Tackling toxic air and climate change

The risk to non-smokers of developing lung cancer is rising significantly: in the UK 6000 people each year now die of lung cancer despite having never smoked, or having smoked a negligible number of cigarettes. This is thought to be as a result of increasing exposure to toxic air.

This makes lung cancer among non-smokers alone the eighth biggest cancer-related cause of death in the UK, ahead of leukaemia, lymphoma and head and neck cancer. However, as lung cancer remains strongly associated with smoking it has created stigma around the disease as self-inflicted, which has had an impact on the level of research into its other causes. Consequently, there is a need to raise awareness with clinicians and policy makers of the other risk factors – including indoor and outdoor air pollution.

While smoking is the single biggest lifestyle factor that affects lung cancer, accounting for around 86 per cent of cases, air pollution, fumes from coal fireplaces, and second-hand smoke are also linked to its development. Smoking history is often the first question clinicians will ask patients who come in with respiratory symptoms that could be an early warning cancer, but a history of not smoking could give false reassurance and send them down the wrong diagnostic path.

Even more worrying is the fact that worldwide nearly four million children develop asthma every year as a result of air pollution from cars and heavy vehicles, equivalent to 11 000 new cases a day. The key pollutant, nitrogen dioxide, is produced largely by diesel vehicles.

Childhood asthma has now reached global epidemic proportions: one in eight of all new cases is due to traffic pollution and evidence shows that existing WHO standards are not protective against childhood asthma. As a result of their high populations and significant pollution levels, the three countries with the greatest number of children developing asthma each year are China (760 000), India (350 000) and the USA (240 000). However, these data may underestimate the true levels in many poorer nations where asthma often goes undiagnosed and undertreated.

The risks to us all – and to all other species – from a combination of environmental pollution and climate change are plain to see: we cannot pretend to be unaware. Each and every one of us could and should modify our lifestyle, and encourage our friends, colleagues and patients to do likewise, by cutting back on air travel, reducing or cutting out the consumption of red meat and converting to a more plant-based diet.
What are your thoughts? How should we respond to the climate change emergency?

Comments (5) Add yours ↓
  1. Mamta Ruparel Respiratory ST7 and Clinical Lecturer

    Very pertinent blog – couldn’t agree more. 25% of lung cancers (the biggest cancer killer in the UK), are not caused by smoking. Outdoor air pollution also accounts for enhancing rates and severity of airways diseases such as asthma and COPD. And even short term exposures to outdoor air pollution can negate the positive effects of cardiovascular exercise such as walking.(https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)32643-0/fulltext)

    Urgent measures are needed to improve air quality, particularly in an era when the production of fossil fuels is being increased in the US when this needs to be urgently reduced.

    What can we do?
    – Boycott supermarkets that use excessive amounts of packaging
    – Switch toiletries to more environmentally friendly options where possible (eg bars of soap)
    – Reusable plastics (water bottles, coffee cups, plastic bags)
    – Save energy- energy saving bulbs, turn off lights and appliances, run dishwashers and washing machines only when full
    – electric cars, carpooling, cycle and walk more

    June 7, 2019 Reply
  2. Bill Dunsmuir Consultant

    A very timely editorial. This dovetails very well with the campaign on clean air being launched by the Times newspaper.


    The current BBC mini series “The War on Plastic” describes how respiratory disease is crippling the innocent people of Malaysia as they (‘illegally’) burn our (from the UK) plastic waste in open fires. We ship our plastic waste 6000 miles (at a cost 250 times greater than if it were dealt with on our own shores) to poison other people in SE Asia.

    June 13, 2019 Reply
  3. Roger Kirby Professor of Urology

    The risk of dying from long-term exposure to London’s toxic air has risen for a second year running in an “utterly horrifying” reversal of the previous improving trend.

    The rate of fatalities linked to breathing in killer particles went up from 6.4 per cent to 6.5 per cent in 2017, according to computer-modelled estimates from government body Public Health England.

    That followed a jump from 5.6 per cent to 6.4 per cent the previous year, suggesting that efforts to clean up particulate pollution are having little impact. Before that the death rate had been falling since 2010.

    Campaigners said the figures were a “terrible reminder” of the dangers of breathing in contaminated air over a long period.

    A breakdown also shows that the death rate for a lifetime of exposure to microscopic PM2.5 particles created by diesel engines, coal-burning power stations, wood fires, agriculture and building sites is rising in almost three quarters of boroughs.

    June 16, 2019 Reply
  4. Roger Kirby Professor of Urology

    Air pollution may shave as much as seven months off the life expectancy of children who live in congested cities, UK research suggests.
    The “mortality burden” of a lifetime of breathing toxic air has been calculated for one of the UK’s largest cities, Birmingham, by a team from King’s College London.
    Researchers estimate that an eight-year-old living in the city today can expect to die two to seven months earlier based on the expected pollution concentrations for the city.
    The impact was considered to be worse than some other major cities in the UK – with the report finding a higher loss of life expectancy in Birmingham than Manchester.
    It calculated the annual health cost of air pollution in Birmingham was between £190m to £470m per year.
    The study looked at the combined impact of two pollutants – particulate matter and nitrogen dioxide – two of the leading causes of poor health from air pollution.

    July 8, 2019 Reply
  5. Roger Kirby Professor of Urology

    Overall emissions of greenhouse gases increased by 2% in 2018. In the power industry, emissions rose by 2.7%, the biggest increase in seven years. This was driven by a high number of days that were either unusually hot or cold, which boosted total energy demand.
    Even more alarmingly greenhouse gases from the United States shot up by 3.4%
    last year, a major reversal from recent years. Republican politicians, including President Trump, who favour doing little or nothing on climate change argue that U.S. emissions have been declining without more federal intervention. However it is fantasy to imagine that the pace of decline, let alone the even more aggressive rate of change the world needs, is sustainable without government action. Clearly the US and other nations, including China and India, must adopt policies such as a carbon tax that would encourage economic growth without emissions growth.

    Recently, the journal Science published a study finding that the oceans are warming at an alarming pace, 40 to 50 percent faster than the United Nations had previously estimated. The world’s waters soak up nearly all the extra heat humans add to the Earth’s energy balance, and the consequences will include more massive coral die-offs, depleted fisheries, sea-level rise, flooding, mega-storms that pack more power and torrential rain, and less oxygen in the ocean that undersea creatures need to survive. Already, a fifth of the world’s corals have died in the past three years, a desperate harbinger of the changes to come.

    Carbon dioxide concentrations have shown several cycles of variation from about 180 parts per million during the deep glaciations of the Holocene and Pleistocene to 280 parts per million during the interglacial periods. Following the start of the Industrial Revolution, atmospheric CO2 concentration increased to over 400 parts per million and continues to increase, causing the phenomenon known as global warming. As of April 2019, the average monthly level of CO2 in Earth’s atmosphere for the first time exceeded 413 parts per million.

    The concentration of carbon dioxide in the atmosphere is this high for the first time in 55 years of measurement—and probably more than 3 million years of Earth history. The current concentration may actually be the highest in the last 20 million years. The risks to health are manifold and include, among many other hazards, hyperthermia, the spread of tropical diseases and pulmonary toxicity from polluted air.

    So what if anything can we as individuals do in our own small way to try to reverse this terrifying trend? Firstly, lobby politicians and other policy makers to address this “climate emergency” far more urgently and energetically. Secondly, do our best to reduce our own carbon footprint by flying less frequently and taking shorter haul flights, buying an electric vehicle and cycling or walking rather than driving, eating less red meat and dairy food, insulating our homes more efficiently and planting more trees. Thirdly, using our influence as clinicians with patients, family and friends to persuade them to do likewise.

    July 11, 2019 Reply

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