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Pollution and lung health

Pollution and Asthma: Helping your patients understand and manage the associated risks

Air pollution is well documented as one of the largest environmental risks currently facing public health, being cited as a key contributing factor to premature death and worsening health worldwide.1,2

Last updated: April 2025

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The total impact of air pollution and household pollution is associated with 7 million premature deaths each year.3 In some notable regions, such as South Asia, it is estimated that 33% of deaths occurred due to air pollution alone.4 This therefore reflects the escalating public health crisis that air pollution presents.

For patients with respiratory diseases, such as asthma, air pollution poses significant implications.1 It is suggested that around 99% of the global population reside in areas where air quality fails to meet WHO guidelines.5 Markers of air pollution, such as high ambient nitric oxide (NO) levels, highlight key correlations between elevated levels of ambient NO and airway irritation in patients with respiratory conditions – noting an increase in exacerbation risk, worsening symptoms and even the triggering of onset asthma in some cases.5-8

 This is especially concerning as ambient NO levels can vary between 2-500 ppb depending on the environment, with greater levels of ambient NO typically found in denser urban areas.8-10 Consequently, as environmental pollutants rise, so does the burden on patients with asthma, making accurate diagnosis and management more critical than ever.1

How can you help patients manage their asthma?

Encourage patients to continue using their preventer and reliever inhalers as prescribed, even when symptoms are mild.8 Additionally, ensure that patients are trained in proper inhaler technique to ensure that medication is delivered effectively.11

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Pollution and Asthma: Helping your patients understand and manage the associated risks

One tool that has proven to be instrumental in asthma care and assessing medication adherence is Fractional Exhaled Nitric Oxide (FeNO) testing.12 This simple, non-invasive test measures nitric oxide levels in exhaled breath, providing a straightforward and accurate way to assess airway inflammation.13,14 By integrating FeNO testing into routine asthma care, you can enhance treatment precision, predict exacerbation risks, and identify patients who may not be responding to their current therapy.15-17 In turn, FeNO testing can help to personalised treatment plans and improve patient outcomes.18-20 

Additional advice for patients

  • Avoid highly polluted areas and travel routes, where possible, to help minimise exposure to high pollution levels and triggers of potential exacerbations.6,8
  • Invest in portable air purifiers to help improve ventilation inside the home and reduce exposure to household pollutants.6
  • Encourage patients to regularly check local air quality levels to help make informed decision and implement protective behaviour on high pollution days.6,8

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References:

  1. European Environment Agency. How air pollution affects our health. 2024. Available at; https://www.eea.europa.eu/en/topics/in-depth/air-pollution/eow-it-affects-our-health. Accessed; Apr 2025. 
  2. Institute for Health Metrics and Evaluation. Global Burden of Disease 2012: Findings from the GBD 2021 Study. 2024. Available at; https://www.healthdata.org/research-analysis/library/global-burden-disease-2021-findings-gbd-2021-study. Accessed; Apr 2025.  
  3. World Health Organisation. Air Pollution. 2025. Available at; https://www.who.int/health-topics/air-pollution#tab=tab_2. Accessed; Apr 2025. 
  4. Institute for Health Metrics and Evaluation. Air pollution. 2024. Available at; https://www.healthdata.org/research-analysis/health-risks-issues/air-pollution. Accessed; Apr 2025.  
  5. Zhou X et al. effect of air pollution on asthma. Annals of Allergy, Asthma and Immunology. 2024;132(4):426 – 432. Available at; https://www.annallergy.org/article/S1081-1206(24)00018-8/fulltext 
  6. Bronte-Moreno O et al. Impact of Air Pollution on Asthma: A Scoping Review. Open Respiratory Archives. 2023;5(2):100229. Available at; https://doi.org/10.1016/j.opresp.2022.100229 
  7. Asthma and Allergy Foundation of America. Air Pollution and Asthma. 2024. Available at; https://aafa.org/asthma/asthma-triggers-causes/air-pollution-smog-asthma/. Accessed; Apr 2025. 
  8. Asthma and Lung UK. Air pollution and asthma. 2023. Available at; https://www..org.uk/conditions/asthma/asthma-triggers/pollution. Accessed; Apr 2025.  
  9. Clapp L et al. Analysis of the relationship between ambient levels of O3, NO2 and NO as a function of NOx in the UK. Atmos Environ. 2001;35(36):6391-6405. 
  10. Jarvis DJ et al. Nitrogen asthmaandlung dioxide. WHO Guidelines for Indoor Air Quality: Selected Pollutants. Geneva: World Health Organization. 2010. Available at; https://www.ncbi.nlm.nih.gov/books/NBK138707/  
  11. Jahedi L et al. Inhaler Technique in Asthma: How Does It Relate to Patients' Preferences and Attitudes Toward Their Inhalers?. Journal of aerosol medicine and pulmonary drug delivery. 2017;30(1): 42-52. doi:10.1089/jamp.2016.1287 
  12. Ali H et al. The Potential of Fractional Exhaled Nitric Oxide as a Biomarker in Predicting and Optimizing Use of Treatment in Asthma. South East European Journal of Immunology. 2023;6(1):18-23. 
  13. Gao J et al. Association between fractional exhaled nitric oxide, sputum induction and peripheral blood eosinophil in uncontrolled asthma. Allergy, Asthma & Clinical Immunology. 2018;1 
  14. Busse W et al. Baseline FeNO as a prognostic biomarker for subsequent severe asthma exacerbations in patients with uncontrolled, moderate-to-severe asthma receiving placebo in the LIBERTY ASTHMA QUEST study: a post-hoc analysis. The Lancet Respiratory Medicine. 2021;9(10):1165-73. 
  15. Carroll WD. NIOX VERO: Individualized Asthma Management in Clinical Practice. Pulmonary Therapy. 2016;2:171-88. 
  16. Provenzano B et al. Use of fractional exhaled nitric oxide as a potential predictor of bronchodilator response. Medicine. 2023;102(28):e34073. 
  17. Dweik RA et al. An official ATS clinical practice guideline: interpretation of exhaled nitric oxide levels (FeNO) for clinical applications. Am J Respir Crit Care Med. 2011;184(5):602-15. 
  18. Loewenthal L et al. FeNO in asthma. Semin Respir Crit Care Med. 2022;43:635-645 
  19. Hanania NA et al. Measurement of fractional exhaled nitric oxide in real-world clinical practice alters asthma treatment decisions. Ann Allergy Asthma Immunol. 2018;120(4):414-418. 
  20. NHS England. Fractional Exhaled Nitric Oxide (FeNO). Available at; https://www.england.nhs.uk/aac/what-we-do/innovation-for-healthcare-inequalities-programme/rapid-uptake-products/fractional-exhaled-nitric-oxide/. Accessed; Apr 2025. 


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