravali range, with stone-crushing and stone-cutting as an industry. Stone dust is inhaled by these workers every day due to lack of protective equipment. Many people from factories and stone-crushers are coming to us, suffering from lung disease due to long-term exposure to pollutants at workplace.”

Also Read: Impact of air pollution on health and life – reduces life expectancy by 8 years.

The doctors said that another challenge is the reluctance of people in rural areas to allow children suffering from asthma to use pumps or nebulizers. “Asthmatic young children studying in school are not allowed to use pumps or nebulizers by parents due to fears that it will become a lifelong habit and hamper their marriage prospects. This is a deep social prejudice in rural and semi-urban areas that needs to be tackled,” said Dr. Sourabh Pahuja.

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During the winter months, colds, flu, and other respiratory illnesses are quite common. These infections have also been linked to an increase in asthma symptoms. When an asthmatic inhales cold, dry air, the muscles in the lungs may spasm in an attempt to keep the airways open. This irritates the airway lining even more, resulting in coughing, wheezing, and shortness of breath. Asthma symptoms and flare-ups can be triggered by chilly air, especially when it is dry. The dryness of cold air can cause breathing issues for many persons with asthma. Some of the symptoms are coughing, whether dry or with phlegm, wheezing, especially while exhaling, shortness of breath and stiffness in the chest. Symptoms might also be triggered by cold air combined with windy circumstances. The more severe your asthma is, the more likely you are to be affected by cold air.

Tips to manage asthma during winter:

1. Before the winter approaches, make sure your asthma is under control. Consult your doctor to create an asthma action plan, and then follow your doctor’s instructions for taking the medications he or she recommends.

2. If you plan to exercise outside in chilly weather, use your inhaler 15 to 30 minutes before you start. This opens up your airways, allowing you to breathe more easily. Carry an inhaler with you at all times in case of an asthma attack. Warm up for at least 10 to 15 minutes before exercising, and keep your face warm by using a mask or scarf.

3. Make use of humidifiers in your home. Keep them mould-free, and if dust mites and mould are causing your problems, keep your house cold and dry to prevent their growth. Filters in your heating and cooling air ducts should be cleaned and replaced on a regular basis. Ensure that filters are cleaned at the start of each season. Check on a regular basis to ensure that the interior air quality is optimal.

4. If you are sensitive to pet dander, limit your time with them. Maintain a pet-free environment in your room.

5. Hands should be washed often using a hand sanitizer or washing with soap for 20 second to avoid transmitting germs.

Also read: The Asthma Diet : What you eat definitely makes a difference

Refer to the asthma action plan you created with your doctor if you start to wheeze or feel short of breath. Other basic recommendations for what to do if you experience an asthma attack include: Using a quick-acting rescue inhaler, take two to six puffs. The drug should help you breathe more easily by opening up your airways. Instead of an inhaler, you might be able to utilise a nebulizer. A nebulizer is a device that converts your medicine into a tiny mist that you inhale. Wait 20 minutes before taking another dosage if your symptoms aren’t severe but don’t improve after the first few puffs from your inhaler and call your doctor as soon as you feel better.

Despite the fact that winter eliminates seasonal pollen allergies, millions of people suffer from additional winter allergies as a result of their inactivity. In the winter, distinguishing between an allergy and a cold might be difficult. In both cases, sneezing, a runny nose, and congestion are frequent symptoms. Allergies, on the other hand, are the immune system’s reaction to an irritant or trigger, whereas colds are viral infections.  Winter allergens, including moulds, dust mites, and animal dander, can cause illness in the house. Airborne dust comprising lint, fabric fibre, microorganisms, food stuff, and animal dander is circulated by forced-air furnaces. House dust mites, animal dander, and cockroach droppings are three of the most frequent allergens, and they are all worsen in the winter when there is less ventilation causing allergies.

Following are some tips to minimize allergen exposure:

1. Use a humidifier to lessen dryness in the air as dust mites and mould grow at humidity above 60% and temperatures between 60- and 85-degrees Fahrenheit.

2. Avoid using wall-to-wall carpeting, which creates a breeding ground for dust mites. Instead, use area rugs.

3. Cleaning, dusting, and vacuuming should be done on a regular basis, preferably using a vacuum equipped with a high-efficiency particle air filter. Wash linens regularly in hot water to kill dust mites at least 130 degrees Fahrenheit, and use hypoallergenic coverings for mattresses and pillows to keep dust mites contained.

4. Bathe pets once a week to reduce dander, but not more frequently, since too frequent bathing can dry up a pet’s hair and skin and keep animals out of the bedroom of anybody in the family who has allergies.

5. Consult your doctor and pharmacist to see whether using any over-the-counter medicine is appropriate for your symptoms and any adverse effects.

Dr. Pavan Yadav

Consultant – Interventional Pulmonology and Sleep Medicine, Bengaluru

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7^th May 2019 -the World Asthma day and the theme “STOP asthma”. Many children are suffering from asthma due to myths and doubts. Here we have answers for frequently asked questions

Many parents of children suffering from asthma end up with poorly controlled asthma due to myths and many doubts are often not addressed in office management in clinics due to lack of time. We can address some of the issues which are frequently asked questions by many parents and we shall address a few of them.

The world Asthma day is celebrated on 7^th May 2019 and this year the theme is STOP for asthma. STOP means:

• S – Symptom Evaluation
• T – Test Response
• O – Observe and Assess
• P – Proceed to Adjust Treatment

Is it asthma?

Asthma is a disease of the airways in the lungs, wherein the airways become swollen, narrow and sensitive to irritants, which leads to recurrent attacks of cough, breathlessness, noisy breathing and chest discomfort.  The number of cases have been on the considering the changes in lifestyle and environment. Diagnosis of asthma in children under age 5 can be challenging as the symptoms may indicate other conditions. With older children Pulmonary function tests that measures how well the lungs work can be done.

Why do the children suffer from Asthma?

Children who have inherited a genetic predisposition, and exposed to inducers in the environment develop inflammation of airways, the hallmark of asthma. The most common triggers of asthma in children is a cold apart from dust, pollen, smoke and other irritants including air pollutants.

Can we recognise if child is at more risk of Asthma?

A family history of allergy and asthma is a predominant risk factor. If one parent has been diagnosed with allergies or asthma, the risk of the child developing asthma is approximately 50%, while if both parents have been diagnosed allergies and or asthma the risk of the child developing asthma is 75%.

Which allergens to be avoided?

What foods to avoid in an asthmatic child?

Generally avoiding the food items calling them “cold” items, like some fruits are not advisable. Rarely a child can be allergic to certain foods, such as milk, eggs, peanuts, tree nuts, soy, wheat, fish and shellfish, and food additives.

Does child need allergy testing?

In general, in day to day practice allergy testing does not add much to the lines of management.

Will an air cleaner help child’s asthma?

It is not as effective with smaller particles such as dust and pollen. A HEPA (high-efficiency particulate air) filter has been proven to be effective in decreasing pet dander.

Child becomes breathless after running. Should he avoid games?

Children who have exercise-induced asthma (EIA) develop asthma symptoms after activity such as running, swimming, or biking. The time varies from 5-20 minutes post exercise before symptoms appear. With the proper medications, kids with EIA can usually play sports without a problem. Control asthma not exercise.

What are relievers and controllers?

Controllers are medicines that reduce inflammation in asthma, that work by reducing the swelling in the airways. The most effective of them being steroids. These medicines help to reduce severity of asthma if taken regularly as instructed. However, they must be taken regularly, even if child is not wheezing. Relievers are airway openers by dilating the narrowed bronchi and provide rapid relief airways known as bronchodilators. They only relieve symptoms but not airway inflammation. We must use controllers for long term and relievers for short term, and not vice versa.

Should we use nebulisers or inhalers?

Meter dose inhalers with spacers are preferred over nebulisers. Buying nebulisers by parents to use them for just relief of symptoms, and not taking long term medications are not advisable.

What is a spacer and is it necessary to use a spacer?

A spacer is a chamber that attaches to the MDI and holds the burst of medication. This allows child to breathe the medication into his lungs at his own pace. Spacers are recommended in children due to increased drug delivery.

Why steroids?

Steroids are the most effective anti-inflammatory medicines. They are safe in mild to moderate doses which most asthmatics use. Inhaled steroids are the best way to manage infants with asthma. Depending on young child’s age, one may use inhaled asthma drugs via MDI with spacer. It may need a mask in younger children less than three years.

How to know if child’s asthma is controlled? Should child take asthma medications even though he/she is feeling better?

Children feel better with relievers and some duration of controller medication makes the parents feel that they are “cured”, while on the contrary, still there will be inflammation in the airways. The parents should follow instructions of the paediatrician and continue the controllers which will be slowly stepped down and finally stopped. They should not abruptly stop medications. In older children paediatricians advise pulmonary function tests before stopping controllers.

How should one talk to people at child’s school about asthma?

It’s important that your child’s teachers, coaches, and school nurses know about his or her asthma. Talk to doctor about the best way to handle these discussions. Make sure that child has an “asthma action plan” and the proper medication at school with detailed instructions that include the location of the medicine or permission for child to carry it. Ask child’s doctor to help personalize this plan based on child’s asthma and treatment.

 What Are the Goals of Treating Child’s Asthma?

The goals of asthma treatment for child are:

Child should be able to-

• Live an active life, engage in activities without restrictions
• Be able to attend school every day.
• Is free of any breathing difficulties during the night.
• Use medications to control asthma with minimal or no side effects

Prof. Dr Subramanya N K
Pediatrics
Vydehi Institute of Medical Sciences and Research Center
White field, Bangalore – 560066
Ph 080 28413381/2
secretaryrespiratorychapter@gmail.com

subramanya.nk@gmail.com

The author is also The Honorary secretary of IAP National respiratory Chapter, an all India National academy in Pediatric Pulmonology.

Dr Farzeen,
Senior resident of Pediatrics,
Vydehi Institute of Medical Sciences and Research Center
Bangalore 560066.

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