Clinical Handbook of Air Pollution Related Diseases

Air pollution is a global concern. The Earth has gone through a number of phases and natural selections that have marked the history of our species. Epochal changes have influenced those processes, such as major catastrophes, plagues, famines, and pandemics. Air pollution, although not new, may signal the rise of a new era, being able to modify locally and globally the composition of the air that we breathe, which ultimately is what keeps us alive. For these reasons, actions need to be taken, starting from the definition of a new medical category. Air pollution–related diseases are those diseases and acute, subacute, chronic, and permanent medical conditions that are directly or indirectly related to, triggered, promoted, facilitated, or caused by air pollution at the macro, micro, genetic, and molecular levels, regardless of the type of exposure or the timing of the exposure. The extent of this problem is reaching a level of concern worldwide, in both developing and highly developed countries. As every individual may be potentially affected by air pollution, shared policies are needed to foster coordinated plans of intervention and research, aimed at reducing emissions; cleaning up the environment where it is already polluted and preserving those areas that are free from pollution; reducing the risks of exposure; and protecting communities and individuals, with particular attention to the most vulnerable categories such as children, the elderly, and people from disadvantaged backgrounds. Failure to do so may lead to devastating consequences and to an unsustainable burden for people and societies. Possible solutions include creation of networks of research and environmental administration at local, national and international levels, aimed at improving the level of education, health promotion, data sharing, research, coordination and planning; implementing environmentally friendly policies, monitoring and data analysis processes, and community-based and individual protection measures; and enhancing our quality of life and ultimately the air that we breathe.

Air pollution can be considered a model to describe complexity and its implication in medicine. The number of components and interactions, the distribution of airborne pollutants through space and time and the possible short-and long-term effects on cells, tissues, organs and apparatus are an exhaustive example. The whole human being is more complex than the sum of its parts which are systems more complex than the sum of their parts and so on. The risk for health which comes from exposure to air pollutants can be measured partially and the hazard may be known. However, the real long-term implications may remain unknown becoming a not crossable limit for medical research. We can estimate the risk for individual and population, and we can try to find solutions, such as new technologies like artificial intelligence; but the system will remain complex and so unpredictable.

Risk communication is crucial in response to any hazard to human health. Sharing information can help triggering necessary actions that can eventually lead to the solution of a problem or to a reduction of its negative effects, improving the outcome. Some basic rules must be followed, though, in order to create an effective communication, avoiding those mistakes that undermine the trust that people rely on risk assessors and decision-makers. Air pollution is a peculiar problem in risk communication as its effects are blurred although partially known also by the public. Most of them appear later in life and not always the cause- effect relationship is clear. For this reason, air pollution remains a major challenge in risk communication and health education.

Air pollution is a complex matter because of its inner features; because of its social, economic, political, and ethical implications; and because of the complex interactions between pollutants and the human organism. The effects of air pollution, in fact, are still largely unknown; some are, and will remain, unpredictable. The promotion of medical literacy in this sense is crucial: all the actors involved must have their say, provided that the correct information is shared and that appropriate and effective communication is fosttered. The aim of this book, therefore, is to try to give a complete overview of the problem, starting from a clinical point of view on air pollution and, at the same time, merging this with knowledge that has come from other fields of research.

Children are particularly exposed to the effect of air pollution when compared to adults because of behavioural, environmental and physiological features. Exposure to air pollutants can start since foetal and early life, and the consequences on health can show up later in childhood or in adulthood with chronic or lifelong conditions. Although the effect on the respiratory tract secondary to acute and short-term exposure is known, constant exposure to background pollution can cause harmful effect on different organs and systems. As children develop and grow, the constant action of toxins coming from airborne compounds can cause inflammation, oxidative stress and immune responses that could lead to the onset of chronic diseases and to the exacerbation of subacute conditions

To overcome problems related to air pollution, and for protection against its negative effects on health, a number of actions are required at the individual, local, national, and international levels. The role of prevention is crucial, as the effects of pollution on health are still largely unknown; some of them could show up years after exposure. For this reason, international bodies and experts are needed to foster proper environmental administration, to coordinate research, and to promote healthy behaviors that could reduce the risk of exposure for communities and individuals.