This winter, you cannot get a bed in pulmonary ICUs in Delhi or NCR for love or money. The wards are full, said hospital administrators, with people needing ventilator support to breathe. Even in cases where the trigger was an infection, the respiratory distress has been compounded by underlying lung damage.
Blaming shortness of breath and frequent coughs on infection or pollution is usually not far off the mark, but if you experience breathlessness and difficulty breathing after exertion for longer than three weeks, you might want to take tests to rule out chronic obstructive pulmonary disease (COPD).
COPD is a disease where the lungs are damaged from smoking, exposure to industrial lung irritants such as pesticides and asbestos, and air pollution. A combination of emphysema and chronic obstructive bronchitis, COPD is being reported increasingly across India's towns and villages, with pesticide use and indoor air pollution from cooking over open smoke fires in poorly-ventilated rooms being the leading causes of lung damage in rural areas.
The initial symptoms of this progressive lung disease are so subtle that most people don't realise they have a problem, dismissing frequent cough and breathlessness as fatigue, pollution, increasing weight or advancing age. The lung damage is irreversible, but treatment using medication and lung rehab can stop and even slow its progression.
Shortness of breath is among the first giveaways, with most affected people complaining of an inability to inhale deeply while doing routine activity that boosts heart rate, such as climbing the stairs or carrying a heavy object. The affected person and people around them are best placed to notice stress-related lung distress because they can compare it with lung-function in the past.
A frequent, lingering or chronic cough is the other symptom that appears early on. COPD inflames the bronchial tubes and the air sacs (alveoli) inside the lungs, making them thicker and less elastic
This makes the walls of the airways produce more mucus, which clogs them and results in a phlegmy cough. The phlegm is usually clear, but it may be yellow, green or spotted with flakes of blood, all of which are red flags to the condition worsening. Smokers, however, often don't produce sputum despite advancing COPD, with its production increasing only after they quit smoking.
Lung damage usually interferes with sleep, with most people complaining of restless, interrupted sleep, often waking up with a headache. Interrupted sleep is a result of posture, as lying flat on the bed forces lungs to work harder. The strain on the lungs makes breathing shallow and interrupted, causing some people to cough through the night. The affected person ends up feeling listless and fatigued all the time. The headache is caused by the build-up of carbon dioxide in the blood, which causes blood vessels in the brain to dilate and push against the brain's membrane.
Then there are the physical signs that make you look unwell even when you're sitting still. Chronic oxygen shortage - oxygenated blood is bright red, while deoxygenated blood has a darker, bluish hue - gives the skin a grey-blue pallor.. The discolouration - called cyanosis in medicalese and easily measured using a finger/pulse oximeter -- occurs when blood oxygen levels drop below 90% and is most visible in the lips, gums, and around the eyes.
Untreated COPD may lead to heart failure over time, largely because the circulatory system is not getting enough oxygen to function optimally.
With the lungs getting progressively worse, the heart doesn't get enough oxygen to supply the liver and kidneys, which in turn fail to flush out toxins and remove excess fluid. This leads to fluid buildup in the body, which is the most easily recognisable as swollen feet and ankles. Another physical sign that's picked up by a physician is enlarged lungs, which makes the affected person appear barrel-chested.
COPD can be managed with a combination of medicines and pulmonary rehabilitation to rebuild lung capacity and improve sleep. This includes a series of exercises to strengthen the breathing muscles to improve physical fitness and conserve energy, and is best done under the watchful eye of a pulmonoligist.
Since lung damage and the lack of oxygen makes movement progressively difficult, affected people often avoid strenuous activity, which further lowers lung capacity. The way ahead is to use medicine and lung rehab to maintain and then increase your activity level. We can't wish away air pollution. The next best option is to rescue your lungs and save your body from slow collapse.