Many diseases could be combated by one of the simplest and cheapest actions possible – opening the windows. Dirty air in homes, particularly in poor homes, is responsible for a range of diseases for millions of people, according to the World Health Organization, and while poor air is primarily associated with poverty-stricken homes, it can affect people considerably higher up the economic ladder.

Polluted air circulating from incomplete combustion of burning solid biomass fuels such as wood, coal or cow dung --used by 826 million Indians – as well as poor ventilation and tobacco smoke are the culprits. Tobacco smoke releases more than 4,000 chemicals, of which at least 250 are harmful, and more than 50 are known to cause cancer. This endangers not only the smoker but also others present in the vicinity.

Most of the acute respiratory infections which kill over I million Indians every year are associated with indoor air pollution.

“Other causes (besides tobacco and bio fuel smoke) leading to respiratory diseases include overcrowding and poor ventilation that increase the concentration of harmful infectious and toxic agents indoors,” said Dr Donald Enarson, an authority on lung health, tuberculosis and indoor air pollution at the International Union Against Tuberculosis and Lung Disease. “In houses, offices and even in airplanes, when ventilation is reduced to seal the environment for cooling and heating purposes, it leads to an increase in respiratory and general illnesses called the sick building syndrome.”

Indoor air pollution is responsible for 2.7 percent of the global burden of disease. Three types of lung diseases have a strong association with solid fuel smoke: (i) acute lower respiratory infections in children, (ii) chronic obstructive pulmonary disorder (COPD) in women, and (iii) lung cancer in women exposed to coal smoke.

According to the World Health Organization, worldwide nearly 2 million people die each year from diseases caused by unhealthy cookstove technologies, including more than 1 million, mostly women, who die from COPD. Nearly half of deaths among children under 5 years old from lower respiratory infections are due to particulate matter inhaled from household solid fuels’ smoke and 1.5 percent of annual lung cancer deaths are also attributable to exposure to carcinogens from polluted indoor air.

Several children being treated for pneumonia at the Bahraich District Hospital and Nelson Hospital of Pediatrics and Neonatal Medicine Lucknow were found to be coming from families which used wood/charcoal cook stoves and where elders habitually smoked bidis – cheap cigarettes -- or more expensive ones, suggesting that cigarette and cook stove smoke increases the risk of pneumonia in children.

The Acute Respiratory Infections Atlas confirms that indoor air pollution significantly increases the incidence of pneumonia which globally kills close to 1 million children under 5, each year.

Nearly half of the world’s children are exposed to tobacco smoke in their daily lives, which doubles their chances of developing acute respiratory illnesses. Fetuses are at special risk, and abnormal lung function at birth may result in more severe infections in infancy. Non-smokers who are exposed to tobacco smoke in the workplace or at home face a 25 percent to 30 percent greater risk of heart disease and a 20 percent to 30 percent greater risk of lung cancer.

“Even living in posh houses behind closed doors and windows, with no proper ventilation and flow of clean air, poses a danger to lung health,” says Ajay Misra, Managing Director of Nelson Hospital of Pediatrics and Neonatal Medicine.

Passive smoking and exposure to biomass smoke are also risk factors for developing active tuberculosis, especially in children, according to Surya Kant, Head of the Pulmonary Department, King George’s Medical College. Cooking fumes and cigarette smoke can also trigger asthma attacks.

“The practice of using biomass fuel should be replaced by other safer energy options. A house should be neat and clean, with proper ventilation and admit natural sun light and people should be made aware not to smoke inside homes or in presence of children,” Kant said.

In the opinion of Kumud Anup, a practicing pediatrician in Lucknow, India, “In urban areas tobacco smoke is a major source of indoor air pollution. Children are exposed to second hand smoke which is extremely dangerous and increases the risk of pneumonia. Tobacco smoke greatly increases the susceptibility to not only pneumonia but also asthma and several other lung infections.”

There is a dismal lack of awareness in the common public and even in the medical community about the ill effects of polluted air circulating in living spaces. “Tobacco smoking or cooking on chulhas does not directly increase risk of childhood pneumonia. It can suffocate the child but it does not lead to any infection,” said P K Mishra, a gynecologist at the District Hospital, Bahraich.

Enarson insists that it is important to educate people about the dangers of open exposure to biomass and tobacco smoke so that they can take simple inexpensive precautions to reduce the problem.

Shifting from biomass to liquid fuels is an important step forward although it may not be practical for very poor people. It is best to do the cooking with biomass fuel either outside or in a separate room away from the main house, Enarson said. Improvements in ventilation -- planning open windows or ventilation shafts under the eaves -- using simple ‘enclosed stoves’ and preparing venting chimneys are practical ways to improve the situation.

“And the most crucial thing is to prevent people from smoking tobacco,” he said.

(Shobha Shukla is the Managing Editor of Citizen News Service She has also authored a wide range of reports on pneumonia, Hepatitis C and HIV treatment access issues. Email: shobha@citizen-news.org, website: http://www.citizen-news.org)