Call for evidence on the long term effects of air pollution on children and adults

Royal College of Physicians of Edinburgh, Royal College of Physicians of London and Royal College of Paediatrics and Child Health
call for evidence on the long term effects of air pollution on children and adults

The Royal College of Physicians of Edinburgh (the College) is pleased to respond to the call for evidence on the on the long term effects of air pollution on children and adults.

Overview

Children and young people are affected, as adults are, by levels of all aero pollutants.  There is evidence of adverse effects on respiratory health from high environmental levels of tobacco smoke, particulates and chemical fumes.  However, young children are particularly at risk from inflammatory responses in the growing lung, and so the younger the child the greater the risk.  This is particularly relevant for children with atopia, as research suggests that their susceptibility to asthma may be increased, and reversibility compromised, by the effect of early remodelling associated with aero pollutant exposure.

Although the long term physiology of the respiratory system in infants and children who are born preterm or have respiratory problems and suffer neonatal lung disease is poorly understood, it may be that an early inflammatory process may compromise later function, resulting in reduced potential for recovery from exposure to airborne toxins.

Focus has widened from the obvious environmental hazards of antenatal effects of smoking to the impact of tobacco smoke in the home or car, diesel fumes from vehicle exhausts, chlorine and disinfectant by-products in swimming pools, toxic fumes from chemical products and waste disposal.  As different particulates and airborne fumes vary in density the exposure of small children or infants in buggies to more dense particles may be greater than to taller adults but this is rarely emphasised in environmental studies.

The complex interaction between particle size and chemical composition is often unclear, but the combined risks to the growing airway and lung and to its maturing immune and inflammatory response point to the need for sustained environmental vigilance and atmospheric protection.

Literature review

A recent literature review[i] has highlighted evidence from historical records[ii] showing a link between air pollution and an increase in death rate, and has stated that the body of evidence from scientific studies confirms a strong causal link between air pollution and health. There does not appear to be a level below which health effects are not seen[iii] therefore to protect health there must be a continual attempt to lower air pollution to as low as reasonably practicable, and support improvements in general health thereby reducing the population of vulnerable people.  Research is required to find mechanisms to engage with communities to reduce vehicle use and increase sustainable forms of transport.

Reviews have shown an increased risk of infant mortality as a result of elevated particulate matter (PM) exposure[iv].  There is also evidence of increased morbidity in the first year of life[v] and an increase in asthma in 8-12 year olds linked to exposure to particulate matter (PM₁₀₎ and nitrous oxide[vi] (NO_2).

The literature review found that evidence for the association between air pollution and health has been provided in many studies and summarized in robust reviews[vii] [viii] [ix] [x] and that pollutants from traffic are associated with an increase in all-cause mortality, morbidity from cardiovascular and pulmonary disease, cancer and have a detrimental impact in pregnancy and the neonate.

Conclusion

In summary, therefore, the College wishes to highlight the growing body of evidence which suggest a strong relationship between levels of air pollution and respiratory health.  This relationship may be particularly important to consider in the prevention of childhood respiratory disease, which has the potential to then manifest as chronic adult lung disease.