Lancet study links deaths to city pollution: How do we protect kids with accurate diagnosis?

From respiratory disorders to missing school, the impact of air pollution on public health is pervasive. A new study (published in the Lancet Planetary Health on July 4) has mapped the association between PM2·5 exposure and approximately 3·6 million daily deaths in 10 Indian cities between 2008 and 2019. This is the first multi-city study to examine the association between short-term exposure to air pollution and daily mortality in India, says Dr Poornima Prabhakaran of the Trivedi School of Biosciences, Ashoka University, and among the study authors. Delhi had about 12,000 pollution-related deaths per year, while the lowest rate was in Shimla, with 59 deaths per year between 2008 and 19.

Why is it difficult to diagnose pollution-related illness?

That’s because tests cannot differentiate between air pollution–related illness and other causes of lung disorders. The causative role of a specific pollutant may become clear if many people in the same environment and with equal exposure develop similar symptoms or lung disorders. “Sometimes pollution exacerbates existing diseases. However, in recent years, the pollution has been so bad that people can actually link poor air quality with worsening cough or irritation in the eyes and throat,” Dr Prabhakaran adds.

Avoid triggers among children

Pune-based paediatrician and asthma consultant Dr Barnali Bhattacharya routinely prescribes medication with a “No agarbatti (joss stick)” warning. “I advise wearing masks in polluted areas and construction sites for those who suffer from asthma or respiratory problems,” she says. She recalls how one of her patients, 10-year-old Raunaq, collapsed in a heap during a puja and despite using an inhaler thrice, had to be hospitalised. This shows how extreme indoor pollution levels are so that even burning an incense stick can result in a medical emergency.

Children are most vulnerable to air pollution because their lungs and brains are still developing and their immune systems are weaker than adults. This increases the risk of respiratory infection and reduces their ability to fight it.

Sharp increase in lung cancer among non-smokers

Dr Arvind Kumar, chairman of chest surgery and lung transplantation centre at Medanta Hospital, Gurugram, says when he started operating on lung cancer patients at Delhi in 1998, about 90 to 95 per cent patients were smokers, mostly men in their 50s and 60s.

“However, in 2018, I was astonished to find that nearly 50 per cent of patients being treated were non-smokers, mostly in their 40s, majority being women,” he says, attributing the case spike among non-smokers to air pollution.

PM 2.5 particles in the air are small enough to penetrate deep into the lungs. According to studies, inhaling air with high levels of PM 2.5 is equivalent to smoking. “Hence if you are living in a city where the PM 2.5 level is 220 and are exposed to it for 24 hours, then by the end of the day, you have already smoked ten cigarettes,” he adds. Even images of teenager’s lungs have black deposits instead of being pink, he says.