Kashmir’s winter pollution crisis we are ignoring

I am witnessing a large number of patients with upper respiratory issues. They come with familiar complaints, cough, chest tightness, throat irritation, watering eyes, but something is different this time. Many do not have fever. Antibiotics do not help. Chest X-rays are often clear. Symptoms worsen outdoors and ease indoors. This winter, what looks like infection is often air pollution wearing a seasonal mask.

Air pollution is not only an urban summer problem. In Kashmir winters, stagnant cold air traps pollutants close to the ground. Biomass burning, kangris, bukharis, making of charcoal, burning of saw dust, diesel generators, traffic emissions and reduced air circulation combine to create a toxic mix. Fine particulate matter (PM2.5), carbon monoxide, nitrogen oxides and soot enter deep into the lungs, irritating airways without causing classical infection.

Symptoms that hint more toward air pollution than infection

A careful history often tells the story.

More suggestive of air pollution:

Persistent dry cough or throat irritation without fever

Chest tightness, heaviness, or burning sensation

Breathlessness that worsens outdoors, during morning or evening hours

Eye irritation, redness, excessive watering

Headache, dizziness, unusual fatigue

Wheeze in non-asthmatics or sudden worsening of controlled asthma

Symptoms improve after moving indoors or to cleaner air

More suggestive of infection:

Fever, chills, body aches

Productive cough with yellow or green sputum

Localized chest pain, worsening over days

Raised inflammatory markers, abnormal chest imaging

Poor response to bronchodilators but response to antimicrobials

This distinction matters. Treating pollution-induced airway inflammation with repeated antibiotics only delays recovery and promotes resistance.

Why pollution symptoms get mistaken for “usual winter infections”

Winter cough is culturally normalized. Patients expect it; clinicians anticipate it. The overlap is large, but pollution triggers irritation and inflammation, not infection. Cold air itself constricts airways. Add polluted air, and even healthy lungs get bad.

Who are most susceptible?

Not everyone exposed becomes symptomatic, but certain groups are more vulnerable:

Elderly individuals, especially those with fragile lungs or hearts

Children, whose lungs are still developing

Patients with asthma, COPD, interstitial lung disease

Those with heart disease, diabetes, anemia

People using kangris or bukharis in poorly ventilated rooms

Outdoor workers, traffic police, vendors

Smokers and passive smokers

In older adults, pollution does not just cause cough, it destabilizes blood pressure, worsens heart failure, triggers arrhythmias and increases hospitalizations.

Risk factors unique to Kashmir winters

Prolonged indoor stay with closed ventilation

Indoor burning for heat

Early morning walks near traffic during temperature inversion

Use of commercial generators during power cuts

Overcrowded living spaces

Lack of awareness that “clean-looking cold air” can still be poisonous

Aggravating and relieving factors

Patients often unconsciously report the diagnosis.

Aggravating factors: Going outside in early morning or evening, exposure to smoke, traffic, cold dusty winds, physical exertion outdoors.

Relieving factors: Staying indoors, warm fluids, steam inhalation, humidified air, wearing a proper mask, moving to less polluted areas.

These patterns are classic for pollution-triggered airway irritation.

Prevention is more effective

The most powerful intervention is exposure reduction.

Avoid outdoor activity during peak pollution hours

Wear a well-fitted mask (N95 if possible) when outdoors

Ensure adequate ventilation when using heating devices

Never use kangri, bukharis, or charcoal fires in closed rooms

Delay morning walks; exercise indoors

Stay well hydrated; use humidifiers if air is very dry

At a community level, cleaner heating alternatives, public awareness and pollution monitoring are urgently needed.

Treatment has to be targeted, not excessive

Pollution-related illness is treated differently from infection.

Bronchodilators for cough and wheeze

Inhaled steroids when inflammation is significant

Steam inhalation and warm fluids

Avoid unnecessary antibiotics unless infection is clear

Optimization of underlying asthma, COPD, or cardiac disease

Short-term anti-allergic medications when indicated

Most importantly, improvement depends on reducing exposure. Medicines help lungs cope; clean air allows them to heal.

Not every cough needs an antibiotic. Not every chest symptom is an infection. Air pollution is a silent seasonal disease, made louder by winter.

Antibiotic resistance is emerging as a serious and largely unrecognized public health threat in Kashmir. A large number of patients with winter cough, throat irritation, or breathlessness, often triggered by air pollution or viral infections, are being treated with antibiotics that offer no benefit. Pollution-related airway irritation and viral illnesses do not respond to antibiotics, yet self-medication and pressure for “strong medicines” remain common. This unnecessary exposure allows bacteria to adapt and become resistant, making future infections harder, costlier and sometimes impossible to treat. Avoiding self-medication and reserving antibiotics only for confirmed bacterial infections is no longer optional, it is essential for protecting individual and community health. Let your doctor decide, not you.