UNDER A CLOUD

Pollution and smoking — the two main causes of COPD — are coming together in a lethal cocktail. Across urban India, the number of cases is growing, and the average age at diagnosis, dipping

Seven years ago, Rajendar Kumar Mahna, 71, was rushed to a hospital emergency room with breathlessness, and ended up on a ventilator. Doctors told the family that he had chronic obstructive pulmonary disease (COPD), which had decreased his lung capacity. “His condition was so bad, we didn’t think he would survive. He was bedridden for a long time and developed bed sores,” says his wife Sharda, 70, a homemaker. “Even now, he can go to the washroom, but answering the door leaves him out of breath. He cannot even speak much.”

The Delhi winters, with their pollution and smog, are especially difficult for him.

“Initially, when his symptoms were not well managed, we ended up in Emergency again and again. In fact, one year, we had three hospital visits in January alone,” Sharda says.

Every Diwali, Rajendar has to add steroids to his list of medications to boost his respiratory system. Mahna’s case is a classic example of pollution and smoking — the two main causes of COPD — coming together in a lethal cocktail.

All his life, Mahna kept fit. He walked and did yoga every morning. “But his smoking, one or two packs a day since he was 16, eventually caught up with him,” Sharda says.

COPD is an umbrella term used to describe progressive inflammatory lung diseases that gradually block air flow and make breathing difficult.

Across urban India, the number of COPD cases is growing, and the average age at diagnosis dipping.

Mumbai may think it’s better off, but there are invisible pollutants here all year round, and rising COPD numbers to prove it. “We can’t see as much pollution in Mumbai as in Delhi because our temperature is not as cold, so the smog is not so dense,” says Dr Arvind Kate, pulmonologist and chest physician at the city’s Zen multispecialty hospital.

In addition to the smog, there is a quintessentially Mumbai aspect to air pollution — construction activity.

“The construction boom and the rise in vehicular traffic have increased the incidence of COPD in Mumbai,” says Dr Suresh V Rang, senior consultant chest physician at the city’s Jaslok Hospital and Research Centre. “Cement dust from construction activity and fumes from vehicles contribute heavily to pollution, as does biomass

burning.”

As a result, doctors are seeing a rise in the number of non-smokers diagnosed with COPD. “On average, one or two in every 10 COPD cases in my practice are nonsmokers,” says Dr Rohan Aurangabadwalla, pulmonologist at Apollo Hospitals, Navi Mumbai.

The average COPD patient is also getting younger. “Over the last ten years, more patients closer to 40 are being diagnosed with COPD,” says Amit Agarwal, research scientist and head of the molecular biology department at the Chest Research Foundation, Pune.

“Where earlier 1% or 2% of patients were around 40, this number is now 4% to 8%. Earlier the age range was largely above 45.”

Instances of cough and breathlessness among non-smokers are also evaluated much more closely now. “Increased COPD awareness among both doctors and patients has contributed to the increase in the number of patients being diagnosed,” says Dr Aurangabadwalla.

WHO’S AT RISK

You are at greater risk of developing COPD if you smoke, use a kerosene stove, or are exposed to pollution for a long period of time. Any infection or injury to the lung puts a person at greater risk for COPD in later life too.

Kunda Khawnekar, 62, a homemaker from Mumbai, began suffering from sustained bouts of coughing, especially during winter months, four years ago.

In December last year, she approached chest physician Dr Rajendra Kesarwani; by this point, she was having trouble breathing even at rest.

“Till 10 years ago, she worked over a kerosene stove, and the hydrocarbon exhaust has contributed to her condition,” Dr Kesarwani says.

The fringe suburb where she lives, Dombivli, also has a lot of small-scale chemical industry units polluting the air, which affected her respiratory system.

Diagnosed with COPD, Khawnekar was admitted to the ICU, where she was given oxygen support, steroids and bronchodilators via a nebuliser, to stabilise her condition.

She returns for regular checks every three months. “I also do some breathing exercises and blow up a balloon every morning,” Khawnekar says.

Deep inhalation and deep exhalation for 10-15 minutes daily, combined with the regular exercises over the past year, have helped improve her lung capacity, Dr Kesarwani says. Not every bout of cough and breathlessness should cause alarm, though. If routine medication does not help and they persist for ten days, you should consult a specialist. The Pulmonary Function Test (PFT), along with the X-ray, are main tests to check for obstruction in the airways. “Based on factors such as age, gender, smoking habits and the patient’s family medical history, it could either be chronic bronchitis or emphysema which are the two main types of COPD, or asthma,” says Dr VA Sajit Babu, consultant pulmonologist at Dr LH Hiranandani Hospital, Powai.

WHAT YOU CAN DO

If you want to help keep your respiratory system healthy, first up, stop smoking.

“If a patient quits smoking, it arrests decline in lung function almost immediately,” says Dr Vikas Maurya, head of the department of pulmonary medicine at Fortis Hospital, Delhi.

“Sadly, even after being diagnosed, many people do not quit smoking as they are addicted.”

In a country that ranks fourth worldwide in number of deaths caused by smoking (11%), cigarette smoke remains a major pollutant too, particularly indoors.

Also, check the ventilation in your home, especially the kitchen. Indian cuisine involves a lot of extensive frying, and fumes combined with oil adhere to surfaces and cause indoor pollution.

“One must always use extractors when frying, or an exhaust, so that the smoke does not circulate in the home,” says Dr Kesarwani.

“Exercises help, but it is important to do them in clean environments like parks, or indoors, as long as the home is pollutionfree,” says Dr Babu.

“If you live around a construction site, or see smog during the day time, wear a mask with a fine net, which will filter most of the particulate matter.”

It takes 15 to 20 years for COPD to manifest, and prolonged exposure to its chief causes — smoking and pollution — accelerates it.

“Typically, if a patient has two to three months of cough and breathlessness per year, for a period of two years or more, he should get himself tested for chronic lung diseases,” Dr Rang says.

In a bit of good news, treatment options have progressed considerably over the past decade.

Ten years ago, a patient like Manha would have been sent home to bide their time, says Dr Maurya, who finally brought the Delhi senior’s condition under control.

“Now medical devices like Bi-level Positive Airway Pressure (BiPAP) can help support the patient’s breathing and even at his age, he can live in his house with the help of non-invasive ventilation and oxygen support.”

Of course, it shouldn’t come to that. So take World COPD Day (November 15) as your reminder; if you’re still coughing three weeks after you started, check in to see if your lungs need some help.