The Spanish Society of Pulmonology and Thoracic Surgery (SEPAR) warns that every time there is more scientific evidence supporting the harmful effects of environmental pollution on respiratory health. A new study has found that pollution predisposes the immune system to be more pro-inflammatoryeven in healthy people, and to a greater allergic-type response in asthmatics, since contamination induces a synergistic effect with allergens which makes these much more powerful and increases the reaction of asthmatic people against them. The pollution actually aggravates asthma, it can favor its appearance in children and the doctor must take this into account and ask patients in the interviews if they live in a contaminated environment. These are the main conclusions of the paper on Asthma of environmental origin presented by Dr. María Jesús Cruz Carmona, biologist and member of the SEPAR Environment Area, on the occasion of the 3rd SEPAR Areas Virtual Winter Meeting.

Pollution produces a synergistic effect with allergens

Approximately 6% of the Spanish population has asthma and, although it is not known exactly how many asthma cases have their origin in environmental causes, in the cities there are more cases of this respiratory disease and these are increasing in places with higher air pollution, mainly attributable to road traffic. The evidences that air pollution favors the increase in asthma cases they are, on many occasions, indirect, but they are increasing. In children, studies on this association between pollution and asthma are easier to carry out, since it can be followed a cohort of children from birth to adolescence and check if they have developed asthma or not depending on the area in which they reside. Studies have also been carried out in experimental models, particularly mouse models, that develop asthma and that are exposed to contaminants. Due to this exposure to contamination, experimental animals have more allergiesmore inflammation and more bronchial response.

COVID-19 lockdown and asthma

Recently, a new study has been carried out around the three months that the confinement lasted due to COVID-19 in Spain. During the lockdown period, pollution levels fell by 80% in Barcelona and took advantage of this exceptional circumstance to study What impact did it have on people’s bodies?. To do this, blood samples were taken from 58 people from the healthy population of Barcelona, ​​at the end of the confinement period, when they had not yet left it and, in these blood samples, More than 20 biomarkers of inflammation and oxidative stress were analyzed. “It was observed that, while we were confined, the levels of oxidative stress and pro-inflammatory biomarkers were much lower. Upon returning to normal, these biomarkers were again higher. And we have to think that this happened in healthy people, who did not have respiratory pathologies, which means that even in healthy people the immune system reacts to contamination”, explained Dr. Cruz Carmona. The novelty of the ongoing study is that “pollution predisposes the immune system to be more proinflammatory even in healthy people and also predisposes to a greater allergic-type response in asthmatics,” explains Dr. Cruz Carmona. “In addition, pollution has a synergistic effect with allergens, making them much more powerful,” points out Dr. Cruz Carmona.

action measures

The measures that should be taken to mitigate the effect of pollution on asthmatic people vary depending on whether they have a tendency to allergic asthma or not. Asthmatics who do not have allergic-type asthma may improve when they go to an area without contamination, where your inflammation levels go down. In contrast, those with allergic asthma, if they move to a rural area, where there may be more allergens such as various pollens, can suffer a worsening of your symptoms. “They will find less contamination, but with more allergens that could aggravate asthma,” says Dr. Cruz Carmona as an example, so the ideal is that “they move to a very clean area, without contamination and where there are no levels elevated levels of allergens that produce allergic symptoms. The association between environmental pollution and its effects on the lungs requires at least three courses of action, according to Dr. Cruz Carmona: the personal, which consists of become aware of the effects of pollution on health and avoid taking the private vehicle so continuously; in the medical field, where doctors must raise the level of suspicion about how pollution is affecting people’s respiratory health, “they must always keep it in mind”; and from politics, seeking to promote the implementation and greater use of clean energy sources. “In the political sphere, the interests of health must be put above,” says Dr. Cruz Carmona. On the other hand, she has pointed out that air pollution not only affects asthma patients, but also very notably to patients with chronic obstructive pulmonary disease (COPD) and other respiratory diseases, which can also worsen their pathologies. Therefore, at the local level, cities must continue warning of high contamination levels and warn people with respiratory pathologies that, when they are high, they should avoid going outside. In these large cities advises against running or exercising on large avenues and roads with a lot of road traffic and thus avoid exposure in the places with the most pollution in these cities. FFP2 masks do not allow to filter gases and NO2 particles, SO2 or diesel particles below PM2.5, can penetrate it and do not serve to protect against pollutants and their effects. Masks do not filter gases, which is why you smell tobacco, gasoline or perfume

Conclusions

«The main conclusions of the paper presented is that pollution really aggravates asthma, it can favor asthma and the doctor must take it into account in the interviews with patients. You have to ask them what environment they live in, since pollution can exacerbate their pathology,” says Dr. Cruz Carmona. In office interviews, the physician should ask patients aboutwhere they live and where they work and propose prevention measures designed to avoid environmental exposure to pollutants so that they improve their asthma.