Battle for breath: Vulnerable, sick queue up at Delhi ERs

Prolonged exposure to such high levels of air pollution can increase risk of lung cancer, cardiovascular diseases, and neurological disorders

As the skies above Delhi turned grey and apocalyptic, with the city air quality inching dangerously closer to the “severe” category on Thursday, hospitals in the Capital saw patients lining up with complaints of breathing issues and flared allergies, among other ailments.

On Thursday, a toxic cocktail of pollutants led by PM 2.5 engulfed the Capital. Delhi’s 24-hour average air quality index (AQI) was 392 (very poor) at 4pm. (Sanchit Khanna/HT Photo)

Health experts across the city rang alarm bells, yet again, about the public health emergency the city is hopelessly staring at. The impact of foul air is clearly visible in the emergency rooms and the OPDs (outpatient departments) of hospitals.

“In the last few days, there has been an exponential rise in patients with acute attacks of asthma and chronic obstructive pulmonary disease (COPD),” said Dr GC Khilnani, chairperson, PSRI Institute of Pulmonary, Critical care and Sleep Medicine and member, World Health Organisation’s (WHO) technical advisory group on global air pollution and health.

He said that lately, patients who had been otherwise been stable for some time, now complain of severe cough, wheezing, breathlessness, and sleeplessness, but usually no fever. “ There is only partial response to inhalers and nebulisation. The markers for an advanced test called fraction of exhaled nitric oxide (FENO), a measure of airway inflammation, are remarkably raised. Antibiotics do not help and quite often systemic corticosteroids have to be used to give relief to these patients,” Dr Khilnani said.

He said that the other group of patients showing up at hospitals is one with no asthma or COPD. “They have mild fever for one or two days, followed by prolonged, troubling cough, and wheezing at times, which keeps them up through the night. In my opinion, this is due to worsening air pollution, but the worst is yet to come,” Dr Khilnani said.

On Thursday, a toxic cocktail of pollutants led by PM 2.5 engulfed the capital. Delhi’s 24-hour average air quality index (AQI) was 392 (very poor) at 4 pm, when the Central Pollution Control Board (CPCB) released its daily national bulletin. By 5 pm, however, it crossed the 400 mark, and reached the ‘severe’ category.

Neetu Kant, a senior nursing staff at east Delhi’s Guru Teg Bahadur Hospital, said that over the last week, patients have been lining up with complaints of prolonged congestion, cold and respiratory distress. She said a majority of these patients comprised senior citizens and children.

“We are prepared to handle such an influx because it is a seasonal issue now. These patients are also from the lowest financial backgrounds who are the worst impacted and exposure to pollution and who do not have the option of staying back home or installing air purifiers,” Kant said.

While such alarming levels of pollution spare no one, there are vulnerable groups -- newborns, children, pregnant women, the elderly, and those with pre-existing health conditions such as asthma, chronic bronchitis, and cardiac diseases — who are at a higher risk, said Dr Puneet Khanna, head of the department, respiratory medicine, Manipal Hospital.

“When air pollution peaks, the upper and lower respiratory systems often get irritated, and this makes it harder to breathe. This aggravates symptoms of asthma and COPD. Even a mild spike in air pollution levels leads to heavy rush in OPDs, increased emergency room visits, hospitalisations, and deaths. Long-term risks include lung cancer and a reduction in life expectancy,” Dr Khanna said.

A 2023 report by the University of Chicago’s Energy and Policy Institute highlighted that air pollution shortened the life spans of residents of Delhi by around 11.9 years. While there is no comprehensive study on the number of people falling ill to pollution each season, health experts in the Capital have estimated that the patient load is consistently rising each year.

Health experts said that while short-term impacts of pollution can manifest in the form of cough, irritation to airway, skin allergies, and tightness to the chest; prolonged, year-on-year exposure to such high levels of air pollution can increase risk of lung cancer, cardiovascular diseases, neurological disorders, and reproductive and developmental problems.

“It would be wise that on such high-pollution days, people wear N95 or KN95 masks when outdoors, avoid busy roads and other areas where air pollution levels are likely to be higher than the rest of the city, check air quality forecasts, andshould ideally stayindoors,” advised Dr Vikas Maurya, director and head of the department, pulmonology and sleep disorders, Fortis Hospital, Shalimar Bagh.

“Growing evidence suggests that exposure to air pollution may be associated with reduced IQ scores, impaired cognition, increased risk of psychiatric disorders such as depression, and poor perinatal health,” Dr Maurya added.