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Urgent action is needed on air pollution

As many as 40,000 deaths a year in the UK are attributed to exposure to air pollution, but nurses can help patients minimise the risks to their health.
Air pollution

Around 40,000 deaths a year in the UK are caused by exposure to outdoor air pollution, according to a major report. Nurses can help patients minimise the risks to their health

Most of us are aware of outdoor air pollution: spend time in traffic-clogged streets and you can taste the chemicals. Even spring days in the countryside can be spoiled by ozone haze.

Picture: SPL

But a report published earlier this year by the Royal College of Physicians (RCP) and the Royal College of Paediatrics and Child Health (RCPCH) revealed that air pollution is much more than an inconvenience it is a major health risk.

Every Breath We Take: the Lifelong Impact of Air Pollution estimates outdoor air pollution is responsible

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Around 40,000 deaths a year in the UK are caused by exposure to outdoor air pollution, according to a major report. Nurses can help patients minimise the risks to their health

Most of us are aware of outdoor air pollution: spend time in traffic-clogged streets and you can taste the chemicals. Even spring days in the countryside can be spoiled by ozone haze.

Air pollution
Picture: SPL

But a report published earlier this year by the Royal College of Physicians (RCP) and the Royal College of Paediatrics and Child Health (RCPCH) revealed that air pollution is much more than an inconvenience – it is a major health risk.

Every Breath We Take: the Lifelong Impact of Air Pollution estimates outdoor air pollution is responsible for up to 40,000 UK deaths annually. It is linked to cancer, chronic lung and cardiac disease, stroke, diabetes and dementia, plus thousands of additional hospital admissions.

Lifelong impacts

The report emphasises that air pollution has lifelong implications for health, affecting fetal and childhood lung development.  

The long-term health effects on vulnerable groups living in polluted areas are particularly worrying, says RCN professional lead for public health nursing Helen Donovan. 'Air pollution is a major public health issue, often affecting those already disadvantaged by inadequate housing and leading stressful lives with poor diet and lifestyle.

'As part of an overall drive to improve everyone’s health, the UK must take action to reduce pollution now, ensuring future generations breathe cleaner air.'

Former Nursing Standard nurse of the year Matthew Hodson, chair of the Association of Respiratory Nurse Specialists, has no doubt that air pollution is damaging the health of his patients. 'As a nurse specialist I have seen how people living with asthma and chronic obstructive pulmonary disease have had their symptoms exacerbated, and their quality of life reduced by poor air quality.’

Cause of distress

RCN professional lead for long-term conditions and end of life care Amanda Cheesley says people with respiratory conditions are often aware that high pollution levels cause them distressing symptoms.

She emphasises that action on pollution is needed not just to help these individuals, but to ease the strain on the NHS. The financial cost of air pollution in the UK is more than £20 billion a year, according to the RCP and RCPCH report.

‘Failing to tackle this problem will lead to premature deaths, pain and misery for many, and a health system that simply cannot cope with an aging population with multiple, complex, conditions,’ says Ms Cheesley.

Call for action

Every Breath We Take: the Lifelong Impact of Air Pollution calls for action, including:

  • As a major polluter, the NHS should lead by example and set a benchmark for clean air.
  • Pollution monitoring results should be communicated to the public in an understandable format.
  • Local authorities should protect public health when pollution levels are high by diverting traffic, especially near schools.

Hundreds of London schools are sited in areas exceeding legal nitrogen dioxide levels, with schools elsewhere likely to be similarly affected. As evidence mounts of air pollution’s effects on children’s health, nurses will have a role in supporting worried parents, suggests RCN professional lead for children and young people Fiona Smith.

'Nurses and health visitors should always respond honestly to parents’ concerns, empowering them to voice such issues with their local councillor or MP,' she says. 'Nurses may also raise public health issues with their local authorities to influence environmental health policies.'

Collecting data

School and Public Health Nurses Association professional officer Sharon White adds: 'While school nurses should continue encouraging children to walk to school and keep updated in best practice on avoiding allergy triggers, they may also collect aggregated data to take forward to environmental health departments.'

Keeping professionally updated and advising patients how to avoid pollution is part of nurses’ role. But the RCN's Ms Cheesley says nurses should also be looking at their own lifestyles.

'As someone whose own asthma is triggered by air pollution, I would recommend that patients and nurses adjust their working times to avoid rush hour traffic.' She adds that they should also lobby their local authority for more parks and pedestrianised areas.

Front line influence

Charities such as Asthma UK, the British Lung Foundation and British Heart Foundation (BHF) are playing an increasing role in researching, campaigning, raising patient awareness and lobbying government on air pollution’s health risks. But BHF’s senior cardiac nurse Maureen Talbot insists it is nurses on the front line who can make an immediate difference to how patients cope with outdoor air pollution.

`The unique, trusting bond nurses build with patients, makes them ideally placed to help patients adapt their lifestyles to avoid the health hazards of polluted air,’ she says.

 

How to minimise the health risks of outdoor air pollution

  • Air pollution is highest on hot and windless days or when it is cold and foggy. Check local air pollution levels on the government website, sign up for text alerts, or call their helpline (0800 55 66 77).
  • Those with a chronic lung and heart conditions, or who are pregnant, should limit time spent outdoors when pollution levels are high, keeping doors and windows closed until it subsides. But they should remain active indoors to gain the health benefits of exercise.
  • If possible, time journeys to miss rush-hour traffic. Avoid vigorous exercise near airports, industrial sites and busy main roads.
  • Use public transport or lift-share if possible. If driving is essential, keep car windows closed in heavy traffic and ensure exhaust systems are well maintained and a diesel particulate filter is in place.
  • Stand back from bonfire or barbecue smoke and contact the local council if this kind of smoke is a regular neighbourhood problem.
  • Researchers believe most pollution masks are ineffective and may increase breathing difficulty if uncomfortable. Those who find they prevent runny, sore eyes, throat symptoms or a 'pollution taste' should ensure the mask fits well and has a regularly changed fine filter.
  • Those with chronic heart and lung conditions, such as asthma, should keep a symptom diary, ensure their condition is regularly reviewed by a specialist nurse or GP and always carry appropriate medications, such as a reliever inhaler.
  • Those concerned about an increase in cardiac or lung symptoms, such as wheeze, breathlessness or chest pain when pollution is high, should seek medical advice immediately. For mild breathlessness, the British Lung Foundation have launched an online Breath Test to help assess if they need to see a GP.

Sources: British Lung Foundation, British Heart Foundation, Asthma UK Advice

 

Types of Air Pollution and their Health Effects

Particulate Matter (PM)

A mixture of solids, chemicals and dust, PM includes visible soot or smoke and minute particles such as pollen grains, diesel and petrol engine emissions, plus dust from road surface tyre friction. Large PMs may irritate the eyes, nose or throat, while smaller particles can reach lower airways, alveoli or possibly the bloodstream, causing inflammation or clot formation. PM pollution is thought to increase hospital admission for chronic obstructive pulmonary disease (COPD), bronchitis, asthma, heart-attacks and strokes.

Nitrogen dioxide

A major source of smog, nitrogen dioxide comes from diesel cars and power stations. High levels irritate the upper airways and lungs, causing breathing difficulties, cough, asthma and COPD flare-ups. Most likely to affect children, older people and those with pollen allergies.

Ozone

Highest on warm afternoons, ozone is formed at ground level by the chemical reaction between sunlight and nitrogen dioxide. Often blown into the countryside, ozone irritates the airways of healthy people and those with lung conditions. It reduces lung capacity, causing wheezing and coughing, and often results in increased asthma-related hospital admissions.

Sulphur Dioxide

A colourless, pungent-smelling gas produced by industrial fossil fuel burning and petrol refining. Contributes to ozone formation. Causes airway narrowing by irritating nasal, upper airway and lung linings, particularly in those with asthma.

Catharine Sadler is a freelance writer

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