Let us look at some sobering facts: India has the highest number of people living with diabetes in the world, with an estimated 212 million cases in 2022.

According to the World Health Organization, there are an estimated 77 million people in India above the age of 18 who are suffering from diabetes (type 2) and nearly 25 million are prediabetic (at a higher risk of developing diabetes in near future). That is probably the largest part of the non-communicable diseases (NCD) pie. Add to this the number of people with hypertension, stroke, cancer, cardiovascular disease and chronic lung disease and the actual position is truly staggering.

NCDs occur because of a combination of factors — primarily changing lifestyles, environmental factors, and genetics — and have grown to a huge proportion in the country. The messaging, therefore, is that interventions have to be immediate, and effective, both in terms of launching treatment as well as prevention strategies.

A session at The Hindu Huddle, which will be held in Bengaluru on May 9 and 10, titled “Non-communicable diseases: Trojan horse of India’s health”, seeks to discuss the multiple dimensions of India’s NCD ‘epidemic’ and evaluate strategies that may be deployed by the public and private health sectors to ensure that the tide is stemmed and that all those who already have NCDs have access to treatment and affordable healthcare. On the panel are three key experts from India who stand at various points of the care paradigm. They will share real-time experiences, and possible solutions for the way forward.

While Preetha Reddy, executive vice-chairperson, Apollo Hospitals, comes armed with the experience of being at the head of cutting-edge private care in the country, Anoop Mishra, chairman, Fortis C-DOC Hospital for Diabetes and Allied Sciences, brings to the table avant-garde research in the sector and experiences from close patient interactions. Chandrakanth Lahariya wears many hats, but will participate as someone who keenly watches the health systems of the country and a sagacious policy adviser.

The session will be moderated by Ramya Kannan, Health Editor and Chief of Bureau, Tamil Nadu, The Hindu.

If you have any questions that you would like the moderator to ask the panellists, write to huddle@thehindu.co.in

A rendering of the structure of the CFTR protein
| Photo Credit: Emw, CC BY-SA 3.0 , via Wikimedia Commons

Have you heard of Cystic fibrosis? If you haven’t this month, May, is Cystic Fibrosis Awareness Month, and makes for a good time to learn about the condition!

What is cystic fibrosis?

Cystic fibrosis or CF, is a genetic condition that causes the mucus in the body to become thick and sticky instead of being thin and slippery. When there is a build-up of thick mucus, it can cause clogs and blockages, damaging the lungs, pancreas and other organs in the body. It is a progressive condition and can get worse over time.

CF occurs, when there is a mutation or change to a gene known as the CFTR gene. The gene makes a protein that helps move chloride to the surface of cells. When chloride moves out of a cell, it takes water with it, thinning out the mucus. When the protein is not working correctly due to the gene mutation, this process is disrupted, leaving the mucus thick.

Whom does CF affect?

CF is a genetic condition. People who inherit two mutated CFTR genes, one each from their and mother and father, are born with this condition. There does not have to be family history of the condition for someone to be born with it. People who have only one copy of the defective gene are carriers.

While CF is more common in people of Caucasian descent, research in India has suggested that it is not as rare in the country as it was previously thought to be. In India, the first CF case was reported in 1968. A 2024 research paper, ‘Diagnosis and treatment of cystic fibrosis in India: What is at stake for developing countries?’ states that India is said to have the most number of undiagnosed CF patients in the world. The paper adds that although the exact prevalence of CF among Indians is unknown, it is estimated to be 1:43,321 to 1:100,323. Estimates vary however, and exact numbers for India are not known: another 2024 research paper, ‘Diagnosis of Cystic Fibrosis Beyond Childhood in India,’ states that while in India, the true incidence of CF is unknown, it is estimated to be 1:10,000–1:40,000 based on data from migrant Indian populations in the U.S. and U.K., respectively. With a population of [over] 1.3 billion, this could translate to high absolute numbers, it notes. The Cystic Fibrosis Trust of India, a non-profit working to further the cause of children with CF, estimates that there about 39,000 people living with CF in India.

What are the symptoms of CF?

CF symptoms depend on the organs that it affects and vary from person to person. CF mainly affects three systems: the respiratory system, the digestive system and the reproductive system.

Symptoms include: salty-tasting skin, a nagging cough, sometimes with phlegm, frequent lung infections such as pneumonia or bronchitis, wheezing, shortness of breath, repeated sinus infections, poor growth in spite of a good appetite, nasal polyps, clubbed fingertips or toes, oily or greasy stools, blocked intestines in babies, constipation, rectal prolapse and pancreatitis.

What are its complications?

Frequent respiratory infections are one common complication due to bacteria becoming trapped in the airways due to the thick mucus. Over time this can damage the lungs and lead to loss of lung function or to lung collapse. In the digestive system, the pancreas may be affected, causing a decrease in the enzymes that help digest food, causing trouble with the absorption of nutrients. This may put the person at risk of malnutrition and also at risk of other conditions such as lower bone density. Damage to the pancreas may also lead to glucose intolerance and CF-related diabetes. The liver may also get affected in some people with CF, causing liver disease.

CF can also affect fertility. Men with CF may have congenital bilateral absence of the vas deferens, a condition where the sperm-carrying tubes are not present. In women it may cause thicker cervical mucus or irregular ovulation.

How is CF treated?

There is no cure for CF, but treatment can help manage symptoms and lessen complications. Research is ongoing in gene therapy. At present treatment involves keeping airways clear and preventing infections and ensuring that the person gets adequate nutrition and preventing intestinal blockages.

Treatment can involve breathing techniques and airway clearance therapy, or the use of devices. Medications may include those to thin the mucus, medications called CFTR modulators to make the faulty protein work better, antibiotics to prevent or treat infections, pancreatic enzyme supplements to help take in nutrients and stool softeners. People with an advanced form of the condition may need a lung or liver transplant. A special diet plan may also be recommended.

Newer therapies have now increased the lifespan of those with CF. Careful management can help improve quality of life. Regular check-ups are important, as is finding support for mental health care if needed. Always consult a doctor if you believe you or a family member have symptoms.

Estimates are difficult to get, but the Global Burden of Disease study (1990-2019) has estimated approximately 34.3 million individuals with asthma in India, which represents about 13.09% of the worldwide burden. Photograph used for representational purposes only
| Photo Credit: Getty Images/iStockphoto

Asthma in India has a disproportionately high death rate, representing three times greater mortality and over two times greater Disability-Adjusted Life Years (DALYs) than the global share of the asthma burden. While asthma is recognised by a multitude of symptoms including shortness of breath, wheezing, coughing, and tightness in the chest, in the wake of rising temperatures, unprecedented heat, and the relentless progress of climate change, it is becoming an underappreciated threat to respiratory health, especially for those who already have asthma. Aside from the unpleasantness of the blistering heat, environmental changes can aggravate asthma symptoms and, worse, seem to be causing new cases among healthy people.

Patients with severe asthma have an enhanced sensitivity of their airways to dry air. This dryness causes a reduction in water content of the airway, which evokes an inflammatory response. This inflammation, in turn, makes the airways narrowed, a process also referred to as airway constriction, which further restricts breathing. The already vulnerable respiratory system cannot handle the additional load of intense heat and therefore, has more episodes of asthma attacks.

The scenario is further compounded by the synergistic effects of increasing temperatures and intensifying air pollution – a direct fallout of urbanisation and industrialisation driving climate change. This causes injury to the epithelial cells of the airway, the defensive lining of the respiratory tract. This makes the respiratory system more vulnerable to high temperatures, and also enhances the allergenicity of current pollutants. The twin burden of heat and pollution results in a more reactive and susceptible respiratory bed.

Asthma-like symptoms in previously healthy individuals

Clinicians are now seeing an increase in patients with asthma-like symptoms who have no previous history of respiratory ailments. Although severe temperatures can cause mild respiratory symptoms even in normal individuals, the growing frequency and duration of heat waves, combined with increased levels of allergens, could be tipping some over an edge, precipitating the onset of asthma.

Interestingly, when asked about new or unforeseen environmental irritants within their practice that were not widespread a few years ago, there was a negative response. This indicates that as the intensity and effect of current irritants intensify, completely new triggers are perhaps not yet the main issue.

There are particular groups of patients at risk of asthma exacerbations when the weather is very hot or unstable. As medical officers have pointed out, the extremes of age: very young children and the old are especially at risk. Their physiological reserve and regulatory capacity might be less, and so they are less capable of coping with acute or sustained temperature stress.

In terms of geographical patterns in weather-related asthma severity, the general opinion is that the risk is more or less similar in urban and rural settings, mainly as a result of the general influence of industrialisation and related pollution. Although urban areas tend to have greater levels of pollutants, rural settings may also be influenced by agricultural activities and long-range transport of air pollutants.

Proactive steps and preventive strategies for asthma patients

With these escalating dangers, proactive measures are important for asthma patients on extremely hot or smoggy days. Physicians advise proper hydration to offset the dehydrating properties of dry air. Staying indoors during the most intensely hot part of the day is also necessary to avoid heat and pollutants. Wearing a clean mask can serve as an immediate physical shield against airborne allergens. Importantly, patients need to follow their physician’s instructions carefully regarding the use of regular inhalers to control their baseline inflammation and keep quick-relief medication handy.

For those who do not have asthma but have seasonal respiratory symptoms that may be climate-related, the recommendation is slightly different. Although routine preventative inhaler use is not usually advisable in the absence of a proper asthma diagnosis, seeing a healthcare provider to determine specific triggers and create an individualised management plan is recommended. This may involve such strategies as avoiding known allergens or taking over-the-counter medication for mild symptoms.

Long-term health risks and the need for climate action

The long-term health impacts of deteriorating climate trends are becoming a major concern. Physicians are highlighting the imperative for community action to reverse climate change. Actions like reforestation to enhance air quality and fostering a healthier environment are crucial. A priority of making a “breathful India” through sustainable environmental management is viewed as vital to protect the respiratory health of all individuals. Finally, a focus on the underlying causes of climate change is critical to protecting vulnerable groups and helping everyone breathe easily and safely in the future.

This is especially significant, as India has a heavy asthma burden. Estimates are difficult to get, but the Global Burden of Disease study (1990-2019) has estimated approximately 34.3 million individuals with asthma in India, which represents about 13.09% of the worldwide burden. A high proportion of asthma cases in India are not diagnosed. It has been estimated by experts that more than 80% of the cases of asthma in India may go undiagnosed, and this can progress over a period of time. There are differences in prevalence among regions and populations. There is evidence of increased prevalence in rural locations and in females. Childhood asthma is a significant reason for emergency department visits, hospitalisations, and school absence.

Higher temperatures are likely to intensify air pollution, notably ground-level ozone, which is a confirmed asthma inducer. Heatwaves also have the potential to aggravate respiratory diseases. Climate change can result in longer pollen seasons and higher pollen production, impacting people with allergic asthma. Alterations in rainfall patterns and higher humidity can foster the development of mould and dust mites, indoor allergens that induce asthma. Severe weather conditions such as wildfires, increasingly caused by global warming, emit particulate matter and smoke that can lead to asthma attacks.

Air pollution too, continues to remain a health emergency

While the impacts of climate change are now increasingly being felt, air pollution still remains a severe environmental and health emergency in India. The recent statistics from the World Air Quality Report 2024 indicate that India was the fifth most polluted nation in the world, with a mean PM2.5, more than ten times the World Health Organization safe threshold. Particulate pollution (PM2.5) is a significant issue. Between 1998 and 2021, the Indian average annual particulate pollution grew by 67.7%, lowering average life expectancy by roughly 2.3 years. An estimated 59.1% of the world’s growth in pollution between 2013 and 2021 originated from India.

Protecting vulnerable populations, especially children and the elderly, requires proactive strategies at both individual and societal levels. Ultimately, safeguarding the right to breathe clean air necessitates a concerted effort to mitigate climate change, implement stringent pollution control measures, and prioritise public health to prevent a future where respiratory distress becomes the norm.

(Dr. Amrish Patel, is a pulmonologist at Sterling Hospitals, Gurukul. Email: Drarpatel79@yahoo.co.in)