• Expert says any form of respiratory illness has direct link with air pollution
• PAQI report says city’s human-caused emissions create constant public health emergency

KARACHI: The city has seen a dramatic increase in cases of respiratory infections with the onset of winter, health experts shared on Wednesday, linking the spike in these illnesses directly with worsening air quality.

The experts specialising in internal and pulmonary medicine, critical care and ear-nose-throat diseases, underscored the need for promoting and prioritising lung health which, they said, had been overlooked by the government as well as citizens for too long.

“Yes, we have been seeing an increasing number of [influenza] patients this winter compared to last winter. Patients are reporting at the outpatient clinics as well as the hospital’s emergency department,” said Prof Dr Javaid Ahmed Khan, senior pulmonologist at Aga Khan University Hospital (AKUH).

Influenza, he pointed out, could get complicated by turning into acute viral bronchitis and later pneumonia.

“Any form of respiratory illness has a direct link with air pollution as it destroys the lungs’ immunity and makes [individuals/patients] vulnerable to viral infections,” said Prof Khan, recalling that when he returned from the UK in the 1990s, patients of interstitial lung disease (ILD) were hardly seen.

“We used to see one patient (ILD) in six months. But, today, pulmonologists at AKUH are seeing around 100 patients per week who have some form of interstitial lung disease — a group of conditions that initially cause inflammation in the lungs but later might cause irreversible damage, if not properly treated. The illness has a strong link with the environment,” he said.

Prof Khan also referred to an AKUH study, which provided evidence on how polluted air was affecting public health.

Inhaling toxic air

The AKUH study titled ‘Impact of fine particulate pollution exposures on respiratory health in a megacity of Pakistan’ was published last year in the journal Atmospheric Pollution Research.

The study — the first to provide evidence of ambient fine particulate matter PM2.5 and its association with pulmonary diseases in a megacity of Pakistan — revealed alarmingly high levels of harmful particles in Karachi’s air.

It also found high levels of sulphate, ammonium, nitrate and black carbon widespread across the city that contributed to poor air quality.

The study showed a 30 to 40 per cent increase in hospital admissions and ER (emergency room) visits on a daily basis for respiratory issues due to short-term exposure to ambient fine particulate matter (PM2.5) — which poses the greatest risk to the respiratory system — and other pollutants.

“It’s high time that we treat air pollution as a public health emergency. It affects everyone, especially children, the elderly and those with compromised immunity levels,” said senior ENT specialist Dr Qaiser Sajjad, while seconding Prof Khan’s observations.

Sharing his clinical experience, he said: “Cases of [upper] respiratory tract infections have seen a sharp increase in Karachi in a decade. The situation is directly associated with city’s deteriorating air quality. While we see these cases the whole year, patients’ numbers dramatically increase in winters.”

In his response, senior physician Dr Abdul Ghafoor Shoro said that he examined cases of tuberculosis more in winter than the rest of the year.

“It’s a highly contagious respiratory infection. Poor air quality affects lungs’ immunity and people with compromised health are affected easily,” he explained, adding that contaminated respiratory droplets travel more easily in dry air.

Pollution level worsens in winters

Currently, there is no government system in place to monitor air quality in the province. A recent Pakistan Air Quality Initiative (PAQI) report provides further evidence on the environmental challenge the city faces.

In 2024, the report says, the city’s annual average PM2.5 concentration was 46.2µg/m³. “This level is over nine times WHO’s annual health guidelines and more than three times Pakistan’s own National Environmental Quality Standards (NEQS) and the Sindh Environmental Quality Standards (SEQS).

“This data confirms that even with the coastal breeze that helps disperse air pollution, Karachi’s own human-caused emissions create a constant public health emergency.”

According to the report, Karachi’s air has never met WHO’s safe guideline over the past eight years (2017-2024).

“The annual average pollution consistently exceeds even the NEQS and SEQS, with no significant trend of improvement. While Karachi does not experience the extreme winter smog of inland cities in Punjab, a clear seasonal pattern persists. During the winter of 2023-2024, pollution levels were 4.3 times higher than the subsequent monsoon average.

“The sea breeze provides some dispersion, but not enough to overcome the combined effect of winter meteorology and the city’s massive emissions load,” the report says.

To address these challenge, the experts called for immediate government measures for implementing environmental protection standards, including control over industrial and vehicular emissions, establishing a proper waste disposal and recycling system and promoting a culture of tree plantation.

They also underscored the need for individual measures, such as wearing face mask in crowded places, adopting coughing etiquette and ensuring hand hygiene.

Published in Dawn, December 11th, 2025