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Breathing poison: Smoking, pollution and the Haze,

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Breathing poison: Smoking, pollution and the Haze,

By Dr A. Rebuck, 2014, Partridge, ISBN 978-1-4828-9808-1, RRP $30.20 [hardcover], $18.20 [softcover], $6.89 [ebook], pp153.

One day in June last year, the air pollution across Sumatra, Singapore and the Malay Peninsula became so bad that schools, businesses and airports were forced to close and driving became almost impossible because of poor visibility.

On that day, Singaporean authorities reported a Pollutant Standards Index reading of 401, a level considered life threatening for the ill and the elderly, and hazardous for all.

The diseases of poverty, particularly malaria and diarrhoea, remain Asia’s biggest killers.

But Australian-born respiratory medicine expert Dr Anthony Rebuck warns the clouds of pollution that regularly smother the region, blanketing hundreds of millions of people in thick, pungent, toxic air, are sowing the seeds of massive population-wide health problems.

In his bluntly-titled book, Breathing poison: Smoking, pollution and the Haze, Dr Rebuck argues estimates that around 56.6 million people in Asia currently suffer from Chronic Obstructive Pulmonary Disease (COPD) are wildly inaccurate, and the real number is likely at least double that.

He says the combined effects of tobacco smoking, industrial and vehicle air pollution, the smoke haze generated by slash and burn farming and the fumes from kitchen fires breathed in by women and children in their homes, mean the problem goes well beyond the heavy blankets of smog that grab international headlines when they descend on Beijing, Singapore, Jakarta, Shanghai, Dhaka, Calcutta, Delhi and other major Asian cities.

Dr Rebuck, who graduated from Sydney University Medical School in 1971 before becoming a specialist in respiratory medicine at the University of Toronto and eventually a clinical research director in Singapore, warns COPD in Asia is “a gathering storm”.

In 1996, the World Health Organisation predicted that by 2020 COPD would become the fifth-leading cause of death and disability in the world.

But it has already achieved this grim title, and is instead on track to become the third most common cause of death worldwide by the end of the decade.

Already, according to the American College of Chest Physicians, 2.5 million people die annually from COPD and, once diagnosed, people only survive on average little more than 10 years.

COPD develops over a long period of time breathing in dust, smoke and other pollutants. As airways become inflamed and lung tissue begins to break down, sufferers develop a persistent cough which eventually progresses to shortness of breath, heart failure and death. The course of the disease is inexorable.

What frustrates Dr Rebuck, and why he considers it such a tragedy, is that COPD – which is incurable – is entirely preventable.

By far, the most common cause of the disease is smoking.

But, while smoking rates in affluent countries such as Australia are coming down, in Asia they are climbing.

Dr Rebuck’s book is peppered with interesting and stunning statistics, such as this: a third of all the cigarettes smoked in the world each day are in China, where there are about 300 million smokers (around 20 per cent of the population).

What is particularly worrying for Dr Rebuck is that, contrary to the experience in other parts of the world, in Asia as people become more affluent, more take up smoking.

So, while economic development is dragging hundreds of millions out of poverty, it is also giving them the money to partake in a deadly habit much of the Western world is trying hard to give up.

Add to this the pollution pumped into the air by coal-fired power stations (which are being built at a massive rate in energy-hungry China and India) and Asia’s burgeoning car and truck fleet, as well as the haze from burning forests, fields and cooking fires, and its is not hard to see the region’s air quality – and respiratory health – becoming even worse.

Particularly when, as Dr Rebuck observes, there is little official recognition of it as a problem and a general acceptance of such pollution as an unhealthy and unpleasant but unavoidable cost of economic development.

“Many Asian countries at the moment look at it as an unsolvable problem linked to financial success,” he told Australian Medicine. “The attitude is that there are other problems that are much more pressing than this.”

But, in his book, Dr Rebuck sets out action that can be taken right now to help stem the prevalence of the disease, including public anti-smoking campaigns, and the development of effective treatments and therapies.

Eventually, the enormous human and financial cost caused by widespread COPD will cause governments to focus on the problem, he thinks, but that is not going to happen any time soon.