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Air pollution is a critical risk factor for non-communicable diseases (NCDs), causing an estimated 43 percent of all adult deaths from COPD

Air pollution and smoking are the biggest risk factors for COPD

Women are more susceptible to COPD than men with the number of new cases growing nearly three times faster in women than in men every year[1]





It has been yet another year when the air pollution levels in Delhi remain at a record high despite the revised timings for bursting fireworks, extension of the ban on the entry of trucks, restrictions on construction, polluting industries and crop burning in the adjoining states.



Recently, the overall Air Quality Index (AQI) of the city was recorded in the "severe plus emergency" category. The overall air quality index or AQI was 10 times the safe limit. According to the government-run System of Air Quality and Weather Forecasting and Research, AQI above 500 falls in the "severe-plus emergency" category.



Studies indicate that such long-term exposure to pollution can reduce life expectancy by altering lung function and making people more susceptible to COPD. In a report published by WHO, it recognized that air pollution is a critical risk factor for non-communicable diseases (NCDs), causing an estimated 43 percent of all adult deaths from COPD[2].





Understanding COPD



COPD, also known as Chronic Obstructive Pulmonary Disease is a group of progressive lung diseases including emphysema, chronic bronchitis, and refractory (non-reversible) asthma which causes difficulty in breathing and severe exacerbation. The symptoms of COPD like chronic dry cough or cough with phlegm, shortness of breath or wheezing are often confused with asthma or other respiratory disorders. Hence, the disease is often misdiagnosed, contributing to further worsening of the quality of life. The disease is irreversible and can only be managed with effective treatment.



Studies reveal that, about 33.6 percent of COPD disability adjusted life years (DALYs) could be attributed to ambient air pollution, 25.8 percent to household air pollution and 21 percent to smoking[3].



Despite being the leading cause of mortality amongst all non-communicable diseases, COPD receives scant attention as a women’s health issue. It has been found that women are more likely to die of COPD than of breast and lung cancer combined.[4]



According to Dr. Sandeep Nayar, Director & HOD-BLK Centre for Chest & Respiratory Diseases, BLK Super Speciality Hospital, New Delhi, “Once again, the citizens of Delhi-NCR are battling the annual phenomenon of severe air pollution and smog. The current level of pollution is extremely dangerous for human health, and prolonged exposure is the key risk factor for developing several respiratory diseases, including COPD. Though the progression of COPD is comparatively slow, it is an irreversible disease and accounts for high death rates and hospitalizations. Therefore, it is important for patients to not ignore symptoms like chronic dry cough, cough with phlegm, shortness of breath or wheezing. The symptoms of COPD should not be confused with asthma or other respiratory diseases as it delays treatment. It is most advisable to consult a pulmonologist if one experiences any of these symptoms frequently or for a prolonged duration. Advanced treatment options can help improve patient’s quality of life and improve further progression of the disease.”



COPD in Women



Women are more susceptible to chronic obstructive pulmonary disease (COPD) than men.[5] The number of new cases of COPD is growing nearly three times faster in women than in men every year[6].



Women living with COPD have more disease flare-ups and use more healthcare resources. There is also higher prevalence of other co-existing diseases such as anxiety and depression, in female COPD patients.



In India, 70 percent of the homes use biomass fuel for cooking and heating purposes in poorly ventilated kitchens and the amount of particulate matter pollution generated by the burning of biomass fuel is extremely high[7]. Biomass fuels are now considered a major cause for development of COPD[8].



Dr. Ashok Mahasur, Consultant Chest Physician, Hinduja Hospital, Mumbai says, “A significant number of working women in tier 1 and 2 cities, who mostly have a hectic work schedule have started indulging in social smoking or are exposed to passive smoke at their workplaces. They often don’t realize that they are placing their health at risk which could result in chronic irreversible diseases like COPD. Previously COPD was found to be more common in men, however, due to comparably high levels of tobacco smoking among women especially in high income urban centers, the disease now affects men and women almost equally.”



Treatment for COPD



Preventing exacerbations is one of the primary goals of long-term care for COPD patients. These episodes have a detrimental effect on quality of life and disease progression[9], contributing to further lung function decline[10] and, in severe cases, hospitalization[11]and even death[12].



As per the FLAME study, published by the New England Journal of Medicine, LABA/LAMA dual bronchodilator significantly reduced the rate reduced the rate of moderate or severe exacerbations with a 17% risk reduction and prolonged the time to the first of these episodes with a 22% risk reduction, amongst COPD patients.





[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3775194/



[2] WHO Global Ambient Air Quality Database (update 2018)



[3] The burden of chronic respiratory diseases and their heterogeneity across the states of India: The Global Burden of Disease Study 1990–2016



[4] https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.0030442



[5] Silverman EK, Chapman HA, Drazen JM, et al. Genetic epidemiology of severe, early-onset chronic obstructive pulmonary disease. Risk to relatives for airflow obstruction and chronic bronchitis. Am J Respir Crit Care Med 1998; 157: 1770–1778.



[6] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3775194/



[7] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3775194/



[8] Chronic obstructive pulmonary disease in non-smokers.



Salvi SS, Barnes PJ



Lancet. 2009 Aug 29; 374(9691):733-43.



[9] Soler-Cataluña JJ, Martinez-Garcia MA, Sanchez PR, et al. Severe acute exacerbations and mortality in patients with chronic obstructive pulmonary disease. Thorax. 2005;60:925-931.



[10] Donaldson GC, Seemungal TA, Bhowmik A, Wedzicha JA. Relationship between exacerbation frequency and lung function decline in chronic obstructive pulmonary disease. Thorax. 2002;57:847-52.



[11] Müllerova H, Maselli DJ, Locantore N, et al. Hospitalized exacerbations of COPD: risk factors and outcomes in the ECLIPSE cohort. Chest. 2015;147:999-1007.



[12] Soler-Cataluña JJ, Martinez-Garcia MA, Sanchez PR, et al. Severe acute exacerbations and mortality in patients with chronic obstructive pulmonary disease. Thorax. 2005;60:925-931.