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. 1994 May;70(823):319–325. doi: 10.1136/pgmj.70.823.319

Air pollution and asthma.

P J Barnes 1
PMCID: PMC2397595  PMID: 8016001

Abstract

The role of air pollution in the increased prevalence and morbidity of asthma has been widely debated, but results to date indicate that the normally encountered levels of air pollution are unlikely to contribute to a worsening of asthma. When the levels of sulphur dioxide (SO2) are exceptionally high it is possible that asthmatic patients may have increased symptoms after exertion, since this irritant gas acts as a trigger to bronchoconstriction. There is also evidence that suspended particles may also act as an inciter of asthma symptoms when concentrations are high. Experimentally, ozone in high concentrations may increase airway responsiveness in both normal and asthmatic subjects by inducing airway inflammation, but asthmatic individuals show the same responses as normal subjects and there is little or no evidence to link increases in ambient ozone with an increase in asthma. There is little evidence that nitrogen dioxide (NO2), even at the peak levels recorded, has any significant effect on airway function in normal or asthmatic individuals. Other air pollutants which are present in lower concentrations have not been studied as extensively, but there is no convincing evidence that they cause significant respiratory symptoms in asthmatic patients. It is still possible that combinations of air pollutants may have greater effects on airway function than exposure to a single pollutant, although there is little evidence to support this. Epidemiological evidence provides little support for the idea that atmospheric pollution levels are related to the frequency of asthma symptoms or the frequency of attacks. More importantly, there is no evidence that asthma prevalence or aetiology is related to the level of air pollution. A review of currently available information therefore provides little evidence for the widely expressed view that atmospheric pollution is related to increased prevalence or morbidity of asthma or is related to the causation of asthma.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Adams W. C., Brookes K. A., Schelegle E. S. Effects of NO2 alone and in combination with O3 on young men and women. J Appl Physiol (1985) 1987 Apr;62(4):1698–1704. doi: 10.1152/jappl.1987.62.4.1698. [DOI] [PubMed] [Google Scholar]
  2. Aris R. M., Christian D., Hearne P. Q., Kerr K., Finkbeiner W. E., Balmes J. R. Ozone-induced airway inflammation in human subjects as determined by airway lavage and biopsy. Am Rev Respir Dis. 1993 Nov;148(5):1363–1372. doi: 10.1164/ajrccm/148.5.1363. [DOI] [PubMed] [Google Scholar]
  3. Aris R., Christian D., Sheppard D., Balmes J. R. Acid fog-induced bronchoconstriction. The role of hydroxymethanesulfonic acid. Am Rev Respir Dis. 1990 Mar;141(3):546–551. doi: 10.1164/ajrccm/141.3.546. [DOI] [PubMed] [Google Scholar]
  4. Avol E. L., Linn W. S., Peng R. C., Valencia G., Little D., Hackney J. D. Laboratory study of asthmatic volunteers exposed to nitrogen dioxide and to ambient air pollution. Am Ind Hyg Assoc J. 1988 Apr;49(4):143–149. doi: 10.1080/15298668891379530. [DOI] [PubMed] [Google Scholar]
  5. Barnes P. J., Belvisi M. G. Nitric oxide and lung disease. Thorax. 1993 Oct;48(10):1034–1043. doi: 10.1136/thx.48.10.1034. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Barnes P. J., Lee T. H. Recent advances in asthma. Postgrad Med J. 1992 Dec;68(806):942–953. doi: 10.1136/pgmj.68.806.942. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Bascom R., Naclerio R. M., Fitzgerald T. K., Kagey-Sobotka A., Proud D. Effect of ozone inhalation on the response to nasal challenge with antigen of allergic subjects. Am Rev Respir Dis. 1990 Sep;142(3):594–601. doi: 10.1164/ajrccm/142.3.594. [DOI] [PubMed] [Google Scholar]
  8. Bauer M. A., Utell M. J., Morrow P. E., Speers D. M., Gibb F. R. Inhalation of 0.30 ppm nitrogen dioxide potentiates exercise-induced bronchospasm in asthmatics. Am Rev Respir Dis. 1986 Dec;134(6):1203–1208. doi: 10.1164/arrd.1986.134.6.1203. [DOI] [PubMed] [Google Scholar]
  9. Braun-Fahrländer C., Ackermann-Liebrich U., Schwartz J., Gnehm H. P., Rutishauser M., Wanner H. U. Air pollution and respiratory symptoms in preschool children. Am Rev Respir Dis. 1992 Jan;145(1):42–47. doi: 10.1164/ajrccm/145.1.42. [DOI] [PubMed] [Google Scholar]
  10. Burney P. G. Asthma. Epidemiology. Br Med Bull. 1992 Jan;48(1):10–22. doi: 10.1093/oxfordjournals.bmb.a072527. [DOI] [PubMed] [Google Scholar]
  11. Burney P. G., Chinn S., Rona R. J. Has the prevalence of asthma increased in children? Evidence from the national study of health and growth 1973-86. BMJ. 1990 May 19;300(6735):1306–1310. doi: 10.1136/bmj.300.6735.1306. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Devalia J. L., Campbell A. M., Sapsford R. J., Rusznak C., Quint D., Godard P., Bousquet J., Davies R. J. Effect of nitrogen dioxide on synthesis of inflammatory cytokines expressed by human bronchial epithelial cells in vitro. Am J Respir Cell Mol Biol. 1993 Sep;9(3):271–278. doi: 10.1165/ajrcmb/9.3.271. [DOI] [PubMed] [Google Scholar]
  13. Devlin R. B., McDonnell W. F., Mann R., Becker S., House D. E., Schreinemachers D., Koren H. S. Exposure of humans to ambient levels of ozone for 6.6 hours causes cellular and biochemical changes in the lung. Am J Respir Cell Mol Biol. 1991 Jan;4(1):72–81. doi: 10.1165/ajrcmb/4.1.72. [DOI] [PubMed] [Google Scholar]
  14. Djukanović R., Roche W. R., Wilson J. W., Beasley C. R., Twentyman O. P., Howarth R. H., Holgate S. T. Mucosal inflammation in asthma. Am Rev Respir Dis. 1990 Aug;142(2):434–457. doi: 10.1164/ajrccm/142.2.434. [DOI] [PubMed] [Google Scholar]
  15. Dockery D. W., Speizer F. E., Stram D. O., Ware J. H., Spengler J. D., Ferris B. G., Jr Effects of inhalable particles on respiratory health of children. Am Rev Respir Dis. 1989 Mar;139(3):587–594. doi: 10.1164/ajrccm/139.3.587. [DOI] [PubMed] [Google Scholar]
  16. Evans R., 3rd, Mullally D. I., Wilson R. W., Gergen P. J., Rosenberg H. M., Grauman J. S., Chevarley F. M., Feinleib M. National trends in the morbidity and mortality of asthma in the US. Prevalence, hospitalization and death from asthma over two decades: 1965-1984. Chest. 1987 Jun;91(6 Suppl):65S–74S. [PubMed] [Google Scholar]
  17. FRY J. Effects of a severe fog on a general practice. Lancet. 1953 Jan 31;1(6753):235–236. doi: 10.1016/s0140-6736(53)90906-4. [DOI] [PubMed] [Google Scholar]
  18. Fleming D. M., Crombie D. L. Prevalence of asthma and hay fever in England and Wales. Br Med J (Clin Res Ed) 1987 Jan 31;294(6567):279–283. doi: 10.1136/bmj.294.6567.279. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Folinsbee L. J., Bedi J. F., Horvath S. M. Pulmonary function changes after 1 h continuous heavy exercise in 0.21 ppm ozone. J Appl Physiol Respir Environ Exerc Physiol. 1984 Oct;57(4):984–988. doi: 10.1152/jappl.1984.57.4.984. [DOI] [PubMed] [Google Scholar]
  20. Frampton M. W., Morrow P. E., Cox C., Gibb F. R., Speers D. M., Utell M. J. Effects of nitrogen dioxide exposure on pulmonary function and airway reactivity in normal humans. Am Rev Respir Dis. 1991 Mar;143(3):522–527. doi: 10.1164/ajrccm/143.3.522. [DOI] [PubMed] [Google Scholar]
  21. Hackney J. D., Linn W. S., Avol E. L. Acid fog: effects on respiratory function and symptoms in healthy and asthmatic volunteers. Environ Health Perspect. 1989 Feb;79:159–162. doi: 10.1289/ehp.8979159. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Hackney J. D., Linn W. S., Avol E. L., Shamoo D. A., Anderson K. R., Solomon J. C., Little D. E., Peng R. C. Exposures of older adults with chronic respiratory illness to nitrogen dioxide. A combined laboratory and field study. Am Rev Respir Dis. 1992 Dec;146(6):1480–1486. doi: 10.1164/ajrccm/146.6.1480. [DOI] [PubMed] [Google Scholar]
  23. Hazucha M. J., Ginsberg J. F., McDonnell W. F., Haak E. D., Jr, Pimmel R. L., Salaam S. A., House D. E., Bromberg P. A. Effects of 0.1 ppm nitrogen dioxide on airways of normal and asthmatic subjects. J Appl Physiol Respir Environ Exerc Physiol. 1983 Mar;54(3):730–739. doi: 10.1152/jappl.1983.54.3.730. [DOI] [PubMed] [Google Scholar]
  24. Hoek G., Fischer P., Brunekreef B., Lebret E., Hofschreuder P., Mennen M. G. Acute effects of ambient ozone on pulmonary function of children in The Netherlands. Am Rev Respir Dis. 1993 Jan;147(1):111–117. doi: 10.1164/ajrccm/147.1.111. [DOI] [PubMed] [Google Scholar]
  25. Holtzman M. J., Cunningham J. H., Sheller J. R., Irsigler G. B., Nadel J. A., Boushey H. A. Effect of ozone on bronchial reactivity in atopic and nonatopic subjects. Am Rev Respir Dis. 1979 Nov;120(5):1059–1067. doi: 10.1164/arrd.1979.120.5.1059. [DOI] [PubMed] [Google Scholar]
  26. Högman M., Frostell C. G., Hedenström H., Hedenstierna G. Inhalation of nitric oxide modulates adult human bronchial tone. Am Rev Respir Dis. 1993 Dec;148(6 Pt 1):1474–1478. doi: 10.1164/ajrccm/148.6_Pt_1.1474. [DOI] [PubMed] [Google Scholar]
  27. Ishizaki T., Koizumi K., Ikemori R., Ishiyama Y., Kushibiki E. Studies of prevalence of Japanese cedar pollinosis among the residents in a densely cultivated area. Ann Allergy. 1987 Apr;58(4):265–270. [PubMed] [Google Scholar]
  28. Jörres R., Magnussen H. Effect of 0.25 ppm nitrogen dioxide on the airway response to methacholine in asymptomatic asthmatic patients. Lung. 1991;169(2):77–85. doi: 10.1007/BF02714145. [DOI] [PubMed] [Google Scholar]
  29. Kleinman M. T., Bailey R. M., Linn W. S., Anderson K. R., Whynot J. D., Shamoo D. A., Hackney J. D. Effects of 0.2 ppm nitrogen dioxide on pulmonary function and response to bronchoprovocation in asthmatics. J Toxicol Environ Health. 1983 Oct-Dec;12(4-6):815–826. doi: 10.1080/15287398309530472. [DOI] [PubMed] [Google Scholar]
  30. Koenig J. Q., Covert D. S., Hanley Q. S., van Belle G., Pierson W. E. Prior exposure to ozone potentiates subsequent response to sulfur dioxide in adolescent asthmatic subjects. Am Rev Respir Dis. 1990 Feb;141(2):377–380. doi: 10.1164/ajrccm/141.2.377. [DOI] [PubMed] [Google Scholar]
  31. Koenig J. Q., Covert D. S., Marshall S. G., Van Belle G., Pierson W. E. The effects of ozone and nitrogen dioxide on pulmonary function in healthy and in asthmatic adolescents. Am Rev Respir Dis. 1987 Nov;136(5):1152–1157. doi: 10.1164/ajrccm/136.5.1152. [DOI] [PubMed] [Google Scholar]
  32. Koren H. S., Devlin R. B., Graham D. E., Mann R., McGee M. P., Horstman D. H., Kozumbo W. J., Becker S., House D. E., McDonnell W. F. Ozone-induced inflammation in the lower airways of human subjects. Am Rev Respir Dis. 1989 Feb;139(2):407–415. doi: 10.1164/ajrccm/139.2.407. [DOI] [PubMed] [Google Scholar]
  33. Kurata J. H., Glovsky M. M., Newcomb R. L., Easton J. G. A multifactorial study of patients with asthma. Part 2: air pollution, animal dander and asthma symptoms. Ann Allergy. 1976 Dec;37(6):398–409. [PubMed] [Google Scholar]
  34. Linn W. S., Avol E. L., Peng R. C., Shamoo D. A., Hackney J. D. Replicated dose-response study of sulfur dioxide effects in normal, atopic, and asthmatic volunteers. Am Rev Respir Dis. 1987 Nov;136(5):1127–1134. doi: 10.1164/ajrccm/136.5.1127. [DOI] [PubMed] [Google Scholar]
  35. Linn W. S., Shamoo D. A., Avol E. L., Whynot J. D., Anderson K. R., Venet T. G., Hackney J. D. Dose-response study of asthmatic volunteers exposed to nitrogen dioxide during intermittent exercise. Arch Environ Health. 1986 Sep-Oct;41(5):292–296. doi: 10.1080/00039896.1986.9936699. [DOI] [PubMed] [Google Scholar]
  36. Magnussen H., Jörres R., Nowak D. Effect of air pollution on the prevalence of asthma and allergy: lessons from the German reunification. Thorax. 1993 Sep;48(9):879–881. doi: 10.1136/thx.48.9.879. [DOI] [PMC free article] [PubMed] [Google Scholar]
  37. Molfino N. A., Wright S. C., Katz I., Tarlo S., Silverman F., McClean P. A., Szalai J. P., Raizenne M., Slutsky A. S., Zamel N. Effect of low concentrations of ozone on inhaled allergen responses in asthmatic subjects. Lancet. 1991 Jul 27;338(8761):199–203. doi: 10.1016/0140-6736(91)90346-q. [DOI] [PubMed] [Google Scholar]
  38. OSHIMA Y., ISHIZAKI T., MIYAMOTO T., KABE J., MAKINO S. A STUDY OF TOKYO-YOKOHAMA ASTHMA AMONG JAPANESE. Am Rev Respir Dis. 1964 Oct;90:632–634. doi: 10.1164/arrd.1964.90.4.632. [DOI] [PubMed] [Google Scholar]
  39. Orehek J., Massari J. P., Gayrard P., Grimaud C., Charpin J. Effect of short-term, low-level nitrogen dioxide exposure on bronchial sensitivity of asthmatic patients. J Clin Invest. 1976 Feb;57(2):301–307. doi: 10.1172/JCI108281. [DOI] [PMC free article] [PubMed] [Google Scholar]
  40. Peat J. K., Salome C. M., Woolcock A. J. Factors associated with bronchial hyperresponsiveness in Australian adults and children. Eur Respir J. 1992 Sep;5(8):921–929. [PubMed] [Google Scholar]
  41. Pierson W. E., Koenig J. Q. Respiratory effects of air pollution on allergic disease. J Allergy Clin Immunol. 1992 Oct;90(4 Pt 1):557–566. doi: 10.1016/0091-6749(92)90128-o. [DOI] [PubMed] [Google Scholar]
  42. Pope C. A., 3rd, Dockery D. W. Acute health effects of PM10 pollution on symptomatic and asymptomatic children. Am Rev Respir Dis. 1992 May;145(5):1123–1128. doi: 10.1164/ajrccm/145.5.1123. [DOI] [PubMed] [Google Scholar]
  43. Rubinstein I., Bigby B. G., Reiss T. F., Boushey H. A., Jr Short-term exposure to 0.3 ppm nitrogen dioxide does not potentiate airway responsiveness to sulfur dioxide in asthmatic subjects. Am Rev Respir Dis. 1990 Feb;141(2):381–385. doi: 10.1164/ajrccm/141.2.381. [DOI] [PubMed] [Google Scholar]
  44. Samet J. M., Utell M. J. The risk of nitrogen dioxide: what have we learned from epidemiological and clinical studies? Toxicol Ind Health. 1990 Mar;6(2):247–262. [PubMed] [Google Scholar]
  45. Sheppard D., Wong W. S., Uehara C. F., Nadel J. A., Boushey H. A. Lower threshold and greater bronchomotor responsiveness of asthmatic subjects to sulfur dioxide. Am Rev Respir Dis. 1980 Dec;122(6):873–878. doi: 10.1164/arrd.1980.122.6.873. [DOI] [PubMed] [Google Scholar]
  46. Wardlaw A. J. The role of air pollution in asthma. Clin Exp Allergy. 1993 Feb;23(2):81–96. doi: 10.1111/j.1365-2222.1993.tb00303.x. [DOI] [PubMed] [Google Scholar]
  47. Ware J. H., Ferris B. G., Jr, Dockery D. W., Spengler J. D., Stram D. O., Speizer F. E. Effects of ambient sulfur oxides and suspended particles on respiratory health of preadolescent children. Am Rev Respir Dis. 1986 May;133(5):834–842. [PubMed] [Google Scholar]
  48. Weitzman M., Gortmaker S. L., Sobol A. M., Perrin J. M. Recent trends in the prevalence and severity of childhood asthma. JAMA. 1992 Nov 18;268(19):2673–2677. [PubMed] [Google Scholar]
  49. Wichmann H. E., Mueller W., Allhoff P., Beckmann M., Bocter N., Csicsaky M. J., Jung M., Molik B., Schoeneberg G. Health effects during a smog episode in West Germany in 1985. Environ Health Perspect. 1989 Feb;79:89–99. doi: 10.1289/ehp.897989. [DOI] [PMC free article] [PubMed] [Google Scholar]
  50. Zwick H., Popp W., Wagner C., Reiser K., Schmöger J., Böck A., Herkner K., Radunsky K. Effects of ozone on the respiratory health, allergic sensitization, and cellular immune system in children. Am Rev Respir Dis. 1991 Nov;144(5):1075–1079. doi: 10.1164/ajrccm/144.5.1075. [DOI] [PubMed] [Google Scholar]
  51. von Mutius E., Fritzsch C., Weiland S. K., Röll G., Magnussen H. Prevalence of asthma and allergic disorders among children in united Germany: a descriptive comparison. BMJ. 1992 Dec 5;305(6866):1395–1399. doi: 10.1136/bmj.305.6866.1395. [DOI] [PMC free article] [PubMed] [Google Scholar]

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