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People Sick
March 4, 2014
AFP / Getty ImagesIndonesian
motorists travel under a blanket
of haze in Dumai town located
in Riau province in Indonesia's
Sumatra island on March 3,
2014. Riau province, the heart of
a Southeast Asian smog crisis
last year, has declared a state of
emergency after being blanketed
in thick haze from forest fires
People with asthma need to take special care in order to minimize the impact of the haze
on their health and day-to-day activities. Even a person who had asthma as a child and
has not experienced an attack in years may start to experience asthma symptoms
Asthma is an inflammatory disease the airways get easily irritated and narrowed when
triggers such as smoke and strong odors are inhaled.
During the haze, the air is filled with fine particles such as ash and a heavier
concentration of gasses; when inhaled, they act as irritant which triggers asthma attacks.
An asthma attack can be identified when a person experiences the following:
Difficulty breathing as airways are narrowed, normally accompanied by wheezing
Coughing
Shortness of breath; gasping
Tightness in the chest area
Night-time waking due to coughing or difficulty breathing
In severe cases, the airways narrow so severely that the person is unable to breathe
adequately and may lead to a situation that is potentially fatal. Because asthma is a
chronic condition, it cannot be cured and requires treatment with a combination of one
inhaler for immediate relief and one preventor for long-term control.
A reliever medication is an inhaler that relaxes the airways and is used whenever an
attack occurs. A preventor is an inhaler which is used daily (even when there are no
attacks) to reduce the inflammation in the airways, thereby helping to prevent future
attacks.
If you have asthma and are currently managing your asthma well with daily medication,
continue to do so. See your doctor if you find that you are experiencing more symptoms
or attacks than usual.
If you have asthma and you are not taking any medication, it is best for you to see a
doctor who may then prescribe you the appropriate medication for emergency use and
long-term treatment, if necessary.
If you had asthma as a child but have not experienced an attack in years, it is still
advisable for you to get a reliever (blue inhaler), to be used in the event of a sudden
attack.
A
A
NEW DELHI: The United Nations report about the increasing air pollution in Asia has
put the spotlight on the immediate effect of the haze on health of people. In fact,
experts say Delhiites should take all necessary precautions.
It is a known fact that asthma cases increase drastically during winter due to the
presence of smog. But experts say that in the last five years there has been a
cumulative increase of 20% in asthma cases. Not just asthma, even cardiovascular
events shoot up due to smog.
"Asthma cases definitely shoot up. Chronic bronchitis, lower respiratory tract
infection like pneumonia etc are also reported in large numbers during this time of the
season. The pollutants in the air result in inflammation of airways, thereby, blocking it.
Children and elderly people stand a high chance of suffering an asthma attack or a
serious episode of bronchitis," said Dr GC Khilnani, professor medicine, AIIMS.
There are some heavy metals in the air that can trigger allergic reactions. Throat and
eye infections are very common. "There are micro-particles of dust and salts in the air
that act as irritants and can trigger an allergic reaction. Along with these microparticles there are various gases like nitrogen oxide, carbon dioxide, carbon monoxide
etc. A cocktail of all these can have a devastating effect on health. Due to smog, a lot
of people complain about burning sensation in eyes or bad throat, sneezing etc," said
Dr Sanjeev Bagai, director and head of the paediatrics department, Rockland hospital.
For asthma patients, driving in the city becomes even more difficult, especially at
traffic signals. In fact, newborns too stand a chance of developing breathing difficulty.
"The asthma episodes are frequent in those who travel a lot, especially during rush
hour, as the pollution level is really high. But newborns are at greater risk of
developing breathing difficulty. We see a lot of newborns who are re-admitted at the
hospital with such serious conditions," said Dr Bagai.
Doctors say the pollution levels have gone up so drastically that one inhales all
poisonous substances while breathing. The pollutants enter our body through the
respiratory tract and mixes with the blood, thereby, making it more viscous, which in
turn puts a person at risk of having a serious cardiovascular event. "As blood becomes
viscous due to these suspended particles, it increases the blood pressure. It also exerts
pressure on fat deposits in the arteries, which can burst under excess pressure," said Dr
Rajat Mohan, senior consultant, interventional cardiologist, Sir Ganga Ram Hospital.
1.
The key air pollutants of concern include particulate matter (PM), sulphur dioxide, ozone,
nitrogen dioxide and carbon monoxide. Short term exposure (i.e. continuous exposure to
unhealthy daily average PSI levels over a period of a few days) to these air pollutants can
cause respiratory symptoms and aggravate existing heart or lung disease. Exposure to
particulate matter and sulphur dioxide may also cause irritation of the eyes, nose and
throat in healthy individuals.
In Singapore, the main air pollutant in the event of haze is particulate matter (PM).
2.
Among healthy individuals, short term exposure (i.e. continuous exposure to unhealthy
daily average PSI levels over a period of a few days) to high levels of haze particles may
cause irritation of the eyes, nose, and throat in healthy individuals. Such irritation
resolves on its own in most cases.
Haze particles can affect the heart and lungs, especially in people who already have
chronic heart or lung disease e.g. asthma, chronic obstructive pulmonary disease (COPD),
or heart failure.
There may be up to 1-3 days of time between exposure to haze and health effects/
symptoms.
3.
Singapore is not affected by the haze throughout the year. Any exposure is short-term in
nature (i.e. continuous exposure to unhealthy daily average PSI levels over a period of a
few days) and such exposure may vary from year to year. As international studies are
based on long term exposure to air pollution, there is little robust data on the longer-term
effects of short-term exposure to haze like the pattern seen in Singapore.
Studies have shown that persons living overseas with continuous exposure over several
years to high ambient pollution from fine particles (i.e. particulate matter 2.5 (PM2.5);
particles smaller than 2.5 micrometres), may have a higher risk of (i) cardiovascular
effects, such as heart attacks, (ii) reduced lung development, as well as (iii) the
development of chronic respiratory diseases, such as asthma, in children.
4.
What is the revised Pollutant Standard Index? How is it different from PSI
reporting last year?
The new, integrated air quality reporting index incorporates PM2.5 in addition to sulphur
dioxide (SO2), particulate matter (PM10), nitrogen dioxide (NO2), carbon monoxide
(CO), and ozone. Previously, health advisories issued by the Government were based on
both 24-hour PSI and 24-hour PM2.5, whichever was worse. Under the new air quality
reporting system, the health advisory will be based on the new 24-hour PSI as it now
directly takes into account PM2.5.
5.
Why is the health advisory based on 24-hour PSI, rather than the 3-hour
PSI? Why does Singapore calculate the Particulate Matter (PM) in air pollution
based on the 24-hour measurement? Why not use sub-daily measurements?
The health impact of exposure to particulate matter in the air depends on the
concentration and duration of the exposure, as well as the health status and level of
activity of the individual. The health advisory is based on the 24-hour PSI (incorporating
24-hour PM2.5 concentration), as most scientific studies on the health effects of shortterm exposure to PM use 24-hour averages, and have demonstrated good links with 24hour PM averages. The use of 24-hour averages for PM is also consistent with
international guidelines, such as the US Environmental Protection Agencys (EPA)
National Ambient Air Quality Standards and the World Health Organizations Air Quality
Guidelines. Fewer studies have investigated shorter (sub-daily) exposure timeframes. In
fact, a US EPA study in 2011 concluded that there was insufficient basis to establish a
national standard with a shorter-than-24 hour averaging time. MOH will continue to
monitor research in this area.
6.
In general, children, elderly, and people with chronic lung disease, heart disease are more
sensitive to the health effects of haze, and should adopt the preventive measures in the
MOH health advisory when air quality is poor. Individuals are advised to consult their
doctor should they develop breathing difficulties. In addition, it is advised that pregnant
women reduce exposure to haze for the health of their unborn baby.
7.
The public is recommended to adhere to the MOH haze health advisory (Annex A). In
most cases, it is still safe to carry on with outdoor activities. However, do drink plenty of
water to stay well hydrated. Individuals with existing chronic heart and lung conditions
should ensure that your medications are on hand and readily available.
8.
While the health advisory provides generic precautionary advice, individual reactions to
pollutants may vary. For instance, some vulnerable people, such as those with heart and
lung conditions, may experience increased symptoms at PSI levels below 100. Such
individuals are advised to be cautious and seek appropriate medical attention as needed.
9.
How will the haze impact patients in nursing homes and subsidised wards with
natural ventilation?
These patients are indoors and sedentary. The healthcare institutions, such as hospitals
and nursing homes, will monitor patients closely, and ensure ample circulation of clean
air indoors.
10.
http://www.nea.gov.sg/psi/
http://mom.gov.sg/haze/Pages/haze.aspx
http://www.moh.gov.sg/content/moh_web/home/pressRoom/Current_Issues/2014/haze.ht
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