Pulmonologist: air pollutants damage virtually all tissues and organs

– There has long been talk of the impact of smog on the respiratory system. We also talked about the effects on the cardiovascular system and the endocrine system, but an especially important problem is the effect on the fetuses. We talk a lot in our country about the protection of unborn life, and we do not really protect it, because we expose it to very serious damage to health – says Dr. Tomasz M. Zielonka. Today, together with Airly, we publish an annual report on the state of air in Poland.

1. Many people are not aware of the fact that if the first period of pregnancy (1st and 2nd trimester) is in the smog period, it favors the low birth weight of the child and prematurity. And these two factors contribute to the disease throughout life – warns Zielonka
2. The doctor reminds that the WHO recently introduced new recommendations on the health impact of air pollution. – This is a medical signpost for the coming years. The document was created 16 years after the previous WHO position and it is important because the knowledge about the impact of environmental pollution on health is the last 20 years. This document contains fundamental statements that should stick in the minds of all doctors, as well as in the public awareness – believes
3. The pulmonologist also warns that air pollution causes damage to virtually all tissues and organs. They also have a great influence on the progression of asthma and can even cause it
4. Today, together with Airly, we publish an annual report on the state of air in Poland. You can download it from the website oddychajpolsko.TvoiLokony
5. For more up-to-date information on the coronavirus epidemic, visit the TvoiLokony home page

Smog has a detrimental effect on every human organ

Adrian Dąbek, Medonet: What can smog do in our body?

Dr hab. Tadeusz M. Zielonka: This is a very broad question. The World Health Organization recently introduced new recommendations on the health effects of air pollution. This is a medical signpost for the coming years. The document was created 16 years after the previous WHO position and it is important because the knowledge about the impact of environmental pollution on health is the last 20 years. This document has been awaited for several years and highlights what will happen in medicine. These new recommendations are extremely important to many scientific societies. This document contains fundamental statements that should stick in the minds of all physicians, as well as in the public awareness.

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Air pollution causes damage to virtually all tissues and organs. The harmful effect of smog on virtually every organ has been proven. Therefore, all specialists should be interested in this topic, because there is really no specialization that would not apply to it. Today I sent a review of an article by a British center that investigated the effects of communication pollution on cognition, memory, mental processes and children’s academic performance at school. Research has clearly shown that dust pollution causes cognitive impairment and worsens school performance. Until recently, we did not associate smog with it. And it turns out that children are less focused, remember worse, have worse results at school due to exposure to smog. It was especially visible in foreign language learning, math, memorization and reading comprehension. This harmful effect of air pollution is both short-term and long-term.

Previously, we did not associate cognitive, mental and neurological disorders with smog. Effects on the respiratory system have long been talked about. Both for the upper roads, i.e. ENT problems, and for the lower ones, i.e. pulmonary ones. We also talked about the effects on the cardiovascular system and the endocrine system, but an especially important problem is the effect on the fetuses. We talk a lot in our country about the protection of unborn life, and we do not really protect it because we expose it to very serious damage to health.

Many people are not aware of the fact that if the first period of pregnancy (1st and 2nd trimester) is in the smog period, it favors the low birth weight of the child and prematurity. I remember from the time of my studies, although at that time the causes of prematurity and low birth weight were not known, that these two factors contribute to sickness throughout my life. We do not realize that if a woman becomes pregnant in the smog region during the heating season, her child will be sick for the rest of her life. These are enormous achievements in the field of knowledge about the impact of air pollution. In the case of Poland with enormous excesses of carcinogenic compounds, we must realize that if we are afraid of cancer, we should be afraid of smog. Because pollution in smog is important carcinogens.

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Smog is an extremely wide range. After all, it attacks our gates, that is skin, eyes, conjunctiva. So ophthalmologists and dermatologists are other specialists who should be interested in smog. This is their domain. Also, pediatricians, due to the greater harmfulness of air pollution in children. The dust falls, and at the ground, where the child breathes, there is a much higher concentration of pollutants than at the adult human level. This effect, both by size and by the different structure of the child’s airways, will be more detrimental to children than to adults.

The rest of the text below the video.

Smog and air pollution kill

When talking about the harmfulness of smog, it is commonly believed that it is primarily about the respiratory system. Can it be said then that asthma is a disease at the top of the smog impact ranking?

The effects are very diverse. If you look at it in terms of mortality, because smog and air pollution kill, it is not. It is the most dangerous for the circulatory system. The greatest number of deaths caused by air pollution is related to the circulatory system.

In Poland, 50 thousand people die from smog each year. people. We erase a town the size of Skierniewice from the map of the country. There are so many premature deaths caused by smog. Most people die not from asthma, but from a heart attack, stroke or embolism.

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It all depends on the aspect of the effect on health. If we are talking about mortality, it is greatest in the circulatory system. If we are talking about the exacerbation of chronic diseases, we have a strong impact of smog on asthma and COPD. We are dealing here with chronic diseases, which are exacerbated by smog. The quality of life of these patients deteriorates, and more needs to be spent on drugs.

But looking at the deaths, after cardiology, the biggest harvest is in oncology. Smog causes death associated with long-term exposure and the formation of cancer.

But there is one more important aspect related to COVID-19. The smog period has begun, a new wave of COVID-19 has begun. Previously, we had numerous cases only during the smog period. Poland did not observe it during the first wave, which practically did not exist (because we had the first and the second wave, while others had the second, third). In the spring and summer period of the previous year, Poland did not have a significant number of cases, because the lockdown resulted in a reduction in the emission of pollutants. There was no peak infection then, as in other European countries. It started when the smog started. He has long caused the death toll of infections. Just look at the flu or other infections – they are also mainly in the smog period. During the heating season, we have the most infections. COVID-19 is now proof of that. When there was the fourth summit in France or Great Britain, Poland had 50 cases, and now the smog has come and we have 16. This is a completely different scale. Smog is a very strong element in the emergence of respiratory infections.

Smog-initiated infections exacerbate asthma or COPD. There are other associations between smog and asthma. Smog itself exacerbates asthma and this is a non-infectious exacerbation of asthma, and at the same time smog causes infections, and each infection exacerbates asthmaę. These links between smog and worsening asthma are very clear. But there are rarely deaths, because fortunately we have effective treatment, but this translates into more frequent visits to the doctors, into greater consumption of drugs, and therefore costs. In the smog period, we spend more on doctors or drugs, we have more hospitalizations related to the exacerbation of the disease. We have more deaths with COPD, which is the more severe disease. It has also been shown that asthma can be caused by exposure to air pollutants

Smog exacerbates asthma and also causes it

Does an asthma exacerbation work differently across age categories?

It is hardly any different. But in general, more severe disease is seen in the elderly and children. We always have an element of smaller reserves in these cases. Children and the elderly have fewer reserves, and diseases mean that we have to mobilize reserves, so the exacerbation of the disease is more difficult in people with lower reserves. This applies to both of these arms, the elderly and the youngest population. In the middle age range, we have much larger reserves and we experience these tightening more gently.

And if we have never suspected asthma in ourselves, and we cough during the smog period, what should prompt us to test for asthma?

Asthma exacerbations are caused by smog. But there is growing evidence that smog can trigger asthma. For years, we have been sensitized to atopic asthma, i.e. asthma caused by allergies, which has already appeared in young children. And this disease accompanies them throughout their lives. But at the moment we have a growing number of non-allergic diseases. That is, non-atopic asthma, in which there is no allergy to pollen or animal allergens. The non-atopic ones have a different background. Until recently, we thought asthma was mostly post-infectious. We now see that air pollution can also cause this non-allergic asthma. It is the same, but has a different background. As a pulmonologist, I can see that the number of people suffering from asthma is increasing dramatically. This disease in the XNUMXth century, when I started working as a doctor, was much rarer than it is in the XNUMXst century. There is an asthma epidemic.

1. Smog – how does air pollution affect our health?

Data from Krakow are shocking. Prof. Ewa Czarnobilska repeated the research carried out years ago by her predecessor and teacher, prof. Wiesław Jędrychowski, who showed a very high percentage of asthma and allergies in children from Kraków. The maximum numbers in Australia or Great Britain were 30%, and in Kraków at the end of the 37th century it was 38-XNUMX%. Much more than in countries where one in three children has been reported to have asthma. Mrs. prof. Czarnobilska published a similar study some time ago. And surprisingly, the percentage of children who are treated for asthma by doctors or who have skin-tested allergies has risen to 54%. And she examined the entire year, over 80 thousand. kids. It was not a fragmentary study involving several hundred children, but the entire year was examined. And it turned out that every second child in Krakow has asthma or allergies. What does this show? This is an explosion of disease. The deterioration of air quality is one of the most important factors contributing to these changes. This research was done in Krakow on purpose, because we know how bad the air quality is in this city. But today, Krakow is in a better situation than many cities in Upper Silesia, Lower Silesia or even Wrocław.

It is not that everyone ignores the smog threat, there are many places that are making efforts, such as Krakow, which systematically reduces air pollution and the effects are already visible. But, for example, there is Zakopane, where the councilors said that there would be no anti-smog measures, so the situation would worsen there.

In Upper Silesia, for example, there is Katowice, the cradle of mining and industry, where, thanks to specific activities, it is getting better and better. At the same time, it is much worse in other poviats of the region. For example Rybnik, Pszczyna. Of the 10 dirtiest cities in Europe, seven are from Poland. And out of 50 or 33 the dirtiest cities in Europe are Polish cities. I’m surprised we don’t feel ashamed to be such a dirty country.

It must be action at all levels. Local and central authorities, but also educational. You have to teach from a child that you must not throw plastic into the oven. And it is very good that there are already educated children at school who tell their parents this. We have to do something in our field, also in journalism. Everyone has something to do. Doctors also make the public aware of the health effects of smog. The Polish medical community is somehow responsible for such a huge air pollution, because it speaks too rarely about it. I have been drawing my patients’ attention to the need for pollution monitoring for a long time. A person suffering from asthma during the smog season should limit going outside. At home, pollution is halved. If we turn on the air purifier, we will have better air quality.

Shopping or a walk on a day with increasing pollution must be postponed. Because we know it is changeable. And it is absolutely unreasonable to walk or run along communication routes. Then this physical activity not only does not help, but even harms. Asthmatics, who, even without smog, walk along streets with high traffic, and God forbid, will go jogging or cycling there, not only will not improve, but even harm their health. Breathing polluted air with exercise will exacerbate your asthma.

Smog and asthma – three elements of prevention

What can an asthmatic who has to go to a stop to go to work or school, and sees red in his area in the smog application?

I have to refer to the WHO document, which is poorly distributed in Poland, in which the results of the experts’ consensus were published. Experts discussed and launched the green light on several elements.

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The first thing is to raise the role smog alarm. The public, and especially the sick, need to be notified of the increase in air pollution. Thanks to this, they will be able to limit their activity. But there has to be information first. You can expect the patient to be interested in it, but the patient must know that it is important to him and that he should be interested in it. I tell my patients this, they follow it and thus avoid unnecessary exposure. This is something similar to what allergists have done with pollen information. We have had maps, pollen calendars, pollen information in the media for years. It fulfills its role perfectly, because people allergic to certain elements check it and avoid exposure, they effectively improve their quality of life. We do not have such good information about smog.

Moreover, in relation to other countries, we have higher standards, at which the public is informed about exceeded pollution. It should be that above a certain level people are informed. And we have too high information ceilings. Because it is different for the patient to check the pollution level himself, and another thing is for the services to inform about it. We have too high a bar for compulsory information by the services.

We should introduce information on pollution reaching citizens at a much lower level than it is today. The second issue that has been assessed favorably in this WHO document is the element of masks with filters. When the indicator is red, the asthmatic should go to a stop, to work in a mask with HEPA filters and carbon filters. So with double protection, against gases and dust. Then it will reduce exposure to harmful substances.

Paradoxically, COVID-19 has played one good role. He got us used to seeing people in masks. Before COVID, a person wearing a filter mask would be treated very strangely, possibly even ostracism. We treated pictures from Japan, where people had masks on their faces before the pandemic, as curiosities or freaks. The masked person was treated as threatening, not as protecting himself from something. And COVID-19 has shown that the one in the mask is the one who is safe for the environment. But in the context of an asthmatic mask, we are not talking about a surgical mask that is put on so as not to infect others, but a mask that protects. FFP2 or FFP3 masks that protect against pollution or allergens. They have long been recommended to asthmatics in Western countries because they protect them when they go outside. They are a very important protection for them, not only against the allergen, but also against smog.

And the third thing, well rated by experts and recommended for asthmatics, are air purifiers. More than half of my patients report that they already have a purifier at home. The house protects us. If we have tight windows and we close them, we have half of what is outside. This is a big profit. But that’s still half. So if the standard is 5 micrograms, the new standard (because the World Health Organization, introducing new recommendations, reduced the permissible concentration of PM2.5 suspended dust from 25 to 5 µg / m³, i.e. five times lower), then we will have 100 µg / m³, with standard 50. And this is nothing special. In Poland, exceeding 5 µg is a frequent phenomenon during the heating season.

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Turning on the purifier will effectively reduce dust and pollution exposure and this is another protection that we need to implement. Because we can’t fight decarbonization overnight. Fortunately, Poland joined the countries that declared decarbonisation at the Glasgow climate summit. We joined 192 countries which have announced that they are abandoning coal as an energy source. It is carbon that causes the harmful effects of asthma when burned.

But it will be a blanking process. Therefore, changing the lifestyle in the smog period, masks with a HEPA filter, carbon filter and purifiers with double filters is something we can do now.

Speaking of masks. Because it’s a bit of a paradoxical situation. Masks protect asthmatics, but also make breathing difficult, and this condition allows you not to wear a covid mask. How to find the golden mean?

Patients asked me to be exempt from face masks, because they choke on them. I always explain that they have to approach this problem in such a way as to calculate when there are more losses and when there are more gains. If we get into an elevator with eight unknown, perhaps coughing people, despite being short of breath, I advise you to wear a mask. Even though it will worsen the quality of your breathing. But when we are outside, and here we are reminded of the situation when there was an order of masks in forests and parks, I say that the sick person should take advantage of this exemption and take off the mask. The risk of becoming infected with COVID-19 is then negligible.

On the other hand, if there is smog, the greater benefit of protection against it will be by using an appropriate mask with HEPA filters, as it may exacerbate the disease, which is worse than the discomfort resulting from wearing the mask. We have to weigh the gains and losses. If we are to catch the infection on the bus, it is better to wear a mask, even if your breathing is worse.

We have to put it on the line. I repeat that the greater loss will be if we inhale polluted air, flu viruses or COVID-19 than the discomfort of wearing a mask. But if the air is clean and safe, we know absolutely not to wear a mask. The benefit of fresh air is greater, it just has to be clean.

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