Respiratory Disease and Public Health
As the world becomes increasingly more urban, the global burden of respiratory disease becomes more and more of a community concern.
Just over 65 million people worldwide are living with chronic obstructive pulmonary disease (COPD), upwards of 235 million are living with asthma, and nearly 4 million people die prematurely as a result of complications from chronic respiratory conditions, making it the third leading cause of death. The death rate is especially concerning in developing and industrializing countries, where infants and young children are the most vulnerable to developing respiratory complications. Asthma is especially brutal on young kids living in urban environments, and accounts for 30 percent of all pediatric hospitalizations. The death toll from chronic respiratory illness is intrinsically linked with structural lack of access to ailing communities. This means that necessary immunizations, medicine, and healthcare providers are unfortunately inaccessible to the most vulnerable populations.
As you may have surmised already, respiratory diseases are not a monolith. Several branching diseases all fit under the umbrella of ‘respiratory disease’ and contribute to the severity of the public health impact. The most common and chronic examples of respiratory diseases include COPD and asthma as were mentioned briefly above, but also acute respiratory infections, tuberculosis, and lung cancer. Each disease is associated with differing symptoms, though often there are overlaps. For asbestosis and silica-related lung disease, dyspnea and a dry, rattling cough are common. With lung cancers and mesothelioma, chest pain, unexplained weight loss, fatigue, and painful coughs can all be indicators of disease. With something like pleural plaques on the lung tissue, symptoms are often not overtly present or relatively benign, so they may only be diagnosed after a radiology exam.
But how are people contracting these lung conditions in the first place, and why are incidences of chronic respiratory illnesses increasing?
As with most chronic diseases that have proliferated in the 20th and 21st centuries, an expansion of industry is a leading factor. First and foremost, growing industrial centers in and on the outskirts of populated cities expose everyone in a wide radius to air pollution. It has been shown time and time again that people living in densely populated, heavily industrial city centers often have the largest burden of respiratory disease in a given population.
Occupational exposure to hazardous material in manufacturing, office buildings, and even hospitals can also contribute significantly to chronic lung disease. Though there are far more workplace regulations in place now than at the turn of the 20th century, lingering damage can occur upwards of 30 years after initial exposure. The heyday of asbestos usage in construction continues to haunt people living with mesothelioma and asbestosis today, even long after regulations required most buildings to be gutted or cordoned off for asbestos contamination.
Industrial particulates that contribute to chronic lung disease incidence include the off-gassing from the mixing of detergent solutions, soluble gases like sulfur dioxide and chlorine, chemicals involved in food and grain processing, cotton textile processing in unventilated environments, latex in healthcare settings, as well as repeated exposure to ammonia, ozone, arsenic, epoxy adhesives and paints, silica from stone-cutting and drilling, ionizing radiation, and contact with fungus or mold.
It’s not only workplace and environmental particulates that are of public concern, though. Even in domestic living spaces--where people spend a majority of their time--polluted air is an issue. This is an especially pressing problem in rural and poorer areas, where heating and cooking rely on burning wood, coal, and other kinds of biomass. Inefficient stoves leak polluted hearth air into the home and can slowly choke out someone’s healthy lung tissue if exposure remains consistent. The health risks related to domestic pollution are expounded in communities where women are traditionally expected to remain in the home, and also in environments where it is typically colder year-round and therefore requires extensive fuel-burning to keep living quarters warm.
While it might seem like a challenging situation, reducing airborne particulate is possible. Occupational exposure has lowered dramatically over the years, with protective masks, isolation apparel, and wetting down surfaces continually in the instance of stone-working professions, where airborne silica can be deadly otherwise. For indoor air pollution, many communities have supported subsidized donations to impoverished households, replacing inefficient heating fixtures for cleaner-burning alternatives. Pushing to support regulations that require local industry to emit at or below established safe particulate limits will also go a long way towards ensuring clean air in urban environments. And all this is heartening news, because when the air is clean, our lung health--and quality of life--will see dramatic improvements.
Respiratory Disease Associated with Community Air Pollution: https://ajph.aphapublications.org/doi/pdfplus/10.2105/AJPH.79.5.623
Occupational Respiratory Diseases: https://lung.hallym.ac.kr/pds/clin/occup_ds.pdf
Interstitial lung disease guideline: https://thorax.bmj.com/content/thoraxjnl/63/Suppl_5/v1.full.pdf
A measure of quality of life for clinical trials in chronic lung disease: https://thorax.bmj.com/content/thoraxjnl/42/10/773.full.pdf
Asbestos-Related Lung Disease: https://bit.ly/2CYUBmZ
Respiratory Diseases: https://www.healthypeople.gov/2020/topics-objectives/topic/respiratory-diseases
The Global Burden of Respiratory Disease: https://www.atsjournals.org/doi/pdf/10.1513/AnnalsATS.201311-405PS
Respiratory health effects of indoor air pollution: https://bit.ly/2NRaVwk