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Dr. Manoj K Goel
Director & Head
Dept of Pulmonology, Critical Care & Sleep Medicine
Fortis Memorial Research Institute,Gurugram(Delhi & NCR)

How Air Pollution Contributes to Lung Disease ?


When we breathe in dirty air, we bring air pollutants deep into our lungs, so it’s no surprise that air pollution causes serious damage to the respiratory tract. Air pollution exposure can trigger new cases of asthma, exacerbate or worsen a previously-existing respiratory illness, and provoke development or progression of chronic illnesses including lung cancer, chronic obstructive pulmonary disease, and emphysema. Air pollutants also negatively and significantly harm lung development, creating an additional risk factor for developing lung diseases later in life.

There are many triggers to asthma attacks, including dust, smoke, pollen, and volatile organic compounds.  Common outdoor pollutant triggers include ozone, carbon monoxide, sulfur dioxide and nitrogen oxides.


Are Children more vulnerable to the effects of Pollution ?


Children are particularly susceptible to the effects of air pollution. They breathe through their mouths, bypassing the filtering effects of the nasal passages and allowing pollutants to travel deeper into the lungs. They have a large lung surface area relative to their weight and inhale relatively more air, compared to adults. They also spend more time out of doors,  when  pollutant levels are at their highest. And, children may ignore early symptoms of air pollution effects, such as an asthma exacerbation, leading to attacks of increased severity. Combine those factors with the adverse impact of some pollutants on lung development and the immaturity of children’s enzyme and immune systems that detoxify pollutants, and you have a series of factors that contribute to children’s increased sensitivity to air pollutants.


What is global impact of Respiratory Diseases?


Respiratory disorders are increasing worldwide. Asthma is estimated to affect 5%-12% of people. These diseases cause loss of workdays and may even impair school performance in children.  


What are the symptoms of Respiratory Diseases?

The patients with Rhinitis present withblocked or running nose, sneezing, itching and watering eyes. Rhinitis can progress to asthma if not well treated.  Bronchial asthmais a commonly occurring and potentially life-threatening illness where the respiratory airways become inflamed and swollen.  The patient presents with shortness of breath, tight chest, cough or wheezing which is a whistling noise while breathing. These symptoms are usually associated with widespread but variable airflow limitation in the lungs that is at least partly reversible with medication.  Chronic Obstructive Pulmonary Disease (COPD), chronic bronchitis and emphysema Chronic Obstructive Pulmonary Disease (COPD) is another condition characterized by narrowing of the airways, but these changes are permanent rather than reversible. COPD is caused by exposure to pollutants that produce inflammation, an immunological response. In larger airways, the inflammatory response is referred to as chronic bronchitis. In the tiny air cells at the end of the lung’s smallest passageways, it leads to destruction of tissue, or emphysema. Although current and ex-smokers account for most patients with COPD, exposure to air pollutants plays an important role in the development of COPD and the origin and development of acute exacerbations.



How to diagnose Respiratory Diseases?


The diagnosis of respiratory diseases is based on clinical history,physical examination and specific tests. Asthma is characterized by variability in the airway narrowing and symptoms as it is an episodic disease. The patients usually have varying intensity of symptoms.  However, there are periods when the patients are symptom free.  This   variability of airflow obstruction can be  measured by home monitoring of lung function with a peak flow meter - a simple device to measure the flow of air out of the lungs. If, over a period of time, the morning and evening values vary by more than 15%, this is indicative of asthma.  This home monitoring is especially useful in children who may not complain of their symptoms. Lung function tests are useful in assessing the severity of narrowing in the bronchi.  Lung function tests also help in differentiating asthma from other respiratory disorders which present with similar symptoms.   


What is the management of Respiratory Diseases?

Effective management of respiratory diseases is crucial in keeping control of the condition to avoid exacerbation; and ultimately to improve the quality of life of the patients. Too often patients tend to adapt to and to live with their symptoms. The lack of appropriate control may cause exacerbations that, in asthma, may even cause irreversible damage to the lungs in the form of severe irreversible obstruction of the airways which may cause decrease in oxygen content and rise in carbon dioxide in blood.  A variety of measures   are available to keep rhinitis and asthma under control.  The first line therapy is in the form of inhalers for asthma and nasal sprays for rhinitis.  The inhalers deliver drugs in much less doses directly in the air passages which causes rapid control of the disease. The inhalation therapy has several advantages over the tablets as the onset of action is quick and side effects are negligible. The inhalers contain drugs to reduce swelling in the airways and also for relieving bronchial spasm.  The inhalers and nasal sprays may be advised as long term therapy for treatment as well as prevention of asthma and rhinitis.  Guided self-management helps patients recognize the start of exacerbation of their lung and nose symptoms, so that they can immediately act according to their individual treatment plan in consultation with a doctor.  


How to prevent Respiratory Diseases?


Avoid known triggers such as deodorants, perfumes, specific food items, smells, pets etc if you have tendency of allergic rhinitis and asthma.  Maintenance of hygienic and clean home environment is essential which will control house dust mite and fungal spores and moulds.  Effective measures are required by government and society to control outdoor pollution.    A regular check up with a doctor will help you optimize your medication. You may require prolonged inhalation therapy even during symptom free periods as use of inhalation therapy is very important for prevention as well as control the disease.  


What should you do if you have a lung condition?


Reduce or avoid strenuous, outdoor exercise. The benefits of exercise are great if you have a lung condition, so make sure you exercise indoors in a well-ventilated room or gym instead. Stay away from pollution hotspots such as main roads and road junctions.  Try to get to work a little earlier before rush hour has begun and levels of pollution have built uptake back streets away from the bulk of vehicle congestion if you cycle, run or walk as part of your commute.  Make sure that, if you use one, you carry your reliever inhaler with you and continue to take preventive inhaler.




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