Ask asthma patients and their parents about exposure to air pollution, study suggests

Ella Kissi-Debrah was the first person in the UK whose death, at 9 years of age, was attributed to air pollution. Her severe asthma symptoms and eventual death were attributed to exposure to high levels of outdoor air pollution.

A paper by Centre members which was published in the journal Archives of Disease in Childhood examines the relationship between air pollution and fatal and near-fatal asthma.

Air pollution impact

Air pollution can impact people’s health while they are in utero, during childhood and as an adult. The WHO identifies sulfur dioxide (SO2), nitrogen dioxide (NO2), ozone (O3), carbon monoxide and particulate matter (PM) as the main air pollutants negatively impacting on people’s health. UK air pollution levels are currently higher than that recommended by the WHO.

Children are more vulnerable to the effects of air pollution compared with adults as they spend more time outdoors, have smaller airways and inhale a larger volume per kilogram per body mass compared with an adult. Children exposed to air pollution can have lower lung function, increased asthma medication use, and an increase in primary care, emergency care and hospital admissions.

Air pollution and asthma

Asthma is a condition which is impacted by air pollutants, and for children with asthma, there is growing evidence that outdoor air pollution has an even larger impact. These children are at a higher risk of having asthma attacks compared to those with lower exposure to air pollution.

The authors of the paper highlight the challenges of interpreting air pollution data and asthma attacks. The data can be affected by:

• How air pollution is monitored and reported in different countries,
• Different types of weather, and
• The various types of pollutants in the air, which can all have an effect on the airways of people with asthma

The reported data can also miss the highs and lows of pollutants in the air in highly congested areas, reporting an average sum rather than these granular differences.

Near-fatal and fatal asthma impacted by air pollution

Fatal and near-fatal asthma is uncommon, but the UK has one of the highest death rates from asthma in children age 10–24 years. People experiencing a near-fatal attack are at high risk of future severe attacks and it is important for clinicians caring for children with asthma to evaluate the risk factors and features associated with near-fatal and fatal attacks with an aim to reducing future risk.

There is a lack of data which identifies near-fatal asthma attacks and a lack of recorded severity of the asthma attacks associated with air pollution exposure. This small body of literature examining asthma mortality and air pollution, means that there is a significant gap in our understanding of the impact of air pollution on near-fatal and fatal asthma attacks in children and young people.

Looking forward

The authors state that there is now an opportunity to start to build the data around air pollution and near-fatal and fatal asthma attacks. They suggest that clinicians should include air pollution as an asthma risk factor when assessing a patient’s clinical history. This could raise awareness among patients and their parents on how air pollution is a risk factor for asthma. Additionally, the evidence collected will support policymakers to deliver safer and lower exposure to air pollution levels in children and young people with asthma.

Dr Deepa Varghese is an MD student in the Centre based at the University of Edinburgh. Deepa was the lead author on this paper. She said:

One small question on air pollution could make a big difference to reducing exposure and risk for an asthma attack. We hope this paper will stimulate a change in practice to integrate questions on air pollution within asthma consultations.

Dr Deepa Varghese

Read the paper

This paper is available from Archives of Disease in Childhood

Cite as

Varghese D, Clemens T, McMurray A, et alNear-fatal and fatal asthma and air pollution: are we missing an opportunity to ask key questions? Archives of Disease in Childhood Published Online First: 10 November 2023. doi: 10.1136/archdischild-2023-325548

image: Baloncici