Issue 3, 2013. June-July



Higher rates of asthma have been diagnosed in Georgian children and teenagers. Marta Ferrer Lubeck investigates the causes for

Marta Ferrer Lubeck

My three-year old son suffers from asthma, and some friends have told me that I should leave Tbilisi for a while and spend time in a health resort in the mountains. This raises some questions, like what does this say about Tbilisi's air quality? How prevalent is asthma in Georgia, and how interconnected is asthma to air pollution?

According to the World Health Organization, asthma affects 235 million people worldwide, and it is the most common chronic disease among children. In an asthma attack the airways in the lungs become swollen and constricted, causing coughing and wheezing and limiting the flow of air in and out of the lungs. More than 13,000 children from Tbilisi and Kutaisi have taken part in the International Study of Asthma and Allergies in Childhood, a multiphase program that started in 1995. The results of ISAAC phase V, which studied more than 11,000 children in 2012, revealed that the prevalence of asthma in Georgia has increased significantly in the past 17 years, and for ages 13-14, it has doubled.

Dr. Maia Gotua, the director of the Center of Allergy and Immunology in Tbilisi, believes that asthma rates have increased for "many reasons," including more pollution, as well as more exposure to chemicals used for cleaning and in food.

Dr. Gotua notes that asthma is often linked to allergies, and an allergy test can identify what triggers a person's attacks. House dust mites are the most common allergen, she says, but pollen, molds, and certain foods are common causes too.

In some instances, the allergen can be removed from a person's environment, such as removing carpets and stuffed animals to decrease exposure to house dust mites.

Lily Mulatu, who moved from Washington, DC to Tbilisi three years ago, was diagnosed with asthma about one year ago. She treats her asthma with Flixotide as a long-term preventive measure, and uses her Ventolin "rescue" inhaler when necessary.

Mulatu noted that pollution could have played a role in her newly developed asthma. "[G]iven the lack of emission controls, and the large number of road and housing construction sites in the part of the city where I both live and work, it's hard to rule out pollution and particulates as possible triggers for my symptoms," she said in an email interview.

"But this is all obviously anecdotal. I would love to have access to a professional air quality study for Tbilisi to confirm (or not) my assumptions."

That type of data, however, can be difficult to come by in Tbilisi. Despite several attempts to reach the Tbilisi Municipality about its programs to study and improve the air quality, City Hall did not provide information to

One monitoring program, which was started by the Dutch government in January 2011, funds the only automated air quality monitoring station in Tbilisi—located in the Vashlijvari district. There are three other stations in Tbilisi, but they are not automated. The Vashlijvari station works 24 hours and sends information to the National Environmental Agency on a regular basis.

According to the NEA, there has been an improvement in the levels of ozone and carbon monoxide, but the levels of dust, sulfur dioxide and nitrogen dioxide exceed the permissible limits according to Georgian regulations.

Data from the Ministry of Environment (MoE) for 2012, based on readings from the non-automated stations in more heavily polluted neighborhoods, echoed the NEA's findings.

The ministry stressed, however, that it is difficult to draw a direct parallel between air quality in Tbilisi and other international urban areas because of a discrepancy in how air quality is measured.

Nitrogen dioxide and sulfur dioxide are created by cars: nitrogen dioxide is created by fuel combustion at a very high temperature in abundance of oxygen - motor vehicle exhaust. Diesel fuel sends sulfur dioxide into the air.

One of the problems, according to Tamriko Maghlakelidze, the deputy head of the Department of the Environmental Pollution Monitoring of NEA, is the increase in the transport sector in Tbilisi. "Families used to have one car," she explains. "Families now have two or three cars." Also, "many cars are old and not up to standards." She notes that the Tbilisi City Government plans to reinstate obligatory technical inspections for motor vehicles starting in January 2014. Tbilisi City Hall has not confirmed this.

In the meantime, some Tbilisi residents are turning to the Air Quality Egg, a community-led air quality-sensing network. The device consists of an outdoor sensor taking regular air samples, and an egg-shaped base station that receives the data.

Mitch Belkin, a Tbilisi resident originally from Maryland, says he highly recommends the use of the air quality egg to others. The Shota Rustaveli Egg, which he helped install in downtown Tbilisi, "is a prototype egg, which means the kinks are still being worked out," he said.

"We need a large number of dedicated people to obtain accurate information on the air quality in any particular city. It is only by comparison with other egg readings that this relatively inexpensive technology can get good measurements of the air quality of our city."

For those worried about living in urban Tbilisi, there are the mountains of Abastumani. I still have not taken my son to a health resort, and before doing that I wanted a more scientific answer. Asked whether going to the mountains makes a positive difference to asthma sufferers, Dr. Gotua agrees, but adds: "Going to such places is fine, as long as you are not allergic to the vegetation growing there!"