Pneumonia, a dangerous lung infection, remains one of the leading causes of illness and comorbidities globally, escalating from a simple cough often due to the compromised air we breathe. Experts emphasise that poor air quality, combined with factors like smoking, significantly raises the risk.
According to the World Health Organization, pneumonia is the single largest infectious cause of death in children worldwide, killing over 7,40,000 children under the age of five in 2019 alone, and almost half of these deaths are associated with air pollution.
On World Pneumonia Day, medical experts delve into the impact of air pollution and smoking on the increased risk of pneumonia and share strategies that can help recognise symptoms. They also recommend adopting corrective lifestyle measures and seeking timely medical care to combat this persistent global health crisis.
Air quality, and pneumonia risk in India
Dr Salil Bendre, director of pulmonology at Nanavati Max Super Speciality Hospital, Mumbai, states, “What often starts with a simple cough, sometimes escalates into a dangerous lung infection, mainly due to the air we breathe, both from the ambient environment and from inside our homes.” He explains the mechanism, “Fine particulate matter like PM 2.5 is small enough to travel deep into the lower airways. These particles also carry a mix of toxic chemicals which irritate the airways. They are also linked with acute respiratory infections, such as pneumonia.”
He notes that children and women exposed to high concentrations, such as those from solid-fuel-using homes, are particularly at risk. He adds that young children exposed to tobacco smoke and pollution have about two times the risk of pneumonia.
Targeted prevention: Strengthening lung resilience
Dr Rupali Pattnaik, consultant critical care medicine at Manipal Hospital, Bhubaneswar, emphasises that for individuals living in areas with chronic bad air, prevention must start long before illnesses occur.
She states, “Though masks and air purifiers are useful, the superior defence against airborne pollution is to strengthen our lungs’ ability to resist damage and enhance our body’s natural capacity to filter and respond to soot.”
Below, she outlines a few simple strategies for lung defence:
Breathing routines
Simple breathing routines, including diaphragmatic and pursed-lip breathing, should be performed daily to assist in respiratory muscle strength and oxygen exchange and help increase the elasticity of your lungs and decrease inflammation of your airway. Additionally, steam inhalation with lukewarm plain water or mild saline can alleviate trapped pollutants in the air passage and provide relief.
Nutrition
Antioxidant-rich superfoods such as citrus, amla, turmeric, berries, green tea, and nuts help to neutralise the free radicals that are produced when pollution is breathed in. Omega-3 fatty acids found in fish, flaxseed, and walnuts are anti-inflammatory and “can prevent the oxidative damage to lung tissue. Adequate hydration is also crucial to keep mucous membranes moist and aid in the natural clearance of inhaled particles.
Environmental awareness and indoor quality
Individuals must schedule outdoor activity when pollution levels are generally at their lowest, such as early in the day and after a rain shower, and stay away during rush hour. Inside, one must maintain good ventilation and incorporate the use of HEPA filters and air-purifying plants like spider plants, aloe vera, or peace lilies to help remove indoor toxins.
Monitoring
Pattnaik advises that those with occupationally related long-term exposures should receive annual lung health evaluations, including spirometry or pulmonary function tests, for early detection of decrements in lung function or airway.
Vaccination beyond routine
“Vaccination is still the bedrock of pneumonia prevention,” Pattnaik asserts, but it must extend beyond routine pneumococcal shots for those with chronic exposure or a smoking history.
She lists the key recommended vaccinations:
Annual Influenza vaccine: This is strongly recommended because the flu virus can act as a gateway infection, weakening the lungs and facilitating bacterial pneumonia.
Covid-19 vaccination and boosters: These remain relevant as SARS-CoV-2 infections may lead to severe lower respiratory tract disease that looks like or leads to pneumonia, particularly in people who already have weakened lungs.
Tdap (Tetanus, Diphtheria, and Pertussis): Pertussis (whooping cough) can be especially hard on adults with compromised respiratory systems.
RSV Vaccine: Preliminary studies suggest a benefit to older adults and patients with chronic lung disease, as the virus is now increasingly being recognised as an important etiologic agent in adult pneumonia.
Pattnaik concludes, “These vaccinations are vital in the long run because they’re also reducing the likelihood of severe disease — and that’s key for people whose respiratory systems are already under stress from their environment.”
Recognising severity: Five red flags that signal emergency
Bendre highlights, “The most common reason for delayed treatment is brushing off the symptoms and not recognising severity early enough. Air pollution and smoking can cause a persistent cough which, in some patients, may progress to pneumonia. In seniors or those with chronic lung disease (like COPD), one might observe confusion, fatigue, or a sudden drop in oxygen levels.”
Bendre notes, “Oxygen saturation below 90 per cent and abnormal chest radiographs are strong indicators of the severity of this condition and the need for immediate care.” He provides crucial instructions, saying, “It is important to know the red flags, seek immediate care when they appear; and where available, use a pulse oximeter at home to check oxygen levels in high-risk elders or those with COPD.”
Dr. Bendre lists five warning signs you should go straight to the emergency department:
1. Severe unexplained breathlessness or struggling to speak full sentences.
2. Oxygen saturation below 90 per cent or a bluish shade on the lips or face.
3. Unexplained confusion, drowsiness, or sudden worsening in seniors.
4. High fever with chills and low blood pressure.
5. Inability to drink or keep fluids down, or signs of dehydration in a child.
Treatment effectiveness and complications
Pattnaik says, “A heavy smoking history or long-term exposure to polluted air can make pneumonia more difficult to treat and increases the risk of hospitalisation.” She further explains that pollutants and tobacco smoke destroy the cilia in our airways. This means that once infection takes hold, the lungs are less able to clear bacteria or secretions, which slows recovery.
“Patients with this history are more likely to have underlying chronic conditions like bronchitis or COPD, and reduced lung elasticity, which predisposes them to hypoxia (low oxygen levels). Consequently, they are more likely to be hospitalised for infection, require oxygen therapy, or even sustain critical care,” Pattnaik warns.
She advises that antibiotic selection may differ, often consisting of wider-spectrum or multiple antibiotics, as these patients are frequently colonised with resistant bacterial strains or mixed infections. “It is important that oxygen saturation and respiratory rate be closely observed during treatment, with temporary discontinuation of smoking or contamination by pollutants, to allow lung tissue to recover,” she concludes.
Post-pneumonia lung health: Rehabilitation
Pattnaik emphasises that recovery does not end with antibiotics, as the lungs commonly linger in a weakened and inflamed state for weeks. “Without rehabilitation, scarring or chronic bronchitis may take hold,” she warns.
Pattnaik outlines the five-step long-term rehabilitation plan:
1. Pulmonary rehabilitation: This is a formal program involving breathing exercises, physical conditioning, and education. Patients should start with guided breathing maneuvers such as incentive spirometry and balloon inflation.
2. Physical activity: Mild forms of aerobic exercise like walking or swimming will help increase endurance and maximise the peripheral use of oxygen.
3. Nutrition: Post-recuperation, foods rich in protein support tissue repair, and antioxidants (Vitamins C and E) counteract oxidative stress. Remember to hydrate as drinking water thins mucus.
4. Smoking and environment: A smoking patient must quit. Furthermore, patients must stay away from dust, construction sites, or industrial smoke while recovering and “must wear certified N95 masks if that is not doable.
5. Monitoring: Follow-up imaging and pulmonary function test should be performed within 4–6 weeks from recovery to confirm resolution of inflammation.
Self-management for lingering symptoms
Pattnaik recommends evidence-based self-management strategies for home recovery:
1. Fatigue management: Mild physical activity, alternating with proper rest, aides in the recovery of strength without over burdening the lungs.
2. Cough management: Do not suppress a productive cough. Instead, use warm fluids, honey with turmeric, or saline gargles to soothe the throat. Running a humidifier or breathing in steam can help relieve irritation and loosen mucus.
3. Resuming activity: Exercise should be gradually reintroduced after the patient can walk easily without getting breathless. She mandates a lifelong surveillance for symptoms of poor lung recovery.
Practical advice for vulnerable groups
Recognising vulnerable groups is key to targeted prevention and early care. “The most susceptible individuals are children under five years of age, who face the highest risk of contracting pneumonia. Among adults, individuals with COPD are commonly affected due to their long-term exposure to pollution. Furthermore, older age groups witness sharply rising mortality with each passing decade, making focused preventive measures essential for these populations,” explains Bendre.
He offers practical measures to reduce pneumonia risk across all ages:
1. Clean home air: Invest in advanced, vented stoves and better ventilation cut smoke exposure, if in rural areas, cook outdoors or in semi-open spaces.
2. Quit tobacco or exposure to second-hand smoke: Quitting smoking reduces risk of pneumonia in adults. Keep the homes, residential areas, playgrounds, schools and colleges and public areas smoke-free to protect the children.
3. Vaccinations on time: In some cases, measles and pertussis may lead to pneumonia. Routine immunisation can reduce the episodes.
4. Supporting nutrition and immunity of children: Exclusive breastfeeding for six months, sufficient complementary feeding, and supplementation as recommended by the paediatrician can reduce respiratory infections.
