Are you breathing free?


The air quality index levels have risen in the South Asian region, indicating severe air pollution; and for the first time Colombo has made it to the news that it is not a safe place to breathe in. The smog in Colombo has alerted the public who were earlier joyful mistaking the fog to the mist that comes in the cooler months towards the year end. Apart from being equipped with the statistics on how the air quality levels are fluctuating, it is the need of the day to get medical opinion on how to safeguard one from the polluted air. A team of consultant respiratory physicians serving different parts of the island with diverse and extensive experience on respiratory issues and medical management with regard to air quality was interviewed. The team includes the president of the Sri Lanka college of Pulmonologists Dr. Saman Kapilawansa, Chair Working Committee on Air Pollution of the Sri Lanka college of Pulmonologists Dr. Chandana Kulatunge who is the Consultant Respiratory Physician at the District General Hospital Matara, Dr. Nandika Harischandra Consultant Respiratory Physician at the District General Hospital Anuradhapura and Dr. Dinesh Dassanayake Consultant Respiratory Physician at the District General Hospital Polonnaruwa.

Are we safe?

Dr. Nandika Harischandra Consultant Respiratory Physician District General Hospital Anuradhapura illustrated that the air quality is measured with the Air Quality Index (AQI). Readings up 50 is considered safe, whereas those above 300 are considered hazardous. The AQI on the morning of early this week (as at November 29th), recorded 126 in Colombo city, 70 in Homagama, 154 in Battaramulla and 114 in Kandy. However the readings were much worse a few weeks ago, as it was 170 by the morning on the 7th.

Is it the fog or the smog?

Chair of the Working Committee on Air Pollution of the Sri Lanka college of Pulmonologists and Consultant Respiratory Physician at the District General Hospital Matara Dr. Chandana Kulatunge explains how fog is different from the smog. He says that "Fog is visible water vapor that evaporates with the influx of the sun. Smog is the composition of particulate matter which is a sign of severe air pollution".

What is particulate matter?

Particulate matter (PM) which refers to a mixture of solid particles and liquid droplets found in the air such as dust, dirt, soot, or smoke, is an important ingredient in measuring the air quality.

Have we been safe till now?

According the Sri Lanka college of Respiratory physicians, though the alarms started ringing in the public sphere now, this has been a gradual process. One cannot forget the fact that our immediate neighbours India, Pakistan, Bangladesh have been notorious for severe air pollution for decades. Our not as close neighbour China records some of the worse rankings in the world. Air travels with ease. Once cannot say that one area could be safer than the other, as the respiratory physicians cited examples that they have been having the experience that there is an increase in the number of respiratory patients they see from year to year.

"This is not a problem that has come up overnight", says Dr. Dinesh Dassanayake Consultant Respiratory Physician at the District General Hospital Polonnaruwa; "It is ongoing and it is worse. One could be more affected that the other, but at the end we are all in it".

What are the sensitive groups?

The elderly over the age of 65 years, children below 2 years, pregnant women, patients whose immunity is suppressed due to usage of long term drugs, patients with chronic heart and lung diseases are the most vulnerable says the president of the Sri Lanka college of Pulmonologists Dr. Saman Kapilawansa. "But every living being is affected" reiterates Dr. Kapilawansa; "The gravity of the problem of air pollution should not be undermined".

How affected are we in reality?

Dr. Kulatunge exemplifies using the statistics of the World Health Organization (WHO). "In 2016, 8 million premature deaths occurred and the reason solely was air pollution". As he goes on to reveal the scary figures that in included 600,000 children. The most affected parts of the world are Asia and Africa. May be you live in a greener part of the island, or even living in a polluted city, your garden may be heavy with foliage. That by no means mean that you are safe. Air travels, and there are no compartments for air.

What are the medical concerns?

It is a myth of the public that air pollution causes only respiratory problems. "It is not only the chest that pollutions affects. But the cardio-vascular system as well as the neuro system. Viral infections, pneumonia, asthma in the long run, chronic obstructive pulmonary disease (COPD) which causes chronic inflammation in the lungs, lung cancer are some among the many of the bad consequences", says Dr. Harischandra.

No use of exercise?

You are well aware of non alcoholic cirrhosis. All this time you thought that the main culprit of lung cancer was smoking. Not any more! "Unlike those days, now it is a result of air pollution too" explains Dr. Kulatunge stating that a study done by the British Heart Foundation on the adults exercising in the Oxford Street in London indicate that bad air quality cancelled out the positive health benefits gained by exercise. "I cannot emphasize enough how grave this issue is."

Any precautions?

The consultant respiratory physicians of the Working Committee on Air Pollution of the Sri Lanka college of Pulmonologists emphasize that this is not the time for ad hoc solutions. They insist on a national policy on air pollution control with a comprehensive policy plan which need to be put into practice by the medically responsible citizen, who does not want to be a patient due to air pollution:

Ways to combat the issue would be:

Public transport is the best way out. Encourage active travel. Active travel by means of cycling and walking should be encouraged, as well as shared travel in the instances where private transport is unavoidable. It is the responsibility not only of the State, but also of the individual citizen to discourage oneself from private individual transport at least during peak hours.

Create a demand for bio gas as opposed to LP gas

Indoor air pollution need to be addressed as much as outdoor air pollution, which is equal in 50% weightage. Outdoor pollution includes vehicle exhaust, emissions from industries and power plants. Indoor pollution which is most underrated occurs due to traditional fire places for cooking. Most of the rural women suffer from lung cancers and COPD due to this.

Discourage diesel vehicles as they emit substances that cause lung cancer

Use energy efficient electric devices, which will work on minimizing the amount of diesel and coal used in power plants.

It is advisable that wearing a face mask when the air quality is poor would make a difference. Staying indoors during the time AQI is unfavourable should be followed by patients who are susceptible to respiratory, cardio vascular and neurological problems.

Call for Action

The news has it that schools in Delhi closed as it was declared unhealthy for children to step out of the houses. The city of Delhi adopted many a measure such as banning the use of vehicles with odd numbers one day, and those with even numbers on the other. Environment Protection Department in Pakistan fines farmers who burn their crop residue and a two month brick factory shut down in twelve districts including those in the capital. The Department of Environment in Bangladesh drafted an Air Pollution Reduction Strategy far back in 2012 itself. What are the measures we have taken? Are we waiting till we risk irreversible lung damage? Do we want warnings to stay indoors be issued as that happens with our neighbouring States? You are born to breathe free. But unless you take action now, days are numbered that you breathe free!

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