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Air pollution, lung health and what you can do to help


Key Takeaways


  • Patients with chronic respiratory conditions should be advised during routine health appointments on actions to take during times of poor air quality.1
  • Short term exposure to air pollution can increase risk of acute exacerbations in chronic obstructive pulmonary disease (COPD) patients.
  • Long-term PM2.5 exposure can accelerate lung function decline in both forced expiratory volume (FEV1), forced vital capacity (FVC).3,10
  • Lower-income individuals may experience a greater vulnerability to the respiratory health effects of air pollution exposure compared with higher-income individuals.4
  • Resources are available to assist in conversations about air pollution with your patients.


Poor air quality is the greatest environmental risk to public health in the UK.5 Despite significant progress in improving air quality since the 1950s, a 2010 report by the Committee on the Medical Effects of Air Pollutants (COMEAP) estimated that the long term impact of particulate pollution in the UK has equated to 340,000 years of life lost.6 To this day, levels of Nitrogen dioxide (NO2), another established air pollutant, continues to regularly exceed set limits across the UK.5

A 2016 report by the Royal College of Physicians (RCP) and the Royal College of Paediatrics and Child Health (RCPH) estimated that air pollution in the UK has a burden on mortality equivalent to 40,000 deaths per year.7

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The View Outside

The impact of outside air pollution on respiratory health has been widely documented.2 Poor air quality may not only act to increase risk of acute exacerbations in those already suffering from asthma or COPD but may also have an important role in the development of these disorders.3,8,9 

Long term exposure to traffic and atmospheric particulate matter with a diameter <2.5µm (PM2.5) has also been associated with lower FEV1, FVC and an accelerated decline in lung function.10  However, the short-term impact is also significant. Studies indicated that short term exposure to outside air pollution can lead to:2

  • Decreases in pulmonary function 
  • Increases in inflammatory markers and respiratory symptoms 
  • Worsening of COPD symptoms and respiratory infections 
  • Increase in overall respiratory mortality

What can I do?

If you have a patient with a chronic respiratory condition who is attending a routine health appointment, you can provide advice on what they can do when the outdoor air quality is poor including.

  • Avoiding or reducing strenuous activity outside, especially in highly polluted locations such as busy streets
  • Using an asthma reliever inhaler more often, as needed
  • Closing external doors and windows facing a busy street at times when traffic is heavy or congested
The European Respiratory Society have also developed a handy fact sheet which provides top tips on explaining the impact of poor air, advice for patients who exercise in polluted environments and comparisons between outside air pollution and smoking.11

You can also provide advice on how patients can track when the air quality may be poor. 

  • Share the Daily Air Quality Index from the Department for Environment, Food and Rural Affairs to help patients know when the air quality may be polluted

The Inside Story 

The link between outside air pollution and respiratory health has resulted in increasing legislation and regulation to attempt to limit exposure to these pollutants. However, in a report published in 2020, the RCP and RCPH explain that the potential risk to health from poor indoor air quality is often over-looked.12 The quality of air indoors is key as many people spend so much time inside.7 Research that analysed the daily habits of children between 1975 and 2015, found a trend towards children living increasingly home-based lives.12 

Key sources of indoor pollution include:12

Smoking
Damp
Cooking
Burning of wood and fossil fuels
Dust
Chemicals from building materials and furnishings
Aerosol sprays
Cleaning and other household products

Patients with pre-existing conditions such as asthma, allergies, COPD and cardiovascular disease are amongst those most at risk due to poor indoor air quality.13 Other population groups at risk include pregnant women, pre-school children and the elderly.13 Poverty is also a risk-factor for vulnerability to ill health from poor air quality.13 Research has shown that low-income groups are more strongly associated with COPD following exposure to polluting particles than higher income groups.4 Adverse housing conditions such as location near high levels of outdoor air pollution, poor physical infrastructure (e.g. poor ventilation), poor standard of housing (including the presence of damp and mould) and overcrowding may all contribute to a higher risk of indoor air pollution and as such, respiratory issues.13

Doiron et al demonstrated an over 3x stronger association between COPD and pollutants amongst lower income individuals compared to higher-income individuals.4

What can I do?

There is a significant behavioural component to improving air quality, so you can follow the Making Every Contact Count (MECC) initiative to approach discussions with patients or individuals at risk.12 

The National Institute of Health and Care Excellence (NICE) suggest offering the following advice to your patients with respiratory or cardiac disorders:14

  • Explain that indoor air pollutants can trigger or exacerbate asthma, other respiratory conditions and cardiovascular conditions 
  • If repeated or worsening cough or wheezing, ask about housing conditions and help request a housing assessment if concerned 
  • If household sprays or aerosols trigger asthma, advise avoiding them or using non-spray products
If your patient is a smoker you should also provide advice and support on how to quit. Follow our quick tips to help your patient quit smoking.

A Joint Effort

The WHO lists air pollution and climate change as one of their ten threats to global health in 2019 and tackling the issue requires action across sectors.15 As part of the healthcare industry we can help to provide patients with the best information to help them manage the risks of poor air quality for the benefit of themselves and those around them. 

References
Date of access of all websites: February 2019 
  1. National Institute for Health and Care Excellence, (2019). Air pollution: outdoor air quality and health. Available at https://www.nice.org.uk/guidance/qs181/chapter/Quality-statement-4-Advice-for-people-with-chronic-respiratory-or-cardiovascular-conditions 
  2. Faustini A, Stafoggia M, Colais P, et al. Air pollution and multiple acute respiratory outcomes. Eur Respir J. 2013;42(2):304 LP-313. doi:10.1183/09031936.00128712
  3. Liu S, Zhou Y, Liu S, et al. Association between exposure to ambient particulate matter and chronic obstructive pulmonary disease: results from a cross-sectional study in China. Thorax. 2017;72(9):788 LP-795. doi:10.1136/thoraxjnl-2016-208910
  4. Doiron D., de Hoogh K., Probst-Hensch N, et al. Air pollution, lung function and COPD: results from the population-based UK Biobank study. Eur Respir J. 2019;55(1) 1802140. doi:10.1183/13993003.02140-2018 
  5. Department for Environment, Food & Rural Affairs, (2019). Air pollution in the UK 2018. Available at: https://uk-air.defra.gov.uk/library/annualreport/viewonline?year=2018_issue_1&jump=r#report_pdf
  6. The Committee on the Medical Effects of Air Pollutants (COMEAP), (2010) ‘The Mortality Effects of Long-Term Exposure to Particulate Air Pollution in the United Kingdom’ (ISBN 978-0-85951-685-3) 
  7. Royal College of Physicians, Royal College of Paediatrics and Child Health, (2016). Every breath we take. Available at https://www.rcplondon.ac.uk/projects/outputs/every-breath-we-take-lifelong-impact-air-pollution
  8. Guarnieri M, Balmes JR. Outdoor air pollution and asthma. Lancet. 2014;383(9928):1581–1592. doi:10.1016/S0140-6736(14)60617-6
  9. Global Initiative for Chronic Obstructive Disease, (2020). Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease 2020 report. Available at https://goldcopd.org/wp-content/uploads/2019/12/GOLD-2020-FINAL-ver1.2-03Dec19_WMV.pdf
  10. Rice MB, Ljungman PL, Wilker EH, et al. Long-Term Exposure to Traffic Emissions and Fine Particulate Matter and Lung Function Decline in the Framingham Heart Study. Am J Respir Crit Care Med. 2015;191(6):656-664. doi:10.1164/rccm.201410-1875OCRice 
  11. European Respiratory Society. Air quality and lung health – the risks. Breathe. 2016;12(3):299 LP-300. doi:10.1183/20734735.ELF123
  12. Royal College of Physicians, Royal College of Paediatrics and Child Health, (2020). The inside story: Health effects of indoor air quality on children and young people. Available at https://www.rcpch.ac.uk/sites/default/files/2020-01/the-inside-story-report_january-2020.pdf
  13. National Institute for Health and Care Excellence, (2020). Indoor air quality at home. Available at https://www.nice.org.uk/guidance/ng149/resources/indoor-air-quality-at-home-pdf-66141788215237
  14. National Institute for Health and Care Excellence, (2020). Improving indoor air quality. Available at https://www.nice.org.uk/guidance/ng149/resources/visual-summary-pdf-7022755693
  15. World Health Organization, (2019). Ten threats to global health in 2019. Available at https://www.who.int/news-room/feature-stories/ten-threats-to-global-health-in-2019 
 

PM-GB-RS-WCNT-200006 February 2020

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