By Nabamita Mitra
Air pollution is suddenly in the news, after consistent reports from Delhi-NCR, where the Air Quality Index (AQI) has gone far beyond acceptable limits. Hence people in Delhi, Uttar Pradesh and the rest of north India have begun suffering from chest congestion, cough, shortness of breath, and other problems.
When we breathe polluted air, microscopic particles of dust settle down in the breathing passages and inside the lungs, and cause the air passages to become narrower than normal. The group of illnesses is known as Chronic Obstructive Pulmonary Disease (COPD).
The Global initiative for Obstructive Lung Disease (GOLD) set up in 1997 has classified COPD into four stages, depending on the severity of symptoms. In the first and second stages, the symptoms of cough, expulsion of sputum, etc would be mild to moderate. You may not even associate these minor problems with a serious disease. In the third and fourth stages, the cough and breathlessness becomes severe enough to affect your daily routine activities.
Among other things, sleep quality is poor in COPD patients, because the level of oxygen in their blood constantly remains low. Hence, they are forced to breathe rapidly – the natural slowing down of night time does not happen. All the harmful effects of sleeping poorly then begin to show up in these patients.
The causes of COPD are different in various parts of the world. In the western countries, the biggest cause is consumption of tobacco in all its forms. But according to the Chest Research Foundation (CRF), Pune, at least 50 per cent of COPD patients in India are non-smokers. Many are women who have never used tobacco in their lives. In these cases, the reasons for COPD include indoor air pollution, use of mosquito coils, cooking on earthen chulhas, frequent exposure to smoke from agarbattis, etc.
The CRF estimates that about 55 million Indian people suffer from COPD, of whom a million people die of the disease. One of the reasons is that COPD is vastly underdiagnosed even by family physicians because the symptoms are rather innocuous and often mistaken for chronic bronchial asthma or even mild episodes of infection.
The government may not be able to prevent the use of mosquito coils or persuade people to avoid agarbattis, since it is a part of religious ceremonies. But the Ujjwala scheme introduced a few years ago to wean the homemakers away from earthen chulhas and towards LPG cylinders is a step in the right direction.
The management of COPD are avoidance of risk factors and bronchodilators. In the end stage of disease patient needs ventilator support.
The Non-invasive ventilation (NIV) which includes methods like BiPAP (Bi-level Positive Airway Pressure) commonly use in COPD patients with ventilator failure. Here the air is pushed into the breathing passages to ensure adequate oxygen supply, rather than depending on the natural process of breathing. Bi-PAP is delivered through a device with a mask placed on the face, covering the nose and air is pumped into the air passages. Masks of various designs are available as per the patient’s convenience. If this device is introduced early enough, the COPD patient’s life can be much closer to normal. The days when ventilators were used only in the ICU of a hospital are long behind us.
In addition, mass awareness and education programs to inform people about these illnesses on the pattern of TB, malaria, etc are required with a suitable initiative from the government health departments.
Besides, health insurance companies should be instructed to reimburse the expenses of effective COPD therapies such as non-invasive ventilation (NIV), so that the patient does not have to wait until he is admitted to a hospital.