India struggles to breathe as it battles deadly combination of COVID-19 and air pollution

With deteriorating air quality, lung-related complications are expected to worsen - numbers may be higher than the previous year - considering there is now a new set of people who have suffered COVID-19 infections with mild, moderate or severe lung involvement. These people, doctors believe, are more vulnerable and may face trouble due to air pollution.

The doctors across India including in cities such as Delhi, Bangalore, Ahmedabad, and Indore, have started witnessing the surge in cases of chronic cough attacks, asthma and inflammation of the tissues around airways. They expect cases to go up further in the next month as winter grips the country.

In the last few days, patients with a history of respiratory illnesses have begun lining up at the country’s largest public hospital, the All India Institute of Medical Sciences, New Delhi.

“This has been a trend every year, now. This year, we may also see cases of worsening symptoms among people who suffered from Covid-19 infection (with lung involvement). People with lung fibrosis or compromised lung function are more vulnerable during these months. In the next 3-4 months, we expect a higher number of people visiting for respiratory illnesses compared to earlier years due to a combination of factors including winter season, air pollution and respiratory sequelae of covid,” Dr Anant Mohan, head of Pulmonology at AIIMS, News Delhi told News18.com.

According to ResMed, a California-based medical equipment company that provides cloud-connectable medical devices to hospitals for the treatment of respiratory illnesses, 18% of the global population lives in India. However, 4.2% of the Indian population suffer from COPD and other respiratory illnesses making it a critical public health issue.

Acute cough, breathlessness, lung infections & more

According to Dr Manjunath PH, consultant, pulmonology, Narayana Health, Bengaluru, “Every year, post-Diwali, we have been noticing an increase in the number of complaints triggered by air-pollution. Right now, out of every 10 patients, 6-7 patients’ conditions are triggered by deteriorating air quality.”

“People who have a history of respiratory illness, complain of acute cough, breathlessness or infection in lungs whereas people who have never faced lung conditions, generally begin complaining about a persistent and acute cough.”

Similar estimates were shared by other doctors. “Out of every 10 patients at my clinic, on a daily basis, the conditions are triggered by air pollution. As AQI levels flare-up, patients land in hospitals sometimes breathless,” said Dr Tanay Joshi, consultant, respiratory and sleep medicine, Medanta Hospital, Indore.

Covid-19 patients would add to the usual burden, experts claim.

“As the temperature starts falling, AQI starts going up and hence the number of cases. In the next 20 days, I expect to witness an actual jump in cases. This time the cases would also come from patients who suffered from lung fibrosis due to Covid-19,” said Dr Mitesh Dave, consultant pulmonologist at Narayana Health in Ahmedabad.

Lung cancer not the only long-term side effect of air pollution

While in the long term, lung cancer has been associated with air pollution, there are many other illnesses that can be manifested.

“Breathing terribly poor air can lead to bronchitis which causes inflammation in airways. Other possible diseases are bronchiolitis and bronchiectasis. These are obstructive airway diseases due to increase in pollution and poor air quality index,” Dr Joshi said.

Many studies have not linked the increase in lung cancer among non-smokers, Dr Manjunath pointed, adding that diseases such as chronic pulmonary disorders have been proven to be caused by poor air quality index.

Similar observations were echoed by other health experts. “Pollution is one of the contributors for acute exacerbation of Chronic Obstructive Pulmonary Disease (COPD). In the past few days, pollution has severely impacted the residents of Delhi-NCR, Bengaluru and other cities leading to a rise in OPD visits and even hospital admissions with issues mainly related to acute attacks of bronchitis, asthma and COPD,” Dr Sibasish Dey, Head, Medical Affairs, Asia and Latin America, ResMed said.

What not to do?

According to Dr Animesh Arya, senior consultant in respiratory medicine, Sri Balaji Action Medical Institute in New Delhi, around a 20% increase can be seen in the patients reporting respiratory issues when compared to the pre-festival season in September.

Existing patients with respiratory illnesses such as COPD and asthma must continue with their prescribed medications. “It is essential to move quickly and check in with the treating physician in case of difficulty in breathing or shortness of breath. Those individuals in advanced respiratory disease should continue with a prescribed home-based Non-Invasive Ventilation (NIV) and Long-Term Oxygen Therapy (LTOT) to avoid exacerbation of symptoms,” Arya said.

Doctors added that air-purifiers have proven to reduce indoor pollution. “They have shown a good amount of reduction in indoor pollution. It’s a good option especially for those living in industrial areas or if any construction site is nearby,” Dr Manjunath said

“People should refrain from using mosquito coils or incense sticks at home as they contribute to indoor pollution,” Dr Dave from Narayan Health suggested.

Also, exercise and walking should be avoided, especially when smog is around.