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Although your nose is the first line of defence against irritants, chemicals and particles present in the air around us, the incidence of health issues increases even at pollution levels below internationally acceptable levels. Keep your nose clean and ensure your well-being by controlling pollution.
The effect that pollutants have on our health is dependent on a multitude of factors such as the size and concentration of particles, their chemical properties, time of exposure, breathing rate (more air inhaled during work or exercise), the body’s defence mechanisms, our general health and nutritional state, the body’s ability to convert the offending pollutants into harmless substances, and finally environmental parameters such as humidity, temperature or altitude.
Although subjective symptoms may decrease during exposure and the body seemingly adapts to a polluted environment, micro-scopic changes in the lining of the airways often progress relentlessly towards disease.
Pollution can cause health conditions such as allergic airway conditions (rhinitis, asthma), sinusitis and middle ear infections (in children).
The average person spends 90% of his or her life indoors, where concentrations of certain pollutants are often considerably higher than outside. Smoking, heating, cooking and building materials are the most important contributors. More stringent building regulations aimed at conserving energy lead to more insulation material being used and less air circulation, which again increases pollutant concentrations. The result is the sick building syndrome characterised by headaches; irritation of the nose, throat and eyes; cough; fatigue; dizziness and a lack of concentration. The worst indoor pollutants are: cigarette smoke, nitrogen and sulphur oxides, formaldehyde and hydrocarbons.
Tobacco use remains a big problem despite smoking legislation. Several thousand chemical components have been identified in tobacco smoke, some of them carcinogenic, most of them irritants of nasal membranes leading to inflammation, decreased immune response and neurotoxicity. The exposure to aromatic hydrocarbons by passive smokers is even greater than in active smokers. Gatherings of smokers in ‘smoking rooms or areas’ compounds the problem.
Formaldehyde, a pungent smelling gas, is everywhere in our modern homes. Insulation material, furniture, carpeting, to name just a few, all exude this substance which is almost completely absorbed in the nose and sinuses. It is highly toxic to the membranes causing a burning, runny congested nose. It facilitates allergic reactions and decreases mucociliary clearance and has even been associated with cancers in the upper airway. Formaldehyde concentrations are greatly increased in caravans, cars and aircraft cabins.
Nitrogen and sulphur oxides released into a room by indoor braais, wood burners or gas heaters exceed values permissible for outside air.
Most importantly both patient and physician should be aware that pollution might be a cause for the patient’s symptoms.
Elimination of sources of indoor pollution is the most effective intervention. Smoking, if not quit completely, should only take place outside. Fossil fuel or wood burning heaters and stoves should be banned from indoors and the use of aerosols, air fresheners etc. discontinued. Safety and emission rates of building material, appliances and furniture should be monitored.
Proper ventilation decreases levels of airborne pollutants. Regular nasal rinsing decreases the amount of toxins and contaminants in the nose and thereby their effect on health. If mucociliary clearance has already been negatively affected, nasal douching is the most effective way to clean the nose from noxious substances, micro- organisms and mediators of inflammation.
Air purification systems have been shown to be beneficial to sufferers of chronic lung diseases but have not been studied in sinusitis patients.
Air pollution has always have been and will always be part of our lives; but, because greater exposure to pollutants occurs indoors, we are in a powerful position to set things right both at home and at work. Remember: a healthy nose has defence systems in place that prevent systemic disease from pollution.
DR MARCO KNAPPE
He qualified as a medical doctor in 1989. As an intern and medical officer he worked at several hospitals in the different provinces of South Africa. He specialised as an otolaryngologist at Tygerberg Hospital, University of Stellenbosch between 1995 and 1999.
Since 2000 he has been in private practice in Cape Town at the N1 City Hospital and Cape Gate Mediclinic.
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