Air Pollution and Respiratory Tract Diseases in Asia

Respiratory tract diseases affect millions of people worldwide. Sufferers encounter problems with air passages, including the nasal passages, the bronchi and the lungs. Respiratory diseases range from acute infections, such as bronchitis, pneumonia to chronic conditions such as obstructive pulmonary disease and asthma.

People living in countries in Asia are particularly prone to suffering from a respiratory disease at some point in their life.

Singapore is not traditionally a high producer of air pollution but their Malaysian and Indonesian neighbours are, causing problems in all three countries. Malaysia and Indonesia still practice slash and burn agriculture as well as intensive logging and heavy industrial manufacturing. These activities release significant amounts of smoke and smog into the air, causing pollution that can cause 'smog cough', difficulty breathing, respiratory irritation and even asthma for locals and expats alike. Such has been the effect on Singapore that the issue has been frequently covered by the global media ( and across social media channels in recent months.

According to the Ministry of Health in Singapore (, in 2014 pneumonia was the second largest cause of deaths with chronic lung disease coming in at number 10. Similarly, HealthyHK (, Hong Kong's Department of Health, lists chronic lower respiratory diseases as the fifth leading cause of death for men and the ninth for women in 2013.

Recently, new diseases such as SARS and Bird Flu have also been causing concern for the Asian health authorities and specialist respiratory centres are springing up in places such as Singapore, Hong Kong and mainland China to provide assistance.
Asthma and bronchitis are two specific side-effects of air pollution and here we discuss them in more detail.

Asthma, a disease of the airways, occurs in all ages. The Global Asthma Report ( estimates that as many as 334 million people currently suffer from asthma and most people affected are in low and middle income countries. Asthma is particularly prevalent in Asian cities such as Hong Kong, Shanghai and Beijing and the numbers are rising.

Asthma causes wheezing, coughing, tightness of the chest and breathlessness. The symptoms are caused by irritation and narrowing of the airways and are often set off by an allergy or a virus. When we breathe, air travels into the lungs through a series of bronchial tubes, which branch out like a tree. They gradually get smaller until they turn into millions of tiny air bags called alveoli. From here, the oxygen in the air can be absorbed into the bloodstream and then taken through to the rest of the body.

For children who develop asthma, the airways become irritated and inflamed. As a result, they become narrower and produce extra mucus, making it more difficult for air to flow into and out of the lungs and therefore causing the symptoms of asthma.

Asthma Symptoms
The symptoms of asthma can range from mild to severe and include:
• coughing
• wheezing
• breathlessness
• tightness in the chest
• difficulty breathing
• erratic sleeping patterns
• tiring quickly when exercising

Asthma Treatment
If you think you may have asthma, you should consult a doctor, particularly if you are waking up in the night with shortness of breath. Although asthma can't be cured, with good treatment early on and constant management, most people can live active lives.

Bronchitis is commonly caused by smoke, air pollution, tobacco, chemicals and sometimes poor air quality in crowded conditions. Similar to asthma, it is commonly seen in places such as Hong Kong, Shanghai and Beijing.

Bronchitis is a respiratory disease where the mucus membrane in the lungs' bronchial passages become inflamed. When the irritated membrane swell and grows thicker it narrows and then shuts off the tiny airways in the lungs, which results in coughing that may be accompanied by phlegm and breathlessness.

Bronchitis Symptoms
Bronchitis comes in two forms:
• acute – which lasts from one to three weeks
• chronic – which lasts at least three months of the year for two years in a row

People with asthma may also have asthmatic bronchitis which is inflammation of the lining of the bronchial tubes.

Bronchitis Treatment
Most cases of bronchitis do not need to be treated by a doctor and can be managed at home. While there is no cure for chronic bronchitis, having a healthy non-smoking lifestyle will help relieve the symptoms. To manage bronchitis at home patients generally need plenty of rest, lots of fluids and pain killers for associated headaches and fever.

Expatriates travelling to Asia need to be aware of the air pollution levels in the countries they are visiting and take careful precautions. A number of web sites provide up to date indications of the air quality in Asian countries such as this one for Singapore and this one for Hong Kong. Expatriates should consult their doctors or the clinical teams within their international health insurance companies if they have concerns.

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