Delhi pollution: For those with lung diseases, it’s a double whammy

Health experts say that exposure to ‘severe’ levels of air pollution, like what Delhi experienced on Thursday, when the AQI touched 450, can be a death sentence for patients with asthma and pre-existing respiratory illnesses

Dhriti Rajashekharan, a yoga instructor living in south Delhi’s Vasant Kunj, woke up on Thursday and reached straight for her inhaler. Even before she looked out of her window to see the haze that had enveloped the city, the 48-year-old said she could “feel the pollutants in her lungs”.

Doctors said that exposure to severely polluted air can trigger life-threatening complications even in healthy people. (Sanjeev Verma/HT Photo)

Rajashekharan, who was diagnosed with asthma in her mid-thirties, said winter is a particularly bad time for her -- not only do her visits to her physician increase, she is also forced to be homebound. There are also days when she has to be admitted to the hospital, gasping for air.

“I am able to control a lot of my symptoms with yoga, but winters inevitably make the symptoms worse and I try to move out of the city during this period. I have grown to love yoga, and I am an outdoorsy person, but when environmental conditions are so unfavourable, you have to forgo the things you love,” Rajashekharan said.

Health experts say that exposure to ‘severe’ levels of air pollution, like what Delhi experienced on Thursday, when the AQI touched 450, can be a death sentence for patients with asthma and pre-existing respiratory illnesses.

Dr Vivek Nangia, principal director and head of the pulmonology department at Max Super Speciality Hospital in Saket, said exposure to severely polluted air can trigger life-threatening complications even in healthy people. People with asthma and other respiratory illnesses have it worse.

He said pollutants can be divided into two components — particulate matter and toxic gases. While particulate matter with a diameter greater than 5ug/m3 does not reach our lungs, those smaller than 2.5ug/m3 penetrate deep into the air sacks and trigger an inflammatory cascade. “The inflammatory cascade makes lungs more susceptible to catching infections from outside. In itself also, it causes damage to the lungs. In someone who already has asthma or COPD (chronic obstructive pulmonary disease), where the lung function is already compromised, the inflammatory cascade that is triggered worsens their condition,” Nangia said.

Dr Akshay Budhraja, head of the department of pulmonology at Aakash Healthcare Super Specialty Hospital, said that over the last few days, around 20-25 patients have daily been coming in with respiratory distress triggered by the poor air quality. Currently, in his hospital, there are around ten patients that are on oxygen support and two require ventilator support.

“Patients who have asthma, COPD or interstitial lung disease (ILD) are getting severely affected by worsened air quality. A majority of the patients who have poor compliance to their regular medication are getting severe attacks of cough and breathlessness,” Budhraja said. “Many patients are getting admitted to the ICU requiring oxygen supplementation, and a few of them are on non-invasive and even invasive ventilation due to respiratory failure, which primarily happens due to severe spasm of the wind-pipe or pneumonia.”

Dr GC Khilnani, former head of the department of pulmonary medicine at AIIMS, chairperson of PSRI Institute of pulmonary, critical care and sleep medicine and member of the technical advisory group of global air pollution and health of the World Health Organization (WHO), said that patients with lung and heart diseases are advised to limit all outdoor physical activity when the AQI reaches 200 too 300.

“As soon as the AQI climbs over 200, everyone should avoid all outdoor physical activity. Children, older adults and those with heart or lung disease should remain inside and keep activity levels low. Cloth masks and surgical masks have no role in preventing adverse health effects of air pollution, unlike with Covid. N-95 masks, when fitted properly, are likely to reduce exposure to pollutants,” said Khilnani.