respiratory diseases green facts

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Respiratory Diseases: Level 1 - Summary

Air Pollution-Arsenic-Aspartame-

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Scientific Facts onRespiratory Diseases

in Children

Source document:EC (2003)

Summary & Details:GreenFacts (2005)

About this study

Information on our 3-level structure

Context - Respiratory

diseases are a leading causeof mortality in developingcountries, and one of the themost common cause of illnessin children of developedcountries.

Asthma and allergies areincreasing in a number ofEuropean countries.

Can genetic andenvironmental factors affect achild's likelihood to developsuch diseases?

Questions on Respiratory Diseases

1. To what extent do respiratory diseases affectchildren?

2. Which factors cause respiratory diseases in

children?

3. Which circumstances can affect children's

sensitivity to respiratory diseases?

4. Contribution of outdoor air pollution

5. Contribution of indoor air pollution

6. Which aspects require further research?

7. Conclusions

8. Other views and links

This study is a faithful summary of the leading scientific consensus report

produced in 2003 for the EC (European Commission):

"Baseline Report on Respiratory Health in the framework of theEuropean Environment and Health Strategy" More...

More in Details

Next Question Top

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1. To what extent do respiratory diseases affect children?

1.1 Diseases of the lung and airways are the most common cause of illness in children in developedcountries and a leading cause of death in children in developing areas. More...

1.2In developed countries the frequency of life threatening acute respiratory infections has dropped over

the last 50 years. This is probably due to improved living conditions and health care. More...

1.3Within Europe, there tends to be more asthma and allergy in the West and more infectious diseases in

the East. More...

Conclusion Level 1 Questions More in Details

Next Question Top

2. Which factors cause respiratory diseases in children?

2.1Respiratory diseases, such as asthma and allergies, are caused by combinations of different factors.

These factors are linked to the genetic background and the lifestyle of a person as well as the environment

they live in. For instance, those who have a genetic predisposition and who are exposed to environmental

factors are more likely to develop a disease such as asthma. More...

2.2While underlying causes are responsible for a disease, triggers are factors that bring on or worsen

symptoms. For instance, air pollution may not be responsible for causing asthma, but it is clearly a trigger

that precipitates asthma attacks in children who already have the disease. More...


Next Question Top

3. Which circumstances can affect children's sensitivity to respiratory diseases?

3.1 Some people have a genetic predisposition to develop respiratory diseases. Environmental factors such

as tobacco smoke and air pollution also contribute to the onset ofallergic disease, asthma, and other

respiratory diseases. Once the disease is established, these factors may also trigger symptoms. Theseobservations show the importance of the interplay between genetic background and environmental factors.More...

3.2Asthma affects about twice as many boys than girls in early childhood, but later in life, a larger number

of girls are affected. This suggests a certain role of sex hormones in asthma. More...

3.3Many diseases that appear during childhood or adult life may have their origins during development in

the womb or in very early infancy. If a mother smokes during pregnancy, this exposes her baby to tobacco

smoke, which has adverse effects on lung development. Furthermore, respiratory infections during early

childhood may have consequences for adult lung function. More...

3.4Poverty is linked to an increased risk ofrespiratory infections both in developed and developing

countries. More...

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3.5Living conditions can have an effect on how both environmental and genetic factors lead to respiratory

diseases. In Europe, there has been a steep decrease in severe infectious diseases such as tuberculosis.

However, asthma and allergies have become more and more frequent in Western Europe. One explanation

for this increase might be that infections in early childhood may prevent the development of allergicdiseases. This trend may also be explained by changes in the diet.

In addition, factors affecting the development of the fetus may lead to greater risk ofasthma later in life.

For instance, children born with a low birth weight to older or smoking mothers may be particularlyaffected. More...


Next Question Top

4. Can outdoor air pollution contribute to respiratory diseases in children?

There is clear evidence that air pollution is associated with troublesome respiratory symptoms in children,

but it is less clear whether specific pollutants are directly responsible.

4.1 Key air pollutants that can affect childrens health are particulate matter, ozone, nitrogen dioxide, and

sulphur dioxide. This pollution is mainly linked to road traffic or industrial processes. More...

4.2Air pollution, especially particulate matter and ozone, can trigger asthma attacks and can also worsen

other respiratory symptoms such as wheezing. Whether specific pollutants may actually cause asthma is

less clear. More...

4.3In Europe, pollens from different plant species are responsible for 10-20% ofallergies. Studies disagree

on whether air pollution may affect pollen-related allergies. Global climate change might cause some plantspecies to spread to new areas and to extend their pollen season, but it is not clear to what extent thiswould affect allergic diseases. More...


Next Question Top

5. Can indoor air pollution contribute to respiratory diseases in children?

Indoor air pollution can be much worse than air pollution outdoors. In Europe, most children spend 90% oftheir time indoors. More...

5.1 Indoor air quality may be affected by outdoor pollution, but also by indoor pollutants such as those

produced by smoking and indoor heating and cooking and those released from building materials andcleaning products. It may be worsened by insufficient air exchange with the outside. More...

5.2Poor indoor air quality can cause or contribute to the development ofchronicrespiratory diseases such

as asthma. The most important source of indoor pollutants is environmental tobacco smoke. Other factors

which can contribute to indoor pollution are damp housing, the presence of pets, the use of fuels forcooking and heating, and chemicals released from building materials. More...

5.3When children spend time indoors at places other than home, such as day care or school, they are

exposed to air pollutants similar to those found in the home environment: tobacco smoke, moulds,

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combustion gases, cleaning products, building materials, and outdoor air pollution. Moreover, specificexposures might occur during professional training or recreational activities such as swimming. More...


Next Question Top

6. Which aspects of respiratory diseases require further research?

In order to better assess respiratory health risks for children, further knowledge is needed about the effects

of:

r new building materials,r products used in the home, andr exposure to various environmental factors at different stages of development, before birth up to

childhood.

Moreover, genetic factors which make children more sensitive to respiratory diseases need to be studiedand children should be followed over many years in order to understand disease development.

Finally, there is a need for uniform definitions of respiratory symptoms, so that data from different countriescan be more easily compared. More...


Next Question Top

7. Conclusions

Environmental factors, such as tobacco smoke and nutrition, greatly affect a childs resistance to respiratory

diseases. In prosperous countries, a reduction in severe infectious disease and an increase in asthma and

allergies has been reported. Many environmental factors thought to influence children's respiratory health

remain unclear and sometimes controversial, particularly in the case of asthma and allergies. More...


Top

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8. Other views and links

This summary is based on the report "Baseline Report on Respiratory Health" produced in 2003 in the

framework of the European Environment and Health Strategy for the European Commission by the

Technical Working Group on priority diseases. More...

It is considered by most scientists as a consensus document and other recent scientific assessments reach

similar conclusions, though some people and organizations put forward different views.

q GreenFacts factual links page on Respiratory Diseases

Level 1 Questions

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Respiratory Diseases: Level 2 - Details on Respiratory Diseases







Disinfectants

Home > Studies > Respiratory Diseases > Level 2 > Questions Languages:


in Children



About this study

Information on our 3-level structure

Level 2 - Details on Respiratory Diseases


1.1 How common and severe are respiratory diseases in children?

1.2 Are deadly respiratory diseases becoming rarer in developed countries

1.3 Are there geographical variations in respiratory diseases in Europe?


2.1 What are the multiple causes of disease?

2.2 What is the difference between causes and triggers of diseases?

3. Which circumstances can affect childrens sensitivity to respiratory diseases?

3.1 What is the role of genetic factors?

3.2 Could gender affect the development and frequency of asthma?

3.3 Are the earliest stages of life critical for later respiratory health?

3.4 Does poverty increase the risk of respiratory diseases?

3.5 How are infections, asthma and allergies linked to living conditions?


4.1 Which pollutants are present in outdoor air?

4.2 What respiratory diseases can outdoor pollution lead to?4.3 Does exposure to pollen lead to respiratory allergies?


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Respiratory Diseases: Level 2 - Details on Respiratory Diseases

5.1 In what way can children be exposed to and affected by indoor pollution?

5.2 What air pollutants can affect children at home?

5.3 What air pollutants can affect children at school and in their spare time?

6. Which aspects of respiratory diseases require further research?

7. Conclusions

8. Other views (only in level 1)

Back to Summary Level 2 Questions More in the Source Document


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Respiratory Diseases: 1. To what extent do respiratory diseases affect children?







Disinfectants

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Level 1 Questions Next Question


1.1 How common and severe are respiratory diseases in children?1.2 Are deadly respiratory diseases becoming rarer in developed countries?


1.1 How common and severe are respiratory diseases in children?

Respiratory diseases are the most common cause of illness in children in

developed countries and a leading cause of death in underdeveloped countries.The respiratory health state of children is determined by the interactions ofdifferent factors. These include environmental factors, individual sensitivityand genetic factors. Such factors can determine not only childrens respiratory

health, but may have also consequences for respiratory health in later life. Indeveloped countries, there are now fewer cases of life threatening acuterespiratory infections. However, asthma and respiratory allergies are getting

more frequent and it is not yet entirely clear why. More...

Figure 1: causes of death

in children in Africa and

South East Asia


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9/27

Respiratory Diseases: 1. To what extent do respiratory diseases affect children?

1.2 Are deadly respiratory diseases becoming rarer in developed countries?

In developed countries the frequency of life threatening acute respiratory infections has dropped over the

last 50 years. This is due in part to the use of antibiotics and vaccines against infectious diseases, as well asto a general increase in the standard of living. Respiratory illnesses could be further reduced, for instance,by developing an effective vaccine against viralbronchiolitis or by preventing exposure to cigarette smoke

during pregnancy and early childhood. Sudden Infant Death Syndrome (SIDS) is rarer now than it was in

the 1980s, but it still affects about one child out of 1500. Although its causes are still unknown, the

practical recommendation that infants should sleep on their backs may have helped to reduce the numberof cases.

Better health care allows more and more children to survive serious lung and airway diseases. However,these individuals tend to remain particularly sensitive to environmental triggers such as air pollution in theiradult life. More...


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Within Europe, there tends to be more asthma and allergy in the wealthier West and more infectious

disease in the poorer East. Moreover, there are also differences between the North and the South in termsof asthma and allergies.

It is unclear whether these regional variations can be entirely explained by differences in the way diseasesare diagnosed or by real differences in factors related to the environment or to the sensitivity of individuals.More...


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10/27

Respiratory Diseases: 2. Where are fluorides found?







Disinfectants



in Children



About this study

Previous Question Level 1 Questions Next Question


2.1 What are the multiple causes of disease?2.2 What is the difference between causes and triggers of diseases?

2.1 What are the multiple causes of disease?

There are three main groups of factors which are involved in the development of diseases in general, andalso for respiratory diseases in children:

q the genetic background of a person (host genetics),

q the living conditions or lifestyle of a person (host conditions), which includes nutrition, income andhousing, but also depends on age. It can influence the persons likelihood to respond toenvironmental factors,

q exposure to environmental factors including all kinds of substances present in air, water, food, soil,

and consumer products, as well as other circumstances, such as weather conditions or damphousing.

Asthma, for instance, is a result of different combinations and interactions of

factors from these three groups. Those people who are susceptible due to theirgenetic background and who are exposed to adverse environmental factors

have the highest risk of developing a disease such as asthma.

The fact that there are multiple causes creates many obstacles tounderstanding the mechanisms and factors that lead to disease development,but it also provides opportunities for preventing harm when certain criticalfactors can be identified and removed. More...

Figure 5: Multi-causality

Framework forEnvironment and Health .


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11/27

Respiratory Diseases: 2. Where are fluorides found?

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2.2 What is the difference between causes and triggers of diseases?

While some respiratory diseases have clearly identifiable causes, others including asthma and bronchitis

have a variety of potential causes and triggers.

Whereas underlying causes are responsible for a disease, triggers are factors that bring on or worsensymptoms. For instance, although the role of air pollution in the onset ofasthma is unclear, it has a clear

role in precipitating asthma attacks in children who already have the disease.

Even if reducing a trigger does not remove the underlying causes of a disease and the number of peopleaffected, it may lead to substantial health gains because it reduces the symptoms. More...







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12/27

Respiratory Diseases: 3. Which circumstances can affect children's sensitivity to respiratory diseases?







Disinfectants



in Children



About this study


3. Which circumstances can affect children's sensitivity to respiratory diseases?

3.1 What is the role of genetic factors?3.2 Could gender affect the development and frequency of asthma?




To what extent environmental factors may lead to health effects in children will depend on certain personalcircumstances such as genetic background, gender, age, ethnicity, and social conditions.

3.1 What is the role of genetic factors?

Pulmonary diseases in children may have a genetic basis. Usually several genes are involved, except in the

case ofcystic fibrosis, which results from a change in a single gene.

In the case ofasthma a genetic predisposition is usually necessary for the onset of the disease, butenvironmental factors are also involved. Children of affected parents are two to three times more likely todevelop asthma. However, in addition to genetic factors, environmental factors may also be important since

the increased prevalence of asthma and allergy cannot be explained by genetic factors alone.

Environmental and genetic factors often interact. Therefore,researchers are interested in identifying environmentalfactors, such as exposure to tobacco smoke and air pollution,

that may contribute to causing or triggering asthma,allergies, or other respiratory diseases. More...

See also studies on Tobacco and Air Pollution


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13/27



3.2 Could gender affect the development and frequency of asthma?

In early childhood, about twice as many boys suffer from asthma than girls do. During adolescence this

ratio is reversed and a larger number of girls are affected. The timing of this gender reversal suggests thatsex hormones play a certain role in asthma. More...




Many diseases that appear during childhood or adult life may have their origins in very early stages of life.

In humans, the development of the lungs occurs during development in the womb or shortly after birth, andthere seems to be a link between low birth weight and respiratory problems later in life.

It has been observed that both serious respiratory infections in childhood and early exposure to adverse

environmental factors may result in respiratory problems in adults. For instance, exposure to environmental

tobacco smoke after birth can cause respiratory problems in children. However, if a mother exposes her

unborn child to tobacco smoke by smoking during pregnancy, this can lead to even longer lasting effects.

Children have a higher breathing rate than adults. This means that children breathe in more air relative to

their body weight compared to adults and are thus more exposed to environmental factors, such as

airborne particulate matter. More...




In developing countries, respiratory infections, often combined with malnutrition, are one of the most

common causes of death in children under 5 years of age. Lack of access to clean water and sanitation,malnutrition and poor access to medical services can foster the development of infectious diseases.

In developed countries, such as the United Kingdom, adults and children of lower socio-economic statushave also been demonstrated to be at higher risk ofrespiratory infections. This may be due to crowding,

increased exposure to infectious agents or reduced immunity related to a bad diet. More...


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Living conditions can modify the effect of both genetic and environmental factors. Thus in theory, improving

living conditions is a powerful way to prevent disease. More...

3.5.1 In Western Europe, there has been a steep decrease in the prevalence of severe infectious diseases

such as tuberculosis. Worldwide, pneumonia is the respiratory disease that causes the largest number of

deaths in children, and is linked both to infections and living conditions. More...

3.5.2Asthma and allergies have become more and more frequent in Western Europe. One explanation for

this increase is the hygiene hypothesis which assumes that infections in early childhood may prevent thedevelopment of allergic diseases. The human immune system uses two complementary types of biological

responses to infections. When one part of the immune system lacks practice fighting bacteria and viruses,

perhaps from an overly sanitary lifestyle, the other part can overreact to harmless substances like pollen,causing an allergic reaction.

Other possible explanations for the increase in asthma and allergies are changes in diet, such as a higher

salt intake, a lower intake of certain vitamins and a lower consumption of fish that contains omega-3 fatty

acids, that may also contribute to the development of asthma.

In addition, factors affecting the development of the fetus may lead to a greater risk ofasthma later in life.

For instance, there is a higher number of children suffering from asthma among those who were very smallat birth or those who are born from older mothers. Moreover, if a mother smokes during pregnancy itaffects on her childs birthweight and early childhood respiratory health. However, it is not clear if this

increases the risks of developing asthma and allergies in the longer term. In contrast, breast feeding for at

least 6 months can protect children against respiratory problems in early life, but longer-term benefits forasthma and allergies are not clear. More...


Previous question Level 1 Questions Next question





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Respiratory Diseases: 4. Can outdoor air pollution contribute to respiratory diseases in children?







Disinfectants



in Children



About this study



4.1 Which pollutants are present in outdoor air?4.2 What respiratory diseases can outdoor pollution lead to?

4.3 Does exposure to pollen lead to respiratory allergies?

There is clear evidence that air pollution is associated with troublesome respiratory symptoms in children.However, it is less clear whether specific pollutants are directly responsible for the development ofrespiratory diseases.

4.1 Which pollutants are present in outdoor air?

Particulate matter is the sum of all solid and liquid particles suspended in air.

Many of these particles are due to the burning of fuel for energy andtransport. In Europe, overall concentrations of particulate matter (PM10) in

outdoor air have generally decreased between 1996 and 2000. However, nearbusy roads, concentrations often exceed recommended limits, because ofmotor vehicle emissions.

See also study onAir Pollution

Another type of pollution are gases, such as ozone (O3), sulphur dioxide (SO2), and nitrogen oxides (NOx)

q Ground level Ozone (O3) is a pollutant that is formed under the action of light from other air

pollutants, particularly during sunny weather. In the last few years annual average concentrations

have generally increased, whereas short term peak concentrations have remained stable.q Nitrogen dioxides (NO2) that results from fuel combustion is a major contributor to smog and acid

rain. Concentrations have generally decreased between1996 to 2000, but in some traffic hot-spots

and urban centres recommended values are exceeded.q Sulphur dioxide (SO2) is a gas released mainly by industrial processes, most notably by coal power

plants. It is a major contributor to acid rain. Urban and local SO2 concentrations continue to

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16/27


decrease in most areas in Western Europe, but short-term peaks still represent a problem in someindustrial hot-spots. More...



4.2 What respiratory diseases can outdoor pollution lead to?

There is increasing evidence that the most common air pollutants (PM, O3, NOx and SO2) adversely affect

the respiratory health of children. While air pollution may not be the main cause of the greater frequency of

respiratory disease, it significantly worsens the symptoms. When levels of air pollution are high, an increasein the number of hospital admissions and emergency room visits is observed.

Particular attention is currently given to particles in air which can be breathed in and that are small enoughto enter deep into the lung, as these may be a major contributor to the adverse effects of air pollution.

Some studies suggest that living near busy roads is linked to respiratory problems including reduced lungfunction, as well as to a higher prevalence ofasthma and respiratory symptoms such as wheezing.

Studies that compare two groups of people exposed to different levels of air pollution provide the strongest

evidence for a relationship between respiratory disease and air pollution.

For example, the temporary closing of a steel mill in the Utah Valley in the late 1980s provided researcherswith the unique opportunity to demonstrate a relationship between exposure to air pollution particles and

respiratory health. During the mills closure the number of children with respiratory symptoms admitted into

hospital decreased substantially and then increased to pre-strike levels when the mill reopened. Anotherstudy followed 110 children who were relocated to areas with either more or less air pollution. Those who

moved to less polluted areas showed an increase in lung function, and those who moved to more pollutedareas showed a decrease. More...


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4.3 Does exposure to pollen lead to respiratory allergies?

Pollen allergies are caused by some specific substances released from pollen into the air (pollen allergens).

In Europe pollen allergens may be responsible for 10-20% of allergic diseases. Although the relationshipbetween pollen allergens and hayfever (allergic rhinitis) is clear the relationship between pollen allergens

and asthma is less clear.

In different regions different plant species are responsible for pollen allergies. For instance, grasses andbirch trees are the main cause of pollen allergies in Northern and Central Europe, ragweed in Central and

Eastern Europe, and olive trees and cypresses in Southern Europe.

The occurrence ofallergic reactions depends on the length of the pollen season, the amount of pollen in the

air, the number and level of the pollen peaks, and how readily allergens are taken up by the body.

One study has suggested that in highly polluted areas air pollution may increase the frequency of pollenallergies. However, other studies have not shown such a relationship and another recent study carried out

on children during the pollen season suggested that air pollution does not increase pollen-related allergies.

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Global climate change might cause particular plant species to spread to new areas which become

climatically suitable. Warming may cause an earlier and longer pollen season for some species. It remainsuncertain how these changes would affect the frequency and severity ofallergies in different regions. More...







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18/27

Respiratory Diseases: 5. Can indoor air pollution contribute to respiratory diseases in children?







Disinfectants



in Children



About this study



5.1 In what way can children be exposed to and affected by indoor pollution?5.2 What air pollutants can affect children at home?

5.3 What air pollutants can affect children at school and in their spare time?

Indoor air pollution can be much worse than the air pollution outdoors. In Europe, most children spend 90%of their time indoors. Therefore, they are particularly affected by indoor air quality at home, but sometimesalso at day care or school, and during recreational activities such as swimming. More...

5.1 In what way can children be exposed to and affected by indoor pollution?

5.1.1 Outdoor pollution may affect indoor air quality. Moreover, there can be indoor pollution due, for

instance, to the presence of hazardous building materials, the use of cleaning products, or to smoking.Increased insulation tends to decrease air exchange between the indoor and outdoor environment.Insufficient air exchange can lead to the build-up of both air pollutants and moisture, which favours the

development of mites and moulds. More...

5.1.2Poor indoor air quality can cause or contribute to the development ofrespiratory diseases such as

irritations and infections of the respiratory tract and exacerbation ofasthma. In addition, it can

cause headaches, dry eyes, nausea, and fatigue. Children who already have respiratory diseases are atincreased risk of suffering from the effects of indoor air pollution. More...



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Respiratory Diseases: 5. Can indoor air pollution contribute to respiratory diseases in children?

5.2 What air pollutants can affect children at home?

5.2.1 In the home, tobacco smoke can be an important source of toxic air contaminants and contribute to a

number of health effects that can be chronic, such as childhood asthma, or even deadly, such as Sudden

Infant Death Syndrome.

If a mother smokes during pregnancy, the growth of the unborn child can beadversely affected, increasing the risk of low birth weight. In children, passive

smoking can lead to a variety of effects affecting the upper and lower

respiratory tract, as well as ear infections and non specific symptoms of cough

and wheezing. Passive smoking can worsen symptoms in children withallergies and may make them more sensitive to food allergens. More...

See also study onActive & Passive smoking

5.2.2Living organisms such as moulds, bacteria, viruses, and dust mites can adversely affect indoor air

quality. In newer houses, due to increasing energy-saving standards, air exchange between indoor andoutdoor is limited. This can increase humidity which promotes the growth ofmicro-organisms and increases

the amount of indoor air allergens. This in turn can lead to a higher risk of allergic disorders an

respiratory diseases green facts

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