As Pollution Debate Takes Centre Stage, Here's a Look at COPD That's Killing Millions of Indians Annually

New Delhi: Delhi ranks first in the list of the most polluted cities in the world. At the time of writing this report, the PM 2.5 level was 130 as per the System of Air Quality and Weather Forecasting and Research (SAFAR) and the air quality index (AQI) would worsen with surface wind speed being low and localised dust lifting low.

Transport level of fumes from stubble burning in the north-westerly direction, SAFAR says, which again is intensifying the crisis in Delhi and the National Capital Region.

In fact, India has a reputation of being one of worst polluted countries in the world with the top 10 polluted cities being located here, a fact pointed out by Anandpur Sahib MP, Manish Tewari, in the Lok Sabha on Tuesday, during a discussion on the crisis that saw only 1/5th of our lawmakers present in the lower House of Parliament.

According to the State of Global Air Report 2019, published earlier this year by the Boston-based Health Effects Institute, an independent global health and air pollution research organisation, an estimated 846 million people in India were exposed to household air pollution in 2017.

And what or rather, how much are Indians smoking? There are approximately 120 million smokers in India. According to the World Health Organisation (WHO), India is home to 12% of the world's smokers. More than 10 million die each year due to tobacco consumption in India.

However, what gets largely ignored is the fact that India, with all the above pre-conditions, has become the world capital of patients suffering from chronic obstructive pulmonary disease or COPD. It is the second-biggest cause of death in India today, says the International Journal of Pulmonary and Respiratory Sciences.

COPD is a severe and progressive lung condition that causes breathlessness (initially with exertion) and predisposes to exacerbations and serious illness, says WHO.

Wednesday was observed as the World COPD Day and this have experts an opportunity to raise awareness on the disease in the country and the plight of the many afflicted by it. The time is also opportune in India as the world’s largest democracy discusses air pollution and the inability to counter it.

A few pointers:

- The primary cause of COPD is exposure to tobacco smoke (either active or second-hand smoking).

- Other risk factors include exposure to indoor and outdoor air pollution and occupational dusts and fumes.

- Exposure to indoor air pollution can affect an unborn child and has a risk of developing COPD later in life.

- Some cases of COPD are due to long-term asthma.

- COPD is likely to increase in the coming years due to higher smoking prevalence and aging populations in many countries.

- The disease is not curable, but treatment can relieve symptoms, improve quality of life and reduce the risk of death.

Besides smoking, some of the other factors responsible are indoor air pollution (such as solid fuel used for cooking and heating), outdoor air pollution, occupational dusts and chemicals (such as vapours, irritants, and fumes) and frequent lower respiratory infections during childhood.

WHO says many cases of COPD are preventable and gives a list of those who are more at risk.

Previously, COPD was more common among men, but due to comparably high levels of smoking among women in high-¬income countries and the higher risk of exposure to indoor air pollution in low¬-income countries, the disease now affects men and women almost equally.

More than 90% of COPD deaths occur in low¬ and middle- income countries where effective strategies for prevention and control are not always implemented or accessible.

Symptoms

Chronic obstructive pulmonary disease develops slowly and usually becomes apparent after the age of 40 or 50 years. The most common symptoms of COPD are breathlessness (or a "need for air"), chronic cough, and sputum (mucous) production.

Daily activities, such as walking up a short flight of stairs or carrying a suitcase, and even daily routine activities can become very difficult as the condition gradually worsens.

Sufferers also frequently experience exacerbations, i.e., serious episodes of increased breathlessness, cough and sputum production that last from several days to a few weeks. These episodes can be seriously disabling and result in need for urgent medical care, including hospitalisation, and sometimes death.

Diagnosis and Treatment

COPD is usually suspected in people who experience the symptoms described above and can be confirmed by a breathing test called ‘spirometry’ that measures how much and how quickly a person can forcibly exhale air.

The most useful and cost-effective available treatment for COPD in people who continue to smoke is smoking cessation.

The International Journal of Pulmonary and Respiratory Sciences has cited the highest incidence of the disease in the north Indian states of Uttar Pradesh, Uttarakhand and Rajasthan. The prevalence of COPD has increased by 29.2% between the years 1990 and 2016 and has turned out to be cause of serious health concern.

It became the fourth leading cause of years of life lost in empowered action group states, including Bihar, Jharkhand, Madhya Pradesh, Chhattisgarh, Odisha, Rajasthan, Uttar Pradesh and Uttarakhand.

Also, COPD ranked seventh among the top killer diseases in the north-eastern states of Assam, Mizoram, Arunachal Pradesh, Meghalaya, Nagaland, Tripura, Sikkim and Manipur. Among the remaining states, it ranked fourth among all causes of years of life lost.