Sins of Civilization Drive Respiratory Risk Factors

Climate change, unplanned urbanization and air pollution are among the major risk factors for respiratory non-communicable diseases, including cardiovascular diseases, cancers, diabetes, and lung diseases, which account for over two-thirds of the world's deaths each year, according to a leading respiratory expert at a global conference in the United Arab Emirates.

Dean Schraufnagel, who heads the Forum of International Respiratory Societies, said in an interview that climate change and unplanned urbanization lead to air pollution, which is one of the main causes of non-communicable respiratory diseases. Schraufnagel is a professor in the Departments of Medicine and Pathology at the University of Illinois at Chicago.

Among the diseases arising from what amount to the blight of unplanned development and pollution, Schraufnagel said, are chronic obstructive pulmonary diseases, affecting more than 64 million people globally, with 3 million dying from them each year. Others include asthma, affecting 334 million people globally, affecting 14 percent of children; pneumonia, the leading cause of death in children under 5, killing about 4 million people annually; lung cancer, which takes away 1.6 million lives each year, and sleep apnea, affecting 100 million, with 80 percent of the cases going undiagnosed.

Workplace mineral and organic dusts, bio aerosols and fumes affect more than 50 million people. Pulmonary hypertension in 1 percent of the world’s population and 10 percent of those over 65 years of age suffer from it and most goes untreated.

Global warming results in the production of air pollutants like methane, hydrochlorocarbons, carbon dioxide; while fire causes particulate matter, nitrogen oxides, ozone and sulphur oxides. But coal produces all of these elements and to some extent exhausts from cars too.

"People with any kind of chronic lung disease suffer when air quality changes,” Schraufnagel said. “NCDs that lie in the respiratory sphere are greatly affected by climate change. Asthma is associated with pollens, which are climate affected. There is recorded evidence to show that asthma symptoms increase after a thunderstorm – the two are directly related. COPDs too are very susceptible to temperature and air pollution. There is a very detailed combination of air pollution and respiratory infections. For example PM10 – large particulate matter – is associated with increase in RSV virus (Respiratory Syncytial Virus), bacterial pneumonia, and viral influenza."

The elderly and newborn children are the most vulnerable. The particulate matter, especially fine particulate matter PM 2.5, gets into the blood vessels and spreads throughout the body. If you were to measure the emergency room admissions, especially for COPD in the elderly, Schraufnagel said. “You would find that there is a good correlation between the amount of PM 2.5 and these events. Air pollution also results in an increase in cardiac deaths, and has even been associated with dementia and renal disease. Fetal exposure to tobacco cigarette smoke results in lower birth weight and could also lead to obstructive bronchitis as the baby grows up.”

With the two main causes of outdoor air pollution – exhaust fumes from cars, and power plants – Schraufnagel advised that governments should encourage use of electric cars that do not pollute, modify existing power plants, switching to materials other than coal, and promote wind power and solar energy.

Schraufnagel said electric vehicles not only prevent air pollution, but also run without much cost for fuel and require much less servicing.

Dealing with air pollution to fight NCDs

"We have to be outraged and demand that it is our right to breath clean air,” Schraufnagel said. “Unless we demand, nothing would change. Twenty years ago you could smoke in hospitals and other public places and nobody would raise an eyebrow. But today, knowing the devastating effects of tobacco smoke, it is no longer acceptable to smoke in a public place in most parts of the world. The same is true about air pollution. Staying indoors to avoid air pollution is not the solution. People have to make a noise about not being able to breathe clean air, and force governments to take action. We have to get legislators to go after pollution and the polluters."

Increasing policymakers’ awareness of the burden of polluted air; eliminating tobacco products; adopting WHO’s air quality standards in all countries; promoting universal health coverage; increasing public awareness for early diagnosis and treatment; and standardizing management of NCDs, especially at primary healthcare level, would perhaps help us achieve the sustainable development goal of reducing premature deaths from NCDs by one-third by 2030.

Shobha Shukla is the Managing Editor of Citizen News Service, which specializes in health coverage, and writes extensively on health and gender justice. With support from the Lilly Global Health Partnership this article is part of her in-depth thematic coverage of the 2nd Global NCD Forum. Follow her on Twitter @Shobha1Shukla or visit