Air pollution in the Asia-Pacific region: Increase in respiratory diseases

APAAACI´s recent white paper showed that various air pollutants threaten human respiratory and cardiovascular health

Respiratory diseases are caused by air pollutants from rapid urbanisation

APAAACI´s recent white paper showed that various air pollutants threaten human respiratory and cardiovascular health.

Key Takeaways

1. The Asia-Pacific region is the most populated region in the world.
2. Epidemiological studies showed that mainly indoor and outdoor pollutants affect respiratory health with rising numbers in asthma and allergy cases.
3. The main risk factors for allergic diseases within the region are the high grade of urbanisation, the rising air pollution and climate change.
4. The main strategies to fight allergic conditions in the Asia-Pacific region should focus on active governmental policies to fight air pollution and to increase air quality.

The Asia-Pacific region’s environment and air quality is rapidly worsening as pollution levels rise

The Asia-Pacific region has been rapidly industrialising in recent years. In combination with rapid economic growth the environment has degraded, and the number of allergic diseases has reached epidemic proportions. In many Asian countries, especially China and India, air pollution levels are much higher than in industrialised countries. In addition, biomass burning in industry, transport and households, as well as indoor pollutants from chemicals and tobacco smoking, are the main sources of air pollutants that are an increasing burden for respiratory allergies.

Furthermore, the Asia-Pacific region has become the most inhabited region containing more than half of the world's population. In this context, the WHO announced that the majority of people who died due to environmental air pollution in 2012 originated from Asia. For this reason, APAAACI calls the attention of global public health and environmental policy makers to implement proactive government policies based on local conditions to tackle air pollution, climate change, and reduced biodiversity. 

Moreover, a recent APAAACI white paper highlighted the importance of environmental awareness and interactive strategies to diminish increasing cases of allergic respiratory diseases such as rhinitis and asthma in the Asia-Pacific region. 

Most countries in the Asian-Pacific region lack pollution awareness and control 

Most of the countries in the Asia-Pacific region still lack pollution awareness. Thus in Indonesia, specifically in the islands of Sumatra and Borneo, great amounts of smoke hazes are still being produced because of the continuous landscape fires for expanding palm plantations. Singapore was also repeatedly affected by these fire emissions in recent years, which increased chronic respiratory ailments in both countries.

Nowadays, throughout the year, there are often only 14 days of fresh air to breathe in Jakarta (Indonesia). The air is becoming more unhealthy, and more people are exposed to it. As a consequence, the numbers of acute childhood asthma have also been increasing in Singapore.

On the other hand, Koreans often spend their time indoors and in underground infrastructure, so they are exposed to various indoor air pollutants such as tobacco smoke, stoves and gas ranges, odorous building materials, and animal waste, resulting in the development of respiratory symptoms, allergies as well as sleeping problems.

More lives are lost because of prevailing indoor and outdoor air pollutants 

Air pollution in the Asia-Pacific region is further increasing due to climate change. For example, all metropolitan cities in Australia have faced harsh climate change-related events. Subsequently, dust storms, bushfires and thunderstorms occurred as well as accidental factory fires and chemical spills; all together causing a decrease of air quality. In 2016 in Melbourne, Australia, 10 people died and more than 9,000 people suffered from respiratory allergies and asthma due to a thunderstorm with strong winds carrying high amounts of grass pollen. 

In China, the continuous increase of outdoor air pollution is evident. In Jinan, from 2011 to 2017, more respiratory deaths among the elderly were recorded, with chronic airway disease specified as their cause.
On the other hand, in Hong Kong and India, household air pollution is another major health factor. India faced higher disease rates for acute respiratory infection, asthma, COPD, and lung cancer, which killed more than one million people in 2015 due to high levels of ambient and household air pollutants. Although India took measures to tackle air pollution, these efforts have not been enough to improve air quality until now. 

Likewise, in Hong Kong, common use of household incense burning and smoking, caused more cases of bronchitis, bronchiolitis, pneumonia, and other respiratory ailments mostly affecting young children. Also second-hand smoke from home or neighbors affected children aged 5–16. Since Hong Kong is densely populated, proper ventilation systems are advised.

A similar problem also exists in the Philippines, where high school students in Quezon City developed low lung function due to smoking exposures. Here almost a quarter of the students (roundly 24 %) suffer from lung diseases and reduced lung function, as the APAAACI white paper revealed.

Irresponsible ways lead to air pollution

Going north, Mongolia has the worst air during the winter season because of the increasing use of household pressure boilers that burn raw coals. However, Mongolia reacted fast and prohibited the use of unprocessed coal, which resulted in a decrease of environmental pollution in the winter of 2020.

Correspondingly, Taiwan´s cases of asthma increased extraordinarily during the cold season. It is because of the rapid industrialisation in combination with motor vehicle emissions that polluted the air. Vietnam, however, experienced more cases of acute lower respiratory infection, particularly during the dry season.

In Malaysia and Thailand, particulate matter (also known as particle pollution) is the most dominant air pollutant. Malaysia burns more biomasses whereas Thailand burns more agricultural land. Additionally, the uncontrolled increase in numbers of motor vehicles in both countries has caused major pollution in the air and affects the respiratory health of most people, especially the elderly.  

Nevertheless, air pollution is not just a problem in developing countries, as increasing automobile traffic has also caused air pollution in Japan. School children and preschoolers have been more frequently affected by asthmatic symptoms than 20 years ago. However, Japan successfully controlled the problem by enforcing Automobile NOx/PM laws in 2001.

How to tackle the problem?

The Asia-Pacific, considered the world’s most populous region, has tremendous exposure to outdoor and indoor pollutants as well as household pollutants such as biomass and tobacco. The risk factors for the epidemic increase in allergies in the Asia-Pacific region are increasing urbanisation, air pollution, lack of environmental awareness, or missing pollution control regulations, which have combined in recent decades with climate change patterns.

As industrialisation continuously grows, people are suffering from respiratory diseases and environmental degradation, further depriving people of fresh air.

Therefore, the APAAACI white paper calls for extensive cooperation for controlling air quality, especially in the Asia-Pacific region. The legislative and administrative branches of government should implement constant environmental awareness programs, active policies, and a coordinated strategy to trigger the necessary social changes that will ultimately allow populations to benefit from a healthier air and a protected biodiversity, not only in the Asia-Pacific region.

Pawankar R et al., Asia Pacific Association of Allergy Asthma and Clinical Immunology White Paper 2020 on climate change, air pollution, and biodiversity in Asia-Pacific and impact on allergic diseases, Asia Pac Allergy 2020; 10(1): e11