Intended for healthcare professionals

Practice Clinical Updates

Reducing the health impacts of ambient air pollution

BMJ 2022; 379 doi: (Published 12 October 2022) Cite this as: BMJ 2022;379:e069487

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  1. C Sorensen, associate professor1 2,
  2. E Lehmann, program assistant11,
  3. C Holder, associate dean of diversity, equity, inclusivity, and community initiatives3,
  4. J Hu, research fellow4 5,
  5. A Krishnan, professor6,
  6. T Münzel, director7,
  7. Rice MB, assistant professor8,
  8. Salas RN, assistant professor, affiliated faculty, Yerby Fellow9 101112
  1. 1Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
  2. 2Department of Emergency Medicine, Columbia Irving Medical Center, New York, NY, USA
  3. 3Department of Humanities, Health and Society, Florida International University Herbert Wertheim College of Medicine, Miami, Florida, USA
  4. 4Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China
  5. 5Zhangjiang Institute, Fudan University, Shanghai, China
  6. 6Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
  7. 7Department of Cardiology, University Medical Center, Johannes Gutenberg University, Mainz, Germany
  8. 8Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
  9. 9Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
  10. 10Harvard Medical School, Boston, MA, USA
  11. 11Harvard Global Health Institute, Cambridge, MA, USA
  12. 12Harvard T.H. Chan School of Public Health, Boston, MA, USA
  1. Correspondence to C Sorensen CJS2282{at}

What you need to know

  • Inhaling polluted ambient air has many health effects, including childhood onset of asthma, and onset and progression of atherosclerosis

  • Vulnerable people can consider using well fitted N95 face masks, avoiding outdoor exercise on days when the air quality is poor, and using indoor HEPA air filters

  • Consider establishing air quality monitoring and warning systems for use by clinicians and in hospitals

Case 1—A man in his late 50s with a history of chronic stable angina, arterial hypertension, and a family history of cardiovascular disease presents with acute onset chest pain and is diagnosed with NSTEMI myocardial infarction. He lives in an industrialised city with annual particulate matter (PM2.5) levels higher than 50 µg/m3, which spiked to 90 µg/m3 in the days before his myocardial infarction.

Case 2—A 9 year old girl with constant cough that interferes with her sleep visits the general practitioner with her mother. Her symptoms have caused tiredness and school absences. The family recently moved to a large city where annual PM2.5 is 85 µg/m3, from a region with annual PM2.5 of 20 µg/m3. The cough began after their move. She has no known allergy or previous similar complaint. Examination reveals a mildly inflamed throat and mild wheezing.

Ambient air pollution is the fifth highest risk factor for death (after hypertension, smoking, high fasting glucose, and high total cholesterol), according to the Health Effects Institute.1

Annually, 8.7 million global deaths are thought to be caused by inhalation of particulate matter released into the air from combustion of fossil fuels.2 In Europe, particulate matter and ozone account for almost 800 000 excess deaths annually.3 Additionally, an exposure-response study has estimated that particulate air pollution has contributed to approximately 15% (95% confidence interval, 7% to …

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