Pneumonia Day: Expert guide to avoiding the pollution-triggered lung infection

Pneumonia a dangerous lung infection remains one of the leading causes of illness and comorbidities globally escalating from a simple cough often due to the compromised air we breathe Experts emphasise that poor air quality combined with factors like smoking significantly raises the riskAccording to the World Health Organization pneumonia is the single largest infectious cause of death in children worldwide killing over 740000 children under the age of five in 2019 alone and almost half of these deaths are associated with air pollutionOn World Pneumonia Day medical experts delve into the impact of air pollution and smoking on the increased risk of pneumonia and share strategies that can help recognise symptoms They also recommend adopting corrective lifestyle measures and seeking timely medical care to combat this persistent global health crisisAir quality and pneumonia risk in IndiaDr Salil Bendre director of pulmonology at Nanavati Max Super Speciality Hospital Mumbai states What often starts with a simple cough sometimes escalates into a dangerous lung infection mainly due to the air we breathe both from the ambient environment and from inside our homes He explains the mechanism Fine particulate matter like PM 25 is small enough to travel deep into the lower airways These particles also carry a mix of toxic chemicals which irritate the airways They are also linked with acute respiratory infections such as pneumoniaHe notes that children and women exposed to high concentrations such as those from solidfuelusing homes are particularly at risk He adds that young children exposed to tobacco smoke and pollution have about two times the risk of pneumoniaTargeted prevention Strengthening lung resilienceDr Rupali Pattnaik consultant critical care medicine at Manipal Hospital Bhubaneswar emphasises that for individuals living in areas with chronic bad air prevention must start long before illnesses occurShe states Though masks and air purifiers are useful the superior defence against airborne pollution is to strengthen our lungsrsquo ability to resist damage and enhance our bodyrsquos natural capacity to filter and respond to sootBelow she outlines a few simple strategies for lung defenceBreathing routinesSimple breathing routines including diaphragmatic and pursedlip breathing should be performed daily to assist in respiratory muscle strength and oxygen exchange and help increase the elasticity of your lungs and decrease inflammation of your airway Additionally steam inhalation with lukewarm plain water or mild saline can alleviate trapped pollutants in the air passage and provide reliefNutritionAntioxidantrich superfoods such as citrus amla turmeric berries green tea and nuts help to neutralise the free radicals that are produced when pollution is breathed in Omega3 fatty acids found in fish flaxseed and walnuts are antiinflammatory and can prevent the oxidative damage to lung tissue Adequate hydration is also crucial to keep mucous membranes moist and aid in the natural clearance of inhaled particlesEnvironmental awareness and indoor qualityIndividuals must schedule outdoor activity when pollution levels are generally at their lowest such as early in the day and after a rain shower and stay away during rush hour Inside one must maintain good ventilation and incorporate the use of HEPA filters and airpurifying plants like spider plants aloe vera or peace lilies to help remove indoor toxinsMonitoringPattnaik advises that those with occupationally related longterm exposures should receive annual lung health evaluations including spirometry or pulmonary function tests for early detection of decrements in lung function or airwayVaccination beyond routineVaccination is still the bedrock of pneumonia prevention Pattnaik asserts but it must extend beyond routine pneumococcal shots for those with chronic exposure or a smoking historyShe lists the key recommended vaccinationsAnnual Influenza vaccine This is strongly recommended because the flu virus can act as a gateway infection weakening the lungs and facilitating bacterial pneumoniaCovid19 vaccination and boosters These remain relevant as SARSCoV2 infections may lead to severe lower respiratory tract disease that looks like or leads to pneumonia particularly in people who already have weakened lungsTdap Tetanus Diphtheria and Pertussis Pertussis whooping cough can be especially hard on adults with compromised respiratory systemsRSV Vaccine Preliminary studies suggest a benefit to older adults and patients with chronic lung disease as the virus is now increasingly being recognised as an important etiologic agent in adult pneumoniaPattnaik concludes ldquoThese vaccinations are vital in the long run because theyrsquore also reducing the likelihood of severe disease mdash and thatrsquos key for people whose respiratory systems are already under stress from their environmentRecognising severity Five red flags that signal emergencyBendre highlights ldquoThe most common reason for delayed treatment is brushing off the symptoms and not recognising severity early enough Air pollution and smoking can cause a persistent cough which in some patients may progress to pneumonia In seniors or those with chronic lung disease like COPD one might observe confusion fatigue or a sudden drop in oxygen levelsrdquoBendre notes Oxygen saturation below 90 per cent and abnormal chest radiographs are strong indicators of the severity of this condition and the need for immediate care He provides crucial instructions saying It is important to know the red flags seek immediate care when they appear and where available use a pulse oximeter at home to check oxygen levels in highrisk elders or those with COPDDr Bendre lists five warning signs you should go straight to the emergency department1 Severe unexplained breathlessness or struggling to speak full sentences2 Oxygen saturation below 90 per cent or a bluish shade on the lips or face3 Unexplained confusion drowsiness or sudden worsening in seniors4 High fever with chills and low blood pressure5 Inability to drink or keep fluids down or signs of dehydration in a childTreatment effectiveness and complicationsPattnaik says ldquoA heavy smoking history or longterm exposure to polluted air can make pneumonia more difficult to treat and increases the risk of hospitalisationrdquo She further explains that pollutants and tobacco smoke destroy the cilia in our airways This means that once infection takes hold the lungs are less able to clear bacteria or secretions which slows recoveryldquoPatients with this history are more likely to have underlying chronic conditions like bronchitis or COPD and reduced lung elasticity which predisposes them to hypoxia low oxygen levels Consequently they are more likely to be hospitalised for infection require oxygen therapy or even sustain critical care Pattnaik warnsShe advises that antibiotic selection may differ often consisting of widerspectrum or multiple antibiotics as these patients are frequently colonised with resistant bacterial strains or mixed infections ldquoIt is important that oxygen saturation and respiratory rate be closely observed during treatment with temporary discontinuation of smoking or contamination by pollutants to allow lung tissue to recoverrdquo she concludesPostpneumonia lung health RehabilitationPattnaik emphasises that recovery does not end with antibiotics as the lungs commonly linger in a weakened and inflamed state for weeks ldquoWithout rehabilitation scarring or chronic bronchitis may take hold she warnsPattnaik outlines the fivestep longterm rehabilitation plan1 Pulmonary rehabilitation This is a formal program involving breathing exercises physical conditioning and education Patients should start with guided breathing maneuvers such as incentive spirometry and balloon inflation2 Physical activity Mild forms of aerobic exercise like walking or swimming will help increase endurance and maximise the peripheral use of oxygen3 Nutrition Postrecuperation foods rich in protein support tissue repair and antioxidants Vitamins C and E counteract oxidative stress Remember to hydrate as drinking water thins mucus4 Smoking and environment A smoking patient must quit Furthermore patients must stay away from dust construction sites or industrial smoke while recovering and must wear certified N95 masks if that is not doable5 Monitoring Followup imaging and pulmonary function test should be performed within 4ndash6 weeks from recovery to confirm resolution of inflammationSelfmanagement for lingering symptomsPattnaik recommends evidencebased selfmanagement strategies for home recovery1 Fatigue management Mild physical activity alternating with proper rest aides in the recovery of strength without over burdening the lungs2 Cough management Do not suppress a productive cough Instead use warm fluids honey with turmeric or saline gargles to soothe the throat Running a humidifier or breathing in steam can help relieve irritation and loosen mucus3 Resuming activity Exercise should be gradually reintroduced after the patient can walk easily without getting breathless She mandates a lifelong surveillance for symptoms of poor lung recoveryPractical advice for vulnerable groupsRecognising vulnerable groups is key to targeted prevention and early care ldquoThe most susceptible individuals are children under five years of age who face the highest risk of contracting pneumonia Among adults individuals with COPD are commonly affected due to their longterm exposure to pollution Furthermore older age groups witness sharply rising mortality with each passing decade making focused preventive measures essential for these populations explains Bendre He offers practical measures to reduce pneumonia risk across all ages1 Clean home air Invest in advanced vented stoves and better ventilation cut smoke exposure if in rural areas cook outdoors or in semiopen spaces2 Quit tobacco or exposure to secondhand smoke Quitting smoking reduces risk of pneumonia in adults Keep the homes residential areas playgrounds schools and colleges and public areas smokefree to protect the children3 Vaccinations on time In some cases measles and pertussis may lead to pneumonia Routine immunisation can reduce the episodes4 Supporting nutrition and immunity of children Exclusive breastfeeding for six months sufficient complementary feeding and supplementation as recommended by the paediatrician can reduce respiratory infections