In today's topic, I want to talk about the impact of environmental pollution on our health, especially our respiratory health. Man exists in close interaction with his environment and our activities in the environment have a way of significantly affecting our health in profound ways.
By Myupchar, CC BY-SA 4.0, Wikimedia
Those of us who reside in the South-South part of Nigeria have this first-hand experience of serious environmental pollution caused majorly by illegal oil refining. Late last year, we experienced heavy black soot here. It was so serious that the sky was so dark and smoky especially during the harmattan period of November/December last year and early this year.
At a point, the soot was settling on surfaces that when you touch any surface, you see dark stains of soot on your hand. The scariest part of it was the black air that we were inhaling. If you use a white handkerchief to wipe the inner lining of your nose, the white handkerchief will turn black. Though at a point, government regulatory agencies intervened, and currently, we can say that the black soot is on the decrease but not absent yet.
Such environmental pollution poses a serious health hazard to people and in this topic, we will talk about one of them called Chronic Obstructive Pulmonary Disease (COPD).
COPD arises from the gradual, irreversible, persistent, and progressive narrowing of the airways of the lungs which limits the amount of air that goes in and comes out of the lungs. This narrowing of the airway is caused by enhanced inflammatory response of the lung tissues to toxic particles or gases. It is not just a disease of the lungs, but it also affects other systems of the body.
This disease is common but the good news here is that this disease is very much preventable. So, we need to continue this awareness for people to know the causes and how to prevent them.
RISK FACTORS FOR COPD
The principal risk factor for COPD is Cigarette smoking. This does not only affect the person smoking it, but also those within the environment who inhale the smoke (secondhand smokers).
Cigarette smoking has been found in about 90% of those who have COPD.
By © 2005 by Tomasz Sienicki, Own work, CC BY-SA 3.0, Wikimedia
Another key risk factor for COPD is environmental pollution, both indoor and outdoor pollution. Indoor pollution is found more in low-income countries and rural communities where biomass fuels, wood and kerosene stoves are the major source of cooking fuel, especially in poorly ventilated rooms.
Outdoor pollution occurs from unregulated activities that release pollutants into the air such as illegal oil refining causing the black soot in my environment. Outdoor air pollution can also come from industries, combustion engines, smoke from bushfires and open burning of wastes, etc. These release toxic substances into the air that irritate and damage the lungs when inhaled.
Exposure to some occupational dust and chemicals like cement workers, gold and coal miners, cotton workers, etc have also been highly implicated in this disease. Exposure to sawdust, welding fumes, oil mist, and some solutions are important risk factors too.
Other risk factors include; advancing age above 50 years, male gender being more at risk, genetic factors, low socioeconomic status, poor nutrition, and presence of other respiratory diseases like asthma, pulmonary tuberculosis, etc.
HOW COPD OCCURS
When the patient inhales these toxic substances from the risk factors above, they go into the airway and cause irritation and damage to the structures in the airway. These cause inflammatory reactions in the airway and excessive secretion of mucous in the airway which ultimately leads to the progressive and irreversible narrowing of the airway. And in severe cases, exacerbations and death can occur.
THE IMPORTANCE OF THIS AWARENESS
According to the World Health Organisation WHO:
Chronic obstructive pulmonary disease (COPD) is the third leading cause of death worldwide, causing 3.23 million deaths in 2019.
Nearly 90% of COPD deaths in those under 70 years of age occur in low- and middle-income countries (LMIC).
This disease is on a steady rise globally both in developed and developing countries. The high rate of COPD in the developed world is attributed to cigarette smoking while in low-income countries, indoor pollution such as the use of wood and kerosene stoves in a poorly ventilated room is the primary cause.
By Lamiot - Own work, CC BY-SA 4.0, Wikimedia
CLINICAL PRESENTATION
COPD can present in two forms as Chronic bronchitis or Emphysema. In those who have Chronic bronchitis, there is an inflammation of the airway and excess production of mucus which presents as a cough that is productive of a large amount of sputum.
They usually have a frequent cough for at least 3 months in more than 2 consecutive years. These patients are generally obese with signs of heart failure. Due to the narrowing of the airway, they have difficulty in breathing and you can see their lips pursed while breathing. Features of right sided heart failure is also common in this group.
For those who have emphysema, there is permanent damage to the airspace in the lungs and the chest is hyper-inflated and they usually have barrel-shaped chests. There may or may not be cough in this group but they have severe breathing difficulties.
Patients can have either or both of these two forms . But most commonly, COPD presents with 3 cardinal symptoms of difficulty in breathing that is progressive and worsening, cough that has lasted for a long time and production of sputum. Other symptoms may include the inability to exercise or do a little work, tiredness, chest pain, etc.
INVESTIGATIONS AND TREATMENT
The most important investigation here is Spirometry which is diagnostic and also shows the severity of the disease. Other investigations include full blood count, chest x-ray, pulse oximetry, sputum culture, etc.
By National Heart Lung and Blood Insitute (NIH), Public Domain, Wikimedia
Treatment is by the use of drugs that help to open up the airway and improve air entry and exit. Some are short-acting which are used for immediate relief of symptoms. Examples here include salbutamol and Ipratropium bromide. While some others are long-acting and have longer effects. Examples here include Salmeterol and Tiotropium.
Other drugs used in the treatment are theophylline, corticosteroids, antibiotics, etc. Long-term oxygen therapy is also beneficial to the patient which improves oxygen supply to the tissues. They are also given lung physiotherapy and nutritional support for proper rehabilitation.
Infections and further exposure to the risk factors can lead to exacerbation which is the worsening of breathlessness and cough which can be fatal. Therefore, those who have COPD must protect themselves from further exposure to the risk factors.
PREVENTION
Recall that at the beginning of this discussion, I stated that this disease is very preventable, and yes, it is. Since most of the risk factors are man-made, we can always modify them to protect ourselves.
The first on this list is the cessation of smoking. Cigarette smoking is the cardinal risk factor in this disease, therefore, cessation of smoking greatly reduces the chance of getting it. It is also important to stay away from smoke coming from other smokers and all forms of secondhand smoke as they are equally very harmful.
By Airman 1st Class Brittany Perry, Public Domain, Wikimedia
Next is a reduction in indoor pollution. Cooking areas where firewood and kerosene stoves are used should be properly ventilated to avoid the inhalation of these toxic irritants. The emission of outdoor pollutants should also be controlled to reduce outdoor pollution.
Those who have occupational exposure to toxic chemicals and gases should wear appropriate respiratory protective equipment to protect them from these diseases. People should also wear face masks outside when the air seems dark and polluted.
It is also important to maintain a healthy lifestyle, healthy diet and regular exercise, regular medical checks, and prompt treatment of other respiratory infections.
Our environment greatly affects our health, let's keep it safe and healthy!
Thanks so much for reading.
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