Impact of Air Pollution on Respiratory Diseases in Urban Areas: A Systematic Review

Daniele Ignazio La Milia R Sciaraffa1 , A Borghini1 , P Montuschi1 , GA Gerosa2 , W Ricciardi1 , U Moscato1 1 Institute of Public
Health, Catholic University of the Sacred Heart, Rome, Italy 2 Department of Mathematics and Physics, Catholic University of
the Sacred Heart, Brescia, Italy Contact: rocco.sciaraffa01@icatt.it

Background:
Air pollution has many negative effects on the public health, especially children, elderly and
those affected by pre-existing respiratory diseases. The aim of this study was to evaluate the
correlation between urbanization and high levels of vehicle emissions and increased frequency
of respiratory diseases, in people living in urban areas compared to those living in rural areas.

Methods:
This review was conducted in PubMed and Cochrane library databases using a search string. We
included articles related to Italian territory, published between 1971 and 2017, analyzing the
effects of air pollution on frequency of respiratory diseases (asthmatic and chronic obstructive
pulmonary disease, COPD, symptoms wheezing and cough), on hospital admissions for
respiratory diseases and lung functioning. This review was carried out with the PRISMA
Statement methodology.

Results:
We obtained a total of 262 articles, after selection we included 19 articles in the review. The
results confirm the association between the effect of air pollution exposure (PM10, PM2.5,
NO2, SO2, CO2, O3) and respiratory diseases. Increased concentrations of all atmospheric
pollutants, in particular of aerial particles, have been associated in 70% of the studies to cough
and phlegm, in 35% to asthma symptoms, in 30% to reduction of volumes and respiratory flows,
in 30% to increase of hospital stay days during hospitalization for exacerbation of pre-existing
respiratory disease.

Conclusions:
Urbanization, elevated levels of traffic and consequent vehicle emissions, and industrial lifestyle
are correlated to an increase in the frequency of asthma exacerbations and respiratory
infections, especially in people who live in urban areas compared with those who live in rural
areas, As well as an increase in sensitivity to pollen-induced allergies. Findings suggest that
environmental control may be crucial for prevention of COPD and other acute and chronic
respiratory diseases.
Key messages:
It is necessary to put in place measures to prevention effects on population health, such as
plans and interventions to disincentive use of vehicles and regulation about domestic heating
systems use. National policies to reduce air pollution are needed for having clean air and no
longer significant adverse effects on public health.