Pushpa Trivedi, a professor at the department of Humanities and Social Sciences at IIT-B, and an author of the study, said, “Increase in pollutants leads to an additional burden of cases, and a monetary burden on the patients.”

Trivedi estimated the total cost of treatment for diseases triggered by air pollution in Mumbai was set to go up from Rs 1,349.42 crore in 2008 to Rs 1,658.20 crore in 2015.

A 50 microgram per cubic metre (µg/m3) increase in NO2 (nitrogen dioxide, largely released by the burning of fuel) led to heath complications, the treatment of which cost Rs888.67 crore in 2008, said Trivedi. The cost was expected to rise to Rs1,090.35 crore in 2015. “The study showed that the burden of diseases caused by 50µg/m3 increase in PM10 (particulate matter 10 – see box) was estimated to rise from Rs460.75 crore in 2008 to Rs567.84 crore in 2015,” said Trivedi.

“Pollution extracts a heavy price from affected individuals, society and the government. During our study, we found many patients were being hospitalised twice or thrice a year because of lung complications. Public hospitals are few in number and crowded, and we found 70% people opting for treatment at private clinics,” said Archana Patankar, co-author of the doctoral study.

According to a 2014 World Health Organisation (WHO) report, the average PM10 level was 136 µg/m3 in Mumbai, compared to 121 µg/m3 in Beijing. The Central Pollution Control Board says the safe limit for PM10 is 100 µg/m3. The average PM10 level in the world is 71µg/m3, according to a WHO report.

Doctors in Mumbai said over a period of five years, the number of patients with allergic bronchitis have increased by 30-40%. “Many times, I have asked my patients to leave the city as a treatment. They go to their village for a few days and their cough disappears. Such cases are a result of increased pollution levels,” said Dr Shahid Barmare, physician, Kohinoor Hospital, Kurla.

Dr Barmare said people who travel in open vehicles such as autos and motorcycles have a higher exposure to pollutants and develop allergic bronchitis because they inhale more particulate matter.

Doctors said people who have existing lung conditions such as asthma and chronic obstructive pulmonary disorder are the worst affected. Higher pollutant levels in the city can trigger allergic rhinitis – which causes a burning sensation in the eyes and increases the risk of heart conditions and cancer, said doctors. Recently, the WHO identified outdoor air pollution as a carcinogenic – something that causes cancer – just like tobacco.

HT found that patients with lung complications spend between Rs 10,000 and Rs 2-lakh annually for treatment, depending on the severity of the conditions and the frequency of hospitalisation. Thane resident Shruti Mani, 23, for instance, spends Rs 24,000 on her treatment annually. “I visit the doctor twice a month. I am trying out alternative medication,” said Mani, who noticed she has more asthma attacks during Diwali, when air pollution levels go up.

What is more worrying is the rise in number of people complaining of respiratory infections that rarely respond to common medicines. “While their lung function test results are normal, their condition does not seem to improve with regular medication. Such respiratory distress could be related to higher exposure to toxic gases inhaled,” said Dr Samir Garde, pulmonologist, Global Hospital, Parel.

Dr Pratit Samdani, physician, Breach Candy Hospital, said, “Particulate matter (PM10 and PM2.5) also carries virus and bacteria, which infect the lungs and cause lung infections.”

Doctors said people should avoid walking in polluted areas. They should also avoid taking early morning and evening walks, as the pollutants are closer to the ground. “I always ask my patients to avoid running on the Marine Drive, as they are inhaling vehicular emission at a much faster rate when they are running,” said Dr Rohini Chowghule from the Indian Institute of Environmental Medicine and a senior chest specialist.

Outdoor air pollution is a carcinogen: WHO study

* Outdoor air pollution is a major environmental health problem affecting people in developed and developing countries alike.

* The World Health Organisation (WHO) estimates that 80% of premature deaths related to outdoor air pollution were caused by ischaemic heart diseases and strokes, while 14% of the premature deaths were caused by chronic obstructive pulmonary disease or acute lower respiratory infections; 6% of the deaths were caused by lung cancer.

* A 2013 assessment by WHO’s International Agency for Research on Cancer concluded that outdoor air pollution is carcinogenic to humans, with the particulate matter component of air pollution most closely associated with increased cancer incidence, especially cancer of the lung.

* This means air pollution is a human carcinogen, similar to tobacco smoke, asbestos and arsenic – a leading cause of cancer deaths globally.

* Health experts have known for years that air pollution increases the risk of a wide range of ailments, including respiratory problems and heart disease. Some compounds in the air we breathe, such as diesel exhaust, have already been deemed cancer-causing. But the 2013 study was the first time the organisation’s International Agency for Research on Cancer classified air pollution in its entirety as a cause of cancer.

# Health impact of specific air pollutants:

Volatile Organic Compounds (VOCs)

Emission source: VOCs are a large group of carbon-based chemicals that easily evaporate at room temperature. While most people can smell high levels of some VOCs, other VOCs have no odour. Smell does not indicate the level of risk posed by the inhalation of this group of chemicals. There are thousands of different VOCs produced and used in our daily lives.

Health hazards: VOCs can cause irritation of the eye, nose and throat. In severe cases, there may be headaches, nausea, and loss of coordination. In the longer run, some of them are suspected to cause damage to the liver and other parts of the body.

Formaldehyde

Emission Source: It is an organic chemical that is present in the environment. Formaldehyde is also found in chemicals, household products, glues, permanent press fabrics, paper product coating, fibre boards and plywood.

Health hazards: Exposure causes irritation to the eyes, nose and may cause allergies in some people.

Lead

Source: The most common cause of lead poisoning is dust and chips from old paint. However, there are non-paint sources, though less common, like soil and water.

Health hazards: Prolonged exposure can cause damage to the nervous system, digestive system, and in some cases, cause cancer. It is especially hazardous to small children.

Ozone

Sources: Unlike other pollutants, ozone is not emitted directly into the air by specific sources. Ozone is created by sunlight acting on oxides of nitrogen (NOx) and VOCs in the air. Some of the common sources include gasoline vapours, chemical solvents, combustion products of fuels. Emissions of NOx and VOC from motor vehicles and stationary sources can be carried hundreds of miles from their origin, and result in high ozone concentration over very large regions.

Health hazards: Exposure to this gas makes our eyes itch, burn, and water and it has also been associated with increase in respiratory disorders such as asthma. It lowers our resistance to colds and pneumonia.

Oxides of Nitrogen

Emission sources: Burning of fossil fuel like coal and wood.

Health hazards: This gas can make children susceptible to respiratory diseases in the winters.

Carbon Monoxide (CO)

Emission source: Higher levels of CO generally occur in areas with heavy traffic congestion. Other sources of CO emissions include industrial processes (such as metal processing and chemical manufacturing), residential wood burning, and natural sources such as forest fires. Wood stoves, gas stoves, cigarette smoke, and heaters are indoor sources of CO.

Health hazards: CO combines with haemoglobin to decrease the amount of oxygen that enters our blood through our lungs. It binds with other blood proteins and causes changes in the functioning of organs such as the brain and the cardiovascular system, and also in a developing foetus. It can impair our concentration, slow our reflexes, and make us confused and sleepy.

Sulphur Dioxide (SO2)

Source: The main source of the gas is industrial activity in which materials that contain sulphur are processed, like the generation of electricity from coal, oil or gas. In addition, industrial activities that burn fossil fuels containing sulphur can be important sources of sulphur dioxide.

Health hazards: SO2 can oxidise and form sulphuric acid mist. SO2 in the air leads to diseases of the lung and other cause wheezing and shortness of breath. Long-term effects are more difficult to ascertain, as SO2 exposure is often combined with that of SPM (suspended particulate matter).

Suspended Particulate Matter (SPM)

Emission source: SPM consists of dust, chemicals, mist, soot and organic substances. The main chemical component of SPM, which is of major concern, is lead, others being nickel, arsenic, and chemicals present in diesel exhaust. SPM of tinier size are called Respirable Suspended Particulate Matter (RSPM), which is virtually impossible to filter out. RSPM is further categorised into PM2.5 (with a diameter of less than 2.5 microns) and PM10.

Health hazards: These particles, when inhaled, lodge in our lung tissues and cause lung damage and respiratory problems.

SPM as a major pollutant needs special emphasis as

a) it affects more people globally than any other pollutant on a continuing basis

b) there is more monitoring data available on this than any other pollutant

c) more evidence has been collected on the exposure to this than to any other pollutant.

(Source: WHO and NEERI)

The price you pay for pollution

Pushpa Trivedi, professor, department of Humanities and Social Sciences at IIT Bombay, Powai, calculated the monetary burden of pollutants on the health of Mumbaites. The study published by Trivedi and Archana Patankar, co-author of the study, had measured the monetary burden on individuals, the community and the government.

2008-2009 2012 2015

Overall monetary burden with rise in pollutants Rs 1,349.42 crore Rs 1,568.54 crore Rs 1,658.20 crore

Monetary burden with 50µg/m3 increase in NO2 per year Rs 888.67 crore Rs 1,031.40 crore Rs 1,090.35 crore

Monetary burden with 50µg/m3 increase in PM10 per year Rs 460.75 crore Rs 537.14 crore Rs 567.84 crore

-- The monetary burden was estimated by assuming that the consumer price index (CPI), with 1993-94 as the base year, showed that since 2000-01, the price of medicines had gone up by an average of 9% per annum (Central Statistics Office, 2008). It was also assumed that overall cost of treatment would increase by 9%, and wage rates by 5% per year. Hence, societal cost on account of loss of productivity would increase by 5% per annum.