As the World observes Environment Day on June 5, the theme Air Pollution is apt considering the fact that air pollution has increased considerably, in developed and developing countries in the recent past. This decline in the air we breathe is due to a number of factors most of which come in the wake of rapid developmental projects that have mushroomed everywhere, especially, in developing nations, increasing vehicles on our roads which emit toxic emissions, changing lifestyles and irresponsible behaviour which encourage tobacco smoking, eating junk food, and using low grade plastic which often find their way to our waterways and canals.
The Sunday Observer asked Consultant Respiratory Physician, District General Hospital, Polonnaruwa, Dr D.L B Dassanayake to share his expertise on how a decline in air quality both outdoor and especially indoors, can impact our health and what steps we can take to make our environment healthier for future generations.
Excerpts…
Q. Air Pollution is this year’s theme for World Environment Day on June 5 . While most people are aware of the factors contributing to outdoor air pollution such as ground water contaminants and vehicular emissions, not many are aware that indoor pollution is even more deadly as it lurks inside our own homes. Define indoor pollution in simple language to our readers.
A.Air pollution is defined as chemical or physical changes brought about by natural processes or human activities resulting in air quality degradation.
Q. Is there a difference between indoor and outdoor air pollution?
A.Yes. Indoor air pollution is the air quality degradation inside your house or habitat and the contributing causes are different to that causing outdoor air pollution.
Q. From your experience as a Chest Consultant is there a decline in the quality of air inside our homes in the past two decades ? If so why?
A. In the recent past there has been an increase in the use of mosquito coils, especially, during the dengue epidemic and also in the use of incense sticks. These have led to a decline in air quality due to the smoke as well as particulate matter.
Q. What are the most common examples of indoor pollution in this part of the world?
A. Indoor air pollution is common in developing countries as firewood is used as fuel in houses. In some developing countries coal is used for cooking.
Q. How does Sri Lanka compare with other developing nations in respect of indoor air pollution?
A. Sri Lanka has the same problem compared to other developing countries as a majority of our population uses firewood for cooking. In areas like Nuwara Eliya firewood is used to heat up homes as well as warming water, contributing to indoor air pollution. On the other hand most households have poor ventilation in their kitchens. Burning coils, incense sticks and ‘sambrani’ is also a significant contributor.
In agrarian areas like Anuradhapura and Polonnaruwa molds seem to play a major role. Molds like aspergillus grow readily in paddy and paddy is stored inside most houses in these areas.
Moreover, in Sri Lanka a large number of people live beside main roads, which exposes them to vehicle exhaust containing toxic gases, including carbon monoxide, carbon dioxide, sulfur dioxide and particulate matter.
It is well known that respiratory disorders are commoner among people who live beside the road compared to people in villages.
This is particularly related to children as growing lungs are continuously exposed to toxic vehicle exhaust resulting in lung damage.
Q. What health effects do indoor air pollutants have?
A. Health effects are dependent on the pollutant. Smoke and noxious substance given off by burning firewood could directly damage lungs causing disease such as chronic obstructive lung disease [COPD]. Being the largest epithelial surface directly exposed to environment it is the most vulnerable organ to air pollution. Lungs filter out 10,000 litres of air per day and are constantly exposed to air pollution.
Toxic gases can directly damage lungs causing lung diseases. Air pollution can retard lung growth in children. Particulate matter 10 micro metres can reach distal airways which not only damage the lung, but the body’s reaction to these particles could lead to diseases that include diabetes, stroke and heart attacks. Some of the pollutants act as carcinogens leading to lung cancer.
Molds can worsen existing asthma and allergic rhinitis as well as cause a disease called allergic bronchopulmonary aspergillosis [ABPA] which is an allergic reaction of the lung against the mold causing wheezing, which is difficult to treat with ordinary asthma medications.
In addition, organic dust of paddy can cause an inflammatory disease in lungs called Hypersensitivity Pneumonitis which presents as shortness of breath, chronic cough and wheeze which needs specialized treatment to prevent permanent lung damage.
Q. Second hand tobacco smoke has also been cited as a cause .
A. Tobacco smoke is a common pollutant that not only leads to COPD but also lung cancer. Both active and passive smoking can lead to respiratory diseases and millions of people worldwide are exposed to tobacco smoke causing nearly 5 million deaths a year. Effects of tobacco smoke is not confined to the lungs. It is a major risk factor for heart attacks, Peripheral vascular disease and strokes and can also cause cancer of the bladder.
Q. Can dust trigger allergic reactions? How dangerous is breathing dust for an asthma patient?
A. Dust can worsen existing asthma as well as allergic rhinitis. Ongoing exposure to dust would lead to chronic asthma which is difficult to treat. In people who don’t have asthma sudden exposure to a large amount of dust could lead to bronchitis or irritant asthma.
Q. Is indoor air pollution easier to manage than outdoor air pollution? If so give us some guidelines?
A. Managing outdoor air pollution requires a collective effort. However, indoor air pollution can be managed easily with individual efforts like not using coils and incense sticks, as well as giving up smoking. Ventilation in kitchens can be improved by having a chimney and additional windows and keeping the vents open during cooking. Store rooms can be set up outside the house for storing paddy. These simple measures can drastically reduce indoor air pollution.
Q. Is air pollution the cause for the current spike in non communicable diseases in Sri Lanka and elsewhere?
A. Household air pollution is a major risk factor for non-communicable diseases. It is also one of the top killers. This is particularly related to particulate matter, especially, ultra fine particulate [particles smaller than 100nm] which can escape the lining cells of lung and enter the blood stream causing blood clots that lead to heart attacks, strokes as well as diabetes.
Q. Your advice to the public on how to reduce air pollution both outside and inside homes and maintain a sustainable healthy environment for future generations.
A. Prevention of outdoor air pollution needs inputs from all stakeholders involved in protecting the environment and should aim at removing or controlling sources of air pollution. Open burning and smoking should be avoided by individuals.
Particular attention should be given in planning of towns and cities. Residential areas and schools should be located away from highways and main roads. People should be educated about choosing a residential place away from main roads and away from traffic congestion to have a healthy life.
People constantly exposed to dusty and polluted environments and work in such places should wear masks.
People should be advised not to burn any items inside homes that gives off smoke such as mosquito coils and incense sticks.
Kitchens which use firewood should have good ventilation and a chimney and windows for smoke to escape. Windows and doors should be kept open during cooking to avoid smoke accumulation inside the kitchen.
Farmers should be advised not to store paddy inside houses and instead have a separate store outside the house.
Most of all people who have chronic respiratory symptoms should see a respiratory physician to diagnose these respiratory disorders before the lung is irreversibly damaged.