Lucknow: The World Health Organization (WHO) and the Forum of International Respiratory Societies (FIRS) designated 25 September 2022 as the World Lung Day 2022 to raise global awareness and action towards better lung health.
On 28th July 2022, the United Nations General Assembly adopted a resolution declaring access to a clean, healthy, and sustainable environment, a universal human right. Millions of Indians are denied this basic right by living in areas with unhealthy polluted air.
Lungs as we know are the primary organs for respiration in human beings. They work tirelessly to supply oxygen to our body and expel carbon dioxide from the body. Breathing also assists in our ability to speak and sing. Breathing is important for survival. Life begins with the first breath and ends with the last breath. It is important for vital functioning of the body and all its organs up to the minutest cellular level.
The impact of respiratory diseases includes both chronic conditions like COPD and acute illnesses like pneumonia or lower respiratory tract infections. More than 2.5 million people died from pneumonia in 2019, making it one of the most prevalent acute illnesses and causes of death in the world. It is also the greatest cause of death for people over 65 and for children under the age of five who are not newborns. Additionally, SARS-CoV-2 mortality increased dramatically as a result of COVID-19 in adults who had underlying comorbidities, notably in those who developed respiratory disease or pneumonia, killing more than 6.3 million individuals, mostly from respiratory causes. In 2020, 1.5 million people died from TB, making it the most prevalent lethal infectious disease after the COVID-19 pandemic. Worldwide, more than 10 million individuals contracted TB an in India 2.6 million people are effected. The onset of chronic respiratory disease may also be linked to such acute respiratory infections and other genetic-environmental interactions, with childhood illness establishing a developmental trajectory for poor health. Globally, an estimated 544.9 million people suffered from a chronic respiratory condition in 2017. In the world, COPD affects almost 200 million people, or 4% of the population, and kills 3.2 million people annually, making it the third greatest cause of mortality. Asthma affects ~350 million people worldwide (35 million in India) and is the most frequent chronic disease in children. The Low- and middle-income countries (LMICs) account for 84% of the world’s disability-adjusted life years (DALYs) and 96% of the world’s asthma-related fatalities. The worst of all diseases, lung cancer kills 1.8 million people annually. Due to a lack of diagnostic resources, poor access to care, and significant underreporting in LMICs, these figures likely underestimate the true burden of respiratory disorders. Additionally, the high prevalence of potentially harmful exposures, the limitations of the healthcare system, and the social and political environments all have a negative impact on health and health outcomes in LMICs.
Air pollution is the fourth leading risk factor of early death globally after high blood pressure, tobacco, and poor diet in 2019. Globally, around 40% of deaths from chronic obstructive pulmonary disease (COPD), 30% of deaths from lower respiratory infections, and 19% of deaths from lung cancer were attributable to air pollution. In India, lung diseases due to air pollution lead to around 45% of deaths and 40% of loss due to ill-health, disability, or early death. Immediate and proper action is needed to combat air pollution and bring about change.
Almost all Indians breathe air that is in excess of World Health Organization guidelines. IQAir’s World air quality report, 2021 highlights that 11 of the 15 most polluted cities in Central and South Asia were from India. Around 16.7 lakh deaths in India were attributable to air pollution accounting for 17•8% of the total deaths in the country in 2019. This means, three deaths per minute were attributable to air pollution in India.
The respiratory system and lungs being the first line of defense for the body to deal with air and its pollutants and is the the most affected human organ when concerned to air pollution. Some common effects are cough, wheezing, shortness of breath, asthma, pneumonia & reduced lung capacity in children, airway obstruction, chronic obstructive pulmonary disease (COPD), lung cancer, and many more.
As per Central Pollution Control Board, Air Quality Index (AQI) of less than 100 is considered normal, 101-200 may result in breathing discomfort to the people with lungs, asthma and heart diseases, while AQI range of 201-300 results in breathing discomfort to most people on prolonged exposure, 301-400 range results in respiratory illness on prolonged exposure, 401-500 range affects healthy people and seriously impacts those with existing diseases. Thus, there is a need to explain to the public the importance of these values and what can be done to combat air pollution by using simple measures.
Children are particularly vulnerable because they are still growing and their lungs, brains, and immune systems are developing. Exposure to air pollution at a young age can hinder lung growth, inhibit brain development and increase the risk of conditions such as asthma. According to a research by the Lung Care Foundation on 3157 adolescent children, 29.3% of children in Delhi were found to have airway obstruction/asthma on spirometry. Isn’t this a scary figure? Asthmatic children’s lungs and airways become easily inflamed, resulting in bothersome daily symptoms that interfere with play, sports, school, and sleep.
Air pollution is a very complex and multifaceted problem that necessitates system change to prioritize clean air and the health of people over short-term economic growth by collaborating with a wide range of stakeholders from various disciplines and sectors to generate awareness, advocacy, and action for clean air.
Dr Surya Kant, KGMU, Lucknow and Member National Core Committee of Doctors for Clean Air.