Air pollution is largely unseen but can have a major impact on patients with respiratory conditions. Kathy Oxtoby reports…
 

Air pollution is a major public health concern. According to Public Health England, poor air quality is “the largest environmental risk to public health in the UK”. Long-term exposure to air pollution can cause chronic respiratory conditions and cardiovascular diseases as well as lung cancer, all leading to reduced life expectancy.1

A 2016 report by the Royal Colleges of Physicians (RCP) and of Paediatrics and Child Health (RCPCH) found that each year in the UK around 40,000 deaths are attributable to exposure to outdoor air pollution.2 In 2010, the Environment Audit Committee considered that the ‘cost of health’ impacts of air pollution was likely to exceed estimates of £8 billion.3

Air pollutants are emitted from a range of both man-made and natural sources. The pollutants vary with places, seasons and times. The major pollutants in outdoor air are particulate matter (PM), ozone (O3), sulphur dioxide (SO2), nitrogen dioxide (NO2), carbon monoxide (CO) and lead (Pb).4

Indoors the major sources of indoor pollutants come from combustion of solid fuels, tobacco smoke, emissions from construction materials and furnishings, and poor ventilation.4

Air pollution is the cause and aggravating factor of many respiratory diseases like chronic obstructive pulmonary disease (COPD), asthma, and lung cancer, studies have found.4

Lung function in adulthood slowly declines with age, and there is emerging evidence that air pollution and living near busy roads can accelerate this decline.1

Research also shows that if children are exposed to air pollution for long periods of time, it can affect how their lungs develop.5 There’s also new evidence that children who grow up in highly polluted areas are more likely to develop asthma.5

For people with lung conditions such as an asthma attack or a COPD, high levels of pollution can cause an exacerbation of their symptoms.6 “In my experience, the sudden or gradual worsening of asthma or COPD and other long-term lung conditions are often pollution-related problems,” says Sid Dajani, contractor at Wainrights Chemist, Bishopstoke, Hampshire.

“People who are living with a lung condition such as asthma or COPD will often find that on days when pollution levels are high, they can't leave their house because it is so much harder for them to breathe and it's making their symptoms much worse than normal,” he says.

Pharmacists help people to understand the effect of air pollution on their health and set out steps they can take to reduce their day-to-day and lifetime exposure to air pollution.

A report published in 2020 by the International Pharmaceutical Federation (FIP) found that community pharmacists could play a bigger role in reducing the health impact of air pollution, but there may be significant training and funding barriers.7

The report looks at the role community pharmacists play in mitigating the impact of pollution around the world and is based on a survey of professional pharmacy organisations in 62 countries. It reveals that while pharmacists promote respiratory health in a number of ways, such as assisting with medication adherence and providing non-pharmacological treatments, just 5 per cent seek out opportunities to discuss and manage the impact of air pollution on respiratory health. A perceived lack of knowledge and need for increased training and a lack of appropriate funding were reported as barriers to taking on a bigger role.

With air pollution the greatest environmental risk to health, FIP practice development lead Goncalo Sousa Pinto says there is “a clear need for pharmacists not only to respond to and manage respiratory illnesses and symptoms, but also to support proactive respiratory wellness”.

Ade Williams, lead pharmacist at Bedminster Pharmacy Bristol, believes pharmacy is “finally waking up” to recognising the impact of air pollution on people’s respiratory health, but says: “I don’t think we’ve fully grasped yet the need for us to lead on this. However, we have got a moral and professional responsibility to do so, or else we are failing our patients”.

Advice is best if it is “tailored to a patient’s level of vulnerability”, says Public Health England.1 “For example, individuals with asthma or other respiratory conditions should be advised not to undertake vigorous exercise when outdoor air pollution levels are high.”1

Patients should be advised to protect themselves by “reducing exposure to air pollution, by avoiding busy roads and streets,” says Mr Dajani. “You can also be more exposed to air pollution inside your car, especially if you're stuck in traffic, than if you walk or cycle. So public transport, cycling and walking should always be the go-to option for short journeys,” he says.

To avoid exposure to high levels of air pollution, people need to be aware of air quality. Pharmacists can advise people to keep an eye on pollution levels in their area on the UK-air website or Defra’s Pollution forecast. Wearing a face mask might be useful for minimising the detrimental effect of ambient air pollutants, research shows.4

To reduce the production of indoor pollutants, people should furniture with low chemical emissions, check the ventilation in the house regularly, ventilate rooms regularly, use clean fuels instead of biomass fuels if possible, and to use an indoor air cleaning device.4

Pharmacists can also help by supporting patients to quit smoking and encourage a high intake of fruit and vegetables which research has shown to have beneficial effects on lung health.4

Patients should be encouraged to take an active  approach in managing their respiratory conditions. They should ensure they know their asthma plan and understand the importance of medication compliance.

Pharmacists could also use their community connections to support patients’ respiratory care by having conversations with local councillors about the need to address pollution issues in their area.

“Everyone needs to be doing more about the problem of pollution,” says Mr Williams. “The pandemic has made everyone aware that respiratory conditions can kill or diminish quality of life. It would help to show patients with respiratory conditions that there’s more that we can do for them.”

References

1 Public Health England (2018) Health matters: air pollution. https://www.gov.uk/government/publications/health-matters-air-pollution/health-matters-air-pollution
2 Royal College of Physicians/Royal College of Paediatrics and Child Health (2016) Every breath we take: the lifelong impact of air pollution. https://www.rcplondon.ac.uk/projects/outputs/every-breath-we-take-lifelong-impact-air-pollution
3 House of Commons Environmental Audit Committee (2010) Air Quality Fifth Report of Session 2009–10 Volume I. https://publications.parliament.uk/pa/cm200910/cmselect/cmenvaud/229/229i.pdf
4 Xu-Qin Jiang et al (2016) Air pollution and chronic airway diseases: what should people know and do?
5 British Lung Foundation (2019) How does air pollution affect children's lungs? https://www.blf.org.uk/support-for-you/risks-to-childrens-lungs/air-pollution
6 British Lung Foundation (2020) What are the effects of air pollution on your lungs?
https://www.blf.org.uk/support-for-you/air-pollution/effects
7  International Pharmaceutical Federation (2020) Mitigating the impact of air pollution on health: The role of community pharmacists. https://www.fip.org/file/4807