Major review finds that air pollution and asthma combine to undermine children’s education

However, the authors warn that the true impact of air pollution may be underestimated due to major gaps in existing research, particularly a lack of large-scale linked datasets that capture health, environmental exposure and educational outcomes together.

Led by researchers at Swansea University Medical School and Imperial College London, the review is the first to examine how both asthma and outdoor air pollution—individually and in combination—affect school attendance and academic performance in people aged 3 to 19. The team analysed 41 studies published between 2000 and 2024.

There was one consistent finding across the studies: asthma leads to missed school. Young people with uncontrolled or severe asthma had the highest rates of absence, with some studies showing asthma causes more missed days than any other chronic illness. Absences were particularly high among younger children, likely due to smaller body size, faster breathing rates and increased vulnerability to respiratory illness.

Asthma was also linked to lower educational attainment in many studies. The authors suggested several reasons for this, including: reduced attendance; poorer sleep and medication side effects; reduced cognition and emotional wellbeing, and lower participation in physical and classroom activity. In some communities, particularly socioeconomically disadvantaged or ethnic minority groups, the academic impact was even more pronounced.

Lead author Cedric Burden, PhD student at Swansea University, said: “Asthma, in particular when uncontrolled, has been found consistently across the world to be a significant contributor to poorer attendance and attainment for young people in school.”

However, unlike the strong evidence for asthma, the authors found mixed results on whether air pollution alone affects school attendance or attainment. Nonetheless, several important patterns did emerge. Firstly, long-term exposure to pollutants such as PM2.5 (fine particulate matter with a diameter of 2.5 micrometers or less) and NO₂ (nitrogen dioxide, found in urban smog) was repeatedly linked with poorer test scores or higher absenteeism. Secondly, short-term pollution spikes (especially peaks in NO₂) were associated with lower performance in mathematics, and in some cases, English. Thirdly, children in low-income communities experienced worse effects from chronic pollution exposure, while those in affluent communities appeared more vulnerable to acute spikes.

Mr Burden added: “The complexity of environmental exposures (and social circumstances) has hidden important associations between pollution and outcomes for young people.’”

However, these findings were hampered by data gaps; the authors highlighted that only one study worldwide used linked health, environmental and education records. Moreover, the authors also noted that air pollution around schools and along routes children travel daily is rarely analysed as a combined exposure—even though young people spend much of their day moving between home, school buildings and outdoor environments.

Additionally, the authors point out that while much research focuses on polluted urban areas, rural locations, where air pollution sources and patterns differ, were largely neglected. Notably, only two studies examined rural environments, leaving open questions about agricultural, industrial or wildfire-related exposures.

Because most studies rely on surveys or single-year cross-sectional data, the authors warn that the subtle cognitive and developmental effects of pollution may be going undetected. They argue that only large-scale, anonymised linked datasets can uncover the long-term consequences.

“The variety in locations and culture where young people are exposed to air pollution,” said Mr Burden, “can only be addressed by fully considering the full range of populations and geographies.”

This review highlights urgent priorities for governments, schools, and public health bodies. Firstly, the authors call for greater investment in linked data infrastructure to understand how pollution and asthma shape life outcomes. Secondly, they call for greater pollution reduction near schools, especially in disadvantaged areas. The authors also argue that there needs to be improved asthma management support within education systems. Finally, they argue that policy-makers need to consider both chronic exposure and short-term pollution peaks when designing interventions.

The authors said: “Policy and its implementation must provide practical (specific) insights and approaches to address the needs of young people and the places where they live, whilst enabling flexibility to meet the specific needs of local communities.”

This study was funded by Health Data Research UK, Inflammation and Immunity Driver Programme.

Full citation: Burden C, Gassasse Z, Alsallakh M, Quint JK, Fry R, Davies G. Impact of air pollution and asthma on school attendance and educational attainment: a scoping review. BMJ Open Respiratory Research. 2025;12:e003527. https://doi.org/10.1136/bmjresp-2025-003527