Journal List > Asia Pac Allergy > v.10(1) > 1148387

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

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.

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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 PM2.5, PM10, SO2, NO2, and O3 An increase of 10 mg/m3 or 10 ppb of PM2.5, 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 PM2.5. 27,28
Japan SO2, NOx, and PM2.5 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, PM2.5 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, PM2.5, CO, and O3 1. Exposure to PM10, PM2.5, 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]). PM2.5 may have increased the risk of AR (1.54 [1.03–2.32]). 37,38
    2. Exposure to PM2.5 and mite allergens had a synergistic effect on the development of asthma. PM2.5, 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 PM2.5 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. PM2.5 and PM10 are primarily responsible for respiratory health problems. 41-44
  PM2.5 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 PM2.5 An assessment during the feast of Ied Al Fitr in 2016 and 2017 indicated a further decrease in PM2.5 due to highly reduced inner-city traffic. These events exhibited an extreme reduction of the PM2.5 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; PM2.5, 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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