Asthma and air pollution: The need for a broader public health response

Asthma is one of the most common chronic medical conditions in children. There has been a sharp increase in the global prevalence, morbidity, mortality and economic burden associated with asthma over the past 40 years, particularly in children. Approximately 300 million people worldwide suffer from asthma. (1). The worldwide increase in childhood asthma prevalence has raised concern for the considerable burden of this disease on society as well as individuals (2).

However, the study of asthma is analytically challenging, due to the complexity of the disease and its causes and/or triggers. Factors that have been associated with the development and exacebation of asthma and other atopic diseases include environmental factors, tobacco smoke, genetic predisposition, socioeconomic status, diet and living conditions. There is growing evidence, but an unclear relationship between asthma and urbanisation (3). Some experts are even suggesting that the global rise in asthma is indicative of an early climate change effect on health (4).

Air pollution a mixture of solid particles and gases in the air that if present in sufficient concentrations could cause harm to human health, is regarded as one of the potential environmental risk factors in the development of asthma. The association between air pollution and asthma symptoms is well established, but in recent years researchers have explored the relationship between asthma and particulate matter, ozone and nitroxides, albeit with conflicting results (5). Drug designers and pharmacologists are also interested in understanding asthma at the molecular and systems level with growing interest on specific protein expression.

In light of the growing global emphasis on management of the rising burden of non-communicable diseases, public health professionals in South Africa should:

  • Do more research on external (air pollution and other environmental influences) and internal (molecular mechanism of action) interaction to elucidate the causal relationships.
  • Conduct research that provides evidence of the interaction between air-pollution and asthma at the biology- environment, biology-social and environment-social interface.
  • Ensure collaboration across different disciplines, namely basic scientists, public health professionals, clinicians, health economists, and other social scientists.
  • Explore an appropriate public health response to non- communicable diseases in general, and asthma in particular.
  • Examine the provision of appropriate and cost-effective health services and programmes to deal with the rising burden of non-communicable diseases.

References

  1. Braman SS. The Global Burden of Asthma. CHEST. 2006; 130:4S–12S. Link to article
  2. Lai CK, Beasley R, Crane J, Foliaki S, Shah J, Weiland S; International Study of Asthma and Allergies in Childhood Phase Three Study Group. Global variation in the prevalence and severity of asthma symptoms: phase three of the International Study of Asthma and Allergies in Childhood (ISAAC). Thorax. 2009;64(6):476-83. Link to article
  3. WHO. Chronic and Respiratory Diseases. Asthma: causes. http://www.who.int/respiratory/asthma/causes/en/index.html Accessed 9 May 2011.
  4. Weiland SK, Hüsing A, Strachan DP, Rzehak P, Pearce N; the ISAAC Phase One Study Group. Climate and the prevalence of symptoms of asthma, allergic rhinitis, and atopic eczema in children. Occup Environ Med. 2004;61:609-615. Link to article
  5. Weinmayr G, Romeo E, De Sario M, Weiland SK, Forastiere. Short-Term Effects of PM10 and NO2 on Respiratory Health among Children with Asthma or Asthma-like Symptoms: A Systematic Review and Meta-Analysis. Environ Health Perspect. 2010;118:449-457. Link to article
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