Making India breathe free beyond Covid-19

The ravages of Covid-19 are well established. We witnessed large-scale disruptions across every sphere of human and business activity. A viral attack on an individual’s respiratory system snowballed into a public health crisis. However, this is not the first time a pandemic affecting the respiratory system has threatened populations, with swine flu, severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS) hitting us in the past; the magnitude of Covid-19 has captured the attention of the world. It indicates that a respiratory health issue is not just that alone but can have far reaching psychological, social, and economic impact. And therefore, it is a timely and apt reminder to pay heed to our respiratory health, and particularly the lungs.

Not only do our lungs supply oxygen to keep each cell in our body alive through inhalation, but also filter out unwanted carbon dioxide through exhalation. It also prevents other external and potentially harmful particles from being circulated further into the body. As gateways for breathing life into us, they are responsible for roughly 6 million breaths in a year. Yet, they remain neglected until we experience a breathing problem. Our lungs sure don’t have it easy, and what further threatens this vital organ is the severely deteriorating air quality especially in the polluted cities of the world. High levels of Particulate Matter (PM) 2.5 are a warning bell for our lungs.

To add to this, tobacco smoking, exposure to biomass fuels, and the rapidly growing number of motor vehicles, have led to a significant deterioration in the quality of air that we breathe. We are already seeing the perils of this with India recording 32% of the global burden of respiratory diseases despite having only 18% of the world’s population. According to the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2016, the contribution of chronic respiratory diseases to the total disability-adjusted life-years in India grew from 4.5% in 1990 to 6.4% in 2016. It is also pertinent to note that this is not just a health concern but also an economic concern.

Data indicates that respiratory diseases can impact economies—healthcare outlays soar, overall productivity diminishes, and families of those impacted suffer a setback. Therefore, understanding the occurrence of respiratory diseases and controlling them are imperative at a society and ecosystem level, while also taking active steps at an individual level towards lung health management. As a country, there is a need to form a comprehensive three-pronged framework that can mitigate the growing burden.

Government interventions

The government has introduced several schemes like the Unnat Chulha Abhiyan, Pradhan Mantri Ujjwala Yojana (PMUY), Direct Benefit Transfer of LPG (DBTL) and others for promoting clean cooking fuels and to reduce air pollution. But a lot more needs to be done. Respiratory health requires policy-level interventions and budgetary allocations in order to build a solid ecosystem that can effectively manage it. Both thecentral and state governments must work on formulating grassroots intervention programmes that focus on education, diagnosis, treatment, and care of chronic diseases in this category. For example, Chronic Obstructive Pulmonary Disease (COPD) is not included as part of the national screening programme for non-communicable diseases as opposed to other diseases like diabetes, hypertension, etc. Regions with the highest burden must have focussedprogrammes that can then be scaled and replicated across other areas as well. Additionally, there must be equal attention to addressing the causative external factors of respiratory diseases like air pollution, use of chulhas, etc. The key to ensuring this is the consistency of such interventions; a seasonal approach during peak months like winters will not suffice.

A conducive healthcare ecosystem

A comprehensive approach requires the participation of all stakeholders in the ecosystem to work towards addressing the current gaps. This network must include primary healthcare workers like Anganwadi workers and general practitioners, pulmonary experts, hospitals and pharma companies, and even academia. For instance, respiratory medicine must be given due attention in medical colleges so that doctors are trained to diagnose and appropriately treat respiratory diseases. Healthcare workers must be equipped with the requisite resources and tools to administer care. Hospitals can support this effort through their extensive networks and pool of resources to provide affordable diagnosis, treatment, and care facilities.

Extending these facilities to regions where the burden is immense but access is poor, is vital. Additionally, pharma companies can contribute through innovative and affordable diagnostic and treatment solutions that address the issues being faced in the continuum. For example, we are working on innovations like hand-held spirometers to enable widespread testing and portable nebulisers for COPD patients who cannot make it to the clinic.

Onus at an individual level

Tackling the respiratory burden is as much an individual responsibility as it is of the government and overall ecosystem. One must play an active role in managing one’s lung health. Akin to the attention we pay to our heart health, we must also do so for a healthy lung. This includes taking preventive measures like reducing exposure to toxic air and performing regular exercises to improve lung health, undertaking periodic lung health checks, and most importantly, not overlooking early signs such as shortness of breath or lingering chest pain.

It is imperative that we act upon our key learnings from Covid-19, that is, giving respiratory health its due attention and working together as one collaborative unit to fight this rising threat, to help India breathe free.