Editorial
Air pollution, climate change, and lung health in Europe
Pollution, climate change, and sustainability was the
official theme of the 2023 European Respiratory Society
International Congress held in Milan on Sept 9–13. The
topic is extremely timely following yet another summer
in Europe where unprecedented heatwaves have
repeatedly made front page news. Experts have called
climate change the biggest global threat to humanity
and associated temperature rises are intrinsically linked
to air pollution, increased aero-allergen exposure,
exacerbation of pre-existing lung diseases, and
increased transmissibility of respiratory infections.
WHO estimates that more than 90% of people globally
breathe unhealthy air, mostly from the burning of fossil
fuels; which translates into health and economic costs of
US$8 billion per day.
Ahead of the Congress, the ERS released a position
statement in the European Respiratory Journal (ERJ)
on Climate change and respiratory health proposing
mitigation and adaptation strategies with consequent
co-benefits on health, discussing how climate change
affects clinical practice, and highlighting the importance
of mobilisation of climate-friendly advocates for
meaningful progress to be made. The latter is crucial
given the ongoing debate in the European parliament
on bringing the Ambient Air Quality Directive (AAQD)
limits to be more in line with those set by WHO in 2021.
In 2019, a European Green Deal was announced
with the aim of Europe being the first climate-neutral
continent by achieving net zero emissions by 2050.
Key elements of the deal included: providing clean and
affordable secure energy; preserving and restoring
key ecosystems and biodiversity; fostering research;
providing a fair and environmentally friendly food
system; and adequate financing of any of these
transitions. On Oct 26, 2022, as part of this Green
Deal, the European Commission agreed to revise the
AAQD which sets quality standards for 12 ambient air
pollutants including PM2∙5, so-called fine particulates.
For PM2∙5, the WHO 2021 air quality standard
recommendation is 5 µg/m³. However, current European
levels far exceed this concentration causing advocates to
call for the EU to become more ambitious in the targets
set to tackle the 300 000 premature deaths per year seen
in Europe. A study in England also noted a 1∙5% increase
in the risk of hospitalisation for patients with COPD for
www.thelancet.com/respiratory Vol 11 October 2023
every 1°C rise in temperature above 23·2°C. According
Walter Zerla/Cultura/Science
to the position statement, the current EU standards are
five times higher for PM2∙5 and four times higher for NO₂
Photo Library
than those set in the 2021 WHO Air Quality Guidelines.
However, encouragingly, a vote in the European
Parliament on Sept 13, 2023, favoured efforts to reduce Published Online
September 20, 2023
AAQD thresholds, although the timeframe to achieve https://doi.org/10.1016/
this change was pushed from 2030 to 2035 after strong S2213-2600(23)00345-4
political lobbying. The 2023 ERS Congress was held
in Milan on Sept 9–13
Transportation is responsible for 20% of global carbon
For more on the ERS position
emissions. Experts in interviews from the ERS discussed statement see Eur Respir J 2023;
62: 2201960
several innovative European strategies that have been
For the study on recent
proposed to tackle this issue; such as a 15-minute city hospitalisations in England see
in Paris (where people are no more than 15 minutes’ Thorax 2022; 77: 1098–104
walk or cycle ride from work, school, or social events); For more on the Air Quality Life
Index report see https://aqli.
superblocks in Barcelona which are car-free zones, and epic.uchicago.edu/wp-content/
low emission zones for cars in the UK. Others called for uploads/2023/08/AQLI_2023_
Report-Global.pdf?
improvements to address the inadequate monitoring of For more on the effects of
pollution levels and paucity of evidence in some Eastern climate change in Africa and
the rest of the world see
European countries, and highlighted that some areas Comment Lancet Respir Med
were returning to the use of older less clean fuels in 2022; 10: 1115–17
face of the current energy crisis. Ultrafine particles also
need to be monitored as these can affect other organs,
in addition to their effects on the lung, and are found
in placentas providing biological plausibility for the link
between air pollution and low birthweight. The 2023
Air Quality Life Index report also indicated the need for
better tools globally to generate high frequency local air
quality data in light of the associated 2∙3 years loss in life
expectancy linked to poor air quality.
Other continents, that are disproportionately affected
by the intertwining effects of biodiversity loss, climate
change, and air pollution, should also be involved in the
setting of priorities. Low-income and middle-income
countries have traditionally been lower polluters and
received less financing to tackle the consequences of
climate change than high-income countries; 62% of
CO2 emissions since the industrial revolution have been
contributed by North America and Europe, compared
with only 3% from Africa. A global problem will need
global solutions. Unite. Act. Deliver. is the strap line for
COP28 which will be held in 2 months. Politics will
likely be at the forefront of any discussions, but we all
need to breathe, and clean air should be a human right.
■ The Lancet Respiratory Medicine
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