Environmental and Health Impacts of Air Pollution: A

review
Ioannis Manisalidis2, Elisavet Stavropoulou3, Agathangelos Stavropoulos4, Eugenia
Bezirtzoglou1*

1
Democritus University of Thrace, Greece, 2Independent researcher, Greece, 3Lausanne
University Hospital (CHUV), Switzerland, 4University of Glasgow, United Kingdom
Submitted to Journal:
Frontiers in Public Health

Specialty Section:
Environmental Health

l
ISSN:

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2296-2565

n
Article type:

o
Review Article

si
Received on:

i
17 Oct 2019

P r o v Accepted on:
17 Jan 2020

Provisional PDF published on:

17 Jan 2020

Frontiers website link:

www.frontiersin.org

Citation:
Manisalidis I, Stavropoulou E, Stavropoulos A and Bezirtzoglou E(2019) Environmental and Health
Impacts of Air Pollution: A review. Front. Public Health 8:14. doi:10.3389/fpubh.2020.00014

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Frontiers in Public Health | www.frontiersin.org

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 Environmental and Health Impacts of Air
Pollution: A review
Ioannis Manisalidis1, Elisavet Stavropoulou2, Agathangelos Stavropoulos3, Eugenia
Bezirtzoglou4*

1
Independent researcher, Greece, 2Lausanne University Hospital (CHUV), Switzerland, 3University of
Glasgow, United Kingdom, 4Democritus University of Thrace, Greece

Submitted to Journal:
Frontiers in Public Health

Specialty Section:
Environmental Health

Article type:

l
Review Article

a
Manuscript ID:

n
505570

sio
Received on:
17 Oct 2019

r i
Revised on:

v
17 Dec 2019

o
Frontiers website link:

P
www.frontiersin.org
Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial
relationships that could be construed as a potential conflict of interest

Author contribution statement

All 4 authors have contributed equally following their Speciality.

Keywords

Air Pollution, environment, Health, Public Health, Gas emission

Abstract

Word count: 254

One of our era’s greatest scourges is air pollution, not only for its impact on climate change but also for its impact on public and

l
individual health by increasing morbidity and mortality. There are many pollutants consisting a major factor of disease in humans.

a
Among them, Particulate Matter(PM), particles of variable but very small diameter, penetrate the respiratory system via

n
inhalation, causing respiratory and cardiovascular dis-eases, reproductive and central nervous system dysfunctions as well as

o
cancer. Despite the fact that ozone in the stratosphere plays a protective role in ultraviolet irradiation, it is harmful when in high

si
concentration on ground-level, also affecting the respiratory and cardiovascular system. Furthermore, nitrogen oxide, Sulphur
dioxide, Volatile Organic Compounds (VOCs), dioxins and polycyclic aromatic hydrocarbons (PAHs), all are considered as air

r o vi
pollutants harmful to the human. Carbon monoxide can even provoke direct poisoning when breathing in it at high levels. Heavy
metals such as lead, when absorbed from the human body can lead to direct poisoning or chronic intoxication depending on
exposure. Diseases occurring from the aforementioned substances include principally respiratory problems such as Chronic
Obstructive Pulmonary Disease (COPD), asthma, bronchiolitis, lung cancer, cardiovascular events, central nervous system

P
dysfunctions and cutaneous diseases. Last but not least, climate change, resulting from environmental pollution affects the
geographical distribution of many infectious diseases as do natural disasters. The only way to tackle with the problem is Public
awareness coupled with a multidisciplinary approach of scientific experts; national and international organizations must address
the emergence of this flail and propose sustainable solutions.

Contribution to the field

This is a Review report on the impact of Air Pollution In the environment and Health. The subject was reached from different
aspects due to the scientific background of the authors and seeks this crucial problem. IM is an Engineer in Athens, ES is a Medical
Doctor in Lausanne University Hospital (CHUV), AS is a political scientist and EB is Professor at the Medical School, Laboratory of
Hygiene and Environmental Polution.

Funding statement

This is a Review article and we have no Funder .

 Environmental and Health Impacts of Air
Pollution: A review
Ioannis Manisalidis1, Elisavet Stavropoulou2, Agathangelos Stavropoulos3, Eugenia
Bezirtzoglou4*

1
Delphis S.A, Greece, 2Lausanne University Hospital (CHUV), Switzerland, 3University of Glasgow,
United Kingdom, 4Democritus University of Thrace, Greece

Submitted to Journal:
Frontiers in Public Health

Specialty Section:
Environmental Health

Article type:
Review Article

Manuscript ID:
505570

Received on:

o n al
si
17 Oct 2019

r i
Frontiers website link:

v
www.frontiersin.org

o
P
Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial
relationships that could be construed as a potential conflict of interest

Author contribution statement

All 4 authors have contributed equally following their Specialty.

Keywords

Air Pollution, environment, Health, Public Health, Gas emission

Abstract

Word count: 254

One of our era’s greatest scourges is air pollution, not only for its impact on climate change but also for its impact on public and

l
individual health by increasing morbidity and mortality. There are many pollutants consisting a major factor of disease in humans.

a
Among them, Particulate Matter(PM), particles of variable but very small diameter, pen-etrate the respiratory system via

n
inhalation, causing respiratory and cardiovascular dis-eases, reproductive and central nervous system dysfunctions as well as

o
cancer. Despite the fact that ozone in the stratosphere plays a protective role in ultraviolet irradiation, it is harmful when in high

si
concentration on ground-level, also affecting the respiratory and cardiovascular system. Furthermore, nitrogen oxide, Sulphur dioxide,
Volatile Organic Compounds (VOCs), dioxins and polycyclic aromatic hydrocarbons (PAHs), all are considered as air pollutants harmful

i
to the human. Carbon monoxide can even provoke direct poisoning when breathing in it at high levels. Heavy metals such as lead,

v
when absorbed from the human body can lead to direct poisoning or chronic intoxication depending on exposure. Diseases occurring

o
from the aforementioned substances include principally respiratory problems such as Chronic Obstructive Pulmonary Disease (COPD),

r
asthma, bronchiolitis, lung cancer, cardiovascular events, central nervous system dysfunctions and cutaneous diseases. Last but not

P
least, climate change, resulting from environmental pollution affects the geographical distribution of many infectious diseases as do
natural disasters. The only way to tackle with the problem is Public awareness coupled with a multidisciplinary approach of scientific
experts; national and international organizations must address the emergence of this flail and propose sustainable solutions.

Contribution to the field

This is a Review report on the impact of Air Pollution In the environment and Health. The subject was reached from different
aspects due to the scientific background of the authors and seeks this crucial problem. IM is an Engineer in Athens, ES is a Medical
Doctor in Lausanne University Hospital (CHUV), AS is a political scientist and EB is Professor at the Medical School, Laboratory of
Hygiene and Environmental Polution.

Funding statement

This is a Review article and we have no Funder

Environmental and Health Impacts of Air Pollution: A review.

Manisalidis I. 1, Stavropoulou E. 2, Stavropoulos A.3, Bezirtzoglou E.4

1 Delphis S.A., 2 Peloponnisou Str., 14564 N. Kifisia, Greece

2 Centre Hospitalier Universitaire Vaudois(CHUV), Service de Medicine Interne, Ruedu

Bugnon 21, CH-1011-Lausanne, Vaud, Switzerland

3 University of Glasgow, School of Social and Political Sciences,Adam Smith Building,

Bute Gardens, Glasgow, G12 8RT Glasgow, UK

4 Democritus University of Thrace, Faculty of Medicine, University Hospital, Laboratory of

Hygieneand Environmental Protection, 68100-Dragana, Alexandroupolis,Greece

Correspondance:

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Ioannis Manisalidis, Delphis S.A., 2 Peloponnisou Str., 14564 N. Kifisia, Greece

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Email: giannismanisal@gmail.com

and

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Elisavet Stavropoulou, Centre Hospitalier Universitaire Vaudois (CHUV),Service de Medicine

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Interne, Rue du Bugnon 21,CH-1011- Lausanne, Vaud, Switzerland

Phone: +306946003063

E mail: elisabeth.stavropoulou@gmail.com
Abstract

One of our era’s greatest scourges is air pollution, not only for its impact on climate change
but also for its impact on public and individual health by increasing morbidity and
mortality. There are many pollutants consisting a major factor of disease in humans.
Among them, Particulate Matter (PM), particles of variable but very small diameter,
penetrate the respiratory system via inhalation, causing respiratory and
cardiovascular dis-eases, reproductive and central nervous system dysfunctions as
well as cancer. Despite the fact that ozone in the stratosphere plays a protective role in
ultraviolet irradiation, it is harmful when in high concentration on ground-level, also
affecting the respiratory and cardiovascular system. Furthermore, nitrogen oxide,
Sulphur dioxide, Volatile Organic Compounds (VOCs), dioxins and polycyclic aromatic
hydrocarbons (PAHs), all are considered as air pollutants harmful to the human. Carbon
monoxide can even provoke direct poisoning when breathing in it at high levels. Heavy
metals such as lead, when absorbed from the human body can lead to direct poisoning or
chronic intoxication depending on exposure. Diseases occurring from the
aforementioned substances include principally respiratory problems such as Chronic
Obstructive Pulmonary Disease (COPD), asthma, bronchiolitis, lung cancer, cardiovascular
events, central nervous system dysfunctions and cutaneous diseases. Last but not least,
climate change, resulting from environmental pollution affects the geographical

n al
distribution of many infectious diseases as do natural disasters. The only way to tackle with
the problem is Public awareness coupled with a multidisciplinary approach of

o
si
scientific experts; national and international organizations must address the emergence of

i
this flail and propose sustainable solutions.

P r o v
Approach of the problem

The interactions between humans and their physical surroundings are extensively studied as
multiple human activities influence the environment. Environment is a coupling of biotic
(living organisms and microorganisms) and abiotic (hydrosphere, lithosphere and
atmosphere).

Pollution is determined as the introduction into the environment of substances harmful

to humans and other living organisms. Pollutants are harmful solid, liquid or gazes produced
in higher than usual concentrations which reduce the quality of our environment.

Human activities have an adverse effect on the environment by polluting the water we
drink, the air we breathe, and the soil in which plants are growing. Although, the
industrial revolution was a great success in technology, society and multiple services,
it also introduced the production of huge quantities of pollutants emitted into the air
harmful to human health. Without any doubt, the global environmental pollution is
considered as an international public health issue with multiple facets. Social, economic,
legislative concerns and lifestyle habits are related to this major problem.
Clearly,urbanization and industrialization are reaching unattended and upsetting

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proportions worldwide in our era. Anthropogenic air pollution is one of the biggest
public health hazards worldwide, given that it accounts for about 9 million deaths per

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year(1).

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Without any doubt, all the aforementioned are closely associated with climate change, and

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in the event of danger, the consequences can be severe for mankind (2).Climate changes
and global planet warming affects seriously multiple ecosystems such as food safety issues,

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ices and icebergs melt, animals’ extinction, plants damage (3).

Air pollution has various health effects. Susceptible and sensitive individuals can
have an impact on health even on low air pollution days. Short-term exposure to air
pollutants are closely related to COPD (Chronic Obstructive Pulmonary Disease),
cough, shortness of breath, wheezing, asthma, respiratory disease, and high rates of
hospitalization (measurement of morbidity).
The long-term effects of air pollution are associated with chronic asthma, pulmonary
insufficiency, cardiovascular diseases and cardiovascular mortality .Following a
Swedish cohort study diabetes seems to be induced after long-term air pollution
exposure(4). Moreover, air pollution seems to have various malign health effects in
human early life, such as respiratory, cardiovascular, mental and perinatal disorders
(3) leading to infant mortality or chronic disease in adult age(5).

National reports have mentioned the increase risk of morbidity and mortality(1).
Those studies were conducted in many places around the world showing a correlation
between daily ranges of particulate matter (PM) concentration and daily mortality.
Climate shifts and global planet warming (3) could aggravate the situation. Besides,
increased hospitalization (index of morbidity) was registered among the elderly and
susceptible individuals for specific reasons. Fine and ultrafine particulate matters
seems to be associated with more serious illnesses (5), as they can invade to the
deepest parts of the airways and reach easier the blood stream.
Air pollution mainly affects large urban dwellers, where road emissions contribute the
most to degradation of air quality. There is also the danger of industrial accidents,
where the spread of a toxic fog can be fatal to the populations of the surrounding
areas. The dispersion of pollutants is determined by many parameters, most notably
atmospheric stability and wind (5).
In developing countries (6), the problem is more serious due to the over population
and anarchist urbanization along with the upcoming industrialization. This conducts
to poor air quality especially in countries with social disparities and missing of
information of sustainable management of environment. Due to the low incomes,
use of fuels for domestic needs such as wood fuel or solid fuel exposes people to a
bad quality of indoor air pollution. It is of note that three billion people around the
world are using the above sources of energy for their daily heating and cooking
needs (7). Household women seem to carry the highest risk for disease
development due to their longer exposure to the indoor air pollution in developing
countries (7) (8). Due to the fast industrial development and overpopulation China is
one of the Asian countries confronting serious air pollution problems (9) (10). Lung
cancer mortality observed in China.is associated to fine particles (11).At stated
already, long-term exposure is associated to cardiovascular system deleterious
effects(3)(4). However, it is interesting to state that cardiovascular diseases were

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mostly observed in developed and high-income countries compared to the
developing low-income countries exposed highly to air pollution(12).Extreme air

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pollution is registered in India as air quality reaches hazardous levels. New Delhi is
one of the more polluted cities in India. Flights are often canceled in New Delhi

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International Airport due to the reduced visibility associated with air pollution.
Pollution is occurring both in urban and rural area in India due to the fast
industrialization, urbanization and motorcycles transportation. Nevertheless,

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biomass combustion associated to heating and cooking needs and practices is a
major source of household air pollution in India and in Nepal (13) (14). Spatial
heterogeneity in India as areas with diverse climatological conditions, population and
education generate different indoor air quality with higher PM2,5. observed in North
Indian States (557-601 μg/m3) compared to the Southern States (183-214 μg/m3 )
(15)(16).Cold climate of the North Indian areas should be the main reason as longer
stay at home and higher heating needs are necessary compared to the tropic
climate of the Southern India. Household air pollution in India is associated with
important health effects especially in women and young children which stay longer
indoor. Chronic obstructive respiratory disease (CORD) and lung cancer are mostly
observed in women while acute lower respiratory disease in young children under
five years of age (17).

Accumulation of air pollution, especially Sulphur dioxide and smoke reaching 1500mg/m³
.resulted in increasing deaths numbers (4000deaths) on December 1952 in London
and in 1963 in New York City (400 deaths) (18) . An association with mortality by
monitoring outdoor pollution in 6 US metropolitan cities is reported (19).
In any case it seems that mortality was closely related to the levels of fine, inhalable, and
sulfate particles more than with the levels of total particulate pollution, aerosol acidity,
sulfur dioxide, or nitrogen dioxide(19).
Furthermore, extremely high levels of pollution are reported to Mexico City and Rio de
Janeiro followed by Milan, Ankara, Melbourne, Tokyo and Moscow (18).

Based on the magnitude of the public health impact, it is certain that different kinds of
interventions should be taken into account. Success and effectiveness in controlling air
pollution, specifically at local level has been denoted. Adequate technological means are
applied considering the source and the nature of the emission as wellas its impact on health and the
environment. The importance of point sources and non-point sources of air pollution control is reported
(20).Without any doubt a detailed emission inventory must record all sources in a given area. Beyond
considering the above sources and their nature, topography and meteorology should be also
considered as stated previously. Assessment of the control policies and methods is often extrapolated
from the local to the regional and then to the global scale. Air pollution may be dispersed and
transported from one region to another area located long away. .Air pollution management mean at the
reduction to acceptable levels or possible elimination of air pollutants whose presence in the air affects
our health or the environmental ecosystem. Private and governmental entities and authorities
implement actions to ensure the air quality (21). Air quality standards and guidelines were adopted for
the different pollutants by WHO and EPA as a tool to the management of air quality (1) (22). Those
standards have to be compared to the emissions inventory standards in order to reveal the problematic
areas by causal analysis and dispersion modeling (23). Inventories are generally based on a

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combination of direct measurements and emissions modeling (23).

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As an example, we state here the control measures at the source by the use of

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catalytic converters in cars as a device reducing pollutants and toxic gases produced from

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combustion engines into less-toxic pollutants by catalysis due to redox reaction(24).

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In Greece, use of private cars was restricted following their licence plate in order to

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reduce traffic congestion during rush hours(24).

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Concerning the industrial emissions, collectors and closed-systems can kept the air pollution to the
imposed minimal standards by legislation (25).

Current strategies to improve air quality require estimation of the economic evaluation of
the benefits gained from proposed programs. Those programs are proposed from public
authorities and Directives are issued with guidelines to be respected.

In Europe, establishment of the air quality limit values AQLVs ( AirQuality Limit Values) are issued
for triggering planning requirements (26). In USA, the NAAQS (National Ambient Air Quality
Standards) establish the national air quality limit values (26). While both standards and directives
are based on different mechanisms significant success was achieved in the reduction of overall
emissions and associated health and environmental effects.(26) .The European Directive identifies
geographical areas of risk exposure as monitoring/assessment zones to record the emission
sources and levels of air pollution(26 ) whereas the USA assure global geographical air quality criteria
according to the severity of their air quality problem and record all sources of the pollutants and
their precursors(26). \

In this vein, funds were financing directly or indirectly projects related to air quality along with technical
infrastructure to keep air quality. These plans focuses on inventory of data bases on air quality
environmental planning awareness campaigns. Moreover, pollution measures of air emissions for
vehicles, machines and industries in urban areas may be taken.
Technological innovation can only be successful if it is able to meet the needs of society. In
this sense, technology must reflect the decision-making practices and procedures of those
involved in risk assessment and evaluation, and act as a facilitator in providing information
and assessments to enable decision makers to make the best decisions possible.
Summarizing the aforementioned in order to design an effective air quality control
strategy several aspects must be considered. Environmental: factors and ambient
air quality conditions, Engineering: factors and air pollutant characteristics and
finally economic operating costs for technological improvement, administrative,
legal costs. Considering the economic factor, competitiveness through neoliberal
concepts is offering the solution in environmental problems (21).

The development of environmental governance, along with technological progress,

has initiated the deployment of a dialogue. Environmental politics created
objections and opposed aspects between different political parties, scientists,
media, governmental and non-governmental organizations (21).Radical
environmental activism actions and movements were created (21).
The rise of the new information and communication technologies (ICTs) are many
times examined on whether and on which way they have influenced the way of
communication and social movements such as activism (27) Since 1990’s the term
digital activism have been used increasingly and in many different disciplines (28).
Nowadays, multiple digital technologies can be used to produce a digital activism

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outcome in environmental means. More specifically, devices with online

change in political and social affairs (29).

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capabilities such as computers or mobile phones can be used as a way to pursue

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In the present paper, we focus on the sources of environmental pollution in relation to
public health and propose some solutions and interventions which may be of

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interest for the environmental legislators and decision makers.

Sources of exposure

It is known that the majority of environmental pollutants are issued through large
scale human activities such as the use of industrial machinery, power producing
stations, combustion engines and cars. Automobiles and cars are responsible for high
pollution numbers amounted to the 80% of today’s pollution.

Because these activities are performed on such large scale, they are by far the major
contributors of air pollution, with cars estimated as responsible for approximately 80% of
today’s pollution (30). Some other human activities are also influencing our environment in
a lesser extent, such as field cultivation techniques, gas stations , fuel tanks heaters and
cleaning procedures(31), as well as several natural sources as volcanic and soil eruptions
and forest fires when happened.

The classification of air pollutants is based mainly on sources producing pollution.

Therefore, it is worth to mention the 4 main sources following this type of

classification: Major sources, Area sources, Mobile sources and Natural sources.

Major sources include emission of pollutants coming from power stations, refineries and
petrochemicals, chemical and fertilizers industries, metallurgical and other industrial plants
and finally municipal incineration.

In door area sources include domestic cleaning activities, dry cleaners, printing shops
and petrol stations.

Mobile sources include automobiles, cars, railways, airways, and other type of vehicles.

Finally, natural sources include as stated previously physical disasters (32), such as forest
fire, volcanic erosion, dust storms and agricultural burning.
However, many classifications have been proposed. Another type of classification is the
grouping following recipient receiving the pollution as following:

Air pollution is determined as the presence of pollutants in the air in large quantities for long
periods. Air pollutants are dispersed particles, hydrocarbons, CO, CO2, NO, NO2, SO3 , etc.

Water pollution is the organic, inorganic charge and biological charge (9) in high levels which
affect the water quality (33) (34).

metals, hydrocarbons, pesticides.

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Soil pollution occurs by releasing of chemicals or disposal of wastes, such as heavy

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Air pollution can influence the quality of soil and water bodies by polluting

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precipitations falling into water and soil environments (33)(35).Notably, the
chemistry of the soil can be amended due to the acid precipitation by affecting
plants, cultures and water quality (36). Moreover, movement of heavy metals is

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favored by soil acidity and metals are so then moving into watery environment. As
known, heavy metals such as aluminum are noxious to wildlife and fishes. Soils
quality seems to be of importance as those with low calcium carbonate levels are
in increased jeopardy to acid rain. Over and above rain, snow and particulate
matters drip into watery bodies (35) (37).

Lastly, pollution is classified following type of origin:

Radioactive and nuclear pollution releasing radioactive and nuclear pollutants in water, air
and soil during nuclear explosions and accidents, nuclear weapons ,handling or
disposal of radioactive sewage .
Radioactive rudiments can contaminate surface watery bodies and being noxious
to the environment, plants, animals and humans. It is known that several
radioactive substances such as radium and uranium concentrates in the bones
and can cause cancers (38).

Noise pollution produced by machines, vehicles, traffic noises, musical installation harmful to
our acoustic ability.
World health Organization introduced the term of DALYs. DALYs for a disease or
health condition is defined as the sum of the Years of Life Lost (YLL) due to premature
mortality in the population and the Years Lost due to Disability (YLD) for people living
with the health condition or its consequences (39). Air pollution is the main cause of
disability adjusted life years lost (DALYs) followed by noise pollution in Europe. The
potential relation between noise and air pollution with health was studied (40).In this
study, DALYs referred to noise was more important than those referred to air pollution
as effects of environmental noise on cardiovascular disease were independent of air
pollution(40). Environmental noise should be counted as an independent public health
risk (40) .

Environmental pollution occurs when changes in physical, chemical or biological

constituents or the environment are produced (air masses, temperature, climate etc.)

Pollutants harm our environmental either by increasing levels out of the usual or by
introducing toxic harmful substances. Primary pollutants are directly produced from the
above sources and secondary pollutants are emitted as by-products of the previous ones.
Pollutants could be biodegradables or non-biodegradable and of natural origin or
anthropogenic as stated previously. Moreover, their origin could be a unique source (point-
source) or dispersed sources.

Pollutants have differences in physical and chemical properties explaining

discrepancy in their capacity for producing toxic effects. As an example, we state
here that aerosols compounds (41)(42)(43) have a greater toxicity than gaseous compounds
due to their tiny size (solid or liquid) in the atmosphere; they have a greater penetration
capacity. Gaseous compounds are eliminated more easily by our respiratory system

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(41). Those particles are able to damage lungs and can even enter the bloodstream (41)
leading to the premature deaths of millions of people yearly. Moreover, the aerosol
acidity ([H+]) seems to considerably enhancing the production of secondary organic

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aerosols (SOA), but this last aspect is not supported by other scientific teams(37).

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Climate and pollution

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Air pollution and climate change are closely related. Climate is another aspect of the same
coin which reduces the quality of our Earth (44). Pollutants such as, black carbon, methane,
tropospheric ozone, and aerosols affect the amount of incoming sunlight .As a result,
temperature of the Earth is increasing and results in melting of ices, icebergs and glaciers.

In this vein, climate changes will affect the incidence and prevalence of both residual
and imported infections in Europe. Climate and weather extremely affect duration,
timing and intensity of outbreaks and change the map of infectious diseases in the
globe(45).Mosquito transmitted parasitic or viral disease are extremely climate sensitive
as warming firstly shorten the pathogen incubation period and secondly shifts the vector
geographic map. Similarly, waters warming following climate changes lead to a high
incidence of occurring waterborne infections. Recently, in Europe due to migration of
population eradicated diseases seems to emerge as it is the case of cholera, poliomyelitis,
tick-borne encephalitis and malaria (46).

Spreading of epidemics is associated to natural climate disasters and tempests which seem
to occur more frequently nowadays (47). Malnutrition and des-equilibration of the
immune system is also associated to the emerging infection effecting on public health
(48).

Chikungunya virus ‘took the airplane’ from Indian Ocean to Europe, as outbreaks of the
disease were registered in Italy (49) and autochthonous cases in France (50).

An increase of cryptosporidiosis in the United Kingdom and in the Czech Republic seems
occurred following flooding (51)(52).

As stated previously aerosols compounds are tiny in size and affect considerably the climate.
They are able to dissipate the sunlight (albedo phenomenon)by dispersing a quarter of
the sun’s rays back to space and cool the planet global temperature over the last thirty
years(53).

Air pollutants

According to the World Health Organization (WHO), six major air pollutants are
reported including particle pollution, ground-level ozone, carbon monoxide, sulfur oxides,
nitrogen oxides, and lead. Air pollution can have a disastrous effect on all
components of the environment, as groundwater, soil, and air. Additionally, it consists of a
serious threating to the living organisms. In this vein, our interest is mainly focus on
these pollutants as they are related to more extensive and severe problems in human
health and environmental impact. Acid rain, global warming, greenhouse effect and
climate changes have an important ecological impact on air pollution (54).

• Particulate Matters (PM) and Health

Studies have exhibited a relation between particulate matter (PM) and adverse health
effects, focused on either short-term (acute) or long-term (chronic) PM exposure.
Particulate matters (PM) are usually formed in the atmosphere as a result of chemical

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reactions between the different pollutants. Penetration of particles is closely dependent on

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their size (54).The term particles was defined as a Particulate Matter (PM) from the United

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States Environmental protection Agency(55).Particulate matters (PM) pollution includes

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particles with diameters of 10 micrometers(µm) or smaller called PM10 and extremely fine

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particles with diameters that are generally 2.5 micrometers (µm) and smaller.
Particulate matters contain liquid or solids tiny droplets which can be inhaled and

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cause serious health effects. Particles less than 10 µm in diameter (PM10) after
inhalation can invade into your lungs and even reach the bloodstream. Fine particles
PM2.5 have a more increased risk to health (5).

Concerning the health effects of Particulate Matter (PM) (56), multiple

epidemiological studies have been performed. Positive relation was shown between
both short-term and long-term exposures of PM2.5 and acute nasopharyngitis (57).In
addition, long-term exposure against particulate matters (PM) for years are related to
cardiovascular diseases and infant mortality.
Those studies depend on PM2.5 monitors are restricted in the study area or city area
due to the missing of spatially resolved daily PM2.5concentration data and in this way
it is not representative of the entire population . Following a recent epidemiological
study of Department of Environmental Health at Harvard School of Public
Health(Boston, MA)( 58 ), as PM2.5 concentrations vary spatially, an exposure error
(Berkson error) seems to be produced and the clear relative magnitude of the short
and long term effects is not yet completely elucidated. The team developed a PM2.5
exposure model based on remote sensing data for assessing short- and long-term
human exposures. This model permits spatial resolution in short-term effects, as well
as assessment of long-term effects in the whole population.
Moreover, respiratory diseases and affection of the immune system are registered
as long-term chronic effects (59). It is worth to note that persons having asthma,
pneumonia, diabetes, respiratory and cardiovascular diseases are especially
susceptible and vulnerable to Particulate Matter (PM) effects. PM2.5 followed by
PM10 are strongly associated to diverse respiratory system diseases (60), as their
size permit them to pierce interior spaces (61). The particles produce toxic effects
according to their chemical and physical properties. PM10 and PM2.5 components
could be of organic (polycyclic aromatic hydrocarbons, dioxins, benzene, 1-3
butadiene) or inorganic nature (carbon, chlorides, nitrates, sulphates, metals) (54).

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Particulate Matters (PM) are divided in 4 main categories following type and size (62);

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si
Gas contaminants include PM in aerial masses,

r o vi
Particulate contaminants include contaminants such as Smog, Soot, Tobacco Smoke, Oil

P
Smoke, Fly Ash, and Cement Dust.

Biological Contaminants are Microorganisms (bacteria, viruses, fungi, mold and bacterial
spores), Cat Allergens, House Dust and Allergens, Pollen.

Types of Dust include Suspended Atmospheric Dust, Settling Dust, and Heavy Dust.

Finally, another fact is that PM10 and PM2.5 particles half-life in the atmosphere is extended
due to their tiny dimensions; this permits their long lasting suspension in the
atmosphere and even their transfer and spreading to distant destinations where
people and environment should be exposed to the same magnitude (52).They are
able to change the nutrient balance in watery ecosystems, damage forests and crops
and acidify water bodies.
As stated, PM2.5 due to their tiny size are causing more serious health effects. These
aforementioned fine particles are the main cause of the ‘haze’ formation in different
metropoles (11) (12).
 • Ozone impact in the atmosphere

Ozone(O3) is a gas formed from oxygen under high voltage electric discharge(63). It is a
strong oxidant, 52% stronger than chlorine. It is arises in the stratosphere, but it could also
arise following chain reactions of photochemical smog in the troposphere (64).

Ozone can travel to distant areas from its initial source moving with air masses (65). It
is surprising that ozone levels over cities are low in contrast to the higher amounts in
urban areas being a risk for cultures, forests and vegetation (66) as it is reducing
carbon assimilation (67). Ozone reduces growth and yield (47) (48) and affect the plant
microflora due to its antimicrobial capacity (68) (69).In this extent, ozone act upon other
natural ecosystems microflora (70) (71) and animal species changing species
composition (72). Ozone increases DNA damaging in epidermal keratinocytes and
leads to impaired cellular function (73).

Ground level ozone (GLO) is generated from a chemical reaction between oxides of nitrogen
and VOCs emitted from natural sources and/or following anthropogenic activities.

Ozone uptake is usually occurring by inhalation. Ozone affects the upper

layers of skin and the tear duct (74). A study of short-term exposure of mice

l
to high levels of ozone showed malondialdehyde formation in the upper skin

a
(epidermis) but also depletion in vitamins C and E. It is likely that ozone

n
levels are not interfering with skin barrier function and integrity to predispose
to skin disease (75).

vi sio
Due to the low water solubility of ozone, inhaled ozone have the capacity to
deeply penetrating into the lungs(76).

r o
Toxic effects induced by ozone are registered in urban areas all over the world causing

P
biochemical, morphologic, functional and immunological disorders (77).
The European project (APHEA2) focuses on the acute effects of ambient ozone
concentrations on mortality (78). Daily ozone concentrations compared to the daily
number of deaths was reported from different European cities for a 3 years period.
During the warm period of year , an observed increase in ozone concentration was
associated to an increase in the daily number of numbers (0.33%),in the number of
respiratory deaths(1.13% ) and in the number of cardiovascular deaths(0.45%).No
effect was observed to the winter cold time.

• Carbon monoxide (CO)

Carbon monoxide is produced by fossil fuel when combustion is in-appropriate. People

inhaling carbon monoxide, poisoning include headache, dizziness, weakness,
nausea, vomiting, and finally loss of consciousness as symptoms.

Carbon monoxide affinity to hemoglobin is much greater than those of oxygen. In

this vein, serious poisoning may occur to persons exhibited to high levels of carbon
monoxide for a long period of time. Due to the loss of oxygen as competitive
binding of carbon monoxide is effective, hypoxia, ischemia and cardiovascular
disease is observed.
Carbon monoxide affects the greenhouses gazes which are tightly connected to
the global warming and climate. This should conduct to an increasing in soil and
water temperature and extreme weather conditions or storms may appear (69).
However, in laboratories and field experiments increased plant growth was
observed (79).

• Nitrogen oxide (NO2)

Nitrogen oxide is a traffic-related pollutant as it is emitted from automobiles motor

engines (81). It is an irritant of the respiratory system as it penetrates deep in the
lung inducing respiratory diseases, coughing, wheezing, dyspnea, bronchospasm and
even pulmonary edema when inhaled at high levels. It seems that concentrations over 0.2
ppm produce these adverse effects in humans, while concentrations higher than 2.0ppm
affect T-lymphocytes, particularly the CD8+ cells and NK cells producing our immune
response(82).It is reported that long-term exposure to high levels of nitrogen dioxide can
be responsible for chronic lung disease. Long-term exposure to NO2 can reduce smelling
ability of an odor (82).

l
Although other systems than the respiratory one can be involved, as symptoms from eyes,

a
throat and nose irritation are registered (82).

i
and discolor fabrics(82).

si n
High levels of nitrogen dioxide are deleterious to crops and vegetation, as reduce in

o
crop yield and plant growth efficiency is observed.Moreover,NO2 can reduce visibility

P r o
•
v Sulfur dioxide (SO2)

Sulfur dioxide is a harmful gas emitted mainly from fossil fuel consumption or industrial
activities. The annual standard of SO2 is 0.03 ppm (83). It affects human, animal and plants.
Susceptible people as those with lung disease, old people and children present a higher risk
of damages. The major health problems associated to sulfur dioxide emissions in
industrialized areas are respiratory irritation, bronchitis, mucus production and
bronchospasm as it is a sensory irritant and penetrates deeper in the lung converted in
bisulfite and interacting with sensory receptors cause bronchoconstriction. Moreover, skin
redness, damage to the eyes (lacrimation and corneal opacity) and mucous membranes, as
well as worsening of the subsisting cardiovascular disease were observed (82).

Environmental adverse effects, such as acidification of soil and acid rain seem to be
associated to sulfur dioxide emissions (84).

• Lead

Lead is a heavy metal used in different industrial plants and emitted from
several petrol motor engines, batteries, radiators, waste incinerators and waste
waters (85).
Moreover, major sources of lead pollution in the air are metals, ore and piston-
engine aircrafts. Poising from lead is a threat to the public health, due to its
deleterious effects upon human, animal and environment, especially in the
developing countries.

Exposure to lead can occur through inhalation, ingestion, dermal absorption. Trans-
placental transport of lead was also reported as lead passes through the placenta
unencumbered. The younger the fetus is, toxic effects are more harmful. Lead toxicity is
affecting the fetus nervous system; edema or swelling of the brain is observed (
Lead when inhaled, accumulates in blood, soft tissue, liver, lung, bones, cardiovascular,
nervous and reproductive systems .Moreover, loss of concentration and memory as well as
muscle and joint pain were observed in adults (86) (87).

Children and newborns (88) are extremely susceptible even to minima doses of lead, as
it is a neurotoxicant causing learning disabilities, impairment of memory, hyperactivity
and even mental retardation.
Elevated lead amounts in the environment are harmful to plants and corps growth.
Neurological effects are observed in vertebrates and animals associated to high
lead levels (89).

• Polycyclic aromatic hydrocarbons(PAHs)

Their distribution is ubiquitous in the environment as the atmosphere is the most

important means of PAHs dispersal. They are found in coal and in tar sediments.

o n al
Moreover, they are coming after incomplete combustion of the organic matter as in the
cases of forest fires, incineration and engines (90). Polycyclic
aromatichydrocarbons(PAHs) compounds, such as benzopyrene, acenaphthylene,

si
anthracene, fluoroanthene are designed as toxic, mutagenic and carcinogenic substances.

r o
•

vi
They include an important risk for lung cancer (90).

Volatile organic compounds(VOCs)

P
Volatile organic compounds , such as toluene, benzene, ethylbenzene, and xylene(64) are
incriminated to be associated to cancer in humans(91).Use of new products and
materials actually has resulted in increased concentrations of volatile organic
compounds(VOCs).VOCs pollutes indoor air(91) and may have adverse effects to
human health (92).Short-term and long-term adverse effects on human health are
observed. VOCs are incriminated for the perception of indoor air odors . Short-term
exhibition is incriminated for irritation of eyes, nose, throat and mucosal membranes
while long period exhibition include toxic reactions (93). The predictable assessment of
toxic effects caused by complex VOC mixtures is difficult to estimate as these pollutants
could have synergic, antagonistic or indifferent effect (92) (94).

• Dioxins

Dioxins are originated from industrial processes but come also from natural processes, such
as forest fires and volcanic eruptions. They accumulate in foods such as meat and dairy
products, fish and shellfish and especially in the fatty tissue of animals (95).

Short-period exhibition to high dioxins concentration may result skin dark spots and
lesions (95).Dioxins long-term exposure can cause developmental problems,
impairment of the immune, endocrine and nervous systems, reproductive infertility
and cancer (95).

Without any doubt, fossil fuel consumption retains a sizeable part of air contamination. This
contamination may be anthropogenic, as agricultural and industrial processes or

transportation, while a contamination from natural sources is also possible. Interestingly,

it is of note that air quality standards established through the European Air Quality
Directive are somewhat superior compared to the WHO guidelines which are more
strict (96).

Air pollution affects health

The most common air pollutants are ground-level ozone and Particulates Matters (PM).

Air pollution is distinguished in 2 main types:

Outdoor pollution is the ambient air pollution.

Indoor pollution is the pollution generated by household combustion of fuels.

People exhibited to high concentrations of air pollutants are experienced to an extent of

disease symptoms and states less or more serious. Those effects are grouped in short
and long term effects affecting health.
Susceptible populations which need to be aware of health protection measures include
old people, children, people having diabetes and predisposing heart or lung disease
and especially asthma.

o n l
As extensively stated previously, following a latest epidemiological study from Harvard

a
School of Public Health, the relative magnitude of the short and long term effects is
not completely clarified (58) due to the different epidemiological methodologies and to

si
the exposure errors. New models are proposed for assessing short- and long-term

r o i
human exposures data more successfully (58).Thus, in the present section, we report

v
the more common short and long-term health effects ,but also general concerns for
both type of effects ,as those effects are often depended on the environmental

P
conditions, dose and individual susceptibility.

Short-term effects are temporary and range from simple discomfort such as irritation of
the eyes, nose, skin, throat, wheezing, coughing and chest tightness, breathing
difficulties to more serious states as asthma, pneumonia, bronchitis, lung and heart
problems. Short-term exposure to air pollution can also cause headaches, nausea and
dizziness.
These problems could be aggravated by extended long-term exposure to the pollutants and
being harmful to neurological, reproductive, and respiratory systems, cause cancer and even
rare deaths.
The long-term effects are chronic lasting for years or the whole life and even lead to
death. Yet, toxicity of several air pollutants may also induce a variety of cancers in the long
term (97).
As stated already, respiratory disorders are closely associated to the inhalation of air
pollutants. These pollutants will invade through the airways and will accumulate at the
cells. Damage of target cells should be related to the involved pollutant component, its
source and dose . Health effects are closely dependent also on country, area, season
and time. The extended exposure period to the pollutant should incline to long –term
health effects in relation also to the above factors.
Particulate Matters (PMs) ,dust, benzene and O3 bring serious damage to the respiratory
system(98).Moreover, there is a supplementary risk in case of existing respiratory disease such
as asthma(99).Long-term effects are more often to people with a predisposing disease
state. When trachea is contaminated by pollutants, voice alterations may be remarked after
acute exposure. Chronic obstructive pulmonary disease (COPD) may be induced
following air pollution increasing morbidity and mortality (100). Long-term effects from
traffic, industrial air pollution and combustion of fuels are the major causes for COPD risk
(100).

Multiple cardiovascular effects were observed after exhibition in air pollutants (101).
Occurred changes in blood cells after long-term exposure may affect cardiac
functionality. Coronary arteriosclerosis was reported following to the long-term
exposure to traffic emissions(102) ,while short-term exposure is related to the
hypertension, stroke ,myocardial infracts and heart insufficiency. Ventricle’s hypertrophy
is reported to persons after long-time exposure to nitrogen oxide (NO2) (80) (103) (104).

Neurological effects were observed after extended term exposure to air pollutants in adults

l
and children.

sio n a
Psychological complications, autism, retinopathy, fetal growth, and low birth weight seems
to be related with long-term air pollution matters (84). The etiologic agent of the
neurodegenerative diseases (Alzheimer’s and Parkinson’s) is not yet known,

o vi
although it is believed that extended exposure to air pollution seems to be a factor.
Specifically, pesticides and metals are incriminated as etiological factors together with diet.

r
P
Mechanisms in the development of the neurodegenerative disease include oxidative stress,
protein aggregation, inflammation and mitochondrial impairment which attained the
neurons (105).

Brain inflammation was observed in dogs living in a high polluted area in Mexico for a long
period (106). In human adults , markers of systemic inflammation (IL-6 and fibrinogen) were
found increased, as an immediate response to PNC on the IL-6 level, possibly leading to the
production of acute-phase proteins(107). Progression of atherosclerosis and oxidative stress
seems to be the involved mechanisms of the neurological disturbances due to long-termair
pollution. Inflammation comes secondary to the oxidative stress and seems to be
involved in the impairment of the developmental maturation affecting multiple
organs(106) (108).Similarly, other factor seems to be involved in the developmental
maturation which define the vulnerability to the long-term air pollution. Birthweight,
maternal smoking, genetic background and socioeconomic environment, as well as
education level .
Although diet starting from breast-feeding is another determinant factor .Diet is the main
source of antioxidants which play a key role in our protection against air pollutants (108).
Antioxidants are free radicals scavengers and limit interaction of free radicals in brain (109) .
Similarly, genetic background may result in a differential susceptibility toward the oxidative
stress pathway (61). For example, antioxidant supplementation with vitamins C and E
appears to modulate the effect of ozone in asthmatic children homozygous for the GSTM1
null allele (62). Inflammatory cytokines released in the periphery (e.g. respiratory epithelia)
upregulate the innate immune Toll-like receptor 2. Such activation and the subsequent
events leading to neurodegeneration have recently been observed in lung lavage in mice
exposed to ambient Los Angeles (CA, USA) particulate matter (62). In children,
neurodevelopmental morbidities were observed after lead exposure. These children
develop an aggressive and delinquent behavior , reduced intelligence and scholar
problems and hyperactivity(110).No level of lead exposure seems to be'safe' and
scientific community ask to Centers for Disease Control and Prevention(CDC) to reduce the
current screening guideline of 10 microg/dl(110).

It is important to state that affection of the immune system causing dysfunction and
neuroinflammation(105) is related to poor air quality. Yet, an increasing in serum levels of
immunoglobulins (IgA, IgM) and the complement (C3) is observed (107). Another issue is that
antigen presentation is affected by air pollutants as there is an up-regulation of
costimulatory molecules such as CD80 and CD86 on macrophages (111).

As known, skin is our shield against ultraviolet radiation (UVR) and other pollutants, as it is
the most exterior layer of our body. Traffic-related pollutants, such as polycyclic aromatic
hydrocarbons (PAHs), volatile organic compounds (VOCs), oxides, particulate matter (PM)
may cause pigmented spots in our skin (112).On one hand, as already stated, when pollutants
penetrate through the skin or are inhaled, damage to the organs is observed as part
of these pollutants are mutagenic and carcinogenic and specifically they affect liver and
lung. On another aspect, air pollutants (and in the troposphere reduce the adverse
effects of ultraviolet radiation UVR in polluted urban areas (112). Air pollutants absorbed by
the human skin may contribute to skin aging, psoriasis, acne, urticarial, eczema and
atopic dermatitis

l
(112) usually caused by exposure to oxides and photochemical smoke(112).Exposure to

a
Particulate Matters (PM) and cigarette smoking act as skin aging agents causing spots,

n
dyschromia and wrinkles. Last, pollutants were associated with skin cancer (112).

sio
i
Higher morbidity is reported to fetus, children when exposed to the above dangers.

v
Impairment in fetal growth, low birth weight and autism were registered (113).

P r o
Another exterior organ which may be affected is the eye. Contamination is occurring usually
by suspended pollutants and may result from asymptomatic eye outcomes,
irritation,(113) retinopathy to the dry eye syndrome(114) (115).

Environmental impact of air pollution

Air pollution is not harming only human heath but also the environment (116) in
which we live.

The most important environmental effect is stated hereby;

Acid rain could be wet (rain, fog, snow) of dry (particulates and gas) precipitation containing
toxic amounts of nitric and sulfuric acids. They are able to acidify watery and soil
environment and damage tree and plantations and even damage buildings and outdoors
sculptures, constructions and statues.

Haze is produced when fine particles are dispersed in the air and obscures the clarity of
the atmosphere. It is caused by gas emissions in the air coming from industrial facilities,
power plants, automobiles and trucks.
Ozone as discussed previously occurs both at the ground-level and at the upper-level
(stratosphere) of the Earth's atmosphere. Stratosphere ozone is protecting us from the sun's
harmful ultraviolet (UV) rays. In contrast, ground-level ozone is a harmful for human
health as a pollutant .Unfortunately, stratospheric ozone is gradually damaged by ozone
depleting substances(p.e. chemicals, pesticides and aerosols).If this protecting
 stratospheric ozone layer is slenderized, then UV radiation could reach our Earth with
harmful effects for human life( skin cancer)(117) and crops(118).In plants, ozone
penetrates through the stomata and inducing them to close ,fact which also blocks
CO2 transfer and inducing reduction in photosynthesis(119).

Global climate change is an important issue which concerns mankind. As known, the
"greenhouse effect" keeps the Earth's temperature stable. Unhappily, anthropogenic
activities have destroy this protecting temperature effect by producing large
amounts of greenhouse gases and the globe warming is mounting with harmful
effects on human health, animals, forests, wildlife, agriculture, water environment. A
report states that global warming is adding to the health risks of poor people (120).
People living in poorly unappropriated constructions and houses in warm climate
countries as temperature is mounting, they are at high risk for heat health problems
(120).

Wildlife is burden by toxic pollutants coming from air, soil or watery ecosystem and in this
way animals can develop health problems when exhibited to high levels of pollutants.
Reproductive failure and birth effects were registered.

Eutrophication is occurring when elevated concentrations of nutrients (especially nitrogen)

stimulate the blooming of aquatic algae which can cause des-equilibration of fish’s diversity
and kill.

Without any doubt, there is a critical concentration of pollution that an ecosystem can
tolerate without being destroyed and associated to the ecosystem capacity to neutralize

l
acidity. The Canada Acid Rain Program established this load to at 20 kg/ha/yr (121).

o n a
Hence, air pollution causes deleterious effects on both soil and water (122).

si
i
Concerning Particulate-matter (PM) as air pollutants, their impact is registered on crop

v
yield and food productivity. Its impact on the watery bodies is associated to the survival

r o
of the living organisms and fishes and to their productivity potential (122).

P
Falling of photosynthetic rhythm and metabolism is observed on plants exposed to the
effects of ozone (122).
Sulphur and nitrogen oxides are involved in the formation of acid rain and are harmful to
plants and marine organisms .
Last but not least, we mentioned here the toxicity associated to lead and other metals as
the main treat for our ecosystems (air, water and soil) and living creatures (122).

Discussion

At 2018, during the first WHO Global Conference on Air Pollution and Health take place and
the WHO General Director Dr. Tedros Adhanom Ghebreyesus called air pollution a “silent
public health emergency” and ‘the new tobacco’ (123).

Undoubtedly, children are particularly vulnerable to air pollution especially during their
development. Air pollution has adverse effects on our lives in many different aspects.
 Diseases associated to air pollution have not only an important economic impact but also a
society impact by missing of effective work and school absences.

Despite the problematic in eradicating the problem of anthropogenic environmental

pollution, successful solution could be envisaged, by a tight collaboration of authorities,
bodies and doctors to regularize the situation. Governments should spread sufficient
information and educate people and involving professionals in these issues for controlling
successfully the emergence of the problem.

Technologies to reduce air pollution at the source must be established and should be used in
all industries and power plants. The Kyoto Protocol at 1997 set as a major target the
reduction of GHG emissions below 5% till 2012 (124), followed by Copenhagen summit,
2009 (125)and then the Durban summit at 2011 (126) decided similarly to keep the same
line of action. Basically, the Kyoto protocol and the upcoming ones were ratified by many
countries. Among the pioneers who adopted this important for the world’s environmental
and climate “health” Protocol was China (3). As known, China, is a fast developing economy
and it’s GDP (Gross Domestic Product) is expected to be highly considerable by 2050, which
is defined as the year of dissolution of the protocol for the decrease of gas emissions .
Recently, another International agreement of crucial importance for climate change , is the
Paris Agreement of 2015 issued by UNFCCC(United Nations Climate Change

l
Committee).This last agreement was ratified by a plethora of UN (United Nations)

sio a
countries as well as the countries of European Union (127). In this vein, parties should

n
promote actions and measures to enhance numerous aspects around the subject. Boosting
of the education, training, public awareness and public participation include some relevant

i
actions for maximizing the opportunities to achieve the targets and goals on the crucial

P r o v
matter of Climate Change and Environment Pollution (127). Nevertheless, the
introduction of technological issues makes our world easier and seems difficult to reduce the
harmful impact caused by gas emissions, but we could limit its use by seeking reliable
approaches.

Synopsizing, a global prevention policy should be designed in order to combat against

anthropogenic air pollution as a complement to the correct handling of the adverse
health effects associated with air pollution. Sustainable development practices should be
applied together with information coming from research in order to handle effectively the
problem.

In this point, international cooperation in items of research, development, administration

policy, monitoring and politics is vital for an effective pollution control. Legislation
concerning air pollution must be aligned and updated and policy makers should propose the
design of a powerful tool of environmental and health protection. As a result, the main
objective of this essay should be to focus on fostering local structures to promote
experience and practice and extrapolate it to the international level through sustainable
management of ecosystems by developing effective policies.

REFERENCES

1. WHO | Air pollution [Internet]. WHO. [cited 2019 Oct 5]. Available from:
http://www.who.int/airpollution/en/
2. Moores FC. Climate Change and Air Pollution: Exploring the Synergies and
Potential for Mitigation in Industrializing Countries. Sustainability. 2009, 1, 43-54;
doi: 10.3390/su1010043
3. USGCRP (2009). Global Climate Change Impacts in the United States. “Climate
 Change Impacts by Sectors: Ecosystems.” Karl, T.R., J.M. Melillo, and T.C.
Peterson (eds.). United States Global Change Research Program. Cambridge
University Press, New York, NY, USA.
4. Eze IC, Schaffner E, Fischer E, Schikowski T, Adam M, Imboden M, et al. Long-
term air pollution exposure and diabetes in a population-based Swiss cohort.
Environ Int. 2014 Sep 1; 70: 95–105.
5. Kelishadi R, Poursafa P. Air pollution and non-respiratory health hazards for
children. Arch Med Sci AMS. 2010 Aug 30;6(4):483–495.
6. Manucci PM, Franchini M. Health effects of ambient air pollution in developing
countries.Int J Environ Res Public Health,2017 Sept 12; 14(9): 1048.
doi:10.3390/ijerph14091048
7. Burden of Disease from Ambient and Household Air Pollution. [(accessed on 15
August 2017)]; Available
online: http://who.int/phe/health_topics/outdoorair/databases/en/
8. Hashim D, Boffetta P. Occupational and environmental exposures and cancers in
developing countries.Ann Glob Health. 2014 Sep-Oct; 80(5):393-411.
9. Guo Y, Zeng H, Zheng R, Li S, Pereira G, Liu Q, Chen W, Huxley R.Sci The burden
of lung cancer mortality attributable to fine particles in China. Total Environ. 2017
Feb 1; 579:1460-1466.
10. Hou Q, An XQ, Wang Y, Guo JP. An evaluation of resident exposure to respirable
particulate matter and health economic loss in Beijing during Beijing 2008 Olympic
Games.Sci Total Environ. 2010 Sep 1; 408(19):4026-4032.
11. Kan H, Chen R, Tong S. Ambient air pollution, climate change, and population
health in China.Environ Int. 2012 Jul; 42:10-19.
12. Burroughs Peña MS, Rollins A. Environmental Exposures and Cardiovascular
Disease: A Challenge for Health and Development in Low- and Middle-Income
Countries.Cardiol Clin. 2017 Feb; 35(1):71-86.
13. Kankaria A, Nongkynrih B, Gupta S. Indoor Air Pollution in India: Implications on
Health and its Control. Indian J Comm Med. 39(4):203-207.

l
14. Parajuli I, Lee H, Shrestha KR. Indoor Air Quality and ventilation assessment of

15.

sio n a
rural mountainous households of Nepal. Int J Sust Built Env.Dec2016;5(2):301-311,
https://doi.org/10.1016/j.ijsbe.2016.08.003
Saud T, Gautam R, Mandal TK, Gadi R, Singh DP, Sharma SK.. Emission
estimates of organic and elemental carbon from household biomass fuel used over

16.

r o vi
the Indo-Gangetic Plain (IGP), India. Atmos Environ. 2012; 61:212–220.
Singh DP, Gadi R, Mandal TK, Saud T, Saxena M, Sharma SK. Emissions
estimates of PAH from biomass fuels used in rural sector of Indo-Gangetic Plains of

P
India. Atmos Environ. 2013; 68:120–126.
17. Dherani M, Pope D, Mascarenhas M, Smith KR, Weber M BN. Indoor air pollution
from unprocessed solid fuel use and pneumonia risk in children aged under five
years: A systematic review and meta-analysis. Bull World Health Organ. 2008;
(86):390–394.
18. Kassomenos P.; Kelessis A.; Petrakakis M.; Zoumakis N.; Christides T.;
Paschalidou A.K. Air Quality assessment in a heavily-polluted urban Mediterranean
environment through Air Quality indices. Ecological Indicators.2012; 18 (5):259–
268.
19. Dockery DW, Pope CA, Xu X, Spengler JD, Ware JH, Fay ME, et al. An Association
between Air Pollution and Mortality in Six U.S. Cities. N Engl J Med. 1993 Dec 9;
329 (24):1753–1759.
20. Schwela, DH and I Köth-Jahr. Leitfaden für die Aufstellung von Luftreinhalteplänen
[Guidelines for the implementation of clean air implementation plans].1994.
Landesumweltamt des Landes Nordrhein Westfalen.
21. Newlands M.Environmental activism ,environmental politics,and representation:The
framing of the British environmental activist movement,PhD Thesis,2015.University
of East London,UK
22. NEPIS (National Service Center for Environmental Publications), US EPA
(Environmental Protection Agency).2017, https://www.epa.gov/clean-air-act-
overview/air-pollution- current-and-future-challenges
23. NRC(National Research Council), https://www.nap.edu/read/10728/chapter/1,2014.
24. Bull A. Traffic congestion: The problem and how to deal with it. Nationes Unidas,
 Cepal, Santiago, Chile, 2003. Sales No. E.03.II.G.88, ISSN printed version: 0252-
2195 ISSN online version: 1727-0413 ISBN: 92-1-121432-7.
25. Spiegel J., Maystre LY. Environmental Pollution Control , Part VII - The
Environment,Chapter 55 ,Encyclopedia of Occupational Health and Safety.
http://www.ilocis.org/documents/chpt55e.htm
26. European Community Reports. Assessment of the effectiveness of European air
quality policies and measures: Case study 2; Comparison of the EU and US air
quality standards and planning requirements.2004.
https://ec.europa.eu/environment/archives/cafe/activities/pdf/case_study2.pdf
27. Gibson R, Ward S. Parties in the digital age; A review. J Repres Democracy,2009,
45(1),87-100, https://doi.org/10.1080/00344890802710888
28. Kaun A, Uldam J. Digital activism: After the hype. Sept19, 2017,20(6), 2099-2106,
https://doi.org/10.1177/1461444817731924
29. Sivitanides M,Shah V.The era of digital activism. 2011 Conference for Information
Systems Applied Research( CONISAR) Proceedings Wilmington North Carolina,
USA v4 n1842, https://www.arifyildirim.com/ilt510/marcos.sivitanides.vivek.shah.pdf

30. Möller L, Schuetzle D, Autrup H. Future research needs associated with the
assessment of potential human health risks from exposure to toxic ambient air
pollutants. Environ Health Perspect. 1994 Oct; 102 (Suppl 4):193–210.
31. Jacobson MZ, Jacobson PMZ. Atmospheric Pollution: History, Science, and
Regulation. Cambridge University Press; 2002. p.206
32. Appleby-Arnold S, Brockdorff N, Jakovljev I, Zdravković S. Applying cultural values

l
to encourage disaster preparedness: Lessons from a low-hazard country. Int J

a
Disaster Risk Reduct. 2018 Oct 1; 31:37–44.

n
33. Stover RH. Chapter 3 - Flooding of Soil for Disease Control. In: Mulder D, editor.

o
Developments in Agricultural and Managed Forest Ecology [Internet]. Elsevier;

si
1979 [cited 2019 Jul 1]. p. 19–28. (Soil Disinfestation; vol. 6). Available from:

i
http://www.sciencedirect.com/science/article/pii/B9780444416926500094

v
34. Maipa V, Alamanos Y, Bezirtzoglou E. Seasonal fluctuation of bacterial indicators in

o
coastal waters: Microbial Ecology in Health and Disease.2001, 13 (3) :143-146,

P r https://doi.org/10.1080/089106001750462687
35. Bezirtzoglou E, Dimitriou D, Panagiou A. Occurrence of Clostridium perfringens in
River Water by Using a New Procedure. Anaerobe. 1996 Jun 1; 2: 169–173.
36. Kjellstrom T, Lodh M, McMichael T, Ranmuthugala G, Shrestha R, , Kingsland S.
Air and Water Pollution: Burden and Strategies for Control. DCP, Chapter 43,817-
832 https://www.dcp-3.org/sites/default/files/dcp2/DCP43.pdf
37. Pathak RK, Wang T, Ho KF, Lee SC. Characteristics of summertime PM2.5 organic
and elemental carbon in four major Chinese cities: Implications of high acidity for
water- soluble organic carbon (WSOC). Atmos Environ. 2011 Jan 1; 45(2):318–
325.
38. Bonavigo L,Zucchetti M,Mankolli H. Water Radioactive Pollution and Related
Environmental Aspects. J Int Env Appl. Sci. January 2009; 4(3):357-363
39. World Health Organization (WHO).Preventing disease through healthy
environments: Towards an estimate of the environmental burden of disease.
pp.1106.https://www.who.int/quantifying_ehimpacts/publications/preventingdisease.
pdf
40. Stansfeld SA. Noise Effects on Health in the Context of Air Pollution Exposure. Int J
Environ Res Public Health. 2015 Oct; 12(10): 12735–12760,
doi:10.3390/ijerph121012735
41. Ethical Unicorn. Everything You Need To Know About Aerosols & Air Pollution
[Internet]. 2019 [cited 2019 Oct 4]. Available from:
https://ethicalunicorn.com/2019/04/29/everything-you-need-to-know-about-
aerosols- air-pollution/
42. Colbeck I, Lazaridis M. Aerosols and environmental pollution. Sci.Nature. October
2009, 97(2):117-131, doi: 10.1007/s00114-009-0594-x
43. Incecik S, Gertler A, Kassomenos P. Aerosols and air quality. Sci Total Env. May
2014,488(1), doi: 10.1016/j.scitotenv.2014.04.012
44. D'Amato G, Pawankar R, Vitale C, Maurizia L. Climate change and Air Pollution:
Effects on Respiratory Allergy. Allergy, Asthma Immunology Research.2016 Sep
 16; 8(5), 391- 395, doi: 10.4168/aair.2016.8.5.391
45. Bezirtzoglou C, Dekas K, Charvalos E. Climate changes, environment and
infection: Facts, scenarios and growing awareness from the public health
community within Europe. Anaerobe. 2011 Jun 2; 17: 337–340.
46. Castelli F, Sulis G. Migration and infectious diseases. Clin Microbiol Infect Off Publ
Eur Soc Clin Microbiol Infect Dis. 2017 May; 23(5):283–289.
47. Watson JT, Gayer M, Connolly MA. Epidemics after Natural Disasters. Emerg Infect
Dis. 2007 Jan; 13(1):1–5.
48. Fenn B. Malnutrition in Humanitarian Emergencies.
https://www.who.int/diseasecontrol_emergencies/publications/idhe_2009_london_
ma lnutrition_fenn.pdf.
49. Lindh E, Argentini C, Remoli ME, Fortuna C, Faggioni G, Benedetti E, et al. The
Italian 2017 Outbreak Chikungunya Virus Belongs to an Emerging Aedes
albopictus–Adapted Virus Cluster Introduced From the Indian Subcontinent. Open
Forum Infect Dis 2019 Jan; 6(1): ofy321, doi: 10.1093/ofid/ofy321
50. Calba C, Guerbois-Galla M, Franke F, Jeannin C, Auzet- Caillaud M, Grard G,
Pigaglio L, Decoppet A, Weicherding J, Savaill MC, Munoz-Riviero M, Chaud P,
Cadiou B, Ramalli L, Fournier P, Noël H, De Lamballerie X, Paty MC, Leparc-
Goffart I. Preliminary report of an autochthonous chikungunya outbreak in France,
July to September 2017. Euro Surveill. 2017 Sept; 22(39): pii=17-00647.
https://doi.org/10.2807/1560-7917.ES.2017.22.39.17-00647
51. Menne B, Murray V. Weltgesundheits organisation, Regionalbüro für Europa.
Floods in the WHO European Region: Health effects and their prevention.

l
Copenhagen WHO; 2013. http://www.euro.who.int/

a
data/assets/pdf_file/0020/189020/e96853.pdf

n
52. Bezirtzoglou E, Dimitriou D, Panagiou A. Occurrence of Clostridium perfringens in

o
River Water by Using a New Procedure. Anaerobe. 1996 Jun 1;2:169–73.

si
53. Schneider SH. The greenhouse effect: science and policy. Science. 1989 Feb 10;

i
243(4892):771–781.

v
54. Wilson WE, Suh HH. Fine Particles and Coarse Particles: Concentration

o
Relationships Relevant to Epidemiologic Studies. J Air Waste Manag Assoc. 1997

P r Dec;47(12):1238–1249.
55. US EPA (US Environmental Protection Agency).2018, https://www.epa.gov/pm-
pollution/particulate-matter-pm-basics
56. Cheung K, Daher N, Kam W, Shafer MM, Ning Z, Schauer JJ, et al. Spatial and
temporal variation of chemical composition and mass closure of ambient coarse
particulate matter (PM10–2.5) in the Los Angeles area. Atmos Environ. 2011 May
1;45(16):2651–2662.
57. Zhang L, Yang Y, Li Y , Qian ZM, Xiao W, Wang X, Rolling CA, Liu E, Xiao J,
Zeng W, Liu T, Li X, Yao Z, Wang H, Ma W, Lin H. Short-term and long-term effects
of PM2.5 on acute nasopharyngitis in 10 communities of Guangdong, China, Sci
Total Env,20 Oct 2019,688,136-142
58. Kloog I, Ridgway B, Koutrakis P, Coull BA, Schwartz JD. Long- and Short-Term
Exposure to PM2.5 and Mortality Using Novel Exposure Models, Epidemiology. 2013
Jul; 24(4): 555–561. doi:10.1097/EDE.0b013e318294beaa
59. New Hampshire Department of Environmental Services. Current and Forecasted
Air Quality in New Hampshire. Environmental Fact Sheet.2019,
https://www.des.nh.gov/organization/commissioner/pip/factsheets/ard/documents/ar
d-16.pdf
60. Kappos AD, Bruckmann P, Eikmann T, Englert N, Heinrich U, Höppe P, et al.
Health effects of particles in ambient air. Int J Hyg Environ Health. 2004 Jan 1;
207(4):399–407.
61. Boschi N. Education and Training in Indoor Air Sciences. Springer Science &
Business Media; 2012.p.245
62. Heal MR, Kumar P, Harrison RM.Particles, air quality, policy and health. Chem Soc
Rev. 2012 Oct 7; 41(19):6606-30. doi: 10.1039/c2cs35076a.
63. Bezirtzoglou E, Alexopoulos A. Ozone history and ecosystems: A goliath from
impacts to advance industrial benefits and interests, to environmental and
therapeutical strategies. In: Ozone Depletion, Chemistry and Impacts. 2009. p.
135–145.
64. Villányi V, Turk B, Franc B, Csintalan Z. Ozone Pollution and its Bioindication. In
2010.
65. Massachusetts Department of Public Health. Massachusetts State Health
Assessment. Boston, MA; October 2017.
https://www.mass.gov/files/documents/2017/11/03/2017%20MA%20SHA%20final%
20 compressed.pdf
66. Lorenzini G, Saitanis C. Ozone: A Novel Plant “Pathogen.” 2003; p. 205–229, doi:
10.1007/978-94-017-0255-3_8
67. Fares S, Vargas R, Detto M, Goldstein AH, Karlik J, Paoletti E, et al. Tropospheric
ozone reduces carbon assimilation in trees: estimates from analysis of continuous
flux measurements. Glob Change Biol. 2013 Aug;19(8):2427–2443.
68. Harmens H, Mills G, Hayes F, Jones L, Norris D, Fuhrer J. Air pollution and
vegetation: ICP Vegetation Annual Report 2006/2007. 2012. Sep 1; ISBN: 978-1-
906698-35-5
69. Emberson LD, Pleijel H, Ainsworth EA, den Berg M, Ren W, Osborne S, Mills G,
Pandey D, Dentener F, Büker P , Ewert F, Koeble R, Van Dingenen R. Ozone
effects on crops and consideration in crop models. Eur J Agron .2018 Oct; 100:19-
34.
70. Alexopoulos A, Plessas S, Ceciu S, Lazar V, Mantzourani I, Voidarou C, et al.
Evaluation of ozone efficacy on the reduction of microbial population of fresh cut
lettuce (Lactuca sativa) and green bell pepper (Capsicum annuum). Food Control.
2013 Apr 1;30:491– 496.
71. Alexopoulos A, Plessas S, Kourkoutas Y, Stefanis C, Vavias S, Voidarou C, et al.

l
Experimental effect of ozone upon the microbial flora of commercially produced

a
dairy fermented products. Int J Food Microbiol. 2017 Apr 4;246:5–11.

n
72. Maggio A, Fagnano M. Ozone Damages to Mediterranean Crops: Physiological

o
Responses. Ital J Agron. 2008 Mar 31;13–20.

si
73. McCarthy JT, Pelle E, Dong K, Brahmbhatt K, Yarosh D, Pernodet N. Effects of

i
ozone in normal human epidermal keratinocytes. Exp Dermatol. 2013

v
May;22(5):360–36

o
74. WHO.Health risks of ozone from long-range transboundary air pollution.

P r http://www.euro.who.int/ data/assets/pdf_file/0005/78647/E91843.pdf

75. Thiele JJ ,Traber MG, Tsang K, Cross CE, Packer L.. In vivo exposure to ozone
depletes vitamins C and E and induces lipid peroxidation in epidermal layers of
murine skin. Free Radical Biology & Medicine, 1997, 23:365–391.
76. Hatch GE, Slade R, Harris LP, McDonnell WF, Devlin RB, Koren HS, Costa DL,
McKee J.Ozone dose and effect in humans and rats. A comparison using oxygen-
18 labeling and bronchoalveolar lavage. Am J Respir Crit Care Med. 1994
Sep;150(3):676-83.
77. Lippmann M. Health effects of ozone. A critical review. JAPCA. 1989
May;39(5):672–95.
78. Gryparis A, Forsberg B, Katsouyanni K,Analitis A,Touloumi G, Schwartz J,
Samoli E, Medina S, Anderson HR, Niciu EM, Wichmann HE, Kriz B, Kosnik M,
Skorkovsky J, Vonk JM, Dörtbudak Z. Acute effects of ozone on mortality from the
"air pollution and health: a European approach" project. Am J Respir Crit Care
Med. 2004 Nov 15;170(10):1080-1087.
79. Soon W,baliunas SL,Robinson AB,Robinson ZW. Environmental effects of
increased atmospheric carbon dioxide.Climate Res.26 Oct 199,,13:149-164
80. Richmont-Bryant J, Owen RC, Graham S, Snyder M, McDow S, Oakes M,
Kimbourgh S. Estimation of on-road NO2 concentrations, NO2/NOX ratios, and
related roadway gradients from near-road monitoring data. Air Quality.Atm
Health.2017 Jun; 10(5):611- 625.
81. Hesterberg TW, Bunn WB, McClellan RO, Hamade AK, Long CM, Valberg PA.
Critical review of the human data on short-term nitrogen dioxide (NO2) exposures:
evidence for NO2 no-effect levels. Crit Rev Toxicol. 2009; 39(9):743–81.
82. Chen T-M, Gokhale J, Shofer S, Kuschner WG. Outdoor air pollution: nitrogen
dioxide, sulfur dioxide, and carbon monoxide health effects. Am J Med Sci. 2007
Apr; 333(4):249– 56.
83. US EPA. Table of Historical SO2 NAAQS , Sulfur Dioxide NAAQS , US EPA
 [Internet]. [cited 2019 Oct 5]. Available from:
https://www3.epa.gov/ttn/naaqs/standards/so2/s_so2_history.html
84. Ghorani A, Riahi-Zanjani B, Balali-Mood M. Effects of air pollution on human health
and practical measures for prevention in Iran. J Res Med Sci. 2016 Sep 1; 21-27.
85. WHO (World Health Organization). Comparative quantification of health risks
.p.1495- 1542 [Internet]. [ cited 2019 Oct 5]. Available from:
https://www.who.int/healthinfo/global_burden_disease/cra/en/
86. Goyer RA. Transplacental transport of lead. Environ Health Perspect. 1990 Nov;
89:101-105.

87. National Institute of Environmental Health Sciences (NIH). Lead and Your
Health.2013 Oct; 1-4.
88. Farhat A, Mohammadzadeh A, Balali-Mood M, Aghajanpoor-Pasha M, Ravanshad
Y. Correlation of Blood Lead Level in Mothers and Exclusively Breastfed Infants: A
Study on Infants Aged Less Than Six Months. Asia Pac J Med Toxicol. 2013 Dec 1;
2(4):150–152.
89. Assi MA,Hezmee MNM,Haron AW,Sabri MYM,Rajion MA. The detrimental effects
of lead on human and animal health, Vet World. 2016 Jun; 9(6): 660–671.
doi: 10.14202/vetworld.2016.660-671
90. Abdel-Shafy HI, Mansour MSM. A review on polycyclic aromatic hydrocarbons:
Source, environmental impact, effect on human health and remediation. Egypt J
Pet. 2016 Mar 1; 25(1):107–123.
91. Kumar A, Singh BP, Punia M, Singh D, Kumar K, Jain VK . Assessment of indoor

l
air concentrations of VOCs and their associated health risks in the library of

a
Jawaharlal Nehru University, New Delhi. Environ Sci Pollut Res Int. 2014 Feb;

n
21(3):2240-2248. doi: 10.1007/s11356-013-2150-7.

o
92. Molhave L, Clausen G, Berglund B, Ceaurriz J, Kettrup A, Lindvall T, et al. Total

si
Volatile Organic Compounds (TVOC) in Indoor Air Quality Investigations. European

i
Collaborative Action; Indoor Air Quality and its Impact on Man. Report No 19. 1997

v
Dec; 7(4):225–

o
93. Gibb T. Indoor air quality may be hazardous to your health [Internet]. MSU

P r Extension. [cited 2019 Oct 5]. Available from:

https://www.canr.msu.edu/news/indoor_air_quality_may_be_hazardous_to_your_h
eal th
94. Ebersviller S, Lichtveld K, Sexton KG, Zavala J, Lin Y-H, Jaspers I, et al. Gaseous
VOCs rapidly modify particulate matter and its biological effects – Part 1: Simple
VOCs and model PM. Atmospheric Chem Phys Discuss ACPD. 2012; 12(2):5065–
5105.
95. WHO (World Health Organization).Dioxins and their effects on human health
[Internet]. [cited 2019 Oct 5]. Available from: https://www.who.int/news-room/fact-
sheets/detail/dioxins-and-their-effects-on-human-health

96. EEA (European Environmental Agency). Air quality standards to the European
Union and WHO. https://www.eea.europa.eu/themes/data-and-maps/figures/air-
quality-standards-under-the

97. Nakano T, Otsuki T. [Environmental air pollutants and the risk of cancer]. Gan To
Kagaku Ryoho. 2013 Nov; 40(11):1441–1445.

98. Kurt OK, Zhang J, Pinkerton KE. Pulmonary Health Effects of Air Pollution. Curr
Opin Pulm Med. 2016 Mar; 22(2):138–143.

99. Guarnieri M,Balmes JR. Outdoor air pollution and asthma. Lancet. 2014 May 3;
383(9928):1581-92. doi: 10.1016/S0140-6736(14)60617-6.

100.Jiang X-Q, Mei X-D, Feng D. Air pollution and chronic airway diseases: what
should people know and do? J Thorac Dis. 2016 Jan; 8(1):E31–40.

101.Bourdrel T, Bind M-A, Béjot Y, Morel O, Argacha J-F. Cardiovascular effects of air
pollution. Arch Cardiovasc Dis. 2017 Nov; 110(11):634–642.
102.Hoffmann B, Moebus S, Möhlenkamp S, Stang A, Lehmann N, Dragano N,
Schmermund A, Memmesheimer M, Mann K, Erbel R, Jöckel KH; Heinz Nixdorf
Recall Study Investigative Group.Residential Exposure to Traffic Is Associated With
Coronary Atherosclerosis Circulation. 2007 Jul 31; 116(5):489-496.

103.Katholi RE, Couri DM.Left Ventricular Hypertrophy: Major Risk Factor in Patients
with Hypertension: Update and Practical Clinical Applications .Int J
Hypertens. 2011; 495349. doi: 10.4061/2011/495349.
104.Leary PJ, Kaufman JD, Barr RG, Bluemke DA, Curl CL, Hough CL, et al. Traffic-
related Air Pollution and the Right Ventricle. The Multi-ethnic Study of
Atherosclerosis. Am J Respir Crit Care Med. 2014 May 1; 189(9):1093–1100.

105.Genc S, Zadeoglulari Z, Fuss SH, Genc K. The Adverse Effects of Air Pollution on
the Nervous System. J Toxicol .2012, Article ID 782462: 1-23
http://dx.doi.org/10.1155/2012/782462

106.Calderon-Garciduenas L, Azzarelli B, Acuna H, et al. Air pollution and brain

damage. Toxicol Pathol 2002; 30: 373–389.

107.Rückerl R, Greven S, Ljungman P, Aalto P, Antoniades C, Bellander T, et al. Air

pollution and inflammation (interleukin-6, C-reactive protein, fibrinogen) in
myocardial infarction survivors. Environ Health Perspect. 2007 Jul; 115(7):1072–

l
1080.

sio n a
108.Peters A, Veronesi B, Calderón-Garcidueñas L, Gehr P, Chen LC, Geiser M, et al.
Translocation and potential neurological effects of fine and ultrafine particles a
critical update. Part Fibre Toxicol. 2006 Sep 8; 3: 13-18.

r o vi
109.Kelly FJ. Dietary antioxidants and environmental stress. Proc Nutr Soc. 2004
Nov; 63(4):579–585.

P
110.Bellinger DC. Very low lead exposures and children’s neurodevelopment. Curr
Opin Pediatr. 2008 Apr; 20(2):172–177.

111.Balbo P, Silvestri M, Rossi GA, Crimi E, Burastero SE. Differential role of CD80
and CD86 on alveolar macrophages in the presentation of allergen to T
lymphocytes in asthma. Clin Exp Allergy J Br Soc Allergy Clin Immunol. 2001 Apr;
31(4):625–636.

112.Drakaki E, Dessinioti C, ANTONIOU C. Air Pollution and the skin. Front Environ
Sci Eng China. 2014 May; 15:2-8.

113.Weisskopf MG, Kioumourtzoglou M-A, Roberts AL. Air Pollution and Autism
Spectrum Disorders: Causal or Confounded? Curr Environ Health Rep. 2015 Dec;
2(4):430–439.

114.Mo Z, Fu Q, Lyu D, Zhang L, Qin Z, Tang Q, et al. Impacts of air pollution on dry
eye disease among residents in Hangzhou, China: A case-crossover study. Environ
Pollut. 2019 Mar 1; 246:183–189.

115.Klopfer J. Effects of environmental air pollution on the eye. J Am Optom Assoc.

1989 Oct; 60(10):773–778.

116.Ashfaq A, Sharma P. Environmental effects of air pollution and application of

engineered methods to combat the problem. J Indust Pollut Control .2012 Dec; 29
(1) . Available from: http://www.icontrolpollution.com/ peer-reviewed/
environmental-effects-of-air- pollution-and-application-of-engineered-methods-to-
combat-the-problem-45739.html
117.Madronich S, de Gruijl F. Skin Cancer and UV radiation. Nature. 1993 Jan 13;
366: 23-29.

118.Teramura A. Effects of UV-B radiation on the growth and yield of crop plants.
Physiol Plant. 2006 Apr 28; 58:415–427.

119.Singh E, Tiwari S, Agrawal M. Effects of elevated ozone on photosynthesis and

stomatal conductance of two soybean varieties: a case study to assess impacts of
one component of predicted global climate change. Plant Biol Stuttg Ger. 2009
Nov; 11 Suppl 1:101–108.

120.Manderson L. How global warming is adding to the health risks of poor people
[Internet]. The Conversation. [cited 2019 Oct 5]. Available from:
http://theconversation.com/how-global-warming-is-adding-to-the-health-risks-of-
poor- people-109520

121.Ministers of Energy and Environment .Federal/Provincial/Territorial Ministers of

Energy and Environment (Canada), editor. The Canada-wide acid rain strategy for
post-2000. Halifax, N.S: The Ministers; 1999. p.11

122.Zuhara S, Isaifan R. The Impact of Criteria Air Pollutants on Soil and Water: A
Review. June 2018,278-284,doi : 10.30799/jespr.133.18040205

o n al
123.WHO | First WHO Global Conference on Air Pollution and Health, 30 October – 1
November 2018 [Internet]. [cited 2019 Oct 6]. Available from:
https://www.who.int/airpollution/events/conference/en/

r i si
124.What is the Kyoto Protocol? | UNFCCC [Internet]. [cited 2019 Oct 6]. Available

v
from: https://unfccc.int/kyoto_protocol

o
125.Copenhagen Climate Change Conference - December 2009 | UNFCCC [Internet].

P
[cited 2019 Oct 6]. Available from: https://unfccc.int/process-and-
meetings/conferences/past- conferences/copenhagen-climate-change-conference-
december-2009/copenhagen- climate-change-conference-december-2009

126.Durban Climate Change Conference - November 2011 | UNFCCC [Internet]. [cited

2019 Oct 6]. Available from: https://unfccc.int/process-and-
meetings/conferences/past- conferences/durban-climate-change-conference-
november-2011/durban-climate- change-conference-november-201

127.Paris Climate Change Agreement- November 2016, https://unfccc.int/process-

and- meetings/the-paris-agreement/the-paris-agreement
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