Interview: Pollution, pigeons and cold weather conspire to spike respiratory illnesses in children

Also Read: What is winter heart attack? 

Edited Excerpt from the interview

Q: There’s a popular belief that respiratory issues in children worsen during winter, especially in areas with high levels of fog and pollution. Is that true? If so, why?

A: Respiratory infections do tend to increase during winter, and there are several reasons for this. Firstly, cold weather stabilises viruses, allowing them to survive longer than in warmer seasons. This naturally leads to a higher rate of infections. Secondly, children often gather in close proximity during winter—whether at schools, malls, or other public places—which facilitates the rapid spread of infections.

The combination of these factors results in a noticeable rise in respiratory tract infections, particularly viral ones, during this time of year.

Q: What are the most common respiratory infections you observe in children during winter? Are they caused by RSV, influenza, or other viruses?

A: A variety of viruses are responsible for respiratory infections during the winter months. The most common among them is influenza, which includes influenza A, influenza B, and H1N1 (commonly known as swine flu).

In preterm infants—babies born very early or with low birth weight—there is a notable increase in RSV (respiratory syncytial virus) infections. RSV can range from causing mild symptoms to being life-threatening in these vulnerable infants.

Other viruses such as rhinovirus, which often causes the common cold, and enterovirus, parainfluenza virus, and others also contribute to respiratory illnesses. These can range from mild upper respiratory tract infections to more severe conditions like bronchitis, which may progress to respiratory failure. In such cases, the lungs struggle to function adequately, necessitating supplemental oxygen or ventilatory support.

While these viruses are present year-round, we observe a spike in cases during the monsoon and winter seasons.

Q: Winter also sees a rise in pollution levels. Does pollution exaggerate respiratory conditions or influence viral infections during this season?

A: Absolutely, pollution exacerbates the problem, although it may not directly increase the incidence of viral infections. When a child’s lungs are already compromised by a viral infection, pollution further damages the respiratory system.

For example, children with asthma already face difficulty breathing due to airway narrowing. Cold weather alone can trigger bronchospasms, which is the further narrowing of airways. Add a viral infection to this, and the small airways in the lungs can become inflamed and obstructed, making it difficult for the lungs to expand and function properly.

Pollution worsens this situation by causing hyperreactivity of the airways, which leads to more severe bronchospasms. This reduces the lungs’ ability to clear infections efficiently, prolonging recovery and increasing the severity of symptoms.

While pollution may not directly increase the spread of viral infections, it undoubtedly contributes to lung damage and complicates recovery, making it a significant concern for children, especially in urban areas.

Q: You mentioned allergies. During winter, we often see an increase in conditions like allergic rhinitis. Is this due to pollution, the drop in temperature, or both?

A: It’s a combination of factors—pollution, colder temperatures, and, surprisingly, pigeons. In the South, we often overlook the impact of pigeon droppings and feathers, which are potent allergens. These can significantly worsen conditions like allergic bronchitis, allergic rhinitis, and even asthma.

Prolonged exposure to such allergens can lead to interstitial lung disease (ILD), an irreversible condition that causes long-term lung damage. This disease can severely affect a child’s quality of life, as damaged lungs cannot be fully restored to normalcy.

So, all these factors—pollution, temperature drops, and allergens like pigeon droppings—contribute to respiratory problems and demand serious attention to protect children’s lung health.

Q: Many parents are hesitant to use inhalers for children prone to wheezing or frequent respiratory infections. What would you say to reassure them about the safety and effectiveness of inhalers for managing wheezing and related conditions?

A: There are several myths surrounding the use of inhalers, but it’s important for parents to understand that inhalers are both safe and effective when used correctly. Let me simplify this:

Inhalers deliver medication directly to the lungs, where the problem lies, ensuring that the drug acts locally rather than being absorbed into the bloodstream. This minimises systemic side effects. To illustrate, the total medication a child receives in five days of oral syrup with a bronchodilator is equivalent to the dose delivered by an inhaler over three months. This shows how inhalers are not only effective but also minimise unnecessary drug exposure.

Parents often worry about dependency, but this is a misconception. Inhalers do not cause addiction or make a child reliant on them. They are tools for managing symptoms and preventing exacerbations when used under a doctor’s guidance.

Another key point is that there are two types of inhalers:

Preventers: Used regularly to reduce the frequency and severity of asthma or wheezing episodes.
Relievers: Used as needed to quickly alleviate symptoms during an acute episode.

To avoid potential side effects like medication deposits in the mouth, children should rinse their mouths after using inhalers. With proper supervision, inhalers are an invaluable and safe solution for managing respiratory conditions in children.

Q: With rising pollution levels and seasonal changes, repeated respiratory infections in children are becoming a common concern. What underlying factors contribute to this, and how can they be addressed?

A: Repeated respiratory infections in children can be attributed to several factors, including environmental pollution, viral exposures, and weakened immunity. Addressing these requires a focus on prevention and early intervention. Here are some key measures:

Basic Preventive Steps:

• Frequent handwashing: This is one of the most effective ways to prevent the spread of respiratory infections.
• Proper cough etiquette: Teach children to cough into their elbows (the “Dracula cough”) instead of their hands, as coughing into hands can spread germs when touching surfaces or other people.
• Masking: Wearing masks can reduce exposure to airborne pollutants and infectious agents, especially in crowded places.
• Avoid gatherings when unwell: If a child is sick or there are known illnesses in a gathering, it’s best to avoid such events.

Vaccinations:

Vaccines are crucial for preventing recurrent respiratory infections. For instance:

• Influenza vaccine: This should be administered annually as the viral strain changes every year. It’s especially recommended for children under six years or those with underlying health conditions like lung or heart problems.
• RSV-specific antibodies: This newer treatment is particularly beneficial for high-risk groups, such as preterm infants under six months at the start of the monsoon season. These antibodies can significantly reduce RSV-related hospitalizations, morbidity, and mortality.

By following these precautions, parents can protect their children from recurrent respiratory infections and reduce the risk of complications. Early intervention and adherence to preventive measures are key to ensuring better respiratory health in children.

Q: Are there specific age groups more vulnerable to respiratory infections during winter? What precautions should parents take for infants, toddlers, and older children?

A: Yes, certain age groups are more vulnerable to respiratory infections during winter:

Infants (less than 1 year): Infants are at a higher risk because their immune systems are not fully developed. A common condition seen in this age group is bronchiolitis, where the smaller airways become inflamed, causing difficulty in breathing.

School-going children: This group is at risk due to frequent exposure to other children, especially when unwell peers attend school. Respiratory infections spread rapidly in classrooms and group settings.

High-risk groups:

• Preterm infants: Babies born before completing nine months of gestation are more susceptible due to underdeveloped lungs and weaker immunity.
• Children with underlying health conditions: Those with congenital heart issues, chronic lung diseases, or other medical conditions are at a higher risk of recurrent respiratory infections.

Precautions parents should take:

• Ensure good hygiene practices, such as frequent handwashing.
• Avoid exposure to sick individuals, especially in schools or gatherings.
• Keep children warm and protected from cold weather.
• Follow up on routine vaccinations like influenza and RSV-specific antibodies for high-risk infants.
• Avoid exposing children to environmental triggers such as pollution, cigarette smoke, or allergens.

Q: Recently, there has been a tendency among parents to administer over-the-counter antibiotics to their children. What symptoms indicate that a respiratory condition requires medical attention, and when should antibiotics be avoided?

A: This is an important concern. Around 90 percent of respiratory infections in children during winter are viral, and viral infections do not require antibiotics. Antibiotics should only be used if there is a secondary bacterial infection, which can occur on top of a viral illness.

When to seek medical attention:

Parents should consult a pediatrician if the child exhibits any of the following symptoms:

• Cough that significantly affects breathing, sleeping, or feeding.
• Rapid or shallow breathing.
• The child is unable to speak a full sentence without pausing for breath.
• Lips or skin appear bluish, indicating low oxygen levels.

These signs can be serious and require prompt medical attention.

Why avoid over-the-counter antibiotics?

• Misusing antibiotics can lead to antibiotic resistance, making future infections harder to treat.
• Antibiotics can cause unnecessary side effects, such as diarrhea or allergic reactions.
• Viral infections are self-limiting and usually resolve with supportive care like hydration, fever management, and rest.

It’s essential for parents to avoid self-medicating and always consult a pediatrician before administering antibiotics to ensure the correct treatment and dosage.

(Edited by Ananya Rao)