Don't breathe easy over AQI improvement, air pollution is not just a seasonal problem: Dr Arvind Kumar

With strong north-westerly winds improving air quality in Delhi-NCR marginally over the last few weeks, residents gasping for clean air are heaving a sigh of relief. But top doctors have a warning.

In an interaction with Moneycontrol, top chest surgeon, Dr Arvind Kumar, who recently presented an alarming analysis on the rise of lung cancer cases in India, busted the false sense of comfort around the issue, saying that an improvement in the optical quality of air should not be a reason to celebrate.

Kumar, Chairman, Institute of Chest Surgery, Chest Onco Surgery and Lung Transplantation with Medanta, led the analysis showing that nearly 50 percent of the lung cancer patients diagnosed over the past decade were non-smokers. It was a major deviation from the conventional understanding that lung cancer mostly affects smokers.

This analysis of 304 patients from various states, who underwent treatment at the facility between March 2012 and November 2022, also showed that nearly 30 percent of the patients were women and a more aggressive form of lung cancer, adenocarcinoma, was increasingly being seen in a majority of the patients.

The evidence produced through the exercise has aided the growing evidence of the impact of air pollution on the lives of citizens in India, which in 2019 had 21 out of the 30 most polluted cities in the world.

The problem of air pollution is estimated to be getting worse every year rather than improving with hardly any measures being taken to check the menace.

Kumar, who set up the Lung Care Foundation, is also part of the Doctors for Clean Air Movement, which has been raising awareness about the ill effects of air pollution.

Kumar explained that when air is polluted by particles or gases, those particles or gases go inside the lungs, get deposited there and cause harm locally. The particles then get absorbed from the lungs and go into the blood, and through the blood to every organ in the body, from the brain to toe, and have deleterious effects on those organs.

“So why we should worry about air pollution is because it is a serious health hazard and has the potential to cause disease, disability and death,” he said.

Not a seasonal problem alone

Kumar says that many people tend to see air pollution as a major problem only when the Air Quality Index (AQI) is in the severe category — 350 or above — but that is a complete misnomer.

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There are two aspects to air pollution: one is the chemical composition as monitored by the meter which ultimately gives us the PM2.5 levels, or AQI, determined by an algorithm, taking into account six pollutants, with PM2.5 being the most important of them, he says.

The other issue is the perceived optical quality of the air. So usually during the months of October-February, when the optical quality of the air is bad, people perceive it to be polluted and therefore start suddenly worrying about it.

Also, the levels happen to be the highest during this period. However, the reality is that the AQI remains in the bad, very bad, or poor, category around the year, Kumar points out, highlighting that during other months, the optical quality improves but the chemical quality is still bad.

“So in summary, air pollution is a problem throughout the year and we must worry about it every day of the year, not only during the days when the optical quality is bad,” he said.

Changing lungs in India

Kumar, who was previously associated with the All India Institute of Medical Sciences and Sir Gangaram Hospital in Delhi, said that in the 30 years of his career, he has seen a dramatic change in the colour of lungs.

“Earlier, I used to see mostly pink lungs, and only when I was handling smokers I used to see black lungs but these days it’s a rarity; even non-smokers have black deposits and the most shocking part is that even teenagers these days have black deposits in their lungs,” he said.

According to him, the only time doctors see pink lungs is when they see a new-born.

So serious consequences are happening, he says, and the effects are seen immediately after birth.

For instance, new-borns and toddlers are seeking medical care for respiratory problems, breathlessness, bronchospasm, pneumonia and asthma apart from brain disorders because pollution also leads to the inflammation of the brain.

As the children grow older, they tend to develop premature hypertension, obesity and early diabetes while the elderly go on to develop chronic obstructive pulmonary disease even as cases of lung cancer, higher incidence of tuberculosis, heart attacks and strokes are rising.

Kumar insists that there is no organ in the body, where some or the other disease now is not being linked to pollution as a significant contributing factor.

In fact, the World Health Organization has suggested that air pollution should be listed as a contributing factor in almost every death, because somewhere or the other, it is contributing to every death in the world, he pointed out.

Need measures

Kumar said that measures can be at two levels — individual and policy-level.

The major contributor to pollution is the use of fossil fuels such as solid fuels like coal and wood, or liquid fuel like petrol, diesel and kerosene, or other forms including CNG, LPG and LCG.

These fuels lead to air pollution and also contribute to the climate crisis, so Kumar says that the solution lies in phasing out these polluting sources of energy and moving to cleaner sources, however inconvenient that may be in the beginning.

“There is no inconvenience which is bigger than the health of the people,” the doctor stressed.

There is a contribution of people in the form of smoke that they create through various activities and the dust that occurs around them. So if each individual can look around his house or place of work, maybe 50 meters’ periphery and see if there is any source which is producing smoke or dust in the 50-meter area around him and try at his personal level to control it.

“If 140 crore people of the country look at a 50-meter periphery around their place of residence and control smoke or dust source in that area collectively, we would have made a huge personal contribution to reducing air pollution. Coupled with policy decisions by the policymakers, it can lead to cleaner air for all of us,” he said.

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He underlined that not many even in the government may be understanding the severity and magnitude of the problem which has been resulting in inaction to control air pollution.

No quick fixes

Most people think that air pollution is something which affects the nose and eyes and only has a minor impact and that the risk can be averted using measures like air purifiers, wearing a mask or the installation of smog towers.

“They don’t realise that air is a 24 by 7 by 365 necessity and unlike water, it can’t be carried in a bottle,” he said.

Therefore, there cannot be a personal solution to a community problem as massive as this one, according to Kumar.

He added that using devices like air purifiers is in fact advised for those with acute chest infections and it is not possible for anyone to completely avoid the effects of pollution if the ambient air is hazardous.

“The only effective and long-term solution to escape the hazards of air pollution is to prevent the air from getting polluted,” Kumar emphasised.