Below are some publications and resources produced by the European Respiratory Society (ERS), relating to the effects of air quality on lung health.
- Air Quality and health
Air quality and health was created by the ERS Environment & Health Committee, primarily as a tool to empower physicians and other health professionals to promote better air quality and defend the health needs of patients and citizens but also to provide politicians, journalists and informed lay readers with an overview of the current knowledge about the nature and health consequences of the prevailing environmental problem of air pollution.
- 10 Principles for Clean air
Air pollution has been linked with a number of health problems including chronic cough, phlegm, lung infections, lung cancer, heart disease and heart attack. Daily concentrations of air pollution in most of Europe are still higher than European Union (EU) target values, causing harm to millions of people across the continent.
Experts from the European Respiratory Society (ERS) have released 10 principles for clean air to help guide Europe’s policy makers to take action to protect people from health risks caused by poor air quality.
The 10 principles for clean air:
1. Citizens are entitled to clean air, just like clean water and safe food.
Although this principle seems obvious, the reality is that millions of Europeans live in areas where it is unsafe to breathe the air around them.
2. Outdoor air pollution is one of the biggest environmental health threats in Europe today, leading to significant reductions of life expectancy and productivity.
The effect of outdoor air pollution should not be underestimated. It can reduce people’s lifespan, cause serious heart and lung disease and reduce the amount of work people are able to do.
Causes of poor air quality:
3. Fine particles and ozone are the most serious pollutants. There is an urgent need to reduce their concentrations significantly.
- Fine particles come from burning fuel, such as diesel in vehicles. They are also formed in the air by chemical reactions involving sulphur and nitrogen oxides
- Ground-level ozone is created by chemical reactions between nitrogen oxides (NOx) and volatile organic compounds (VOC) - emitted by cars, power plants, industrial boilers, refineries, chemical plants and other sources - in the presence of sunlight
4. Roadside pollution poses serious health threats that cannot be adequately addressed by regulating fine particle mass or ozone. Other metrics such as ultrafine particles and black carbon need to be considered in future research and so inform further regulation.
There are some pollutants that are less known than fine particles and ozone, which should be considered in future research. Two examples of these that often exist in the air around the roadside close to where people live and commute, are black carbon and ultrafine particles.
- Black carbon, also known as soot, is generated by the burning of fossil fuels. There is increasing evidence that inhalation of black carbon particles is associated with a wide range of health effects - including heart attacks and reduced lung function
- Ultrafine particles, which come from car exhausts, are much smaller than other particles in the air. They can enter the blood stream and can trigger inflammation
5. Non-tailpipe emissions (from brakes, tires and road surfaces, etc.) pose a health threat for road users and subjects living close to busy roads.
Damaging particles in the air don’t always come from cars’ exhausts, they can also come from the erosion of materials, such as tarmac on the roads and the wear of brakes or tyres from a car.
6. Real-world emissions of nitrogen dioxide from modern diesel engines are much higher than anticipated. This may expose many road users, and subjects living on busy roads, to short-term peak concentrations during rush hours and periods of stagnating weather that may impact on health, although to what extent requires further research.
Modern diesel engines produce more nitrogen dioxide in the real world than when tested in the laboratory. Experts believe that long-term exposure to this gas can cause problems with the lungs. As emissions of this gas seen in recent years are much higher than predicted it could be putting people at risk, particularly those living close to busy roads and those who commute during rush hours. Further research is needed to understand more about this risk.
7. Global warming will lead to more heatwaves, during which air pollution concentrations are also elevated and during which hot temperatures and air pollutants act in synergy to produce more serious health effects than expected from heat or pollution alone.
Hot weather and air pollution together lead to more serious health effects – something that will become increasingly important in the face of global warming.
8. Combustion of biomass fuel produces toxic pollutants. This is true for controlled fires, such as in fireplaces, woodstoves and agricultural burning, as well as for uncontrolled wildfires. There is a need to assess the real health impacts of air pollution from these sources in many areas in Europe to inform on the need for better control.
Biomass includes things such as plants or dead trees. These are burnt across the globe in fireplaces and woodstoves and also during wildfires. This principle suggests experts should focus research on how biomass burning affects our health to help decide how levels can be controlled.
9. Compliance with current limit values for major air pollutants in Europe confers no protection for public health. In fact, very serious health effects occur at concentrations well below current limit values, especially those for fine particles.
Legislation on air pollution in Europe urges governments to reduce concentrations of pollutants to a specific limited value. However, serious health effects can still occur from concentration levels far below the values stated in current legislation, particularly for fine particles.
10. EU policies to reduce air pollution are needed that ultimately lead to air that is clean and no longer associated with significant adverse effects on the health of European citizens. The benefits of such policies outweigh the costs by a large amount.
The final principle highlights the need for EU policies to reduce air pollution so that that the air we breathe is clean and does not damage our health. The benefits of this would far outweigh the costs.
- Respiratory health and indoor air pollutants based on quantitative exposure assessments. Hulin M., Simoni M., Viegi G., Annesi-Maesano I. Eur Respir J 2012; 40: 1033-1045.
- Airways changes related to air pollution exposure in wheezing children. Martins P.C. Valente J., Papoila A.L., Caires I., Araújo-Martins J., Mata P., Lopes M., Torres S., Rosado-Pinto J., Borrego C., Annesi-Maesano I., Neuparth N. Eur Respir J 2012; 39: 246-253.
- Air pollution and multiple acute respiratory outcomes. Faustini Annunziata, Stafoggia Massimo, Colais Paola, Berti Giovanna, Bisanti Luigi, Cadum Ennio, Cernigliaro Achille, Mallone Sandra, Scarnato Corrado, Forastiere Francesco. Eur Respir J 2013; 42: 304-313.
- Air pollution and acute exacerbations of idiopathic pulmonary fibrosis: back to miasma? Jones Mark G., Richeldi Luca. Eur Respir J 2014; 43: 956-959.
- Acute exacerbation of idiopathic pulmonary fibrosis associated with air pollution exposure. Johannson Kerri A., Vittinghoff Eric, Lee Kiyoung, Balmes John R., Ji Wonjun, Kaplan Gilaad G., Kim Dong Soon, Collard Harold R. Eur Respir J 2014; 43: 1124-1131.
- Neighbourhood air quality and snoring in school-aged children. Kheirandish-Gozal Leila, Ghalebandi Mirfarhad, Salehi Mansour, Salarifar Mohammad Hosein, Gozal David. Eur Respir J 2014; 43: 824-832.
- Chronic burden of near-roadway traffic pollution in 10 European cities (APHEKOM network). Laura Perez, Christophe Declercq, Carmen Iñiguez, Inmaculada Aguilera, Chiara Badaloni, Ferran Ballester, Catherine Bouland, Olivier Chanel, Francisco B. Cirarda, Francesco Forastiere, Bertil Forsberg, Daniela Haluza, Britta Hedlund, Koldo Cambra, Marina Lacasaña, Hanns Moshammer, Peter Otorepec, Miguel Rodríguez-Barranco, Sylvia Medina, Nino Künzli. Eur Respir J 2013; 42: 594-605.
- Traffic-related air pollution is related to interrupter resistance in 4-year-old children. Esther Eenhuizen, Ulrike Gehring, Alet H. Wijga, Henriette A. Smit, Paul H. Fischer, Michael Brauer, Gerard H. Koppelman, Marjan Kerkhof, Johan C. de Jongste, Bert Brunekreef, Gerard Hoek. Eur Respir J 2013; 41: 1257-1263
- Why an ERJ series on air pollution? Annesi-Maesano Isabella, Heinrich Joachim, Ayres Jon G., Forastiere Francesco. Eur Respir J 2012; 40: 12-13
- Climate change, extreme weather events, air pollution and respiratory health in Europe. M. De Sario, K. Katsouyanni, P. Michelozzi. Eur Respir J 2013; 42: 826-843
- The airport atmospheric environment: respiratory health at work. Léa Touri, Hélène Marchetti, Irène Sari-Minodier, Nicolas Molinari, Pascal Chanez. Eur Respir Rev, 2013; 128: 124-130.
ERS elearning resources
- Effect of air pollution exposure during pregnancy on the steroid profile of newborns. S. Rüedi, E. Proietti, O. Gorlanova, B. Dick, C. Flück, M. Röösli, P. Latzin, B. M. Frey, U. Frey (Basel, Bern, Switzerland). Annual Congress 2013 - From air pollution during pregnancy to respiratory diseases at work.
- Early life exposure to traffic-related air pollution and lung function in adolescence. E. S. Schultz, J. Hallberg, T. Bellander, A. Bergström, M. Bottai, O. Gruzieva, P. Thunqvist, M. Wickman, G. Pershagen, E. Melén (Stockholm, Sweden). Annual Congress 2013 - Asthma and lung development: from genes to environment.
- From home to the work place: the impact of air quality. N. Kuenzli (Basel, Switzerland). Research Seminar 2013 - ERS Presidential Summit on Research gaps, patient needs and innovative solutions: a forward look on lung health research.
- Air pollution and vulnerability of children to respiratory infections. J. Grigg (London, United Kingdom). Annual Congress 2013 –Paediatric Year in Review.
- Tuberculosis (2012). Editors C. Lange and G.B. Migliori. Chapter 16. TB as an occupational disease by A. Nienhaus, A. Schablon, F. Ringshausen et al.
- Paediatric Asthma (2012). Editors K-H. Carlsen and J. Gerritsen. Chapter 12. Indoor and outdoor air pollution and the development of asthma by J. Grigg.
- Paediatric Lung Function (2010). Editors U. Frey and P.J.F.M. Merkus. Chapter 2. Genetic and environmental factors influencing lung growth and lung function by D. Mullane and P.N. Le Souëf.
- Respiratory Diseases in Infants and Children (2006). Editors U. Frey and J. Gerritsen. Chapter 8. Gene–environment interaction and respiratory disease in children by J. Gerritsen, N.E. Reijmerink, M. Kerkhof et al.
European Respiratory Driving Licence
The primary aim of the European Respiratory Driving Licence is to set educational standards for the training and certification of spirometry at a European level with the ultimate goal of improving patient care and quality of life for respiratory disease patients. This is due to a survey that was conducted in 2008 by ERS on national spirometry training programmes and availability of training in 14 European countries, that confirmed the clear lack of training opportunities in many countries, with most training taking place on the job.
The aim of the Spirometry HERMES project is to train health professionals to produce high quality spirometry tests and award the European Spirometry Driving License. To reach competence, participants will be required to follow a specific training programme. This training programme is put in place across Europe by the European Spirometry trainers. The ERS spirometry train-the trainer programme is mandatory for those hoping to roll out the European Spirometry Driving Licence in their country. The Spirometry train-the-trainer is delivered annually during the ERS Congress. You will find more information on the spirometry train-the-trainer programme on the ERS HERMES website.
ERS elearning resources
- The ESCAPE study: effects of traffic-related air pollution on adult respiratory morbidity. N. Kuenzli (Basel, Switzerland). Annual Congress 2013 –Highlights from ESCAPE.
- Indoor air pollution and vulnerability to bacterial pneumonia in young children: lessons from the developing world. N. Bruce (Liverpool, United Kingdom). Annual Congress 2013 –Pneumococcal pneumonia: animal models to national surveillance.