Why can’t you stop coughing in Delhi Mumbai right now? Is it pollution, the flu, or something else? Doctors explain | Today’s news

Just days before Diwali, Delhi-NCR is already suffocating with “unsafe” air on Thursday, while Mumbai continues to be in the “unhealthy” band. Weather experts believe there could be a spike in pollution the day after Diwali.

With the worsening Air Quality Index (AQI) and the onset of winter, India’s leading metros are facing a sudden rise in cases of persistent, intractable cough. Clinics are crowded with patients with sore throats, chest tightness and fatigue.

But a common question among the masses is: Is this cough a reaction to toxic air, or is it a seasonal viral infection like the flu?

Quick answers to key questions

•5 QUESTIONS

Pollution-related symptoms often develop gradually and cause throat or eye irritation without fever. The flu usually starts suddenly and is more likely to bring fever and body aches, although symptoms can overlap.

Yes. Pollution can exacerbate airway inflammation during a viral infection, while the infection can make the airways more sensitive to polluted air.

A viral infection can leave the airways unusually reactive, causing the cough to persist for several weeks after the infection has cleared. Pollution can make this irritation worse.

Seek medical attention if the cough comes with shortness of breath, chest pain, fever, decreased oxygen saturation, or bloody sputum. A doctor can assess symptoms and decide if tests are needed.

Gradual onset with throat or eye irritation and no fever may indicate contamination. If symptoms improve indoors or when you leave the city, this may also indicate an air quality trigger.

Medical experts told LiveMint that the confusion is completely justified – Physiological responses to smog, seasonal flu and the common cold look remarkably similar, making self-diagnosis tricky and complicating treatment.

Read also | Delhi AQI drops to ‘poor’ ahead of Diwali and is likely to deteriorate further

Diagnostic dilemma: Why do they look the same?

The primary diagnostic problem is that the respiratory system responds similarly to environmental irritants and viral invaders, experts noted.

“At this time of year, the symptoms overlap a lot,” explained Dr. Rommel Tickoo, Senior Director of Internal Medicine at Max Super Specialty Hospital, Saket, New Delhi.

A patient with a persistent dry cough, fatigue and chest tightness may be “due to air pollution, seasonal flu or a bacterial infection in an irritated airway,” he said.

Dr Sagar Srivastava, consultant pulmonologist at Greater Noida’s Kailash Hospital, agreed, noting that this mimicry makes clinical evaluation difficult.

“The factors that lead to air pollution, the common cold, and the flu share some similar symptoms, including cough, sore throat, nasal congestion, and difficulty breathing,” he said, adding that “this similarity makes it difficult to identify the exact cause of the problem, because even though irritation from pollution does not involve fever, infections can also start without a previous fever.”

Read also | Delhi-NCR curbs pollution: GRAP Stage-II implemented before Diwali

How to tell the difference?

While the initial scratchy throat may be the same, doctors advise patients to look for specific patterns in how symptoms develop to narrow down the culprit.

The key indicators are the speed of onset and the presence of systemic symptoms.

“The flu usually starts suddenly and comes with fever and body aches, while the symptoms of pollution tend to build up gradually and are mostly throat and eye irritation, without fever,” noted Dr. Tickoo.

Environmental triggers, he said, also offer a major clue. “If a patient gets better when they’re indoors or when they’re traveling out of town, it points up in the air.”

Dr Tickoo explained that health professionals also keep a close eye on secondary infections – “If someone gets better and then gets a fresh fever with colored sputum, we start thinking about a secondary bacterial infection.”

‘Double whammy’: When it’s both

In many cases, persistent cough is not an either/or situation, noted Dr Divya Gopal, additional director of internal medicine at Sir HN Reliance Foundation Hospital in Mumbai.

Toxic air actually paves the way for viruses, and viruses leave respiratory tracts highly sensitive to pollution.

“Pollution, in addition to the presence of a viral infection in an individual, can exacerbate existing airway inflammation, meaning that a patient may have multiple causes for their condition,” said Dr. Gopal.

The combination, she said, often leads to a lingering, nagging cough long after the initial illness has passed. “There can be post-viral hyperreactivity of the airways, leading to a cough lasting several weeks after the infection has cleared.”

Read also | Dia Mirza vs BJP: What happened to her Diwali pollution video?

When to see a doctor? Why does it matter?

Doctors rely heavily on a detailed patient history to understand the primary cause of overlapping conditions.

“Symptoms, including when symptoms first appeared, duration and severity, along with other symptoms, will help narrow down the cause,” Dr. Srivastava said.

He said doctors ask about recent exposure to pollutants, contact with sick individuals and pre-existing conditions such as asthma or COPD. Then, depending on this history, doctors may order a complete blood count, CRP levels, viral panels (flu/COVID-19), or a chest X-ray to rule out pneumonia.

That’s why Dr. Gopal cautioned against dismissing severe symptoms as mere smog irritation.

“Don’t jump to conclusions that a persistent cough is caused by pollution,” she advised. “In case of shortness of breath, chest pain, fever, reduced oxygen saturation or bloody sputum, it is necessary to see a doctor. A correct diagnosis will help prevent the unnecessary use of antibiotics.”

Preventive measures

While individuals have limited control over their city’s air quality, doctors strongly recommend focusing on what they can control—specifically, getting a flu shot.

“While vaccination does not completely eliminate the flu, it reduces the likelihood and helps us narrow down the cause,” said Dr. Tickoo and urged older adults, pregnant women, young children and people with co-morbidities to get vaccinated. “It takes about two weeks to show up, so it’s better to get it now than to wait.”