A 45-year-old woman, from Loni village, Maharashtra, walked into Pune’s Chest Research Foundation (CRF) with complaints of experiencing breathlessness and severe bouts of cough — symptoms that doctors would usually ascribe to a smoker. A chest x-ray appeared to suggest bronchitis, again much like that of a smoker’s. A thorough check of her medical history showed that she had never smoked; her condition was a result of exposure to smoke, having spent half her life using a chulha , or wood-fired stove, for cooking and being exposed to its smoke.
Often mistaken for asthma, chronic obstructive pulmonary disease (COPD) in those who have never smoked — as the woman’s case was finally diagnosed to be — is increasingly being reported in many rural areas across India. Doctors say that the trigger is mainly indoor air pollution, though outdoor air pollution too is no longer uncommon.
Myth and reality
“We tend to believe that rural air is cleaner and less polluted. But it is mostly a myth. We have carried out several studies that have shown pollution in the rural parts to be as bad as that in urban areas,” says Dr. Sneha Limaye, a physician and air pollution scientist who heads the department of clinical research at the CRF. Of all the patients who manifest symptoms of breathlessness and asthma, nearly 20% of them have non-smokers-COPD due to excess pollution. These patients are typically exposed to the burning of biomass, wood and cow dung, all of which emit extremely harmful particulate matter — PM2.5 — that gets lodged deep in the lungs. There is also exposure to farming and construction dust and vehicular pollution in rural areas that increase chances of harmful exposure.
Keep watch
India’s National Clean Air Programme (NCAP) has for the first time mentioned the need for a rural air monitoring network. A NCAP document says that air quality in certain rural areas all over the world, particularly in developing countries, may be more polluted than in some urban areas. “Rural areas suffer from outdoor air pollution as well as indoor air pollution. Major sources of outdoor air pollution are indiscriminate use of insecticides/pesticides/sprays and the burning of wheat and paddy straw. Atmospheric concentration of ozone has been observed to be higher in rural areas when compared to urban areas. Indoor air pollution exposes more people worldwide to health risks than outdoor air pollution,” it says. It proposes 50 air monitoring stations in rural areas.
“Many rural households lack good ventilation. Therefore, exposure can be extremely high in some houses in certain villages. This, however, varies from household to household and village to village,” says Dr. Rakesh Kumar, director of the National Environmental Engineering Research Institute (NEERI), Hyderabad. Emissions, he says, consisted of carbon monoxide, carbon dioxide, oxides of sulphur, oxides of nitrogen and ozone as well as particulate matter.
The impact
Doctors say that the trickiest aspect of dealing with these cases is the absence of a definitive cure. “The only thing we can offer is alleviating symptoms for patients and suggesting precautions such as avoiding exposure to pollutants,” says Dr. Limaye. Experts say that the harmful effects of pollution can show up even in newborns. A 2009 Lancet article mentions a study in Guatemala that showed that babies born to mothers who were exposed to biomass smoke from open fires were found to be 60g to 70g lighter than those exposed to pollutants from chimney stoves, electricity or gas. The article also noted that indoor air pollution from burning wood, animal dung, and other biofuels was a major factor in acute lower-respiratory-tract infections, which is a key cause of death in children in developing countries. “Such infections account for 20% of the estimated 12 million deaths in children younger than 5 years that occur every year, and about 10% of perinatal deaths,” it stated.
Chest physician Dr. Kuntal Pal, who is based in Mumbai, says that the impact of exposure to air pollution can be acute or chronic. “In acute cases, patients present themselves with acute bronchitis, cough and cold. With proper medication, however, this is reversible,” he says. Chronic cases, due to persistent exposure to pollution, are marked by chronic bronchitis, asthma or interstitial lung disease. Such patients develop structural changes in the lungs which result in respiratory failure and require long-term treatment.
jyoti.s@thehindu.co.in
