We will be talking of respiratory illnesses in this chapter. Clearly the lungs can be affected by very many conditions. Infections which are acute, infections which are long-lasting, like tuberculosis or cancers, but what we will be talking about today is one of the major forms of non-communicable disease, the chronic obstructive pulmonary disease, or chronic obstructive airway disease as it is called. COPD is one of the major problems affecting the health of human beings across the world. And in 2010, it was estimated that 329 million people, that�s about 4.8% of the global population were affected by chronic obstructive pulmonary disease. In 2012, it was the third leading cause of death. But these numbers too appeared to be underestimates because COPD is not often registered as a cause of death because cause of death is attributed to other things like cardiovascular and so on which may coexist or which may actually result from COPD, because congestive heart failure is not an infrequent manifestation of lung disease which then stresses the heart. Most countries don’t have national registries or good population data for the disease and therefore this disease may be even more frequent than has been estimated. But even at the level of the burden that has been now measured, 90% of the deaths occur in low and middle income countries. In 2010, it was estimated that COPD resulted in an economic loss of $2.1 trillion dollars globally, half of which was occurring in the developing world. Now if 90% of the deaths are occurring in the developing world but only 50% of the economic burden is in the developing world, that’s not because the developing world suffers less, but because the wages are estimated to be lower in terms of lost productivity losses. So the low and middle income countries do suffer hugely, both in terms of health and economy. Of this $2.1 trillion, $1.9 trillion is because of direct costs of medical care, which again is sparse in some of the developing countries. About $.2 trillion are indirect costs of missed work. Tobacco smoke is the biggest single risk factor for chronic obstructive pulmonary disease, followed by exposure to air pollution, which can occur both indoor and outdoor. Of lifelong smokers, half develop chronic obstructive pulmonary disease, if they’re not claimed already by cancer or heart attacks. Secondhand smoke is responsible for about 20% of the disease, even in nonsmokers. So lung problems can occur in active as well as passive smokers. COPD is unfortunately not curable. The problem with COPD is that cigarette smoke or other forms of smoke destroy the small airways in the lungs. They shrink the functioning lung tissue which becomes less capable of filling air and extracting oxygen. They also denude the airways of fine hair-like structures which act like brooms to clear the mucous. And when that happens, mucous accumulates and can become the seat of infection. And treatment can slow down the progress but cannot totally reverse the damage that’s already been done on infections or respiratory failure can be the frequent problems in COPD. We also know that there are other risk factors like environmental exposures in the form of biomass fuel consumption. Now when solid fuels are burned in the kitchens for example of homes in low and middle income countries, we have smoke emanating from there and filling the lungs. About 3 billion people are exposed annually to such biomass related air pollution. Outdoor air pollution or ambient air pollution is another major cause of air pollution which can damage the lungs. In addition, there are occupational exposures to a variety of dusts. Like for example the coal dusts in so-called anthracosis or sand in so-called silicosis. All of this dust can also enter the lungs and damage the lungs. In terms of air pollution, we now recognize it as the one, the largest single environmental health risk. In 2012, seven million people died prematurely due to air pollution. And in the same year, 2.7 million of these 7 million deaths were attributable to ambient or outdoor air pollution; 4.3 million premature deaths were attributable to household air pollution. The ambient air pollution is of particular importance where there is a fair amount of pollution because of a large number of causes, particularly industrial pollution as well as transport related pollution. These pollutants contain ozone, nitrogen dioxide, sulfur dioxide and particulate matter, all of which can damage the lungs and cause chronic obstructive pulmonary disease, apart from some of them being also cancer causing. In terms of particulate matter, this is a complex mixture of solid and liquid particles of organic and inorganic substances. And you have sulfates, nitrates, ammonia, sodium chloride, black carbon, mineral dust and water in a fairly deadly mix of pollutants which can damage the lungs very severely. But the particulate size also matters. What we call PM10, or particulate matter under the size of 10 microns, these lodge themselves deep inside the lungs and can cause cardiovascular disease, respiratory diseases and lung cancer. Whereas smaller particles, less than 2.5, what we call PM2.5 can cross into the bloodstream and cause damage to the blood vessels, can also cause a variety of diseases, including cardiovascular disease. Therefore when we are looking at all of these materials, we are really concerned about the quantity as well as the size of the particulate matter. In terms of households air pollution, about 3 billion people cook with solid biomass fuels. And in low and middle income countries, this is the kitchen’s curse, where women cook with these fuels, often holding small babies in their arms or babies have, the children are playing around in the kitchen. And about 50% or more of the under-five deaths in children are due to pneumonia who are exposed to this risk factor, which is soot inhaled from the households air pollution. Women too suffer and you have diseases like pneumonia, stroke, ischemic or coronary heart disease, chronic obstructive pulmonary disease and lung cancer resulting from exposure to indoor smoke from solid fuels. The countries of South Asia, India, Nepal, and others shoulder the biggest burden of households air pollution. It has been said that having an open fire in your kitchen is like burning 400 cigarettes an hour. And that is a level of pollution to which women and children in these countries are exposed when they use solid fuels in the kitchen. In terms of ambient air pollution, which is outdoor air pollution, about 16,000 cities worldwide monitor and report air pollution. But only 12% of the people living in all of these cities have air quality which meets the standards set by the World Health Organization. The most polluted cities in the world, no surprise, are in the low and middle income countries. Karachi, New Delhi, Katmandu, and Beijing are among the most polluted ones in Asia. Whereas Lima and Arequipa are among the most polluted in Latin America and Cairo in African cities. But obviously many others in these regions also have very high levels of air pollution. If you are looking at use of solid fuels for cooking, worldwide it has gone up in the last 20 years and particularly in Africa and South Asia. When we look at the health effects of air pollution, we see a number of diseases which can result. Stroke, heart disease, lung cancer, chronic as well as acute respiratory disease, including infections and a lot of childhood asthma. Childhood asthma can be provoked by multiple smoke exposures, including tobacco smoke or dust. About 80% of outdoor air pollution related deaths were due to ischemic or coronary heart disease, 14% due to chronic obstructive pulmonary disease and 6% due to lung cancer. In 2013, the International Agency for Research on Cancer concluded that air pollution is definitely carcinogenic to humans. When it comes to particulate matter, as we have said there is absolutely no safe threshold and therefore we must try and minimize the exposure to particulate matter both in terms of quantity, size and duration of exposure. When it comes to households air pollution, we ought to make sure that we have alternative fuels because biomass cookstoves or safe cookstoves as they’ve been called, which have tried to protect people who are continuing to use solid fuels, have not had a substantial reduction in the amount of exposure to some of these potential disease causing agents. And obviously we now require better fuel which can be utilized in the form of liquid petroleum gas or a greater supply of electricity which makes it possible for women to use induction heaters. So energy security becomes a very important issue when we’re dealing with households air pollution. And it’s important for us to recognize that when we’re dealing with ambient air pollution too, if we control vehicular emissions by reducing vehicular density, that also contributes to energy security. So we are moving in public health to areas of energy security rather than just looking at air pollution as a health problem alone. When we are looking at ambient air pollution clearly we require a multisectoral approach. We do require to curb industrial emissions which are one of the major sources of ambient air pollution all over the world. We need to reduce transport related air pollution and emissions by reducing vehicular density across the crowded cities of the world. We need to reduce also construction related air pollution in countries which are rapidly expanding their cities. We need to provide more green spaces and by providing greater access to public transport which has an effect on reducing the number of vehicles on the road, we can actually curb a fair amount of air pollution. So by linking up many of these public health measures to urban design, urban transport, energy security and of course tobacco control, we can actually make a dent in what is otherwise an incurable disease.
OpenEdition sugere que esta publicação seja citada da seguinte forma:
Pedro Pereira Leite (18 de Maio de 2015). Non-Communicable Diseases VIII. Global Heritages. Recuperado em 13 de Novembro de 2025 de https://doi.org/10.58079/p2p1