23rd August 2023
In this week’s blog, we’re looking at how healthcare professionals can support patients to understand the effects of air quality on their asthma symptoms.
What do we mean by air quality?
When we talk about air quality, we simply mean how much pollution is present in the air we breathe. Clean air is a fundamental requirement for healthy living and working, and while air quality has improved in recent years, there are still areas of the UK that experience higher, and potentially dangerous, levels of air pollution. For patients with respiratory and other long-term conditions, poor air quality can lead to worsening symptoms and increased risk of premature death. Factors contributing to air pollution include vehicle emissions, fuel burning (such as coal or wood fires), and smoking.
Who is at risk?
Air pollution can affect anyone, but individuals living in urban or industrial areas can be at greater risk. Infants and children are particularly vulnerable to the effects of poor air quality, and research has identified links between antenatal/early infancy exposure to air pollution and the onset of childhood asthma (Tiotiu et al, 2020). While similar causation has not been identified for cases of adult asthma, air pollutants may have a greater effect on asthmatic adults who have comorbidities such as obesity or heart conditions and/or live in areas of high pollution.
You may find it useful to check the air quality in your local area using the government’s UK Air website. Patients can also use this site to check daily pollution forecasts in order to minimise exposure.
How do we know if air quality is affecting a person’s asthma?
Particulate matter (e.g. dust, dirt, or smoke) in the air can affect the respiratory system in different ways: they may irritate the airways leading to increased coughing or sneezing, or cause pain or difficulty breathing if they reach the lungs. In patients with asthma, it can be difficult to tell what has caused an exacerbation but taking a comprehensive history can help to identify potential triggers. Patients may report having to use their inhaler more frequently when working outdoors or engaging in leisure activities outside, so discussions about occupations and hobbies, particularly new ones, can be important. Exposure to fuels or chemicals can trigger asthma symptoms, so patients working in farm or factory settings may notice changes to their asthma control, and second-hand or even third-hand tobacco smoke can affect air quality indoors. It can also be helpful to ask whether a patient has recently been abroad, due to differences in air pollution levels between countries.
So how can we support patients to minimise the impact of poor air quality?
As tobacco smoke has such a significant impact on both air quality and general health, providing very brief advice around smoking cessation at regular intervals is one of the most effective ways to support all patients to improve their health outcomes. Identifying quit opportunities is particularly valuable for those who have asthma themselves and/or have family members who are adversely affected by smoking in the home; indoor air quality can be a modifiable risk factor for asthma control, so checking smoking status at routine reviews as well as when patients present with worsening symptoms can support patients to minimise environmental triggers.
Some patients may benefit from reducing time outdoors in times of high air pollution, but it is important to support individuals to balance quality of life with avoidance of triggers. It may help patients to feel empowered if they are signposted to resources such as Asthma + Lung UK and Defra Health Advice; these websites enable individuals to plan activities according to predicted pollution levels and make informed decisions about avoiding environments that may exacerbate their respiratory symptoms.
Finally, as healthcare professionals you may find it beneficial to learn more about supporting asthma patients to self-manage their condition. Our Asthma Online Refresher Workshop upskills learners to implement a small change in practice to improve patient care and supports professional development via the sharing of best practice – exploring ways to support patients to proactively identify environmental triggers is just one idea you could trial to make a real difference to your patient population.
Our Smoking Cessation Workshop may also be of interest. This one-day online workshop supports health and care professionals to set up smoking cessation initiatives within Primary and Secondary Care, as well as within Public Health and Community services. Sign up now for our next course date 13 September 2023. Visit our Online Shop for more information about upcoming dates and courses.
Tiotiu, A., Novakova, P., Nedeva, D., Chong-Neto, H., Novakova, S., Steiropoulos, P., and Kowal, K. (2020) Impact of Air Pollution on Asthma Outcomes. Int J Environ Res Public Health. 27;17(17):6212. doi: 10.3390/ijerph17176212.