PATS and ERS
Paediatric Webinar Series
Air pollution and the lung in children:
the evidence for exposure and prevention measures
BACKGROUND. Asthma is a heterogeneous condition characterised by chronic inflammation and variable expiratory airflow limitation, as well as airway reversibility. The burden of asthma in children is increasing in low- and middle-income countries and remains under-recognised and poorly managed.
OBJE...CTIVES. To quantify the burden of asthma in the South African (SA) population and identify the risk factors associated with disease severity in the local context.
METHODS. The SA Childhood Asthma Working Group (SACAWG) convened in January 2017 with task groups, each headed by a section leader, constituting the editorial committee on assessment of asthma epidemiology, diagnosis, control, treatments, novel treatments and self-management plans. The epidemiology task group reviewed the available scientific literature and assigned evidence according to the Grades of Recommendation Assessment, Development and Evaluation (GRADE) system.
CONCLUSIONS. Asthma in children remains a common condition, which has shown an increasing prevalence in urban and rural populations of SA. Of concern is that almost half of children in urban communities experience severe asthma symptoms, and many asthmatics lack a formal diagnosis and thus access to treatment. Exposure to tobacco smoke and living in highly polluted areas increase the severity of wheezing in young children.
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Severe and difficult asthma in a low- and middle-income country (LMIC) can relate to lack of availability of basic medications; potentially reversible factors such as poor adherence or comorbidities such as obesity inhibiting a good response to treatment; and (rarely) true severe, therapy-resistant ...asthma. However, definitions of severity should encompass not merely doses of prescribed medication, but also underlying risk. The nature of asthmatic airway disease shows geographical variation, and LMIC asthma should not be assumed to be phenotypically the same as that in high-income countries (HICs). The first assessment step is to ensure another diagnosis is not being missed. Largely, political action is needed if children with asthma are to get access to basic medications. If a child is apparently not responding to low dose, simple medications, the next step is not to increase the dose but perform a detailed assessment of what factors (for example co-morbidities such as obesity, or social factors like poor adherence) are inhibiting a treatment response; in most cases, an underlying reason can be found. An assessment of risk of future severe asthma attacks, side-effects of medication and impaired lung development is also important. True severe, therapy-resistant asthma is rare and there are multiple underlying molecular pathologies. In HICs, steroid-resistant eosinophilia would be treated with omalizumab or mepolizumab, but the cost of these is prohibitive in LMICs, the biomarkers of successful therapy are likely only relevant to HICs. In LMICs, a raised blood eosinophil count may be due to parasites, so treating asthma based on the blood eosinophil count may not be appropriate in these settings.
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Pollution (dirty air) is a big trigger for asthma as it makes it difficult to breathe and affects the health of humans, animals, and plants. Avoiding pollution helps prevent asthma symptoms!
a "risk factor" is something that increases your chances of getting a disease or condition. In the case of asthma there are two diffrent type of risk factors. There are risk factors for developing asthma , and there are separate risk factors for those who already have asthma getting a severe asthma ...attack. We like to refer to the second as "triggers for asthma attacks" instead of "risk factors" to avoid confusion.
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An allergy is when someone has a bad reaction to something in the enviroment that other people can tolerate. We get allergies when our bodies defence system hurt us instead of protecting us.
There is no safe level of secondhand smoke exposure
Secondhand smoke can travel within multiunit housing and common areas through doorways, cracks in walls, electrical lines, ventilation systems and plumbing.
Opening windows and using fans does not completely remove secondhand smoke.
Heating, air... conditioning and ventilation systems cannot eliminate exposure to secondhand smoke.
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Secondhand smoke can infiltrate into other units through hallways and stairwells. Don’t be shy when it comes to your health. Talk to your building manager about making your apartment smokefree.
Secondhand smoke and the harmful chemicals in it are known causes of Sudden Infant Death Syndrome RESPIRATORY INFECTIONS, ear infections.and asthma attacks in infants and children. They are also known causes of HEART DISEASE,stroke, and lung cancer in adult nonsmokers.