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Review
. 2025 May 31;7(3):100448.
doi: 10.1016/j.opresp.2025.100448. eCollection 2025 Jul-Sep.

Influence of Outdoor Air Pollutants on Asthma: A Narrative Review

David Espejo  1   2 , Vicente Plaza  3   4 , Santiago Quirce  2   5 , Juan Antonio Trigueros  6 , Xavier Muñoz  1   2   7
Affiliations
Review

Influence of Outdoor Air Pollutants on Asthma: A Narrative Review

David Espejo et al. Open Respir Arch. .

Abstract
in English, Spanish

Asthma is a chronic lung disease affecting individuals across all age groups, contributing to significant morbidity and mortality. Exposure to air pollutants is a major factor in both the development and exacerbation of asthma symptoms. This study reviewed the impact of key air pollutants, including nitrogen dioxide (NO2), particulate matter with a diameter ≤2.5 μm (PM2.5) or ≤10 μm (PM10), and ozone (O3), on asthma outcomes. Our analysis of 20 studies showed significant associations between exposure to these pollutants and increased asthma incidence and prevalence, particularly in children. Specifically, pollutants such as elemental carbon (EC), benzene, NO2, PM10, and sulfur dioxide (SO2) were found to be significantly associated with asthma development in children, while NO2 and PM2.5 were linked to asthma exacerbations in both children and adults. Additionally, hospitalizations and emergency room visits were positively correlated with exposure to PM2.5 and O3 in both children and adults, and the elderly showed significant associations with O3 exposure. Although asthma-related mortality was not directly linked to specific pollutants, a few studies indicated a broader association between exposure to pollutants like NO2 and PM2.5 and increased overall mortality. These findings highlight the importance of reducing exposure to outdoor air pollutants to mitigate asthma risk and improve public health outcomes, particularly in vulnerable populations like children and the elderly.

El asma es una enfermedad pulmonar crónica que afecta a personas de todas las edades, contribuyendo a una morbimortalidad significativa. La exposición a contaminantes atmosféricos es un factor clave tanto en el desarrollo como en la exacerbación de los síntomas del asma. Este estudio revisa el impacto de los principales contaminantes del aire, incluyendo dióxido de nitrógeno (NO2), material particulado con un diámetro ≤ 2,5 μm (PM2,5) o ≤ 10 μm (PM10), y ozono (O3), sobre los resultados del asma. Nuestro análisis de 20 estudios muestra asociaciones significativas entre la exposición a estos contaminantes y un aumento en la incidencia y prevalencia del asma, especialmente en niños. En particular, contaminantes como el carbono elemental (EC), el benceno, el NO2, el PM10 y el dióxido de azufre (SO2) se asociaron significativamente con el desarrollo del asma en niños, mientras que el NO2 y el PM2,5 se vinculaban con exacerbaciones del asma tanto en niños como en adultos. Además, se encontraron correlaciones positivas entre las hospitalizaciones y las visitas a urgencias con la exposición a PM2,5 y O3 en niños y adultos, y los ancianos mostraron asociaciones significativas con la exposición a O3. Aunque la mortalidad relacionada con el asma no se vinculó directamente a contaminantes específicos, algunos estudios indicaron una asociación más amplia entre la exposición a contaminantes como NO2 y PM2,5 y un aumento en la mortalidad general. Estos hallazgos resaltan la importancia de reducir la exposición a contaminantes atmosféricos exteriores para mitigar el riesgo de asma y mejorar los resultados en salud pública, especialmente en poblaciones vulnerables como niños y ancianos.

Keywords: Air pollution; Asthma; Asthma development; Asthma exacerbation; Childhood asthma; Wheezing.

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Figures

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Graphical abstract
Fig. 1
Fig. 1
Flow diagram of selection of the publications, according to PRISMA.
See this image and copyright information in PMC

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