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Poor air quality exposes astma and TB patients to higher risks

 ASTHMA FACTS
Over 150 million people in the world are diagnosed with asthma, but still there are still many misconceptions about this disease.  Some people believe that if their child has asthma, it is not something to be concerned about because he or she will grow out of it.  Some children do stop exhibiting symptoms of asthma once they reach puberty, but others will continue to be affected by it throughout their lives and in fact, some adults who never had asthma as children develop it in their later years.  Another myth is that children with asthma are weak, or that the disease is all in their heads.  Nothing could be further from the truth! 

On World Asthma Day, we would like you to remember that asthma KILLS BUT CAN BE CONTROLLED.  Trips to hospital, restricted physical activities, and a limited quality of life do not have to be negative consequences of having asthma.  It takes a joint effort between industries, the student with asthma, his or her family, their doctor, people in the workplace and school to create a pollution free environment so that we can all breathe better air.

Medications exist today that can both control the ongoing inflammation in the airways and reduce the effects of an acute episode.  Changes at school and home can reduce exposure to environmental triggers that can make asthma worse.  The best defence against asthma is knowledge.  On World Asthma Day, we encourage people to learn more about this complex but controllable disease.

What is Asthma?
Asthma is a chronic, inflammatory lung disease characterized by recurrent breathing problems.  During normal breathing, air flows freely in and out of the lungs.  But, during an asthma attack, the lining of the airways swells, muscles around the airways tighten and mucus clogs the tiny airways in the lungs, making breathing difficult.   The airways become overly responsive to environmental changes, resulting in wheezing and coughing. 

Asthma symptoms vary from hour-to-hour, day-to-day, week-to-week and over months.  They are often worse at night and in the early hours of the morning.  The severity of asthma varies from individual to individual.  Some patients have occasional symptoms (for example after strenuous exercise), others have symptoms that interfere with daily life yet others have a very severe, relentless disease that almost excludes them from normal school and work activities.

What causes asthma?
People with asthma have airways that narrow more easily than non-asthmatics and are usually allergic to inhaled allergens.  The causes of the airway abnormality and its relationship to being allergic are not known.  A variety of factors can set off an asthma attack including viral infections; exposure to allergens (e.g. dust mites, protein particles shed by cats and dogs and pollen); exercise; tobacco smoke; air pollution; strong emotional expressions; chemical irritants; and drugs (aspirin and beta blockers).  Each person with asthma reacts to a different set of factors.  Identification of these factors in an individual is a major step towards learning how to control an asthma attack. Many scientists are studying the role genetic factors play in asthma.

Who gets asthma?
The World Health Organization  estimates that between 100 and 150 million people around the globe suffer from asthma and this number is rising.  World wide, deaths from this condition have reached over 180,000 annually.  Asthma is a public health problem for both developed and developing countries.  It occurs in all age groups and all ethnic groups.  However, it often starts in childhood.  Indeed, asthma is the single most common chronic disease causing absence from school. 

Why is asthma increasing?
The rapid rise of asthma around the world is one of the biggest mysteries in modern medicine.  The most striking increases have occurred in Australia where about one-quarter of children are diagnosed with asthma. In the United States, the number of people with asthma has more than doubled to an estimated 17.3 million in 1998 from 6.7 million in 1980. No research on asthma and poor air quality has been documented in Swaziland.

Industrial expansion and polluting industries have been cited as increasing asthma among children and the elderly in Swaziland. In door air pollution such as the burning of biomass, paraffin and "imbawula" exposes asthma and tuberculosis patients to higher risks.  With 66% of the Swaziland population living below the international poverty line, many people do not have suitable living conditions. Poor living conditions and lack of ventilation fuel Asthma and other respiratory disorders.

Poor ventilation fuels asthma  and  respiratory disorders

Below are pollutants such ozone, carbon monoxide, nitrogen dioxide, and lead found in Swaziland that can increase one’s risk to asthma. The effects vary from pollutant to pollutant.

POLLUTANT SOURCES EFFECTS

Ozone: A colourless gas that is the major constituent of photochemical smog at the earth's surface. In the upper atmosphere (stratosphere), ozone is beneficial, protecting us from the sun's harmful rays. Ozone is formed in the lower atmosphere as a result of chemical reactions between oxygen, volatile organic compounds and nitrogen oxides in the presence of sunlight, especially during hot weather. Sources of such harmful pollutants include vehicles, factories, landfills, industrial solvents and numerous small sources such as gas stations, farm and lawn equipment, etc. Ozone causes significant health and environmental problems at the earth's surface, where we live. It can irritate the respiratory tract, produce impaired lung function such as inability to take a deep breath, and cause throat irritation, chest pain, cough, lung inflammation and possible susceptibility to lung infection. Smog components may aggravate existing respiratory conditions like asthma. It can also reduce yield of agricultural crops and injure forests and other vegetation. Ozone is the most injurious pollutant to plant life.

Carbon Monoxide: Odourless and colourless gas emitted in the exhaust of motor vehicles and other kinds of engines where there is incomplete fossil fuel combustion. Automobiles, buses, trucks, small engines, and some industrial processes. High concentrations can be found in confined spaces like parking garages, poorly ventilated tunnels, or along roadsides during periods of heavy traffic. Reduces the ability of blood to deliver oxygen to vital tissues, affecting primarily the cardiovascular and nervous systems. Lower concentrations have been shown to adversely affect individuals with heart disease (e.g., angina), and to decrease maximal exercise performance in young, healthy men. Higher concentrations can cause symptoms such as dizziness, headaches, and fatigue.

Nitrogen Dioxide: Light brown gas at lower concentrations; in higher concentrations becomes an important component of unpleasant-looking brown urban haze. Result of burning fuels in utilities, industrial boilers, cars and trucks. One of the major pollutants that causes smog and acid rain. Can harm humans and vegetation when concentrations are sufficiently high. In children, may cause increased respiratory illness such as chest colds and coughing with phlegm. For asthmatics, can cause increased breathing difficulty.

Particulate Matter: Solid matter of liquid droplets from smoke, dust, fly ash and condensing vapours that can be suspended in the air for long periods of time. Industrial processes, smelters, automobiles, burning industrial fuels, wood smoke, dust from paved and unpaved roads, construction and agricultural ground breaking. These microscopic particles can effect breathing and respiratory symptoms, causing increased respiratory disease and lung damage and possibly premature death. Children, the elderly, and people suffering from heart or lung disease (like asthma) are especially at risk. Also damages paint, soils clothing, and reduces visibility.

Sulfur Dioxide: Colourless gas, odourless at low concentrations but pungent at very high concentrations. Emitted largely from industrial, institutional, utility and apartment-house furnaces and boilers, as well as petroleum refineries, smelters, paper mills and chemical plants. One of the major pollutants that causes smog. Can also, at high concentrations, affect human health, especially among asthmatics (who are particularly sensitive to respiratory tract problems and breathing difficulties that SO2 can induce). Can also harm vegetation and metals. The pollutants it produces can impair visibility and acidify lakes and streams.

Lead: Lead and lead compounds can adversely affect human health through either ingestion of lead-contaminated soil, dust, paint, etc., or direct inhalation. This is particularly a risk for young children, whose normal hand-to-mouth activities can result in greater ingestion of lead-contaminated soils and dusts. Transportation sources using lead in their fuels, coal combustion, smelters, car battery plants and combustion of garbage containing lead products. Elevated lead levels can adversely affect mental development and performance, kidney function, and blood chemistry. Young children are particularly at risk due to their greater chance of ingesting lead and the increased sensitivity of young tissues and organs to lead.

Toxic Air Pollutants: Includes pollutants such as arsenic, asbestos and benzene. Chemical plants, industrial processes, motor vehicle emissions and fuels and building materials. Known or suspected to cause cancer, respiratory effects, birth defects, and the reproductive and other serious health effects. Some can cause death or serious injury if accidentally released in large amounts.
Stratosphere Ozone Depleters: Chemicals such as chlorofluorocarbons (CFCs), halons, carbon tetrachloride and methyl chloroform that are used in refrigerants and other industrial processes. These chemicals last a long time in the air, rising to the upper atmosphere where they destroy the protective ozone layer that screens out harmful ultraviolet (UV) radiation before it reaches the earth's surface. Industrial household refrigeration, cooling and cleaning processes, car and home air conditioners, some fire extinguishers and plastic foam products. Increased exposure to UV radiation could potentially cause an increase in skin cancer, increased cataract cases, suppression of the human immune response system, and environmental damage.

Greenhouse Gases: Gases that build up in the atmosphere that may induce global climate change - or the "greenhouse effect". They include carbon dioxide, methane and nitrous oxide. The main man-made source of carbon dioxide emissions is fossil fuel combustion for energy-use and transportation. Methane comes from landfills, cud-chewing livestock, coal mines and rice paddies. Nitrous oxide results from industrial processes, such nylon fabrication. The extent of the effects of climate change on human health and the environment is still uncertain, but could include increased global temperature, increased severity and frequency of storms and other "weather extremes", melting of the polar ice cap, and sea-level rise.

How is Asthma Diagnosed?
A careful medical history, physical examination and tests of pulmonary function provide information needed for a diagnosis of asthma.  Symptoms include breathlessness, wheezing, chest tightness and cough, worse particularly at night or in the early hours of the morning.  Symptoms occur or worsen in the presence of exercise, allergens, irritants and viral infections.  Young children whose primary symptom is a cough or who wheeze with respiratory infections are often misdiagnosed as having bronchitis or pneumonia (including acute respiratory infection, ARI) and thus are ineffectively treated with antibiotics or cough suppressants.  Tobacco smokers and elderly patients frequently suffer from chronic obstructive pulmonary disease with symptoms similar to asthma.  Yet they may also have asthma and benefit from treatment. 

Measures of lung function are useful both for diagnosis and to monitor the course of asthma.  Such tests include spirometry to provide an assessment of airflow limitation and peak flow to measure the maximum speed at which air can flow out of the lungs.  Spirometry is performed in the clinician’s office.  On the other hand, peak flow meters are portable, plastic and ideal for use in home and work settings and thus provide most patients and their health care provider with an effective method to evaluate response to therapy and detect early signs of deterioration.

How is asthma treated?
Asthma can be treated through various types of medication i.e.long term preventive medications (especially anti-inflammatory agents such as inhaled glucocorticosteroids or leukotriene receptor antagonists) that keep symptoms and attacks from starting, and quick relief medications (short-acting bronchodilators) that work fast to treat attacks or relieve symptoms.