Not surprisingly, many of them do, but asthmatics are not the only ones at risk. One in seven people have asthma in Delhi, but the smog causes respiratory attacks and wheezing in some nonasthmatics who are old, who smoke, have respiratory infections or chronic bronchitis. "The cold combined with chest infections worsens symptoms of breathlessness and can cause respiratory problems even in people who do not have chronic asthma," says Dr J. N. Pande, former head of the Department for medicine, AIIMS, and currently with the Sitaram Bhartia Institute.

About 20 per cent people in Delhi get acute respiratory attacks at least once in winter when air pollution combines with cold weather to become a deadly trigger, found a WHOsponsored study on breathing disorders. Asthmatics are at most risk, with hospitalisation because of acute attacks doubling November to January.

Nearly 1,000 new cars a day are added to the existing 4 million registered in the city, which create a haze over the Capital. This smog peaks around Diwali, when the millions of lighted candles and crackers add to air pollution. Rising diesel emissions in Delhi are a major cause of the problem, as diesel fumes - a mix of carbon monoxide, carbon dioxide, sulfur dioxide, nitrogen oxides and mercury - contain up to 100 times more particles (suspended particulates) than petrol exhaust.

Diesel can cause asthma attacks long after the initial allergen contact, at times prompting an attack hours after exposure to pollution, reports the Journal of Allergy and Clinical Immunology.
"Air pollutants such as ozone, nitrogen dioxide and suspended particulates compound the impact of inhaled allergens in asthmatics and increase airway in flammation, causing acute attacks," says Dr Anupam Sibal, consultant paediatrician and head of hospital services, Apollo Hospital.are 20 million There severe asthmatics in India who need regular anti-inflammatory drugs to control airway inflammation. About 10-15 per cent 5-11 year old children in the country have the disorder, though almost half outgrow it by their teens. "Even viral fever can lead to severe wheezing or an asthma attack in chil dren who don't have diagnosed asth ma. This happens because children have small airways and an infection may cause them to get inflamed, mak ing breathing difficult," says Dr Arya. Chronic coughs may mean allergic bronchitis with or without asthma, so parents should get the condition diag nosed.

Attacks can be relieved with salbu tamol inhalers (short-acting beta 2-ag onists) that dilate airways. A combi nation of the inhaled steroid fluticas one propionate and the long-acting beta 2-agonist salmeterol is effective in controlling asthma.

sanchitasharma@hindustantimes.com SENSITIVE LUNGS ARE BAD NEWS Asthma triggers vary for people, but the more common ones include:

Colds and flu can trigger an attack, especially in children. Smoking or secondhand smoke add to attack frequency. Exercise and sports can cause wheezing and an attack, more so in cold weather when the airways are anyway constricted. Extreme emotional arousal such as anger or fear are bad news. Allergies to pollen, grasses, dust mites, some foods, moulds or animal hair or dander causes asthma in susceptible people. Blood tests or skinprick tests can be done to help find out whether your child does have an allergy. Sudden change in temperature and weather, cold weather, cold winds, air conditioning and changes between hot and cold areas can be a trigger. Chemicals and strong smells such as fumes from paint, spray cans, perfumes or cleaning detergents can trigger asthma in some people. Food additives, artificial flavourings and colouring (yellow colour in particular found in some cold drinks, jams, sauces and juices) can trigger an attack. Some medicines such as aspirin and other non-steroid anti-inflammatory drugs, and beta-blockers used for controlling blood pressure, treating heart failure and preventing kidney damage in people with hypertension or diabetes.

SYMPTOMS Early detection and treatment can stop an attack from getting worse. Watch out for symptoms of: ? Wheezing ? Laboured breathing ? Tightness in the chest ? Frequent bouts of coughing ? Exhaustion or inability to walk more than a few steps ? Inability to speak more than one or two words per breath ? Blueness around the lips ? Babies and small chil dren may just breathe fast, appear restless, or may have problems feeding due to short ness of breathe. They may also have severe coughing and vomiting. IS YOUR ASTHMA IN CONTROL? If you have any one of the following symptoms, your asthma medication may need to be changed. ? Wheeze, cough or have chest tightness at night ? Wheeze, cough or have chest tightness in the mornings when you wake up ? Need to use an inhaler more than three times a week (not including before exercise) ? Wheeze or have chest tightness while run ning or during sport. TREATMENT Asthma management involves avoiding known allergens and irritants and controlling symptoms and airway inflammation through medication. The two basic kinds of medication are: ? Long-term control medications used reg ularly to prevent attacks. This is not for treatment during an attack. These include inhaled steroids to pre vent inflammation, leukotriene inhibitors and anti-IgE therapy given by injection to patients with more severe asthma. ? Long-acting bron chodilators to open airways such as Cromolyn sodium or nedocromil sodium ? Rescue medications are used to relieve symptoms during an attack. These include short-acting bron chodilators and corti costeroids, such as prednisone or methyl prednisolone) given by mouth or into a vein

Publication : HT; Section : nation; Pg : 9; Date : 12/11/07

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