World Asthma Day: Why masks can help asthma patients even as Covid norms ease

Mumbai's air quality has been recently fluctuating between ‘poor', ‘satisfactory' and ‘moderate'. That isn't helping people who have issues with breathing. Dr Lancelot Pinto, consultant pulmonologist and epidemiologist at P.D Hinduja Hospital & MRC says asthma patients, especially those whose condition is not well-controlled by the regular use of inhalers, have been reporting increased shortness of breath, wheezing and cough when the Air Quality Index (AQI) worsens. AQI is a system used by government agencies to report the daily quality of air.

Every year, World Asthma Day is observed on the first Tuesday of May by the Global Initiative for Asthma to raise awareness about the breathing condition and care for it around the world. This year, it will be celebrated on May 3 around the world. In Mumbai, as city dwellers tackle the ongoing Covid-19 pandemic, they also have to deal with the increasing pollution in the city. While it is manageable for some, it can be quite a task for those suffering from asthma.

With the double threat of Covid-19 and poor air quality in view, , Mid-day Online reached out to Dr Pinto and Dr (Col) SP Rai, consultant, pulmonary medicine and sleep medicine, Kokilaben Dhirubhai Ambani Hospital to understand how people suffering from asthma are affected by bad air quality, the precautions they can take and if masks can help be a possible solution.

Mumbai's Air Quality Index (AQI) has been shifting in the last few months. How does the decreasing air quality affect those suffering from asthma?

Pinto: Individuals with asthma tend to be very sensitive to fluctuations in ambient temperatures and air quality. Asthma patients, especially those who have not been well-controlled with the regular use of inhalers, have been reporting increased shortness of breath, wheezing and cough when the AQI worsens. Patients with asthma often have allergic rhinitis, and poor AQI tends to aggravate nasal symptoms such as sneezing, runny nose and blocked nose.

Rai: The decreasing air quality can make asthma symptoms worse and trigger asthma attacks.

What are the different levels of severity in asthma?

Pinto: Asthma severity is determined by the frequency of exacerbations (or asthma attacks) and by overall quality of life. A person with well-controlled asthma should not be limited in their day-to-day activities, have awakenings at night because of symptoms or attacks necessitating an increase in therapy or hospitalisation. There are some patients with asthma who despite being on optimal inhaler therapy continue to have attacks and these are individuals who should be considered for newer modalities of treatment such as biologicals (monoclonal antibodies), which are now available in India. Most individuals tend to have asthma that is well-controlled with the regular use of inhalers.

Rai: Asthma can be mild, moderate or severe depending upon frequency and severity of symptoms like cough, shortness of breath, wheezing or chest tightness and also on severity of airflow obstruction on pulmonary function tests. After a targeted, step-based initiation of medications, the classification of asthma control is used to step up or step down the medications, depending on the level of control.

Is there a particular age group that is more vulnerable to suffering from asthma?

Pinto: The prevalence of asthma tends to be higher in children, a significant proportion of whom outgrow asthma in adulthood. It is extremely important to treat children with asthma as poor asthma control can seriously affect growth and development. Most individuals who have asthma will manifest their symptoms when young; late-onset asthma tends to be rarer.

Rai: Asthma can involve all age groups with the highest predisposition in the extremes of ages. This is because of airway responsiveness and lower levels of lung function. Two thirds of all asthma cases are usually diagnosed before the patient is aged 18 years.

While people are dealing with bad air quality, Covid is another aspect that has proved to be a challenge. What are the difficulties for people who have asthma and are dealing with these factors?

Pinto: Asthma, which is well-controlled, is not a risk factor for worsening in Covid (i.e. developing moderate to severe disease). However, the key word is "well-controlled". Respiratory viral infections (SARS-CoV-2 and others) are known to trigger asthma attacks, especially among individuals who are not well-controlled with regular inhalers. If one has asthma and has been advised regular use of inhalers, not adhering to such advice makes one vulnerable to having asthma attacks whenever the lungs are irritated by triggers such as viral infections and a poor AQI. A combination of avoidance of triggers and a regular use of inhalers is the best strategy to protect oneself.

Rai: Air pollution can trigger asthma attacks by irritating the airways, making them swell and tighten up. Covid infections add to the symptoms, thereby further deteriorating the lung functions, causing an increase in medications and hospitalisation in certain cases.

What is the kind of precaution that people suffering from asthma take if they are moving around in places with bad air quality like Mumbai?

Pinto: Wearing masks helps - especially N-95 or K-95 masks which are high-efficiency. However, one needs to change masks frequently, as the clogging of the pores of the mask can make breathing challenging. It is important to remember that indoor air quality can be worse than outdoor air quality at times. One needs to pay close attention to this. Prevent fungus growing on the walls, avoidance of pets if one has asthma, using hypoallergic pillow covers to protect from dust mites, using air purifiers if indicated, ensuring adequate ventilation in highly polluted rooms such as kitchens, avoiding irritants such as air fresheners/mosquito coils/incense sticks can all help.

Rai: The people suffering from asthma should continue their regular inhalers (reliever and controller) with the correct inhaler technique. One should stop smoking cigarettes. Avoid dusty environments, smoke and cold air as much as possible. When pollution levels are high, avoid strenuous activity outdoors. Instead, opt for indoor activities like walking in a shopping mall or gym. Practicing yoga and breathing exercises also help. In addition to Covid vaccination, people suffering from asthma should take their annual flu vaccinations and pneumococcal vaccinations when indicated.

Now that masks aren't compulsory anymore, should people suffering from asthma continue to wear them? How does it help them?

Pinto: Masks such as N95/K95 are highly efficient at filtering tiny particles in the air, in addition to bacteria and viruses, and protect the lung, as a result. However, the seal of the mask is important, as is the changing of the mask regularly. These masks, though highly efficient, tend to be more uncomfortable for prolonged use. A simple three-ply surgical mask will offer protection against larger particulate matter in the air, which is also useful for individuals with asthma, but are not as efficient at filtering smaller particles and viruses. These masks do tend to be more comfortable than high-efficiency masks. A three-ply mask covered with a cloth mask covering the sides might offer a better seal, greater protection, and still be relatively comfortable.

Rai: Masks are effective in reducing the spread of Coronavirus and other airborne infections and pollutants. This holds importance especially when the prevalence in the community is high. However, many severe asthmatics feel extra breathless from wearing N95 masks. Those people have the option of wearing surgical masks or cloth masks.