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Pollution in childhood asthma

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Air pollution has been linked to asthma in children for a long time and it’s known to make symptoms worse. According to the World Health Organization, 4.2 million people die every year from exposure to outdoor pollution and 90% of people live in places where air quality does not meet quality standards. Children are particularly at risk. This article looks at the types of pollution that are the worst offenders and what can be done to help children suffering from asthma.

The World Health Organization describes air pollution as contamination of the indoor or outdoor environment by any chemical, physical or biological agent that changes the atmosphere.1 The most common sources are motor vehicles, industrial facilities, forest fires and household combustion devices, which includes boilers and wood or coal-burning stoves and fireplaces.1 Poisonous gases, such as carbon monoxide, ozone, sulphur dioxide and nitrogen dioxide (NO2), as well as particles in the air, like dust, dirt, soot and smoke, are all types of pollution. NO2 is produced by many kinds of vehicles and it has been pointed out that homes and schools that are closer to roads are linked to an increased risk of asthma-related death.2

Recently, scientists have found that pollution in the air could also interfere with our body's ability to tell the difference between an allergen, which can cause an allergic reaction, and dangerous bacteria or a virus.1 Even if the substance is not harmful, our immune system responds by creating inflammation in our body. This can lead to asthma, with wheezing one of the most common symptoms.2

Air pollution is often linked to poor asthma control in children too. Lots of scientific research has shown it can affect how well their lungs are working. These children also use their reliever inhalers more and face increased hospital visits. The level of allergens and pollution around us at any given time is difficult to predict. Even patients who usually have only mild symptoms can suffer a serious flare-up if their asthma is suddenly made worse.

What can we do to reduce the effects of pollution on asthma?

Experts at the Global Initiative for Asthma, known as GINA, recommend switching to heating and cooking devices that do not pollute the air at home, such as heat pumps, wood pellet burners and flued gas. You should always take care to vent pollutants outside wherever possible too.2 GINA says that, although switching to heating that does not cause pollution does not improve the lungs in asthmatic children, the move does significantly reduce their asthma symptoms so they can avoid missing school and going to the doctor.2

Governments have taken some successful action, such as banning smoking in public places, which has been shown to improve life for asthma patients.4 Researchers in Norway tried out a small sensor that measured the air quality at schools so teachers could plan their outdoor activities for the best times. It's also interesting to note that when local traffic was restricted in Beijing during the 2008 Olympic and Paralympic Games, there was a significant fall in asthma patient visits to hospital.2 In addition, evidence suggests that when pollution levels are high, asthma patients should avoid strenuous outdoor activities and stay inside if they can.2

If you are an asthma patient, or care for someone who is, it is also important to manage your condition properly. People whose asthma is well controlled are less sensitive to pollution and usually do not need to make changes to their lifestyle when they're faced with high levels.2

Managing asthma with tools such as FeNO testing can help. Knowing your FeNO level aids in predicting asthma relapse and helping you make the most of your treatment. Did you know that asthma managed using FeNO testing has been shown to reduce asthma attacks by up to 50%?5

FeNO testing is safe, easy and can produce your results in less than two minutes. If you’d like to know more, take a look at the other resources on fenoandasthma.com and ask your healthcare teams for advice.

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Supporting evidence:

1. World Health Organisation. Health topics: Air pollution. www.who.int
2. Global Initiative for Asthma (GINA). Global strategy for asthma management and prevention. 2021 update.
3. Prunicki M et al. Exposure to NO2, CO, and PM2.5 is linked to regional DNA methylation differences in asthma. Clin Epigenetics. 2018;10:2.
4. Burbank AJ, Peden DB. Assessing the impact of air pollution on childhood asthma morbidity: how, when, and what to do. Curr Opin Allergy Clin Immunol. 2018;18(2):124-131.
5. Petsky HL et al. Tailoring asthma treatment on eosinophilic markers (exhaled nitric oxide or sputum eosinophils): a systematic review and meta-analysis. Thorax. 2018;73(12):1110-9.

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