What Makes Pollution a Risk for Your Lungs?

This is the summary: Some pollutants can’t be seen but are just as harmful as the thick black smoke emitted from factories, diesel engines including vehicles and generators, brick kilns, and burning trash and leaves. In the countryside smoke results from burning firewood for cooking, setting fires to fields after crop harvest, tractors, tube wells powered by engines and vehicular traffic.

Lahore, New Delhi, Peshawar, Beijing. Recently newspapers and social media carried photographs of these cities covered in smog. Children and the elderly were particularly affected in Lahore with several consultations for exacerbations of chronic bronchitis and asthma.


What is pollution?

Everyone has a right to clean air yet we don’t get to breathe it in most cities. The presence of harmful gases and particles in air is pollution. Smog is derived from smoke and fog, when pollutants descend in the form of fog creating a haze and irritation in the throat and chest.

Some pollutants can’t be seen but are just as harmful as the thick black smoke emitted from factories, diesel engines including vehicles and generators, brick kilns, and burning trash and leaves. In the countryside smoke results from burning firewood for cooking, setting fires to fields after crop harvest, tractors, tube wells powered by engines and vehicular traffic.

Forty years ago power was mostly generated from coal plants in many countries. The London smog of 1952 caused 4000 deaths. In 1964 the clean air act was passed for clearing out air pollution.

One in every five people is particularly at risk from air pollution. These include the elderly, very young children, pregnant women, and people suffering from diseases like asthma, chronic bronchitis, emphysema and coronary heart disease.


Which pollutants cause the problems?

Sulphur dioxide (SO2) is produced by coal burning, power stations and diesel burning. It narrows down air passages making breathing difficult. This is a particular problem for young children, asthmatics and patients with emphysema.

Smoke is produced by coal burning, power stations, traffic, kilns and any other form of large scale burning. Large smoke particles are trapped in the upper air passages, but the smaller particles can travel deep into the lungs. These particles include cancer causing polyaromatic hydrocarbons.

Nitrogen dioxide (NO2) belongs to the family of oxides of nitrogen (NOX). These are produced by burning of fuel in motor vehicles and power plants. It irritates the lining of the bronchial tubes in the lungs. Its levels are high along busy roads, and can make breathing difficult for asthmatic patients.

Ozone is the main ingredient of photochemical smog. It is found when NOX and hydrocarbons combine in sunlight. Ozone irritates the lungs causing coughing and chest pain. It also stings the nose, throat and eyes, and may cause headaches. People with lung disease and people exercising are particularly at risk when ozone levels are high.

Carbon monoxide (CO) is odourless and very poisonous. It comes mainly from traffic exhaust. It interferes with the ability of the blood to carry oxygen to the brain, heart and other tissues. People with heart disease are particularly at risk. CO may also retard the growth of unborn children. Cigarette smoke is another source of CO, and smokers have much higher levels in blood than non-smokers.

Diesel exhaust emits smoke and thus more cancer causing chemicals than petrol smoke.

Lead threatens the normal development of children. Lead was present in petrol but levels have declined since the use of lead-free petrol. Lead is added as an anti-rusting agent to paints. Burning or melting such painted objects e.g. ship hulls releases lead in the air. A study done in the 1980s in the Kot Lakhpat area of Lahore — where such plants are located – and published in the Science of the Total Environment revealed high lead levels in the blood of residents of the area. Lead was found in particles settling on food sold by streetside vendors.

Acid air occurs during episodes of photochemical smog when NO2 and SO2 are converted into acid, particularly nitric acid and sulphuric acid. These form into clouds of tiny acid droplets. They damage trees and other plants. When breathed in they cause irritation of the airways, coughing and even wheezing.


What can you do to protect yourself against air pollution?

People who are exposed to pollution for any length of time, such as cyclists, traffic police, couriers, or those involved in any type of outdoors work, should consider wearing an appropriate mask. This is especially important for people who are prone to chest infections or suffer from chronic lung disease.

People are advised to avoid strenuous exercise when pollution levels are high, particularly ozone levels. Most governments issue ozone alerts.

At risk groups such as pregnant women, very young children, the elderly and those with chronic lung disease or heart disease should best stay indoors.

Governments must take up the responsibility of ensuring clean air for all. It is the collective responsibility of road users, business, industry and governments to cooperate to achieve this objective.

Her Tiredness was Increasing by the Day, And No One had a Clue

She was first alerted by others who told her that she appeared short of breath and that she had to pause to catch her breath while talking. But she never felt anything like that. Some days ago she had an episode of cough and cold following which she felt more and more tired by the day. She had to rest between doing her chores, and sometimes taking a shower left her drained out.

It was put down to chronic fatigue, but as it began to interfere with her daily activities she came in for a consultation. There were many other conditions which could cause those symptoms including heart disease, sluggish thyroid, neuromuscular disease such as myasthenia gravis, pulmonary hypertension and lung fibrosis among others.

She was on medication for high blood pressure, and that could be a reason also, though she had never smoked cigarettes. Deep exploration of her medical history, and carefully chosen tests revealed that her airways or the little tubes in her lungs through which air flows were blocked. We then tested if the blockage could be reversed, and it turned out to be so.

Working on the hypothesis of asthma, we put her on treatment. She reported feeling much better and having more energy compared with the recent past on follow up.

This is quite an unusual presentation of asthma. Textbooks don’t usually mention it. How did we find out? Ask questions, several of them, and listen. Listen also to what is unsaid, observe the patient, and then do a careful clinical examination. This will give you an idea of the underlying disease which you then substantiate with relevant tests.

Experienced and Valuable to the Company, Couldn’t Work Because of Asthma: How We Managed

It was in the early days of my practice when an asthmatic patient consulted as he was finding the symptoms troublesome. He was using an inhaler but had frequent episodes of worsening symptoms, and it was becoming difficult for him to work. The clue came when he said that he felt better during long weekends and when on holiday.

He was an engineer in charge of maintaining instruments in a factory. He knew all machines and equipment inside out and thus was extremely valuable because of his experience. Exploring details of his work revealed that he experienced attacks when he repaired an instrument or other equipment. He confirmed my suspicion when he stated that using soldering iron and flux triggered an attack.

His employer didn’t want to place him in any other department, nor did he want to do anything other than look after his beloved instruments.

Taking a cue from workstations designed for preparing chemotherapy medication for cancer patients, I proposed a worktable design which would enable him to do the work he loved, yet avoid having to inhale fumes which triggered the exacerbation.

It consisted of a glass top and sides where he could see everything; on the front there were holes for the arms so that he could hold things. A small extractor fan removed the fumes from the worktable into an exhaust leading out of the building.

This simple arrangement worked beautifully for both the engineer and the employer. He was able to achieve control of asthma, while his inhaler use dropped. Reduced inhaler use also meant a reduction in costs.


Can Anger Affect Asthma?

The short answer, yes.

Anger is one of the most common emotions experienced.  Like most emotions, it can trigger or aggravate an asthmatic episode. It is a response to anything causing physical or mental pain. It may be produced by our own shortcomings, frustrations and what we perceive as injustices. It can be inspired by people and events and is often accompanied by fear.

Whatever the cause, anger is often damaging physically, emotionally, socially and economically. It is displayed vociferously with gesticulations, physical assault and rash acts such as rash driving, slamming doors or smashing objects.

The problem with anger is that it is damaging whether expressed or suppressed. While expressed anger may harm relationships, which in turn has consequences, suppressed anger results in bad health. Stored anger leads to stress, depression, high blood pressure, ulcers, sleep problems, heart attacks and stroke. Some people are quick to express anger, only to regret their outburst later! That too is damaging in the long run.

So what can you do?

To reduce the damaging effects it is important to know how to deal with anger safely and effectively. Aristotle put it very neatly all those years ago: Anyone can become angry – that is easy. But to be angry with the right person, to the right degree, at the right time, for the right purpose, and the right way – this is not easy. (The Nicomachean Ethics.)

The following four things help manage anger.

  • Accept that you are angry. It is a normal emotion, and indicates a need to get something right.
  • Recognise that you are heading to a confrontation. But don’t let that make you push people where they can’t escape without loss of face.
  • Let it out, don’t suppress it. Don’t make it a noisy expression of your unhappiness, verbal abuse, physical assault or cause damage. Instead make specific, powerful complaints expressing your position and feelings, highlighting what has made you upset. Suggest a remedy also, and be open to counter offers.
  • Release physical energy by exercising, hitting a punching bag, playing squash, smashing a ball, doing aerobics, dancing or going for a run.

To do this you have to decide how you are going to manage anger before becoming angry next time. Learn to use it as a tool, for it is a frustration that makes you angry and that you want remedied in the first place.

Does Being Overweight Complicate Asthma?

It certainly does.

A forty five years old business owner visited came in for a consultation. He was portly and quite out of breath when he entered. It took a while for him to catch his breath back. This only after walking from the car park! He had pre-diabetes, mildly raised blood pressure and his knees had begun to hurt. His lung function test was below normal. He now wanted to become fitter as he was tired of declining health.

The challenge

This is becoming typical of many urban dwellers with sedentary work and lifestyles. Approximately 65% population over thirty five years is overweight. Being overweight is a risk factor for developing diabetes, heart disease, kidney failure, gall stones, high cholesterol, stroke and osteoarthritis. This means taking medicines for life at a time which has seen an escalation in health care costs. Since many companies pay for medical bills of employees, their profits are likely to be undermined. Studies in the United States show $123 billion in health care costs because of obesity! This is compounded by productivity loss. This does not include stress, depression and the ripple effect on quality of life.

A body mass index equal to or greater than 27 kg/m2 has equated a productivity loss of 5 hours per week. Medical costs, absenteeism and work limitations have been found to be 77% higher in obese people. A waist circumference of 92 cm and more among males has been linked to a higher risk of metabolic syndrome and heart disease among South Asian populations.

While some people have a genetic disposition to excess body weight, many cases are because of physical inactivity and excess body fat, hence preventable. This means that a lowering of body weight combined with physical activity can improve general health. Thus health care costs and absenteeism can be reduced and productivity increased.

What can be done?

Preliminary studies have shown a health and economic benefit of a modest reduction of 10% in body weight. Lifestyle interventions including one-on-one counseling effected a reduction of 58% in the incidence of diabetes. Health coaching, a blend of behavioural theory and clinical practice has emerged as an effective intervention toward improving health. This is because of several interconnected factors which can sabotage an individual’s efforts to improve health. Although many individuals have succeeded in achieving normal weight by their own efforts, several give up along the way.



National Health and Nutrition Examination Survey 1999-2002

Surgeon General, Obesity in America, National Health Policy Forum 2003

Thomson et al. Estimated economic costs of obesity to US businesses, Am. J. Health Promotion 1998: 12(2)

Avoiding Asthma Triggers Can Help Control Symptoms

More cases are being diagnosed with asthma than ever before. The cause may be an actual rise in the number of patients or increased awareness and better diagnostic facilities.  For the sufferer, moderate to severe asthma remains a challenge to control despite the variety of treatments available.

In some cases, the patient is aware of the trigger, while in others it remains a mystery. House dust mites, pets, aerosols, pollen, flour, nuts and sea food are common trigger factors.

Recently available inhalers have helped control asthma effectively, though a cure remains elusive. Avoidance of trigger factors can help improve control of asthma tremendously.

A study conducted on school children bears this out. A group of school children with asthma was taken to Davos in Switzerland. As there is snow there most of the year, hence house dust mites don’t occur there. Consequently none of the school children needed their inhalers or other treatment of asthma during their stay in Davos.

To make it easier to live with asthma, try to avoid common triggers, as those listed below. Not everyone is sensitive to the same triggers, so you’ll have to find out from experience or observation.

At home

  • Food, e.g. nuts, chocolate, eggs, shellfish and peanut butter.
  • Beverages such as orange juice, milk, squashes. The yellow food colouring, tartrazine, is often associated with asthma.
  • Mold spores and pollen from flowers, trees, grasses, hay and ragweed. If pollen is an offender, an air conditioner with a filter helps.
  • Animal dander, as that from cats, dogs, rabbits, hamsters, birds including chicken, doves and pigeons , cockatiels and budgerigars. Consider finding a new home for the pets.
  • Feather stuffed pillows, wool clothing, stuffed toys. Use smooth washable blankets on your bed, not rough, fuzzy ones.
  • Insect parts, like those from dead cockroaches and house mites.
  • Medicines, such as aspirin and some other pain killers.
  • Vapours from cleaning solvents, paint, paint thinner and liquid chlorine bleach.
  • Spray products such as furniture polish, spray starch and room deodorants.
  • Scents from spray deodorants, perfumes, hair sprays, talcum powder and cosmetics.
  • Heavy furnishings, carpets and curtains that collect dust. Hang lightweight, washable cotton or synthetic fibre curtains; use washable cotton rugs on bare floors. Cover pillows and mattresses with impermeable covers, and wash blankets and sheets in very hot water weekly.  Use unscented laundry soap and avoid fabric softeners.
  • Brooms and dusters which raise dust. Instead, clean your bedroom daily by damp dusting and damp mopping. Keep the door closed.
  • Dirty filters on air conditioners and coolers which blow dust into the air.
  • Dust from vacuum cleaner exhaust.

In the workplace

  • Dusts, vapours or fumes from wood products (particularly western red cedar, some pine and birch woods and mahogany); flour, cereals and other grains (as in baking and mills); coffee, tea; metals (platinum, chromium, nickel, sulphate, soldering fumes); cotton, flax and hemp.
  • Mold from decaying hay.


  • Cold air, hot air, sudden temperature changes (when you go in and out of air-conditioned stores in the summer or winter.
  • Excessive humidity or dryness.
  • Changes in seasons.
  • Smog.
  • Automobile exhausts.
  • High pollen count.


  • Overexertion, as during or after exercise, which may cause wheezing.
  • Common cold, flu and other viruses. (You will need to increase your asthma medicines in this case.)
  • Fear, anger, frustration, laughing too hard, crying or any emotionally upsetting situation.
  • Smoke from cigarettes, cigars and pipes. (Don’t smoke or stay in a room with people who do.)
  • Fumes from perfume, cologne and aftershave.
  • A bout of coughing.

Preventive measures

Remember to:

  • Drink enough fluids (at least eight glasses daily.)
  • Take all medicines exactly as directed.
  • Tell your doctor about any medications that you take (even over the counter ones.)
  • Do only as much activity as you can tolerate, taking frequent rests on busy days.
  • Avoid sleeping pills or sedatives to help you sleep because of a mild asthma attack: these medicines may slow down your breathing and make it more difficult. Instead, try propping yourself up on extra pillows.

How an Outbreak of Asthma was Managed in Barcelona

Back in the 80s hospital emergency units were confounded by a surge of patients with symptoms of severe asthma in Barcelona, Spain. This became a pattern and placed a considerable cost on resources. Every few weeks large numbers of patients would arrive in hospital emergency departments in several hospitals.

The authorities were perplexed and epidemiologists were called in for help, and thus a great epidemiological detective story began. This is where data comes in so handy.

Data revealed that all patients were young healthy adult males without known asthma. Almost all clusters of patients came from areas near the sea port. Further investigation showed that they all worked in the dockyards.

But what caused their symptoms was proving to be a riddle. They were tested for all causes known to cause symptoms but there were no conclusive answers.

After another episode, someone suggested that perhaps the cause was something which was unloaded at the port. Inquiry revealed that those exhibiting the most severe symptoms were involved in unloading shipment of soya bean oil. Checking data of shipments unloaded on earlier dates when those young men fell ill confirmed that they had unloaded soya bean oil on those dates too.

As a result methods of shipping and unloading soya bean oil were changed, and appropriate preventive measures provided to the workers. Happily there were no outbreaks of severe asthma after that.

This goes to show how important accurate records and an open mind are.