One In Three Child In Delhi Is Asthmatic, Their Wind Pipes Getting Narrower: Dr Arvind Kumar, Medanta Hospital
In an exclusive interaction with BW Healthcare World, Dr Arvind Kumar, Chairman, Institute of Chest surgery, Chest Onco-surgery and Lung Transplantation, Medanta, Gurugram speaks on the surging lung cancers cases, rising chest disorders in children, the depleting air quality, and the solutions to tackle the explosion of cancer cases and pollution in India
Medanta Hospital recently released a study of over 300 Lung Cancer patients treated by Dr Arvind Kumar and his team over a decade showing trends with serious public health consequences. The study revealed a trend of rising lung cancers among non-smokers, women, men and children.
The team, led by Dr Arvind Kumar, observed that an increasing number of patients suffering from lung cancers were non-smokers of a relatively younger age group. The trend also showed lung cancers developing in Indians about a decade earlier than in their western counterparts.
The study further revealed that more than 80 per cent of patients were diagnosed in the advanced stage of the disease when complete treatment is not possible, and the intent of treatment gets restricted to palliative. And nearly 30 per cent of patients were initially misdiagnosed with Tuberculosis and treated for many months leading to delays in definitive diagnosis and treatment.
The reasons cited by the study are the increasing pollution in cities, coupled with smoking.
BW Healthcare World Spoke to Dr Arvind Kumar on lung cancers and their rising menace in India.
Which chest diseases you think are showing a rising trend apart from lung cancer?
All chest diseases are seeing a rising trend let's start with asthma. We have shown that almost one out of every three children in Delhi is asthmatic. You look at incidents of pneumonia in children, it's rising. You talk to any child specialist and he will tell you that his clinic is now flooded with little kids who are having breathing problems, and all that they are doing is nebulize them repeatedly. When you see adults, you find that the incidence of various respiratory diseases like COPD is rising and lung cancer. So across the board, every chest disease is rising, and this is direct effect of exposure to pollution.
How is it affecting the children?
When I say that these kids are showing asthmatic function, that means that there is something wrong with their lungs, then only they are becoming asthmatic. Their windpipe is getting narrower. There are studies from China which showed that these children do not develop to their optimum lung capacity. Those who are born and brought up in polluted cities and even brain capacity, the studies say is not fully developed. And there are effects on the heart, so pollutants enter through the lungs, and then they affect every part of the body. There is no organ which is spared from the ill effects of air pollution. Currently, we are doing a great disservice to this generation and the coming generations by not developing methods to bring down pollution.
How do tuberculosis and lung cancer symptoms overlap?
Tuberculosis causes cough and blood in the cough, lung cancer also causes cough and blood in the cough and a lot of people are aware of tuberculosis causing this problem but many are not aware of lung cancer also causing the same, so when the lung cancer patient with that symptom goes to the doctor. The doctor thinks that this is tuberculosis and starts the treatment.
In this case we advise doctors to not start with the clinical treatment but to do a sputum test. If you do a phlegm test and you find that there is no tuberculosis then you will be forced to think that there may be some other cause and then you will investigate. So we will save those precious four or five months, and maybe we will be able to shift the 80 per cent advanced stage diagnosis to 60 to 50 per cent.
How do you train doctors to differentiate between the two?
So basically, when a person is showing tuberculosis symptoms we tell clinicians that don't presume it to be tuberculosis and investigate for both TB and lung cancer.
Talking about the culprit now which is pollution and the measures deployed by the government such as the GRAP. How do you think the policymakers are seeing the pollution challenge presently?
So the measures deployed currently are not bringing the desired results and the air quality remains at unacceptable levels for the people to breathe in. And GRAP is a response and what we need is prevention, GRAP (Graded Response Action Plan) means that the more the pollution, the more serious the response, if it's too much shutdown everything, shut down construction, shut schools, shut the city, shut the vehicle, and shut the offices. That's a response. You can't be living your whole life on these emergency knee-jerk responses. We have got to do to prevent, what is the source? source are vehicles, sources are construction sites and industries, they need to be addressed so that we reduce pollution and there is no need for GRAP.
You have said chest surgery has been neglected in the country why is that?
So there are two field surgeons, one is a cardio surgeon and the other is a thoracic surgeon, but in India, for a long time, we have combined this and made it into a cardiothoracic surgeon who treats both the heart and lungs. But if you look at the cardiothoracic surgeons you will see that they more prominently do cardiac surgeries and hence lung surgeries have been neglected. I started a chest surgery training program a decade back in AIIMS, now that training program has moved to Medanta and we train the students in only chest surgeries and not cardiac.
And if you see in the US or Europe, the cardiac and thoracic are two different fields there. We need a large number of thoracic surgeons in India because old chest diseases like TB and infections are still rising and on top of that we have new diseases like lung cancers, COPD, and asthma. So the volume of chest diseases in our country today is more than in any other western country.
What are the challenges presented, when it comes to treating chest diseases?
The biggest challenge is that the numbers are going to increase. And the treatment facilities I don't think are going to be able to match the rising. That's the biggest challenge. So that's why I say on one hand we make a push to reduce the incidence and on the other hand, you do capacity building. Awareness amongst doctors, and the creation of more specialised centres. So the primary general doctor level and a specialist level, both levels have to be augmented.
Talking about the nonsmoker aspect in lung cancer patients which has been the main point of the study how do you see that and how do you explain it?
So explanation is by exposure to air pollution, the causing agent is there in cigarette smoke and the causing agent is also there in the polluted air, so hypothetically if a child was born today in the city he\she will probably be smoking about 10 cigarettes per day because of this pollution. So he's getting chemicals, not through the cigarette. He's getting it through the normal breathing process. So once the chemicals are getting into the lungs, they will have their effect and that is why we are seeing the chest diseases in younger age groups and in non smokers as well.
So what solutions do you want to provide to fight lung cancer?
The solution lies in raising awareness amongst people so that those who develop symptoms go and get diagnosed in time and the solution is to hit at the causes that are smoking and pollution. So more stringent efforts to reduce smoking, and air pollution.
If we don't bring down the incidence of smoking and air pollution, lung cancer incidents cannot be brought down, in the US if you see the lung cancer graph, it has paralleled the incidence of smoking as the incidence of smoking in men has declined so has the incidence of lung cancer a decade or a half later. In India currently, all graphs of the country are going up and if we don't take measures now there will be an epidemic of lung cancer cases. More cases will be seen in non-smokers, women, men and children alike.
You need exposure to cancer-causing agents for about 20-25 years before the tissues become cancerous. So today if this exposure is starting at birth, it continues for 25 years, and at 25-30 years that person is ready to get lung cancer. So that's why I'm predicting that in the next 10 years, there will be an explosion of lung cancer cases in our country, which I'm already seeing in my OPD.