The impact of air pollution on asthma: clinical outcomes, current epidemiology, and health disparities

ABSTRACT

Introduction

Air pollution has been shown to have a significant impact on morbidity and mortality of respiratory illnesses including asthma.

Areas covered

Outdoor air pollution consists of a mixture of individual pollutants including vehicle traffic and industrial pollution. Studies have implicated an array of individual components of air pollution, with PM_2.5, NO₂, SO₂, and ozone being the most classically described, and newer literature implicating other pollutants such as black carbon and volatile organic compounds. Epidemiological and cohort studies have described incidence and prevalence of pollution-related asthma and investigated both acute and chronic air pollution exposure as they relate to asthma outcomes. There is an increasing body of literature tying disparities in pollution exposure to clinical outcomes. In this narrative review, we assessed the published research investigating the association of pollution with asthma outcomes, focusing on the adult population and health care disparities.

Expert opinion

Pollution has multiple deleterious effects on respiratory health but there is a lack of data on individualized pollution monitoring, making it difficult to establish a temporal relationship between exposure and symptoms, thereby limiting our understanding of safe exposure levels. Future research should focus on more personalized monitoring and treatment plans for mitigating exposure.

KEYWORDS:

• Air Pollution
• asthma
• health disparities
• particulate matter
• traffic related air pollution

Article highlights

• Ambient air pollution and indoor air pollution are major contributors to disease burden for respiratory illnesses and have been recognized as leading causes of asthma morbidity and major contributors to mortality globally.

• Acute increases in air pollutant levels can trigger asthma exacerbations requiring emergency room utilization and necessitating hospitalization.

• It has been well established that chronic pollution exposure increases asthma incidence in children, and an increasing amount of evidence suggests that long-term pollution exposure can lead to asthma onset in adulthood.

• There are significant disparities in pollution exposure, leading to worse asthma outcomes in minorities and individuals of lower socioeconomic status.

• Local and national pollution data are widely accessible and personal monitoring devices that provide more individual level assessment of pollution exposure are becoming increasingly available, which may allow for better mitigation strategies and individualized asthma care.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have received an honorarium from Expert Review of Respiratory Medicine for their review work. Peer reviewers on this manuscript have no other relevant financial relationships or otherwise to disclose.

Additional information

Funding

This paper was not funded.