Asia Pacific Association of Allergy Asthma and Clinical Immunology White Paper 2020 on climate change, air pollution, and biodiversity in Asia-Pacific and impact on allergic diseases

Ruby Pawankar; Jiu-Yao Wang; I-Jen Wang; Francis Thien; Yoon-Seok Chang; Amir Hamzah Abdul Latiff; Takao Fujisawa; Luo Zhang; Bernard Yu-Hor Thong; Pantipa Chatchatee; Ting Fan Leung; Wasu Kamchaisatian; Iris Rengganis; Ho Joo Yoon; Sonomjamts Munkhbayarlakh; Marysia T. Recto; Anne Goh Eng Neo; Duy Le Pham; Le Thi Tuyet Lan; Janet Mary Davies; Jae Won Oh

doi:10.5415/apallergy.2020.10.e11

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Pawankar, Wang, Wang, Thien, Chang, Latiff, Fujisawa, Zhang, Thong, Chatchatee, Leung, Kamchaisatian, Rengganis, Yoon, Munkhbayarlakh, Recto, Neo, Pham, Lan, Davies, and Oh: Asia Pacific Association of Allergy Asthma and Clinical Immunology White Paper 2020 on climate change, air pollution, and biodiversity in Asia-Pacific and impact on allergic diseases

Current Review

Asia Pac Allergy 2020;10(1):e11.

Published online: 4 January 2020

DOI: https://doi.org/10.5415/apallergy.2020.10.e11

Asia Pacific Association of Allergy Asthma and Clinical Immunology White Paper 2020 on climate change, air pollution, and biodiversity in Asia-Pacific and impact on allergic diseases

Ruby Pawankar^1,^*, Jiu-Yao Wang², I-Jen Wang³, Francis Thien⁴, Yoon-Seok Chang⁵, Amir Hamzah Abdul Latiff⁶, Takao Fujisawa⁷, Luo Zhang⁸, Bernard Yu-Hor Thong⁹, Pantipa Chatchatee¹⁰, Ting Fan Leung¹¹, Wasu Kamchaisatian¹², Iris Rengganis¹³, Ho Joo Yoon¹⁴, Sonomjamts Munkhbayarlakh¹⁵, Marysia T. Recto¹⁶, Anne Goh Eng Neo¹⁷, Duy Le Pham¹⁸, Le Thi Tuyet Lan¹⁹, Janet Mary Davies²⁰, Jae Won Oh²¹

¹Department of Pediatrics, Nippon Medical School, Tokyo, Japan

²Division of Allergy and Clinical Immunology, Department of Pediatrics, College of Medicine, National Cheng Kung University, Tainan, Taiwan

³Department of Pediatrics, Taipei Hospital, Ministry of Health and Welfare; School of Medicine, National Yang–Ming University, Taipei; College of Public Health, China Medical University, Taichung, Taiwan

⁴Eastern Health, Monash University, Melbourne, Australia

⁵Division of Allergy and Clinical Immunology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea

⁶Allergy & Immunology Centre, Pantai Hospital Kuala Lumpur, Kuala Lumpur, Malaysia

⁷Institute for Clinical Research, Mie National Hospital, Tsu, Japan

⁸Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital, Medical University, Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China

⁹Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, Singapore

¹⁰Pediatric Allergy & Clinical Immunology Research Unit, Division of Allergy and Immunology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand

¹¹Department of Paediatrics, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China

¹²Division of Allergy and Immunology, Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand

¹³Department of Internal Medicine, Faculty of Medicine, University of Indonesia, Cipto Mangunkusumo National Hospital, Jakarta, Indonesia

¹⁴Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea

¹⁵Department of Pulmonology and Allergology, School of Medicine, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia

¹⁶Division of Adult and Pediatric Allergy and Immunology, University of the Philippines College of Medicine, Philippine General Hospital, Manila, the Philippines

¹⁷Department of Paediatrics, KK Women's and Children's Hospital, Singapore

¹⁸Medicine Faculty, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam

¹⁹Hochiminh city Asthma, Allergy and Clinical Immunology Society, UMC, University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam

²⁰School of Biomedical Sciences, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD; AustraliaOffice of Research, Metro North Hospital and Health Service, Herston, QLD, Australia

²¹Department of Pediatrics, Hanyang University Guri Hospital, Hanyang University College of Medicine, Seoul, Korea

^*Correspondence to Ruby Pawankar Division of Allergy, Department of Pediatrics, Nippon Medical School, 1-1-5, Sendagi, Bunkyo-ku, Tokyo, Japan. Tel/Fax: +81-3-5802-8177 E-mail: pawankar.ruby@gmail.com

Received 30 January 2020 Accepted 5 February 2020

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Air pollution, climate change, and reduced biodiversity are major threats to human health with detrimental effects on a variety of chronic noncommunicable diseases in particular respiratory and cardiovascular diseases. The extent of air pollution both outdoor and indoor air pollution and climate change including global warming is increasing-to alarming proportions particularly in the developing world especially rapidly industrializing countries worldwide. In recent years, Asia has experienced rapid economic growth and a deteriorating environment and increase in allergic diseases to epidemic proportions. Air pollutant levels in many Asian countries especially in China and India are substantially higher than are those in developed countries. Moreover, industrial, traffic-related, and household biomass combustion, indoor pollutants from chemicals and tobacco are major sources of air pollutants, with increasing burden on respiratory allergies. Here we highlight the major components of outdoor and indoor air pollutants and their impacts on respiratory allergies associated with asthma and allergic rhinitis in the Asia-Pacific region. With Asia-Pacific comprising more than half of the world's population there is an urgent need to increase public awareness, highlight targets for interventions, public advocacy and a call to action to policy makers to implement policy changes towards reducing air pollution with interventions at a population-based level.

Keywords: Climate change, Air pollution, Allergic disease, Asia-Pacific

References

1. Haahtela T, Holgate S, Pawankar R, Akdis CA, Benjaponpitak S, Caraballo L, Demain J, Portnoy J. von Hertzen LWAO Special Committee on Climate Change and Biodiversity. The biodiversity hypothesis and allergic disease: world allergy organization position statement. World Allergy Organ J. 2013; 6:3.

2. Pawankar R, Canonica GW, Holgate ST, Lockey RF, Blaiss M. World Allergy Organization (WAO) White Book on Allergy: Update 2013. Milwaukee (WI): World Allergy Organization;2013.

3. Dockery DW, Stone PH. Cardiovascular risks from fine particulate air pollution. N Engl J Med. 2007; 356:511–3.

4. Ayres JG, Forsberg B, Annesi-Maesano I, Dey R, Ebi KL, Helms PJ, Medina-Ramón M, Windt M. Forastiere FEnvironment and Health Committee of the European Respiratory Society. Climate change and respiratory disease: European Respiratory Society position statement. Eur Respir J. 2009; 34:295–302.

5. Michelozzi P, Accetta G, De Sario M, D'Ippoliti D, Marino C, Baccini M, Biggeri A, Anderson HR, Katsouyanni K, Ballester F, Bisanti L, Cadum E, Forsberg B, Forastiere F, Goodman PG, Hojs A, Kirchmayer U, Medina S, Paldy A, Schindler C, Sunyer J. Perucci CAPHEWE Collaborative Group. High temperature and hospitalizations for cardiovascular and respiratory causes in 12 European cities. Am J Respir Crit Care Med. 2009; 179:383–9.

6. Robine JM, Cheung SL, Le Roy S, Van Oyen H, Herrmann FR. Report on excess mortality in Europe during summer 2003 (EU Community Action Programme for Public Health, Grant Agreement 2005114). Montpellier: 2003 Heat Wave Project. Europe;2007.

7. Baccini M, Biggeri A, Accetta G, Kosatsky T, Katsouyanni K, Analitis A, Anderson HR, Bisanti L, D'Ippoliti D, Danova J, Forsberg B, Medina S, Paldy A, Rabczenko D, Schindler C, Michelozzi P. Heat effects on mortality in 15 European cities. Epidemiology. 2008; 19:711–9.

8. Delfino RJ, Brummel S, Wu J, Stern H, Ostro B, Lipsett M, Winer A, Street DH, Zhang L, Tjoa T, Gillen DL. The relationship of respiratory and cardiovascular hospital admissions to the southern California wildfires of 2003. Occup Environ Med. 2009; 66:189–97.

9. Dennekamp M, Abramson MJ. The effects of bushfire smoke on respiratory health. Respirology. 2011; 16:198–209.

10. Takaro TK, Knowlton K, Balmes JR. Climate change and respiratory health: current evidence and knowledge gaps. Expert Rev Respir Med. 2013; 7:349–61.

11. D'Amato G, Baena-Cagnani CE, Cecchi L, Annesi-Maesano I, Nunes C, Ansotegui I, D'Amato M, Liccardi G, Sofia M, Canonica WG. Climate change, air pollution and extreme events leading to increasing prevalence of allergic respiratory diseases. Multidiscip Respir Med. 2013; 8:12.

12. Filippidou EC, Koukouliata A. Ozone effects on the respiratory system. Prog Health Sci. 2011; 1:144–55.

13. WHO Regional Office for Europe (DK). Review of evidence on health aspects of air pollution: REVIHAAP Project. Copenhagen (Denmark): WHO Regional Office for Europe;2013.

14. Asero R. Birch and ragweed pollinosis north of Milan: a model to investigate the effects of exposure to “new” airborne allergens. Allergy. 2002; 57:1063–6.

15. Anenberg SC, Henze DK, Tinney V, Kinney PL, Raich W, Fann N, Malley CS, Roman H, Lamsal L, Duncan B, Martin RV, van Donkelaar A, Brauer M, Doherty R, Jonson JE, Davila Y, Sudo K, Kuylenstierna JC. Estimates of the global burden of ambient PM2:5, ozone, and NO2 on asthma incidence and emergency room visits. Environ Health Perspect. 2018; 126:107004–1. -14.

16. D'Amato G, Liccardi G, D'Amato M, Cazzola M. Outdoor air pollution, climatic changes and allergic bronchial asthma. Eur Respir J. 2002; 20:763–76.

17. D'Amato G, Cecchi L. Effects of climate change on environmental factors in respiratory allergic diseases. Clin Exp Allergy. 2008; 38:1264–74.

18. Wayne P, Foster S, Connolly J, Bazzaz F, Epstein P. Production of allergenic pollen by ragweed (Ambrosia artemisiifolia L.) is increased in CO2-enriched atmospheres. Ann Allergy Asthma Immunol. 2002; 88:279–82.

19. Liang KL, Su MC, Shiao JY, Wu SH, Li YH, Jiang RS. Role of pollen allergy in Taiwanese patients with allergic rhinitis. J Formos Med Assoc. 2010; 109:879–85.

20. D'Amato G, Holgate ST, Pawankar R, Ledford DK, Cecchi L, Al-Ahmad M, Al-Enezi F, Al-Muhsen S, Ansotegui I, Baena-Cagnani CE, Baker DJ, Bayram H, Bergmann KC, Boulet LP, Buters JT, D'Amato M, Dorsano S, Douwes J, Finlay SE, Garrasi D, Gómez M, Haahtela T, Halwani R, Hassani Y, Mahboub B, Marks G, Michelozzi P, Montagni M, Nunes C, Oh JJ, Popov TA, Portnoy J, Ridolo E, Rosário N, Rottem M, Sánchez-Borges M, Sibanda E, Sienra-Monge JJ, Vitale C, Annesi-Maesano I. Meteorological conditions, climate change, new emerging factors, and asthma and related allergic disorders. A statement of the World Allergy Organization. World Allergy Organ J. 2015; 8:25.

21. D'Amato G, Pawankar R, Vitale C, Lanza M, Molino A, Stanziola A, Sanduzzi A, Vatrella A, D'Amato M. Climate Change and Air Pollution: Effects on Respiratory Allergy. Allergy Asthma Immunol Res. 2016; 8:391–5.

22. Davies JM. Pollen allergens. Nriagu JO, editor. Encyclopedia of environmental health. 2nd ed.Amsterdam (Netherlands): Elsevier;2019.

23. Thien F, Beggs PJ, Csutoros D, Darvall J, Hew M, Davies JM, Bardin PG, Bannister T, Barnes S, Bellomo R, Byrne T, Casamento A, Conron M, Cross A, Crosswell A, Douglass JA, Durie M, Dyett J, Ebert E, Erbas B, French C, Gelbart B, Gillman A, Harun NS, Huete A, Irving L, Karalapillai D, Ku D, Lachapelle P, Langton D, Lee J, Looker C, MacIsaac C, McCaffrey J, McDonald CF, McGain F, Newbigin E, O'Hehir R, Pilcher D, Prasad S, Rangamuwa K, Ruane L, Sarode V, Silver JD, Southcott AM, Subramaniam A, Suphioglu C, Susanto NH, Sutherland MF, Taori G, Taylor P, Torre P, Vetro J, Wigmore G, Young AC, Guest C. The Melbourne epidemic thunderstorm asthma event 2016: an investigation of environmental triggers, effect on health services, and patient risk factors. Lancet Planet Health. 2018; 2:e255–63.

24. Thien F. Thunderstorm asthma: potential danger but a unique opportunity. Asia Pac Allergy. 2017; 7:55–6.

25. Junaid M, Syed JH, Abbasi NA, Hashmi MZ, Malik RN, Pei DS. Status of indoor air pollution (IAP) through particulate matter (PM) emissions and associated health concerns in South Asia. Chemosphere. 2018; 191:651–63.

26. Lai VW, Bowatte G, Knibbs LD, Rangamuwa K, Young A, Dharmage S, Thien F. Residential NO₂ exposure is associated with urgent healthcare use in a thunderstorm asthma cohort. Asia Pac Allergy. 2018; 8:e33.

27. Sonomjamts M, Dashdemberel S, Logii N, Nakae K, Chigusa Y, Ohhira S, Ito C, Sagara H, Makino S. Prevalence of asthma and allergic rhinitis among adult population in Ulaanbaatar, Mongolia. Asia Pac Allergy. 2014; 4:25–31.

28. Wong CM, Vichit-Vadakan N, Vajanapoom N, Ostro B, Thach TQ, Chau PY, Chan EK, Chung RY, Ou CQ, Yang L, Peiris JS, Thomas GN, Lam TH, Wong TW, Hedley AJ, Kan H, Chen B, Zhao N, London SJ, Song G, Chen G, Zhang Y, Jiang L, Qian Z, He Q, Lin HM, Kong L, Zhou D, Liang S, Zhu Z, Liao D, Liu W, Bentley CM, Dan J, Wang B, Yang N, Xu S, Gong J, Wei H, Sun H. Qin ZHEI Health Review Committee. Part 5. Public health and air pollution in Asia (PAPA): a combined analysis of four studies of air pollution and mortality. Res Rep Health Eff Inst. 2010; 154:377–418.

29. Yoshihara S, Munkhbayarlakh S, Makino S, Ito C, Logii N, Dashdemberel S, Sagara H, Fukuda T, Arisaka O. Prevalence of childhood asthma in Ulaanbaatar, Mongolia in 2009. Allergol Int. 2016; 65:62–7.

30. Shima M. Health effects of air pollution: a historical review and present status. Nippon Eiseigaku Zasshi. 2017; 72:159–65.

31. Park M, Luo S, Kwon J, Stock TH, Delclos G, Kim H, Yun-Chul H. Effects of air pollution on asthma hospitalization rates in different age groups in metropolitan cities of Korea. Air Qual Atmos Health. 2013; 6:10.

32. Kim HH, Lee CS, Yu SD, Lee JS, Chang JY, Jeon JM, Son HR, Park CJ, Shin DC, Lim YW. Near-road exposure and impact of air pollution on allergic diseases in elementary school children: a cross-sectional study. Yonsei Med J. 2016; 57:698–713.

33. Abdul Halim ND, Latif MT, Ahamad F, Dominick D, Chung JX, Juneng L, Khan MF. The long-term assessment of air quality on an island in Malaysia. Heliyon (Lond). 2018; 4:e01054.

34. Guo Y, Li S, Tawatsupa B, Punnasiri K, Jaakkola JJ, Williams G. The association between air pollution and mortality in Thailand. Sci Rep. 2014; 4:5509.

35. Phosri A, Ueda K, Phung VL, Tawatsupa B, Honda A, Takano H. Effects of ambient air pollution on daily hospital admissions for respiratory and cardiovascular diseases in Bangkok, Thailand. Sci Total Environ. 2019; 651:1144–53.

36. HEI Collaborative Working Group on Air Pollution, Poverty, and Health in Ho Chi Minh City. Effects of short-term exposure to air pollution on hospital admissions of young children for acute lower respiratory infections in Ho Chi Minh City. Vietnam. Boston (MA): Health Effects Institute;2012. p. 5–72.

37. Wang IJ, Tung TH, Tang CS, Zhao ZH. Allergens, air pollutants, and childhood allergic diseases. Int J Hyg Environ Health. 2016; 219:66–71.

38. Kuo CY, Chan CK, Wu CY, Phan DV, Chan CL. The short-term effects of ambient air pollutants on childhood asthma hospitalization in Taiwan: a national study. Int J Environ Res Public Health. 2019; 16:203.

39. Zhang Z, Tan L, Huss A, Guo C, Brook JR, Tse LA, Lao XQ. Household incense burning and children's respiratory health: A cohort study in Hong Kong. Pediatr Pulmonol. 2019; 54:399–404.

40. Gao Y, Chan EY, Li L, Lau PW, Wong TW. Chronic effects of ambient air pollution on respiratory morbidities among Chinese children: a cross-sectional study in Hong Kong. BMC Public Health. 2014; 14:105.

41. India State-Level Disease Burden Initiative CRD Collaborators. The burden of chronic respiratory diseases and their heterogeneity across the states of India: the Global Burden of Disease Study 1990–2016. Althea Med J. 2014; 1:5–72.

42. Rajak R, Chattopadhyay A. Short and long-term exposure to ambient air pollution and impact on health in India: a systematic review. Int J Environ Health Res. 2019 May 9. 1–25. [Epub].

44. Salvi S, Kumar GA, Dhaliwal RS, Paulson K, Agrawal A, Koul PA, Mahesh PA, Nair S, Singh V, Aggarwal AN, Christopher DJ, Guleria R, Mohan BV, Tripathi SK, Ghoshal AG, Kumar RV, Mehrotra R, Shukla DK, Dutta E, Furtado M, Bhardwaj D, Smith M, Abdulkader RS, Arora M, Balakrishnan K, Chakma JK, Chaturvedi P, Dey S, Ghorpade D, Glenn S, Gupta PC, Gupta T, Johnson SC, Joshi TK, Kutz M, Mathur MR, Mathur P, Muraleedharan P, Odell CM, Pati S, Sabde Y, Sinha DN, Thankappan KR, Varghese CM, Yadav G, Lim SS, Naghavi M, Dandona R, Reddy KS, Vos T, Murray CJ, Swaminathan S. Dandona LIndia State-Level Disease Burden Initiative CRD Collaborators. The burden of chronic respiratory diseases and their heterogeneity across the states of India: the Global Burden of Disease Study 1990-2016. Lancet Glob Health. 2018; 6:e1363–74.

45. Singh S, Sharma BB, Sharma SK, Sabir M. Singh VISAAC collaborating investigators. Prevalence and severity of asthma among Indian school children aged between 6 and 14 years: associations with parental smoking and traffic pollution. J Asthma. 2016; 53:238–44.

46. Palabrica FR, Tolentino C, Laroza M, et al. Effect of air pollution of the lung function of high school students at a public school in Quezon City, Metromanila, Philippines. Phil J of Allergy Asthma Immunol. 2015; 18:27–36.

48. Hahm MI, Chae Y, Kwon HJ, Kim J, Ahn K, Kim WK, Lee SY, Park YM, Han MY, Lee KJ, Lee HY, Min I. Do newly built homes affect rhinitis in children? The ISAAC phase III study in Korea. Allergy. 2014; 69:479–87.

Table 1.

The effect of air pollution on allergic diseases in the different countries of Asia-Pacific

Country	Pollutants	Key findings	References
Australia	O₃, NOx, and VOC: principally temperature and wind conditions	Those with higher mean annual residential NO₂ exposure had greater odds of urgent healthcare use in the previous year (OR, 3.45 per one interquartile range increase; 95% CI, 1.31–9.10; p = 0.01).	22,23
China	PM_2.5, PM₁₀, SO₂, NO₂, and O₃	An increase of 10 mg/m³ or 10 ppb of PM_2.5, PM₁₀, SO₂, NO₂, and O₃ corresponds to increments in mortality caused by chronic airway disease of 0.243% (95% CI, 0.172–0.659) at lag 1 day, 0.127% (95% CI, 0.161–0.415) at lag 1 day, 0.603% (95% CI, 0.069–1.139) at lag 3 day, 0.649% (95% CI, 0.808–2.128) at lag 0 day and 0.944% (95% CI, 0.156–0.1598) at lag 1 day. O₃ had a stronger effect on respiratory deaths among the elderly.	26
Mongolia	Households smoking, severe air pollution	The asthma prevalence 20.9% in Mongolian children was higher than that in Asia-Pacific countries. It was attributable to households' (especially mothers) smoking in draft-free houses designed for the cold area and severe air pollution due to rapid industrialization and urbanization. Prevalence of current wheezer and diagnosed asthma were 15.7% (95% CI, 14.7–16.8) and 4.7% (95% CI, 4.3–5.6) among adults in all age respectively. Prevalence of current allergic rhinitis was 23.6% (95% CI, 22.4–24.9) in all age group. Pollutants are SO₂, CO, NO₂, diesel exhaust particle, and PM_2.5.	27,28
Japan	SO₂, NOx, and PM_2.5	During the 1960s, air pollutants are particularly SO₂. After 1970, the increasing automobile traffic has caused increases in concentrations of s NOx and PM. At present, PM_2.5 and photo chemical oxidants have become a major concern.	29,30
Korea	1. PM₁₀, CO, NO₂, and VOC	1. Using adults as the referent, the RR of asthma admissions with 10-μg/m³ increase of PM₁₀ is 1.5% (95% CI, 0.1%–2.8%) lower for children, and 1.3% (95% CI, 0.7%–1.9%) higher for the elderly; RR with 1-ppm increase of CO is 1.9% (95% CI, 0.3%–3.8%) lower for children; RR with 1-ppb increase of NO₂ (1 ppb) is 0.5% (95% CI, 0.3%–0.7%) higher for the elderly. PM, and combustion pollutants such as SO₂, CO, and NO₂. Indoor air pollutants come from various sources: Environmental tobacco smoke, furniture, combustion products such as stoves and gas ranges, building materials, and biological agents from mold and animals. VOCs are important indoor air pollutants produced by evaporation at room temperature from diverse sources, such as building materials, paints, cleaning agents, furnishings, adhesives, combustion materials, floor, and wall coverings. Formaldehyde, xylene, toluene, benzene, ethyl-benzene, and phthalate are commonly found VOCs at home or in buildings. Children who had moved to a newly built home were 2.92 times (95% CI, 1.76–4.84) and 3.09 times (95% CI, 1.71–5.57) more likely to have overlapped rhinitis (rhinitis with asthma or eczema) or overlapped allergic rhinitis (overlapped rhinitis and exhibiting sensitization to more than one inhaled allergen in the skin prick test) from the phase III ISAAC study from Korea.	31,48
	2. CO, NO₂, SO₂, and O₃	2. The frequency of asthma treatment during the past 12 months showed a significant increase with exposure to NO₂ (1.67; 95% CI, 1.03–2.71) in the complex source zones. The frequency of allergic rhinitis treatment during the past 12 months increased significantly with exposure to black carbon (1.60; 95% CI, 1.36–1.90) (p < 0.001), SO₂ (1.09; 95% CI, 1.01–1.17) (p < 0.05), NO₂ (1.18; 95% CI, 1.07–1.30) (p < 0.01) for all subjects.	32
Malaysia	O₃, CO, NO, NO₂, NOx, SO₂, and PM₁₀	Annual average concentrations of all air pollutants (PM₁₀, O₃, CO, NO, NO₂, and NOx) on Langkawi Island were below the suggested limits by RMAQG and the WHO. The diurnal patterns showed an increase in all air pollutant concentrations except O₃ during peak hours which are from 07:00 to 08:00 and from 17:00 to 18:00.	33
Thailand	O₃, NO₂, SO₂, PM₁₀, and CO	An increase of 10 μg/m³ in O₃, NO₂, SO₂, PM₁₀, and 1 mg/m³ in CO at lag 0–1 day was associated with a 0.69% (95% CI, 0.18–1.21), 1.42% (0.98–1.85), 4.49% (2.22–6.80), 1.18% (0.79–1.57), and 7.69% (5.20–10.23) increase in respiratory admission.	34,35
		PM₁₀, SO₂, and O₃ on mortality. They found that all air pollutants had significant short-term impacts on nonaccidental mortality. An increase of 10 μg/m³ in PM₁₀, 10 ppb in O₃, 1 ppb in SO₂ were associated with a 0.40% (95% posterior interval [PI], 0.22%–0.59%), 0.78% (95% PI, 0.20%–1.35%) and 0.34% (95% PI, 0.17%–0.50%) increase of nonaccidental mortality, respectively. O₃ air pollution is significantly associated with cardiovascular mortality, while PM₁₀ is significantly related to respiratory mortality.
Vietnam	PM₁₀, O₃, NO₂, and SO₂ were 73, 75, 22, and 22 μg/m³	PM₁₀, O₃, NO₂, and SO₂ were 73, 75, 22, and 22 μg/m³, with higher pollutant concentrations observed in the dry season compared with the rainy season. The major cause might be the reliance of approximately 80% population conventional biomass burning in the region.	35-37
Taiwan	PM₁₀, PM_2.5, CO, and O₃	1. Exposure to PM₁₀, PM_2.5, CO, and O₃ was associated with asthma (OR [95% CI]: 1.39 [1.03–1.87], 1.45 [1.07–1.97], 1.36 [1.01–1.83], and 0.68 [0.51–0.92]). PM_2.5 may have increased the risk of AR (1.54 [1.03–2.32]).	37,38
		2. Exposure to PM_2.5 and mite allergens had a synergistic effect on the development of asthma. PM_2.5, PM₁₀, O₃, SO₂, and NO₂ were positively associated with childhood asthma
Hong Kong	High- or low-pollution district	_{2.5 10 3 2 2} hospitalization, while O₃ was negatively associated with childhood asthma hospitalization. SO₂ was identified as the most significant risk factor. Compared to those in the low-pollution district, girls in the high-pollution district (HPD) were at significantly higher risk for cough at night (OR adjusted, 1.81; 95% CI, 1.71–2.78) and phlegm without colds (OR adjusted, 3.84; 95% CI, 1.74–8.47). Marginal significance was reached for elevated risks for asthma, wheezing symptoms, and phlegm without colds among boys in HPD (adjusted OR, 1.71–2.82), and chronic cough among girls in HPD (OR adjusted, 2.03; 95% CI, 0.88–4.70).	39,40
India	PM_2.5 and PM₁₀	Short-term exposures to ambient pollutants have strong associations between COPD, respiratory illnesses and higher rates of hospital admission or visit. The long-term effects of ambient air pollution, was associated with deficit lung function, asthma. PM_2.5 and PM₁₀ are primarily responsible for respiratory health problems.	41-44
	PM_2.5 and PM₁₀	The ORs for the risk of asthma in children with exposure to mild, moderate and heavy traffic pollution compared with minimal traffic pollution were 1.63 (95% CI, 1.43–1.85), 1.71 (95% CI, 1.49–1.96). and 1.53 (95% CI, 1.31–1.78) in the younger group. In the older group, they were 1.19 (95% CI, 1.04–1.36), 1.51 (95% CI, 1.31–1.75), and 1.51 (95% CI, 1.29–1.76).	45
Indonesia	SPM, PM₁₀, and PM_2.5	An assessment during the feast of Ied Al Fitr in 2016 and 2017 indicated a further decrease in PM_2.5 due to highly reduced inner-city traffic. These events exhibited an extreme reduction of the PM_2.5 concentration in Jakarta. Impact only on asthma.	Indonesian Government data
Philippines		An assessment of 153 highs school students noted that exposure to air pollution affected lung function which only 54.7% having normal lung functions. Exposure to indirect smoking had a large effect on lower lung function values compared to total suspended particulate matter levels.	46

O₃, ozone; NO₂, nitrogen dioxide; PM, particulate matter; PM_2.5, PM with a diameter of 2.5 μm or less; PM₁₀, PM with a diameter of 10 μm or less; SO₂, sulfur dioxide; NOx, nitrogen oxides; VOC, volatile organic compound; OR, odds ratio; CI, confidence interval; RR, relative rate; ISSAC, International Study of Asthma and Allergies in Childhood; RMAQG, Recommended Malaysian Air Quality Guidelines; WHO, World Health Organization; AR, allergic rhinitis; COPD, chronic obstructive pulmonary disease; SPM, suspended particulate matter.

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