Asthma in India: A Growing and Deadly Health Crisis

Asthma isn’t a disorder that people think about when you mention serious health risks. Their first thoughts flow to heart disease, stroke, and cancer. Asthma is a severe disease affecting 7.6% of adults and 8.4% of children around the world adding up to 300 million people globally.

The Republic of India holds 0.1% of all the asthmatics in the world, a full 15-20 million of its citizens. That means that this respiratory disease is quickly becoming the number one health problem in India.

What is Asthma?

The Mayo Clinic offers the following definition of asthma:

“Asthma is a condition in which your airways narrow and swell and produce extra mucus. This can make breathing difficult and trigger coughing, wheezing and shortness of breath.”

The article from the Mayo Clinic goes on to say that while for some asthma is a minor problem, for others it can interfere with daily living and lead to life-threatening attacks. Asthma has no cure, but there are ways to avoid the worst attacks and treat the other symptoms.

The Symptoms of Asthma

 The symptoms of vary depending on the person. Some have frequent asthma attacks where others seldom have them. Symptoms can get worse over time or remain stable. However, the most common signs of asthma are as follows:

  • Shortness of breath
  • Chest tightness or pain
  • Trouble sleeping due to shortness of breath, coughing or wheezing
  • A whistling sound (wheezing) when exhaling
  • Coughing or wheezing while sick with a virus like the flu

Below are some signs that asthma may be worsening and that a doctor should be consulted right away:

  • Asthma symptoms that are more frequent
  • Increasing difficulty breathing
  • The need to use an inhaler more and more often

The Risk Factors for Developing Asthma

While the mechanism that causes asthma is not known it is believed to be a combination of genetic and environmental risk factors.

The genetic link is not well-established. While the propensity for someone who has a parent or both parents who have been diagnosed with asthma to develop it is higher, it is by no means guaranteed.

However, environmental factors have been recognized as being enormous triggers for the emergence of asthma and its most deadly effect, the asthma attack. These include:

  • Having another allergy such as Hay Fever
  • Being overweight
  • Being a smoker
  • Exposure to secondhand smoke
  • Exposure to exhaust fumes from cars and factories (smog)
  • Exposure to chemicals in farming, hairdressing, and other jobs

Of all the above risk factors mentioned above, those that affect the people of the Republic of India the most are those that have changed the quality of the air that they breathe.

The Air Quality of India

For many asthmatics, symptoms can become more active with certain types of activity such as exercising, working with irritating chemicals or exposure to pollen and mold.

But by far the biggest trigger for the activation of the symptoms of asthma in India is poor air quality.

The economy of many cities in India has been booming since the turn of the twenty-first century. Along with the increased wealth produced by this economic upturn has come a dramatic increase in motor vehicles and manufacturing causing poor air quality.

However, the pollution from cars and factories accounts for only part of the problem of the deteriorating air quality in India. Household pollutants such as the use of solid fuels for cooking and cleaning solvents are harming India’s people in growing numbers too.

Combined, the effect of the increased pollutants put into Indian air is quickly making asthma the number one killer in the nation.

Respirable Suspended Particulate Matter (RSPM)

 The capital city Delhi has been labeled India’s asthma capital due to its higher than usual respirable suspended particulate matter concentration. According to an article found in India Today acceptable levels of RSPM is categorized as being no more than 60 micrograms per cubic meter annually. However, in 2008 Delhi’s RSPM was as being 149 mg/m3 by the Central Pollution Control Board.

RSPM is formed of airborne particles bigger than 4-5 microns that attach to the nasal membrane and are prevented from entering the lungs.

If the RSPM are smaller, they do not get stopped in the nasal tract, and they enter the lungs where this invasion leads to all kinds of respiratory problems including asthma.

The reasons that Delhi has earned the title India’s asthma capital are understandable when you realize that 5.5 million cars are put into use in the city every year. Add the number of vehicles to the rise in the number of diesel trucks and Delhi’s pollution problems worsen.

While construction activity with its dusty pollutants is a large part of the problem with air quality in India, the most significant culprit by far is the high respirable suspended particulate matter being emitted by motor vehicles.

Mounting Death Toll from Asthma in India

A paper published by the Prakash Kumar and Usha Ram reported that the World Health Organization (WHO) states 489,000 people in India die every year in India. Most of those who die are children.

The reason for these unnatural deaths a lack of understanding of the disease and its treatment.

Many people diagnosed for the first time in India with asthma have no family history of it, and so they may feel they cannot possibly have the disorder. These new asthmatics will accept a prescription for an inhaler from their doctor to treat their shortness of breath and then stop using it as soon as they feel better. This lack of understanding can lead to the sudden onset of a fatal asthma attack later on during exercise or work.

The parents of asthmatic children are especially prone to this misunderstanding. These well-meaning parents may conclude that their children are exhibiting symptoms that will disappear in time. While they are partially correct, many children do outgrow their asthma, during their childhood these kids are in danger of dying during an asthma attack.

What Happens During an Asthma Attack?

An asthma attack is when the airway becomes swollen and inflamed. Due to these changes in the airway, the muscles in the breathing tube contract causing the production of extra mucus. This mucus makes the bronchial tubes leading to the lungs narrow causing coughing, wheezing and trouble breathing.

An asthma attack can be minor and can be treated with a prompt at home treatment. However, some asthma attacks are critical and can quickly become life-threatening.

 A key to not dying during an acute asthma attack is never to ignore or brush them off. One-third of asthma deaths occur in the hospital, leaving a whopping two-thirds of asthmatics who die doing so at home.

Asthma attacks that cause death do not happen just to people with a severe case of the disorder. People who live with the milder forms can experience fatal attacks as well. 80-85% of those who die from asthma develop increasingly worsening signs from twelve hours to several weeks before death.

What Can Be Done to End the Carnage?

 In the year 2015, the Steering Committee on Air Pollution and Health-Related Issues that was set up by India’s Federal Military of Health and Family Welfare proposed measures to combat the pollution problems of India.

The proposal which would provide the most substantial reduction of exposure to air pollution includes switching to clean energy sources for cook stoves, public transportation, and industry. It also proposed measures to reduce road traffic by raising fuel taxes and parking fees and charging for congestion. They also suggested the creation of vehicle-free zones and paths for cycling.

Ironically, Delhi is leading the way to reducing the air quality problems of India by pushing for a switch to cleaner compressed natural gas for vehicles and cooking.

By reducing emissions from cookstoves, pollution from diesel product transportation and by restricting the burning of fossil fuels a vast difference can be made in the air quality and deaths by asthma in only a decade.

Blockades to Progress

While the changes that need to be made are vital to the future of the people of India, there remain many blockages to that progress.

First and foremost is the fear that attempting to solve the pollution problem by switching to other fuels other than liquid petroleum, the economic growth that India is now enjoying will halt. Businesses in India fear that since the costs of changing to cleaner fuels and adding sterner restrictions would need to be passed onto customers raising their prices and lowering the amount of business flowing into India.

However, there is proof that these fears are unfounded. In California in the United States, it has been found that for every dollar invested in air pollution prevention nearly $30 is returned.

The officials from California who were consulted explained that businesses there fought the change in air pollution laws as well at first. It took special permission from then-President Lyndon B. Johnson for California to be able to enact the stricter laws to curb the severe problems they were experiencing in the quality of their air.

These strict laws meant that any trucks hauling goods that went into California must meet the emission rules that were higher than anywhere else in the country. The implementation of the stricter air quality regulations in California have prevented the pollution in the state from making it uninhabitable, but problems remain as its population grows.

While not the perfect solution, California’s attempt at restricting emissions that worsen air quality did not by any means cause the state to fail economically. California is still doing a booming business over four decades later.

There are No Easy Answers 

Like many problems, there are no easy answers to either India’s growing problems with air quality or the disastrous rise in asthma diagnoses. Whether it is learning to use alternative fuels or utilizing universal health care, the costs of treating asthma are much higher than would be the costs of prevention.

Prevention methods are limited because as stated earlier in this article, the exact trigger that sets off asthma in the first place is not well-understood.

However, getting vaccinated for influenza and pneumonia along with avoiding the pollutants that can trigger the formation of asthma can help.

Watch your children for signs of wheezing or coughing when they are not ill with another upper respiratory infection such as the common cold. Make sure to take your children or see the doctor yourself should the signs of asthma appear. Do not hesitate as life may be at stake.

Asthma isn’t just a problem of India; it is a worldwide phenomenon that is altering the existence of millions globally. Together as a world, humanity can change the quality of the air we breathe and prevent the occurrence of asthma and pass onto our children a better world.

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Disclaimer: The opinions expressed in this post are the personal views of the author. They do not necessarily reflect the views of PatientNextDoor. Any omissions or errors are the author’s and PatientNextDoor does not assume any liability or responsibility for them.

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