It is widely accepted that air pollution can exacerbate asthma in those who already have the condition. What is less clear is whether air pollution can contribute to the initiation of new cases of asthma. Mechanistic evidence from toxicological studies, together with recent information on genes that predispose towards the development of asthma, suggests that this is biologically plausible, particularly in the light of the current understanding of asthma as a complex disease with a variety of phenotypes. The epidemiological evidence for associations between ambient levels of air pollutants and asthma prevalence at a whole community level is unconvincing; meta-analysis confirms a lack of association. In contrast, a meta-analysis of cohort studies found an association between asthma incidence and within-community variations in air pollution (largely traffic dominated). Similarly, a systematic review suggests an association of asthma prevalence with exposure to traffic, although only in those living very close to heavily trafficked roads carrying a lot of trucks. Based on this evidence, the UK's Committee on the Medical Effects of Air Pollutants recently concluded that, overall, the evidence is consistent with the possibility that outdoor air pollution might play a role in causing asthma in susceptible individuals living very close to busy roads carrying a lot of truck traffic. Nonetheless, the effect on public health is unlikely to be large: air pollutants are likely to make only a small contribution, compared with other factors, in the development of asthma, and in only a small proportion of the population.

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This paper focuses on the use of results of epidemiological studies to quantify the effects on health, particularly on mortality, of long-term exposure to air pollutants. It introduces health impact assessment methods, used to predict the benefits that can be expected from implementation of interventions to reduce emissions of pollutants. It also explains the estimation of annual mortality burdens attributable to current levels of pollution. Burden estimates are intended to meet the need to communicate the size of the effect of air pollution on public health to policy makers and others. The implications, for the interpretation of the estimates, of the assumptions and approximations underlying the methods are discussed. The paper starts with quantification based on results obtained from studies of the association of mortality risk with long-term average concentrations of particulate air pollution. It then tackles the additional methodological considerations that need to be addressed when also considering the mortality effects of other pollutants such as nitrogen dioxide (NO 2 ). Finally, approaches that could be used to integrate morbidity and mortality endpoints in the same assessment are touched upon. This article is part of a discussion meeting issue ‘Air quality, past present and future’.

Dementia is an umbrella term for a range of conditions that affect how the brain works and, in particular, the ability to remember, think and reason. It mainly affects older people, both men and women, and gets worse over time. In recent years, there has been growing interest in the possibility that exposure to outdoor air pollution could increase the risk of dementia. COMEAP reviewed epidemiological and experimental studies and concluded that it is likely that air pollution contributes to a decline in mental ability and dementia in older people. The most likely way this occurs is through effects on the circulatory system. It is known that air pollutants, particularly fine particles, can affect the heart and blood vessels, including those of the brain. These effects are linked to vascular dementia, which is caused by damage to the blood vessels in the brain. Experimental studies suggest that air pollution may also stimulate immune cells in the brain, which can then damage nerve cells. It is also likely that some nano-sized (ultrafine) particles can enter the brain, either by transport along the olfactory nerve or by entering the circulation and crossing the blood-brain barrier. These particles may cause direct damage. Nonetheless, based on the available evidence, it does not seem likely that this is an important mechanism for the development of dementia. Recommendations were made for further research which would help develop the evidence on this important topic.

Statement from the Committee on the Medical Effects of Air Pollutants (COMEAP) on the differential toxicity of particulate matter according to source or constituents Particulate matter in outdoor air comes from a wide range of different sources and contains many different chemical components. Understanding which of these sources and components are particularly harmful would help to focus policies and interventions to reduce impacts on health. COMEAP recently (July 2022) published an updated statement on this topic, drawing on recent reviews of the available evidence. It noted that particulate matter, and constituents of particulate matter, associated with combustion and road traffic have received the most research attention. However, there was insufficient coherence in the epidemiological evidence to conclude that these sources of particulate matter play a significantly greater role in the health effects of particulate air pollution than other sources or constituents. A comprehensive review of the evidence reveals that toxicity has been attributed to a wide variety of constituents and sources, possibly acting by a number of different mechanisms. However, the complexity of sources, sizes and chemical composition of particulate matter makes it extremely difficult to identify which characteristics of particles might make them less harmful or more toxic than others.  Future research assessing the influence of chemical composition of particulate matter should offer greater insights into toxicity. But, at present, PM2.5 (the mass concentration of fine particulate matter in air) remains the most suitable metric for evaluating health impacts and regulating particulate air pollution.

The Environment Act (2021) requires the government to set at least one long-term air-quality target, as well as a target for fine particulate matter (PM2.5) air pollution. COMEAP provided independent expert advice to the Department for Environment, Food and Rural Affairs (Defra) to inform the development of targets to reduce both the annual average (mean) concentration of PM2.5 in ambient air and long term population exposures. COMEAP’s advice includes that: a focus on reducing long-term average concentrations of PM2.5 is appropriate evidence indicates that PM2.5 pollution can have harmful effects on people’s health at low concentrations reducing concentrations to, or below, the World Health Organization’s new Air Quality Guideline (5 µg/m3) would benefit public health available studies have not indicated a threshold of effect below which there is no harm reducing exposure of the whole population would achieve the greatest overall public health benefit some individuals or groups are more at risk, but it might be difficult to reflect this in a national targets framework the health benefits of reducing other pollutants, such as nitrogen dioxide and ozone, should not be overlooked. In response to Defra’s evidence report explaining the rationale for its proposed targets, COMEAP: recommended that Defra should consider roles in continuing to improve air quality, even where legally binding targets are met suggested that interim targets would be important to ensure early progress and maximise health benefits stressed the importance of considering inequalities noted that international engagement will be required