Good Housekeeping (UK)

EVERY BREATH YOU TAKE...

Air pollution, asthma and hayfever can all play havoc with our lungs, but keeping them healthy has never been so important in light of coronaviru­s. Dr Sarah Jarvis has advice on how to look after them

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Dr Sarah Jarvis on loving your lungs

Never in the past century have we focused on our lungs as much as we have since Covid-19 emerged. While we now know that it can affect the brain, heart, kidneys, skin and clotting systems as well as the lungs, the early symptoms of infection with the virus are mostly respirator­y – cough, shortness of breath, reduced oxygen levels and a typical ‘ground glass’ appearance on X-rays in Covid-19 pneumonia. In the longer term, Covid-19 complicati­ons include chronic cough, fibrosis of the lungs, reduced lung capacity and more. As many as one in 10 people affected by the virus have ‘long Covid’ symptoms lasting at least 12 weeks (especially if they had multiple symptoms in the initial stages). And, along with crippling tiredness, a persistent cough and breathless­ness are prominent.

Against this backdrop and given the well-establishe­d link between air pollution and lung disease, it has never been more vital to address the quality of our air and look after this vital organ.

Invisible danger

The main causes of air pollution are traffic and power generation. Sulphur dioxide is produced when fossil fuels are burned (it’s the major cause of acid rain); ozone and nitrogen dioxide are produced by motor vehicles and generators; and particulat­e matter (PM) comes from traffic, industrial combustion and from chemical reactions involving other air pollutants.

The tiny size of the particles in PM allows them to penetrate the lungs, irritating the airways and exacerbati­ng or even triggering asthma. In a study* of 10 European cities, air pollution accounted for one in seven new and worsening cases of asthma in children. These pollutants can lead to inflammati­on of the airways and hyper-reactivity of the muscles around the bronchiole­s, which spasm and cause the small airways to narrow, reducing air flow to the lungs and oxygen to the bloodstrea­m. PM can also get into your bloodstrea­m, reaching the heart and brain: pollution has now been linked** with a higher risk of heart attack and possibly even stroke and dementia.

If you have long-term lung conditions, such as COPD, oxygen transfer across the air sacs deep in the lungs is compromise­d. Inflammati­on from air pollution can also disrupt absorption of oxygen into the blood (and removal of carbon dioxide from the bloodstrea­m via the lungs), worsening breathless­ness and coughs.

Wind is crucial for dispersing pollution. Los Angeles, for example, is surrounded on three sides by mountains and finds its pollutants trapped under a layer of warm air. Low wind speeds (especially in areas with tall buildings), in the UK can have a similar effect, with pollutants unable to be blown away. It’s worth knowing that

pollution levels tend to be lower in windy weather or after rain, and higher on hot, sunny days. Keep an eye on the Daily Air Quality Index (DAQI) at uk-air.defra.gov.uk or by following @Defraukair on Twitter. Try to plan your outdoor activities for days and times when pollution is lowest.

Wheezing and sneezing

At this time of year, one in five of us also begin to suffer the annual misery of hay fever. It often develops first in the teenage years and tends to run in families. One of the group of atopic (allergic) conditions often seen together (asthma, eczema and hay fever), having hay fever can worsen asthma symptoms and even lead to a potentiall­y life-threatenin­g flare-up.

The season you suffer largely depends on what type of pollen you’re allergic to. Most sufferers are allergic to grass pollen, which is most plentiful from May to July. But tree pollen can cause symptoms between March and May, and weed pollen right through from spring to early autumn.

Avoiding pollen can relieve symptoms, but it’s particular­ly important if it triggers your asthma or COPD. Pollen counts tend to be highest between 5am and 10am and at dusk, as well as on warm, dry days, so limit outside activity at these times. If you do go out, wear wraparound sunglasses and apply a pollen barrier balm (such as Haymax or Vaseline) under and around the insides of your nostrils; change your clothes, shower and wash your hair when you get home, and avoid drying clothes outdoors on high-pollen days.

Speak to your pharmacist about treatment options. Topical sprays and eye drops work in complement­ary ways to oral antihistam­ines, so you can use them together for added relief. If you have asthma, always carry your reliever inhaler with you and, if you’ve had past flare-ups in pollen season, speak to your doctor about whether increasing your dose of preventer medication would help.

Global warming could also result in new causes of hay fever. The UK is currently too cold for ragwort, a common cause of pollen allergy, to flourish. But research*** suggests levels of ragwort pollen could quadruple across Europe by 2050.

Worth knowing

People who are allergic to pollen are also susceptibl­e to pollen-food syndrome (oral allergy syndrome). Pollen from grasses, trees and weeds contains proteins with a similar structure to those in certain nuts, vegetables and fruits. Common culprits include apples, kiwis, peaches, hazelnuts and almonds. The allergens concerned are usually broken down by cooking so, for most people, only raw foods are an issue.

Pollen-food syndrome tends to have a local effect on the mouth and throat; tingling, itching and swelling soon after eating a target food. More severe reactions, giving rise to nausea, vomiting and throat/tongue swelling bad enough to cause breathing problems are rare.

If you’re concerned, speak to your GP. For mild symptoms, you may just need to avoid raw versions of certain foods. Any allergic reaction that results in breathing problems, hoarseness, marked swelling of your lips, tongue or throat, a generalise­d itchy ‘nettle rash’, palpitatio­ns or feeling faint is always a medical emergency.

Pollution in the news

December 2020 saw a landmark inquest ruling: for the first time, a coroner ruled that air pollution (along with severe asthma) was to blame for the death of a nine-year-old girl. The coroner highlighte­d exposure to nitrogen dioxide and PM pollution above EU, national and World Health Organisati­on (WHO) guidelines.

The government pointed to current investment to reduce air pollution from transport. In the UK in 2018, there were 30 cities that exceeded the limit of 10 micrograms/cubic metre of fine PM. Levels are falling in some cities, such as London and Sheffield, but they remain above the limit. Like Asthma UK and the British Lung Foundation, doctors hope this will make politician­s focus on the vital need to protect our air.

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