Abstract
The detrimental effects of environmental pollution on one’s health are undeniable and have been demonstrated time and time again. Breathing in pollutants in ambient air often has consequences throughout the body, including cardiovascular disease, effects on the reproductive system, and oncologic implications. In the respiratory system, chronic exposure yields a number of outcomes, including chronic obstructive pulmonary disease (COPD) and asthma exacerbations, increased rates of hospitalizations, and increased severity of acute illnesses. On a macro-level, this morbidity and mortality then leads to vast and far-reaching public health consequences the world over, including the loss of billions of dollars’ worth of labor. This is especially applicable in develo** countries, which often undergo rapid growth, industrialization and urbanization with a resultant increase in vehicular traffic, coal combustion, and fuel emissions as a whole. For this reason, environmental pollutants have been studied extensively, and countries around the globe have established laws that regulate ambient air levels of so-called criteria pollutants. This article will explore several of these criteria pollutants, including particulate matter, nitrogen dioxide, sulfur dioxide, and ozone, and their individual relationships to asthma pathophysiology. However, it is also emphasized that though each one of these toxins yields its own effects, the group of them often works together to have cumulative consequences. For these reasons and many more, it is important to remain aware and educated about these omnipresent environmental pollutants.
![](http://media.springernature.com/m312/springer-static/image/art%3A10.1007%2Fs12098-018-2691-3/MediaObjects/12098_2018_2691_Fig1_HTML.png)
![](http://media.springernature.com/m312/springer-static/image/art%3A10.1007%2Fs12098-018-2691-3/MediaObjects/12098_2018_2691_Fig2_HTML.png)
Similar content being viewed by others
References
Zhang Q, Qiu Z, Chung KF, Huang SK. Link between environmental air pollution and allergic asthma: East meets West. J Thoracic Dis. 2015;7:14–22.
Chung KF, Zhang J, Zhong N. Outdoor air pollution and respiratory health in Asia. Respirology. 2011;16:1023–6.
Buka I, Koranteng S, Osornio-Vargas AR. The effects of air pollution on the health of children. Paediatr Child Health. 2006;11:513–6.
Krzyzanowski M, Cohen A. Update of WHO air quality guidelines. Air Qual Atmos Health. 2008;1:7–13.
Guarneiri M, Balmes JR. Outdoor air pollution and asthma. Lancet. 2014;383:1581–92.
Committee on the Medical Effects of Air Pollutants (COMEAP) Asthma and Air Pollution. London, UK: COMEAP; 2014.
Khreis H, Kelly C, Tate J, Parslow R, Lucas K, Nieuwenhuijsen M. Exposure to traffic-related air pollution and risk of development of childhood asthma: a systematic review and meta-analysis. Environ Int. 2017;100:1–31.
McConnell R, Islam T, Shankardass K, et al. Childhood incident asthma and traffic-related air pollution at home and school. Environ Health Perspect. 2010;118:1021–6.
Pollock J, Shi L, Gimbel RW. Outdoor environment and pediatric asthma: an update on the evidence from North America. Can Respir J. 2017;2017:8921917.
Lippmann M. Targeting the components most responsible for airborne particulate matter health risks. J Exposure Sci Environ Epidemiol. 2010;20:117–8.
Stanek LW, Brown JS, Stanek J, Gift J, Costa DL. Air pollution toxicology--a brief review of the role of the science in sha** the current understanding of air pollution health risks. Toxicol Sci. 2011;120:S8–27.
Gowers AM, Cullinan P, Ayres JG, et al. Does outdoor air pollution induce new cases of asthma? Biological plausibility and evidence; a review. Respirology. 2012;17:887–98.
Liu L, Poon R, Chen L, et al. Acute effects of air pollution on pulmonary function, airway inflammation, and oxidative stress in asthmatic children. Environ Health Perspect. 2009;117:668–74.
Jacquemin B, Kauffmann F, Pin I, et al. Air pollution and asthma control in the epidemiological study on the genetics and environment of asthma. J Epidemiol Community Health. 2012;66:796–802.
Iskandar A, Andersen ZJ, Bønnelykke K, et al. Coarse and fine particles but not ultrafine particles in urban air trigger hospital admission for asthma in children. Thorax. 2012;67:252–7.
GBD MAPS Working Group. Burden of disease attributable to major air pollution sources in India. Special Report 21. Boston: Health Effects Institute; 2018.
GBD 2015 Risk Factor Collaborators. Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990-2015: a systematic analysis for the Global Burden of Disease study. Lancet. 2016;388:1659–724.
World Bank and Institute for Health Metrics and Evaluation. The cost of air pollution: strengthening the economic case for action. Washington, DC: World Bank; 2016.
Hijazi K. Environmental pollution and asthma. Pediatr Pulmonol Suppl. 1997;16:205–7.
Spengler JD, Sexton K. Indoor air pollution: a public health perspective. Science. 1983;221:9–17.
Frampton M, Boscia J, Roberts N Jr, et al. Nitrogen dioxide exposure: effects on airway and blood cells. Am J Physiol-Lung Cellular Mol Physiol. 2002;282:L155–65.
Mohsenin V. Airway response to 2.0 ppm nitrogen dioxide in normal subjects. Arch Environ Occup Health. 1988;43:242–6.
Mohsenin V. Airway responses to nitrogen dioxide in asthmatic subjects. J Toxicol Environ Health. 1987;22:371–80.
Hasselblad V, Kotchmar DJ, Eddy DM. Synthesis of environmental evidence: nitrogen dioxide epidemiology studies. J Air Waste Manage Assoc. 1992;42:662–71.
Bevelander M, Mayette J, Whittaker LA, et al. Nitrogen dioxide promotes allergic sensitization to inhaled antigen. J Immunol. 2007;179:3680–8.
Jakab GJ. Modulation of pulmonary defense mechanisms by acute exposures to nitrogen dioxide. Environ Res. 1987;42:215–28.
Rose RM, Fuglestad JM, Skornik WA, et al. The pathophysiology of enhanced susceptibility to murine cytomegalovirus respiratory infection during short-term exposure to 5 ppm nitrogen dioxide. Am Rev Respir Dis. 1988;137:912–7.
U.S. EPA. Integrated science assessment for sulfur oxides - health criteria. EPA/600/R-08/047F, September 2008.
The Asthma Education Clinic. Sulphur dioxide and asthma. 2015. Retrieved February 2018, from The Asthma Education Clinic: http://www.asthmaed.com/journal/2015/7/27/sulphur-dioxide-and-asthma
Durmišević S, Durmišević-Serdarević J, Ahmetović N, Sivic S, Lelić M. The correlation of average monthly ambient sulfur dioxide concentration and the use of inhalation bronchodilators in children. Med Glas (Zenica). 2012;9:397–400.
Deger L, Plante C, Jacques L, et al. Active and uncontrolled asthma among children exposed to air stack emissions of sulphur dioxide from petroleum refineries in Montreal, Quebec: a cross-sectional study. Can Respir J. 2012;19:97–102.
United States Environmental Protection Agency. Health Effects of Ozone in Patients with Asthma and Other Chronic Respiratory Disease. 2017. Retrieved from United States Environmental Protection Agency: https://www.epa.gov/ozone-pollution-and-your-patients-health/health-effects-ozone-patients-asthma-and-other-chronic.
Author information
Authors and Affiliations
Contributions
Both authors contributed to the manuscript preparation. Dr. Krishnan was the senior and supervising author. He will act as guarantor for this paper.
Corresponding author
Ethics declarations
Conflict of Interest
None.
Rights and permissions
About this article
Cite this article
Krishnan, S., Panacherry, S. Asthma, Environment and Pollution: Where the Rubber Hits the Road. Indian J Pediatr 85, 893–898 (2018). https://doi.org/10.1007/s12098-018-2691-3
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12098-018-2691-3