Environmental pollution has been a matter of concern for many years. The Mellon Institute of Pittsburgh, PA, USA, sponsored the first broad scientific study of smoke abatement, which resulted in legislation designed to decrease the effects of smoke. It is now well known that environmental contamination impacts on health; the World Health Organization estimates that every year, 2.4 million people die from causes associated with air pollution. It is increasingly recognized that the implementation of strategies to reduce pollution can have substantial health benefits. For example, the Environmental Protection Agency proposed that the implementation of measures to reduce emissions from diesel engines could result in 12 000 fewer mortalities and prevent 15 000 heart attacks and 8900 hospital admissions in the United States each year.2 The aim of this review is to provide information on the impact of pollution on respiratory health, as well as to discuss strategies for reducing air pollution, as proposed in a number of clinical reports. Particulate matter (PM) and ozone (O3) pollution are major causes of concern in the community. PM is a complex mixture of solid and liquid particles suspended in air that is released into the atmosphere when coal, gasoline, diesel fuels, and wood are burned. It is also produced by chemical reactions of nitrogen oxides and organic compounds that occur in the environment.
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Vegetation and livestock are also sources of PM. In big cities, production of PM is attributed to cars, trucks and coal-fired power plants. The health effects of PM depend on several factors, including the size and composition of the particles, the level, and duration of exposure, and the gender, age, and sensitivity of the exposed individual. Symptoms of exposure may include a persistent cough, sore throat, burning eyes, and chest tightness. PM may also trigger asthma or lead to premature death, particularly in elderly individuals with the pre-existing disease. In addition, people who are active outdoors are at higher risk, as physical activity increases the amounts of PM penetrating into the airways. People with disease (e.g. diabetes mellitus, malnutrition) are also at increased risk. A comprehensive review of diesel PM by Ristovski was published in an earlier issue of this review series on air pollution and lung disease. Air pollution currently affects the health of millions of people. We have presented evidence on the effects of pollutants on patients with limitations in their respiratory capacities.
For example, O3 and PM may trigger asthma symptoms or lead to premature death, particularly in elderly individuals with pre-existing respiratory or cardiovascular disease. In addition, pollutants enhance the release of allergenic pollen grains, which results in an increased prevalence of pollen-induced asthma. Thus, the case for action to reduce air pollution is overwhelming and this action can take many forms. Some of these include urban planning, technological developments (e.g. the design of new vehicles that produce less pollution), and at the government level, the introduction of new laws. It has been estimated that reducing both black carbon and O3 levels would prevent over 3 million premature deaths and increase crop yields by around 50 million tonnes annually. Improvements to cooking stoves would also decrease the demand for firewood and reduce deforestation in the developing world. Similarly, improved brick kilns that are used in parts of Latin America and Asia use 50% of the fuel used by traditional kilns.
If air pollution levels in heavy traffic areas were reduced, the incidence of asthma and other respiratory diseases would be significantly reduced. While it is generally accepted that efforts to reduce air pollution will prevent further environmental changes, they will not reverse existing warming. Interestingly, an increasing number of studies show that in individuals with low antioxidant levels, dietary supplements could be used as a promising approach to reducing susceptibility to air pollution, and providing an alternative strategy for neutralizing the effects of pollutants on health.
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