A chronic cough of a healthy young male adult living in Gurugram was not improving despite continued medication for two months. All his routine blood investigations were within normal range. Suspected tuberculosis was ruled out even by routine investigations and computerized tomography scans. A temporary shift to a small city hometown improved his cough and general conditions. This is not the solitary incident you may have heard of. Like his CT scans, many others have revealed- Pulmonary infection. The cause is environmental pollution.
The World Health Organization (WHO) estimates that the world’s major population resides in areas with minimum air quality. Adding to the woes is Southeast Asian developing economies providing fossil fuels at subsidized rates to their citizens. This results in greater consumption and production of pollutants. However, vehicular traffic is not the only cause of particulate matter emissions and poor air quality index (AQI).
Chronic obstructive pulmonary disease (COPD) makes breathing not only difficult but everyday chores also challenging. It cannot be cured; you can only improve your life.
Know Your Lung Function is the theme for World COPD Day 2024. Every year, on November 20, COPD Day is marked to increase global awareness about chronic inflammatory lung conditions that millions are unaware of.
Spirometry plays a crucial role in diagnosing COPD. Our lungs develop continuously from early stages through adulthood, and they face air pollution and respiratory infections. These exposures can hinder lung development and elevate the risk of chronic lung diseases in later years. Sadly, a significant lung function may already be compromised when symptoms appear. Lung function is an important indicator of both respiratory and general health.
Modernization, industrialization, accelerated economic growth, and all human-induced activities cause environmental pollution. Air pollutants not only cause lung inflammation but also worsen lung functions.
Irritants are tiny particles that damage the lungs. A small quantity of irritants over a long time can damage the lungs. Environmental factors like temperature, humidity, and extreme weather, increase pollution and cause COPD.
Indoor air pollution
Irritants within the home air cause indoor air pollution. People exposed to tobacco or second-hand smoke have a higher risk of developing COPD.
When smoking indoors, tobacco particles fill the air. Second-hand smoke causes COPD in people who have never smoked.
Air pollution caused by burning fuel indoors damages the lungs. Burning wood or coal indoors to cook food and heat homes, combined with poor air movement (ventilation), further aggravates the problem. Smoke from burning fuels when inhaled damages the lungs.
Urban air pollution
Large cities with heavy traffic and large industrial areas have higher outdoor pollution levels. Motor vehicles, factories, power plants, and wildfires release particulate matter in solid or liquid form- sulfur dioxide, nitrogen dioxide, carbon monoxide, and ozone emitted cause outdoor or urban air pollution.
Using an e-cigarette is vaping. Terminologies modify though the content remains the same; Electronic cigarettes, e-cigarettes, or vapes are battery-operated cigs containing liquid nicotine with flavorings and other additives.
Tobacco smoke has chemicals that cause COPD or worsen it. Vapes have aerosols, which like smoke cause COPD. Nicotine, a buttery flavoring called diacetyl, scars the lungs causing popcorn lungs along with heavy metals like lead, tin, etc.
The idea of using e-cigs seems flawed as it does not help you kick smoking; the aerosol instead causes lung inflammation.
EVALI (e-cigarette, or vaping, associated lung injury), is a new lung illness as the name suggests, is associated with e-cigarettes.1
Some common symptoms are
Cough
Fatigue
Shortness of breath.
COPD is an inflammatory condition affecting lung tissues and pulmonary vessels. It destroys the alveolar air sacs, and the gas-exchange surface of the lungs, leading to obstruction and emphysema. Irritants like smoking cause an inflammatory response. Characteristics of COPD are
Coughing
Dyspnea
Sputum
Oxidative stress occurs when there are many free radicals but not enough antioxidants to neutralize them. Causative factors of oxidative stress are poor diet, smoking, alcohol, medicine use, and exposure to environmental factors such as radiation, toxins, air pollution, pesticides, and sunlight.
Chemical reactions within the body produce unstable molecules called free radicals. Excess free radicals harm the body, causing oxidative stress and diseases. The free radicals damage DNA, lipids, and proteins in cells which take a long time to heal.2
A protease-anti-protease imbalance plays a role in the development of COPD. COPD occurs when an imbalance occurs between enzymes that break down the extracellular matrix and lungs and proteins that oppose it.3 It is genetic.
COPD is currently the 4th most common cause of death worldwide and is expected by 2030 to rank third. Cigarette smoking is one of the common causes that triggers COPD. The World Health Organization estimates that 73% of COPD deaths in high-income countries and over 90% in developing countries are related to tobacco smoking.
Lifestyle changes to manage symptoms of COPD:
Quitting smoking or vaping is an important event.
Avoiding second-hand smoke or smoke from indoor cooking fires.
Staying physically active.
Antioxidant diet comprising fruits and vegetables
One should continue the medical treatment as advised by the treating physician.
On this COPD Day, we highlight a disease that impacts millions. Early diagnosis, lifestyle changes, and proactive management can slow its progression and improve the quality of life. Let’s work together to make breathing easy and raise awareness.
References:
1.Magallón, María, María Mercedes Navarro-García, and Francisco Dasí. “Oxidative Stress in COPD.” Journal of Clinical Medicine 8, no. 11 (November 13, 2019): 1953. https://doi.org/10.3390/jcm8111953.
2.Phaniendra, Alugoju, Dinesh Babu Jestadi, and Latha Periyasamy. “Free Radicals: Properties, Sources, Targets, and Their Implication in Various Diseases.” Indian Journal of Clinical Biochemistry 30, no. 1 (July 15, 2014): 11. https://doi.org/10.1007/s12291-014-0446-0.
3. Abboud, R. T., and S. Vimalanathan. “Pathogenesis of COPD. Part I. The Role of Protease-Antiprotease Imbalance in Emphysema.” The International Journal of Tuberculosis and Lung Disease: The Official Journal of the International Union Against Tuberculosis and Lung Disease 12, no. 4 (April 2008): 361–67.
4. Agarwal, Anuj K., Avais Raja, and Brandon D. Brown. “Chronic Obstructive Pulmonary Disease.” In StatPearls. Treasure Island (FL): StatPearls Publishing, 2024. http://www.ncbi.nlm.nih.gov/books/NBK559281/.
