The Haze in Indonesia Has Just Made 30,000

People Sick

David Stout @david_m_stout

March 4, 2014
AFP / Getty ImagesIndonesian
motorists travel under a blanket
of haze in Dumai town located
in Riau province in Indonesia's
Sumatra island on March 3,
2014. Riau province, the heart of
a Southeast Asian smog crisis
last year, has declared a state of
emergency after being blanketed
in thick haze from forest fires

Slash and burn farming is generating huge

amounts of pollution
An estimated 30,000 people in Riau province, on the Indonesian island of
Sumatra, have fallen ill after excessive exposure to air pollution caused by slash
and burn farming on the island, according to Australian news outlet SBS.
Cases of respiratory infections and other illnesses such as pneumonia, asthma
and eye and skin irritation are increasing, National Disaster Management
Agency spokesman Sutopo Nugroho told the agency.
Officials have said there are reportedly 330 hot-spots where fires are burning.
Authorities have arrested close to 30 people for starting fires and are using
aircraft to battle the blazes.
Several Southeast Asian nations, including Indonesia, Thailand and Malaysia, are
plagued by high-levels of air pollution caused by the annual brush fires during the
spring, when farmers burn their fields to prepare the ground for planting.

Managing asthma during haze

Everyone is affected by the haze, an the effects are felt most keenly by those with
respiratory conditions like asthma. Learn how to cope during these times.
Asthma is sometimes triggered by environmental factors such as cold air, smoke, strong
odors and pollution. When air quality is poor, as it is during the haze, hospitals and clinics
see many more patients requiring treatment for asthma and other respiratory problems.

People with asthma need to take special care in order to minimize the impact of the haze
on their health and day-to-day activities. Even a person who had asthma as a child and
has not experienced an attack in years may start to experience asthma symptoms
Asthma is an inflammatory disease the airways get easily irritated and narrowed when
triggers such as smoke and strong odors are inhaled.
During the haze, the air is filled with fine particles such as ash and a heavier
concentration of gasses; when inhaled, they act as irritant which triggers asthma attacks.
An asthma attack can be identified when a person experiences the following:
Difficulty breathing as airways are narrowed, normally accompanied by wheezing
Coughing
Shortness of breath; gasping
Tightness in the chest area
Night-time waking due to coughing or difficulty breathing
In severe cases, the airways narrow so severely that the person is unable to breathe
adequately and may lead to a situation that is potentially fatal. Because asthma is a
chronic condition, it cannot be cured and requires treatment with a combination of one
inhaler for immediate relief and one preventor for long-term control.
A reliever medication is an inhaler that relaxes the airways and is used whenever an
attack occurs. A preventor is an inhaler which is used daily (even when there are no
attacks) to reduce the inflammation in the airways, thereby helping to prevent future
attacks.
If you have asthma and are currently managing your asthma well with daily medication,
continue to do so. See your doctor if you find that you are experiencing more symptoms
or attacks than usual.
If you have asthma and you are not taking any medication, it is best for you to see a
doctor who may then prescribe you the appropriate medication for emergency use and
long-term treatment, if necessary.
If you had asthma as a child but have not experienced an attack in years, it is still
advisable for you to get a reliever (blue inhaler), to be used in the event of a sudden
attack.

Haze could lead to asthma attacks,

allergic reactions
TNN | Nov 15, 2008, 02.01 AM IST
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A
A
NEW DELHI: The United Nations report about the increasing air pollution in Asia has
put the spotlight on the immediate effect of the haze on health of people. In fact,
experts say Delhiites should take all necessary precautions.
It is a known fact that asthma cases increase drastically during winter due to the
presence of smog. But experts say that in the last five years there has been a
cumulative increase of 20% in asthma cases. Not just asthma, even cardiovascular
events shoot up due to smog.
"Asthma cases definitely shoot up. Chronic bronchitis, lower respiratory tract
infection like pneumonia etc are also reported in large numbers during this time of the
season. The pollutants in the air result in inflammation of airways, thereby, blocking it.
Children and elderly people stand a high chance of suffering an asthma attack or a
serious episode of bronchitis," said Dr GC Khilnani, professor medicine, AIIMS.
There are some heavy metals in the air that can trigger allergic reactions. Throat and
eye infections are very common. "There are micro-particles of dust and salts in the air
that act as irritants and can trigger an allergic reaction. Along with these microparticles there are various gases like nitrogen oxide, carbon dioxide, carbon monoxide
etc. A cocktail of all these can have a devastating effect on health. Due to smog, a lot
of people complain about burning sensation in eyes or bad throat, sneezing etc," said
Dr Sanjeev Bagai, director and head of the paediatrics department, Rockland hospital.
For asthma patients, driving in the city becomes even more difficult, especially at
traffic signals. In fact, newborns too stand a chance of developing breathing difficulty.
"The asthma episodes are frequent in those who travel a lot, especially during rush
hour, as the pollution level is really high. But newborns are at greater risk of
developing breathing difficulty. We see a lot of newborns who are re-admitted at the
hospital with such serious conditions," said Dr Bagai.
Doctors say the pollution levels have gone up so drastically that one inhales all
poisonous substances while breathing. The pollutants enter our body through the
respiratory tract and mixes with the blood, thereby, making it more viscous, which in
turn puts a person at risk of having a serious cardiovascular event. "As blood becomes
viscous due to these suspended particles, it increases the blood pressure. It also exerts
pressure on fat deposits in the arteries, which can burst under excess pressure," said Dr
Rajat Mohan, senior consultant, interventional cardiologist, Sir Ganga Ram Hospital.
1.

What are the key air pollutants of concern?

The key air pollutants of concern include particulate matter (PM), sulphur dioxide, ozone,
nitrogen dioxide and carbon monoxide. Short term exposure (i.e. continuous exposure to
unhealthy daily average PSI levels over a period of a few days) to these air pollutants can
cause respiratory symptoms and aggravate existing heart or lung disease. Exposure to
particulate matter and sulphur dioxide may also cause irritation of the eyes, nose and
throat in healthy individuals.
In Singapore, the main air pollutant in the event of haze is particulate matter (PM).
2.

What is the short term effect of the haze on my health?

Among healthy individuals, short term exposure (i.e. continuous exposure to unhealthy
daily average PSI levels over a period of a few days) to high levels of haze particles may
cause irritation of the eyes, nose, and throat in healthy individuals. Such irritation
resolves on its own in most cases.
Haze particles can affect the heart and lungs, especially in people who already have
chronic heart or lung disease e.g. asthma, chronic obstructive pulmonary disease (COPD),
or heart failure.
There may be up to 1-3 days of time between exposure to haze and health effects/
symptoms.
3.

What are the long term effects of the haze?

Singapore is not affected by the haze throughout the year. Any exposure is short-term in
nature (i.e. continuous exposure to unhealthy daily average PSI levels over a period of a
few days) and such exposure may vary from year to year. As international studies are
based on long term exposure to air pollution, there is little robust data on the longer-term
effects of short-term exposure to haze like the pattern seen in Singapore.
Studies have shown that persons living overseas with continuous exposure over several
years to high ambient pollution from fine particles (i.e. particulate matter 2.5 (PM2.5);
particles smaller than 2.5 micrometres), may have a higher risk of (i) cardiovascular
effects, such as heart attacks, (ii) reduced lung development, as well as (iii) the
development of chronic respiratory diseases, such as asthma, in children.
4.
What is the revised Pollutant Standard Index? How is it different from PSI
reporting last year?
The new, integrated air quality reporting index incorporates PM2.5 in addition to sulphur
dioxide (SO2), particulate matter (PM10), nitrogen dioxide (NO2), carbon monoxide
(CO), and ozone. Previously, health advisories issued by the Government were based on
both 24-hour PSI and 24-hour PM2.5, whichever was worse. Under the new air quality
reporting system, the health advisory will be based on the new 24-hour PSI as it now
directly takes into account PM2.5.

5.
Why is the health advisory based on 24-hour PSI, rather than the 3-hour
PSI? Why does Singapore calculate the Particulate Matter (PM) in air pollution
based on the 24-hour measurement? Why not use sub-daily measurements?
The health impact of exposure to particulate matter in the air depends on the
concentration and duration of the exposure, as well as the health status and level of
activity of the individual. The health advisory is based on the 24-hour PSI (incorporating
24-hour PM2.5 concentration), as most scientific studies on the health effects of shortterm exposure to PM use 24-hour averages, and have demonstrated good links with 24hour PM averages. The use of 24-hour averages for PM is also consistent with
international guidelines, such as the US Environmental Protection Agencys (EPA)
National Ambient Air Quality Standards and the World Health Organizations Air Quality
Guidelines. Fewer studies have investigated shorter (sub-daily) exposure timeframes. In
fact, a US EPA study in 2011 concluded that there was insufficient basis to establish a
national standard with a shorter-than-24 hour averaging time. MOH will continue to
monitor research in this area.
6.

Which groups of people are more sensitive to haze?

In general, children, elderly, and people with chronic lung disease, heart disease are more
sensitive to the health effects of haze, and should adopt the preventive measures in the
MOH health advisory when air quality is poor. Individuals are advised to consult their
doctor should they develop breathing difficulties. In addition, it is advised that pregnant
women reduce exposure to haze for the health of their unborn baby.
7.

What is MOHs advice to the public?

The public is recommended to adhere to the MOH haze health advisory (Annex A). In
most cases, it is still safe to carry on with outdoor activities. However, do drink plenty of
water to stay well hydrated. Individuals with existing chronic heart and lung conditions
should ensure that your medications are on hand and readily available.
8.

Is the health advisory applicable to everyone?

While the health advisory provides generic precautionary advice, individual reactions to
pollutants may vary. For instance, some vulnerable people, such as those with heart and
lung conditions, may experience increased symptoms at PSI levels below 100. Such
individuals are advised to be cautious and seek appropriate medical attention as needed.
9.
How will the haze impact patients in nursing homes and subsidised wards with
natural ventilation?
These patients are indoors and sedentary. The healthcare institutions, such as hospitals
and nursing homes, will monitor patients closely, and ensure ample circulation of clean
air indoors.
10.

Where can I get more information on haze?

Please refer to the following websites:

http://www.nea.gov.sg/psi/
http://mom.gov.sg/haze/Pages/haze.aspx
http://www.moh.gov.sg/content/moh_web/home/pressRoom/Current_Issues/2014/haze.ht
ml

Asthma and allergy

cases up as haze
worsens: Docs
Friday, 22 l 10 l 2010 Source: The Straits
Times
By: Fiona Low
Those with respiratory and heart ailments
should reduce exertion

DOCTORS here are seeing more patients with

haze-related health problems. Most of them
have pre-existing lung
conditions such as asthma or have throat and
nose conditions. The haze, which has blown
over from forest fires in Sumatra, has brought
Singapores air pollution to its highest level in
four years. Doctors are echoing the National
Environment Agencys (NEA) advice, asking
those with existing heart or respiratory
ailments to reduce physical exertion and
outdoor activity for now.

Dr Chng Eng Soon from Chng Clinic and

Surgery in Toa Payoh said that he has seen
about 20 per cent increase in the number of
patients coming in with respiratory problems
likely caused by the haze. Most are patients
with asthma. Particulate matter in the air,
caused by the haze, is inhaled into airways. A
high concentration of this could cause
inflammation in the lungs, said Dr Hui Kok
Pheng, a former president of the Asthma
Association of Singapore.
The haze, which drifted into Singapore last
week, worsened on Tuesday when the
Pollutant Standards Index (PSI) surged to 84.
The PSI has now hit the unhealthy range,
which falls between 101 and 200. Doctors said
that at this range, children and the elderly are
most likely to be affected as their lungs tend to
be weaker. According to an NEA health
advisory, sneezing and coughing can be
expected among healthy people, while those
with underlying conditions could see their
symptoms worsen by a bit.
If PSI levels rise to between 201 and 300
what is termed the very unhealthy range
there will be widespread symptoms of
irritation among healthy people. Those with
chronic and lung diseases will be moderately
affected.
When the reading hits more than 300 the
hazardous range those who are sick will be
significantly affected while healthy people too
will find it hard to tolerate the pollutants.
People would be advised to avoid all
unnecessary outdoor activities.
Should the PSI rise above 400, the pollution
could be life-threatening to the sick and old.
Specialist clinics here are also seeing patients
who are coming in with haze-related health
problems. Dr Ong Kian Chung, a respiratory
specialist at Mount Elizabeth Medical Centre,
saw a total of five patients on Wednesday and

yesterday, who said that their existing

conditions have worsened. All five had either
asthma or nose and sinus conditions.
Doctors said, however, that the situation now
is still manageable and people should not
panic. People should try to avoid rigorous
exercise outdoors now that the PSI is above
100, but there is no need for the general public
to worry too much yet, said Dr Ong.