The kathmandu post __ the air they breathe

Mar 29, 2016- Air pollution is a major environmental issue affecting people across the world. According to the World Health Organisation (WHO), more than 7 million people worldwide die every year from air pollution. This finding more than doubles previous estimates and confirms that air pollution is now the world’s largest single environmental health risk. The WHO has placed countries like India, Pakistan, Bangladesh and Nepal in a category called ‘unhealthy for the sensitive people’. That means people in these countries suffering from respiratory and heart disease, as well as elderly and children, should limit outdoor exertion.

The Air Quality Index (AQI) is the number used by government agencies to communicate to the public how polluted the air is. An AQI of more than 200 is considered to be poor quality. If it is more than 400, it will not only seriously affect ill patients but also cause serious respiratory problems among healthy people. According to the latest pollution index, Kathmandu has been ranked as the third most polluted city in the world. Nepal’s air quality has been placed in the 177th position out of 180 countries, according to the 2016 Environmental performance Performance index Index (EPI), only better than India, China

and Bangladesh.

Air pollution has emerged as the biggest environmental health risk for the country. The reason for this being rapid urbanisation and population growth, particularly in Kathmandu. Having worked as a paediatrician at Patan Hospital and as a pulmonology fellow at Sir Ganga Ram Hospital, New Delhi, I have seen a disproportionate number of children with respiratory illnesses being admitted to the wards on a daily basis. The vulnerability of children to impacts of air pollution is unique. First, because a child’s lungs are still growing, early exposure to environmental pollutants can easily alter lung development and functioning. Second, because they are more physically active, have a faster breathing rate and are predominantly oral breathers, a large amount of air pollutants can enter the respiratory tract. Of all the air pollutants, carbon monoxide, ozone, particulate matter, sulphur dioxide and environmental tobacco smoke are the most hazardous for a child’s health. Carbon monoxide is a by-product of combustion. The major source of carbon monoxide is indoor burning of biomass or coal (solid fuel).

Tobacco smoke contains a very high concentration of carbon monoxide. Household air pollution is associated with acute respiratory infections in children. In some studies, pneumococcal infection (a common respiratory infection) in children has been associated with being carried on mother’s back while cooking and exposure to environmental tobacco smoke.

Ozone is a common summertime pollutant. It has seasonal variation. The highest levels of ozone are seen in the late afternoon in the summer months. With increased levels of ozone, irritation of the nose and throat, coughing, headaches and chest pain increase. Particulate matter is a widespread air pollutant, consisting of a mixture of solid and liquid particles suspended in the air.

Much of the sulphur dioxide in the air is associated with diesel emissions. It is a very water soluble gas and, therefore, most of it is inhaled and absorbed in the upper respiratory tract. Environmental tobacco smoke (ETS) is produced by an active smoker while exhaling smoked tobacco and from the burning end of a cigarette which is inhaled by non-smokers. ETS consists of particles much smaller than those in mainstream smoke and, therefore, has greater penetrability to the airways of children. The concept of third-hand smoking is gradually emerging. The residue from cigarettes, cigars and other combustible tobacco products can linger on surfaces and furnishings long after these products have been extinguished.

At present, the government should encourage urban planning that addresses the health issues of children. Smoke-free policies and mass transportation initiatives can be taken. During the 1996 Olympic Games, mass transit was encouraged and parts of Atlanta were closed to private vehicles. There was a significant decrease in ozone pollution and acute asthma events dropped by more than 40 percent as a result. An increasing number of countries have issued laws to regulate smoking in public places. However, homes remain a place where children are dangerously exposed to environmental tobacco smoke and third-hand smoking.

Exposure of children to ETS in the home increases the incidence of middle ear disease, asthma and pneumonia. Many children are gasping for air in the hospital. For smokers, one of the only effective interventions is quitting smoking. But patients admitted to the paediatric ward have no cigarettes to give up. They work in factories and vehicles and sleep on the street. The air they breathe is making them sick. It is the responsibility of the family, society and the government to make sure that the air our children are breathing is fresh and smoke-free.

Dr Ghimire is a paediatric pulmonology fellow at Sir Ganga Ram Hospital, New Delhi

Published: 29-03-2016 08:21