Asthmacure.com - Triggers

A hole in air pitcher! What is the effect of vehicles on environment?

During running, talking, eating and even while sleeping, cells of body are active. A person consumes oxygen and produces carbon dioxide during such activities. Lungs are air pumping stations of our body which transfer atmospheric oxygen into our body and expel carbon dioxide in the atmosphere, through a process called respiration. Air passes through airways during respiration. Average human consumes about 12 Kg of air each day to form carbon dioxide. It is about twelve times higher than the food we take. Hence, even small concentration of pollutants in the air become more significant in comparison to similar levels present in the food. Human activities are the most important factor in increasing air pollution. Combustion of fuel is one of the most significant source of air pollution. Nearly 15 Kg air is consumed in burning 1 litre fuel in automobiles. Carbon monoxide, lead and hydrocarbons are emitted in high quantities in petrol combustion. These can cause loss of visual accuracy and mental alertness. Diesel combustion emits considerably higher amounts of Nitrogen dioxide, particulate matter and sulphur dioxide. Pollutants of diesel combustion are important trigger factors in aggravation of bronchial asthma. Environment depletion by a human body is replenished by a tree which takes this much amount carbon dioxide to form 12 Kg oxygen. This is the equilibrium of the nature. But man made vehicles consumes air for combustion of fuel to emits harmful pollutants. Since we do not have another equilibrium setting instrument like tree to consume carbon monoxide, sulphur dioxide, nitrogen dioxide to produce oxygen we are depleting breathing atmosphere of the earth. Situation is similar to a full pitcher with a minimal leakage in form of a droplet per minute. Pitcher gets empty in days. Leakage in breathing air will empty atmosphere in few centuries. We have a grave concern about cleanliness of our appearance, we are also very much concerned about cleanliness of food and water. Alas! We do not have any concern about cleanliness of breathing air which is so vital for our very survival. Invention of a substance, which can produce energy without consumption of oxygen and production of toxic gases is the need hour.

What is vehicular pollution?

Human population and vehicle numbers are escalating on a national ladder. As you climb the ladder-highly polluted air clot your breath. You may not notice a series of pollutants hitting your health but they do identify your body weakness. Learn this, if you want to be smart enough to defeat this trigger factor. Vehicles are increasing in cities with development and prosperity. Vehicles are useful and essential but its exhaust smoke may create health problems. It is evident that vehicular exhaust contains the trigger factors for asthma disease. The main constituents of trigger pollutants are sulphur dioxide, nitrogen dioxide and suspended particles. Commuters, who travel by their two-wheelers and public transportations breathe this polluted air containing trigger particles. These noxious particles are the causal agents for increasing the severity of asthma.

People living around busy traffic roads suffer from asthma more severely
In an extensive study in Japan for finding the effects of pollution from automobiles on human being Kagava and his associates found that respiratory symptoms were more common in people living near busy traffic roads. It was also found that the prevalence of symptoms like cough and wheezing was reduced as people moved away from busy highways. Children were more susceptible to adverse effects of these pollutants and hence the prevalence of respiratory symptoms was higher in children than in adults. People living within 20 meter distance from the road were affected in large numbers. High level of Nitrogen-dioxide and SPM were closely associated with chronic bronchitis.

What effects pollutants have on human health?

There are different hypothesis on the effect of air pollutants on human physiology and health. Whether the different levels of air pollution affects at all. Pulmonologists at All India Institute of Medical Sciences (AIIMS), in a review article, states that the normally encountered levels of air pollution are not likely to contribute to onset of asthma and at present there is no epidemiological evidence that prevalence or etiology of asthma is related to the level of air pollution. Whereas, Japanese studies have suggested an interaction between exposure to diesel exhaust particulates and cedar pollens to be the cause of the increased cedar pollens allergy in Japanese. Not the least, a consensus on research studies indicate that air pollutants can not induce asthma in a healthy person (except Ozone effect) but it can trigger the disease of an asthmatic patient. Though, it can cause another lung disease called chronic bronchitis in healthy persons.

Combined effects of two or more pollutants?

Pollutant allergens and tobacco smoke act synergistically in aggravating asthma. Above certain threshold levels, Ozone, Sulphur-dioxide, Nitrogen-dioxide and particulate pollutants are harmful for healthy individuals and even at lower levels these are harmful to asthmatic patients. Is there any safe limit of air pollutants for asthmatic patients? Asymptomatic or asthmatic patients having stable disease can tolerate low levels of atmospheric pollutants but even these levels can aggravate asthma in symptomatic patients.

Another curious aspect of pollutants is that presence of Sulphur-dioxideor Nitrogen-dioxide in atmosphere increases potency of harmful respiratory effects. Lower concentration of Ozone, Sulphur-dioxide and Nitrogen-dioxide acting in combination can produce significant harmful effects in asthmatic patients even when concentration of an individual gas is harmless. The individuals with asthma showed changes in lung function, increased symptoms and increased use of asthma medication during peak concentrations of Ozone and Sulphur-dioxide in summer days and in addition with peak of Nitrogen-dioxide in winters. The combination of particulate and Nitrogen-dioxide has also been found to be a better predicator of harmful effects such as cough, upper respiratory symptoms than the individual pollutants. Not only that combinations of pollutants are more harmful but pollutants also interact with allergens in triggering and aggravating asthma. Elevated Nitrogen-dioxide levels prior to allergen dispersal has also been found to aggravate asthma more severely.

What are the ways in which vehicular pollution afflicts body?

Suspended Particulate matter (SPM)
Main source: Diesel vehicles.
Effects: Chest infection, aggravates asthma, may cause cancer.

Ozone
Main source: Indirectly Oxides of Nitrogen from diesel and petrol. Generates ozone after photochemical reaction with sunlight.
Effects: Can induce asthma even in a normal person and aggravate asthma in patients.

Polycyclic Aromatic Hydrocarbons
Main Source: Petrol and diesel.
Effects: Headache, drowsiness, red eyes and cough

Sulphur dioxide
Main Source: Diesel Combustion
Effects: Aggravates rhinitis and asthma.

Oxides of Nitrogen
Main Source: Diesel Combustion
Effects: Chest Infections, rhinitis, headache, irritation of eyes and aggravates asthma.

Benzene
Main Source: Unleaded petrol emitted from catalytic converters
Effects: A known carcinogen, it has been linked to lung cancer and leukemia and can damage the central nervous system.

Carbon Monoxide
Main Source: Petrol vehicles, mostly two-and-three wheelers.
Effects: Aggravates ischaemic heart disease, affects stamina adversely.

Lead
Main Source: Petrol
Effects: Can affects the central nervous system. Cause renal damage and hypertension. Children are three times more at risk than adults.

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Who Suffers?

Everyone who lives in the vicinity of moving vehicles suffers. These include :

People living in houses on man road of city.
Shopkeepers.
Hawkers.
Rikshaw pullers, porters, carriers, auto-rikshaw and bus commutors.
Walkers.
Traffic policeman.

Apart from the aggravation of asthma, the vehicular pollution causes another serious disease of chronic bronchitis in healthy persons who are constantly exposed to such living conditions

How vehicular pollution affects asthmatic patients?

Have you ever experienced eye flu? If yes, you may have experienced burning pain in eyes while riding a scooter specially when you are following a three wheeler tempo, truck or jeep emitting smoke cloud. The mechanism is very simple, the outer membrane of eyes is inflamed and smoke causes irritation thereby aggravating the eye inflammtion further. An asthmatic patient faces the similar inflammation further. An asthmatic patient faces the similar situation, where his lungs-airways get attacked by pollutants. Membranes of windpipe are inflamed and swollen. When vehicular smoke is inhaled with breath it causes irritation in the wind pipe membranes, and leads to worsening of asthma. A regular exposure to vehicular exhaust also retards the process of recovery of the inflamed membranes of airways thereby leading to continuation of severe asthma

Mechanism of affecting asthmatic patients?

There are three ways by which pollutants can play a role in the expression of asthma.

Firstly, certain pollutants acting either singly or in combination with other pollutants or environmental triggers may cause changes in airways, and consequently may cause symptoms in individuals already suffering from asthma.
Secondly, pollutants may prove to be important in causing the initiation of the asthmatic tendency by a mechanism independent of the other factors.
Thirdly, exposure to pollutant may act in combination with allergens to initiate the asthmatic tendency. The possible roles of different vehicular pollutants in aggravating asthma have been discussed here.

Fog and smog
On a typical humid day when atmospheric temperature falls water vapours of air condense and fog is formed. A natural fog consists of droplets of water in air. When particulate and gaseous pollutants are trapped in fog it is called smog. Smog builds a high concentration of pollutants in it, under stable atmosphere. In cities with high traffic roads Nitrogen dioxide, hydrocarbons and particulate material are trapped in the smog. Sunlight initiate photochemical reaction to form Ozone. Nitrogen-dioxide, Sulphur-dioxide and Ozone in smog are very harmful for asthmatics and patients of bronchitis.
Early morning hours are the worst period for temperature inversions which results in the confinement of pollutant close to the ground. This may produce very high ground level concentration of pollutant and especially in an industrial town. Therefore on a smogy day morning walks may prove to be highly injurious to asthmatics. All episodes in the history of air pollution have been recorded during early morning hours. Hence asthmatic and bronchitis patients are advised not to take morning walk in city areas especially on a foggy day.

Road tax for care of asthmatic patients!

It has been observed that severity of asthma is much more in the persons living on busy traffic road sides. They suffer because of inhalation of toxic pollutants of vehicular exhaust. Vehicles are allowed to ply on roads after collecting the road tax, which is spend on repairing the wear and tear of the roads. A question could be raised, why the one does not ensure health of asthmatic patients affected due to traffic pollution. The road tax money could be utilized on wear and tear of the lungs of asthmatic patients also.

Indicators of pollution induced asthma?

Following symptoms suggest that the vehicular pollution is responsible for aggravation of asthma:

Increased asthma during the night.
Cough, sneezing, watering eyes.
Blocked nose.
Has to clear his throat repeatedly.

Ways to protect from vehicular pollution?

Self care: Use,

Handkerchief: If you are walking on a footpath of a busy road, use of handkerchief covering the nose will reduce pollution load.
Face mask: Putting a face mask can reduce pollution load remarkably. If central part of mask is made wet it will further increase protection. This measure may not suit to working people like shopkeepers, pedestrian, foot-path sellers and persons who do public dealings.
Nasal Filters: are very good aesthetically. One cannot detect nicely fitted nasal filters. However, one-third users cannot tolerate it because it causes nasal irritations. Though the irritation is much less than wearing a nasal pin.
Helmet: A full mask helmet provides desired protection to two wheeler riders.
Car: Car commutors are exposed less to vehicular pollution and if car is air conditioned, the effect of pollution will be far less.

Self care: Avoid,

Avoid unnecessary physical activity on busy traffic roads.
Avoid going to market place while having asthmatic symptoms or during rush hours.
Avoid morning walks on days of fog and smog.
Diesel exhaust is more dangerous to asthmatic patients hence avoid places with generators and diesel vehicles.

Steps at vehicle technology,

Heavy diesel vehicles usually have problem of starting therefore these remain in switch-on position. Better technique of switching-on should be designed.
Advancement in vehicle technology: Air fuel ratio is important factor influencing emission from exhaust. Increasing air-fuel ratio will reduce carbon monoxide and hydrocarbons. However, it will increase nitrogen dioxide . Nitrogen-dioxide emission can be controlled by recirculating a part of exhaust gases back in to engine. It can also controlled by providing a catalytic converter in the engine. In Europe, there is compulsion of using catalytic converters in the vehicles. Recently Supreme court of India has made use of Europian standards in vehicle technology so as to reduce pollution. It is very significant step in the direction of pollution free India.

Steps at administration level,

Entry of diesel vehicles should be banned in city even during night. Cool night keeps pollutants on the surface for longer period. Asthmatic patients sleeping in road side houses suffers more severity.
Non-Government organizations (NGOS) dealing with environment problems should carry out regular monitoring of pollutants at various points in the cities. When pollution crosses the poor level of air quality, proper warning should be issued and published in the newspapers. It will help in saving life of ignorant asthmatic patients who die prematurely simply by breathing in polluted environment.

TRIGGER: POLLUTION

ASTHMA STYLE

People living in houses on main road of city

Keep road-side windows closed.
Wear nasal filters.
Use a damp or wet cloth for most of the cleaning. Articles like Almirah, Furniture, Fans etc. should be cleaned by wiping with a wet cloth.
Wear face mask.

Shopkeepers

Keep spices in polythene packets.
Shops should be provided with collapsible doors.
Use ioniser.

Hawkers, rikshaw-pullers, porters, carriers and auto-rikshaw drivers

Use nasal filter or mask.

Walkers, bus commutors

Commuters should use handkerchief.

Traffic policeman

Wear pollution face mask or nasal filter.

Two wheeler rider

A full mask helmet provides desired protection to two wheeler riders.
Face mask during riding is also useful.

Walking on footpath

Handkerchief: If you are walking on a foot path of a busy road, use of handkerchief will protect you from pollution load. As soon as you see smoke coming, just hold the breath and put handkerchief over nose and mouth.

Working on roadside

Face Mask: Putting a face mask can protect from pollution. If central part of the mask is made wet it will enhance protection further. Though effective yet people working in market such as shopkeepers, footpath-sellers and daily commuters rarely use this.
Nasal filters are very good aesthetically. One cannot detect nicely fitted nasal filters. However, one-third users cannot tolerate it because it causes nasal irritations. Though the irritation is much less than wearing a nasal pin. Therefore it is good alternative for look conscious people.

Vehicle commuters

Helmet: A full mask helmet provides desired protection to two wheelers riders.
Car: Car commuters are exposed less vehicular pollution and if car is air-conditioned, the effect of pollution will be far less.

How Vehicular Pollution causes asthma?
Example:
Mr. Mahesh, a bank officer who used to live on the out-skirts of the city, had to attend his job in the walled city. The roads leading to his office were congested and having high air-pollution rate. However, Mahesh did have asthma history but it got worsened in last one year coinciding the period of his stay in the city branch of the bank.

Curiosity:

What worsened asthma of Mahesh?
How problem was solved?

Recently, under a special loan scheme, Mahesh has purchased a new car. As he quit his scooter riding, surprisingly, the quantity of drug intake also got down remarkably.

Expert Comments:
When Mahesh used his scooter, the vehicular pollution had free access to his respiratory tract. The environmental pollutants were mainly held responsible for triggering his asthma. The main constituents of trigger pollutants are sulphur dioxide, nitrogen dioxide and few suspended particles. Commuters, who travel by their two-wheelers and public transportations breathe this polluted air containing trigger particles. The obnoxious particles are the causal agents for increasing the severity of asthma. The main reason of improvement in asthma was better environmental conditions, especially his air-conditioned car which enabled him to travel in exhaust-free environment.

Some precautionary slogans could be used as "Vehicle smoke may be injurious to asthmatic patient". These may be written on the vehicles or the walls or the road dividers. In a significant judgement the Supreme Court has issued directions to manufacturers of vehicles to use pollution control techniques similar to European countries (EURO II).

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HOW Pollution aggravaTES Asthma?
Example:
Mrs. Mohini Kumar, a house wife, has moved to Jaipur after her marriage. Her house was located on the busy road of the main market. Her room had broad windows with natural ventilation. Traffic on the busy road was used to be very heavy. Mrs. Mohini had mild seasonal asthma since childhood. A couple of months after her marriage, she developed asthmatic problem on regular basis. Her asthma symptoms were controlled with two puffs of inhaler. She consulted almost all eminent doctors of the city but could not get a complete cure.

After six months, somebody told her that these inhalers are habit-forming. On advice of a neighbour she started ayurvedic medicines. However, these failed to give her relief. The consulting "Vaidhyaraj" had inferred upon her treatment that she was given strong allopathic medicines which had destroyed her body resistance hence even good ayurvedic were not effective. Then she started homeopathic medicines. After couple of weeks, her disease symptoms were controlled. Homeopathic doctor assured her a complete cure in a one year time. She continued to take homeopathic medicines for 3 years but she still had a problem of coughing at the time of cooking or exertion.

Curiosity:

Why Mohini's asthma worsened after marriage?
Which therapy was ineffective?
Mohini left modern medicines: what is your opinion?
Do you think whether homeopathic medicines are habit forming or not?
What solution do you suggest?
How the problem was solved ?

After 4 years of her marriage Mrs. Mohini's husband shifted his house from market place to outer city. It was comparatively a better locality and the couple started regular morning walk. As a result, in next few months, lady's asthma got improved. Now, she does not develop cough during cooking and exertion. She has stopped all other medicines, and she believes that a regular homeopathy dose has cured her asthma in 3 years.

Expert Comments:

After marriage Mohini shifted to Jaipur. Her house was located on the main market road. Vehicular pollution has easy access to her room through big windows. Regular inhalation of vehicular pollutant aggravated her asthma.
Ayurvedic medicines did not provide relief to Mohini.
Mohini got good relief by inhalers but someone suggested her not to take inhalers because these were habit forming. It confused Mohini and she left inhaler medicines. As a matter of fact it is not true because most of the times inhaler and tablets contains same medicine.
It has been observed that once started people keep on taking homeopathic medicines for years. Some of the doctor believe that homeopathic medicines are habit forming.

Main cause of aggravation of Mohini's asthma was vehicular pollution. When she changed her house she was no longer exposed to pollution and hence she improved.

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