Abstract
Background: Ground-level ozone has been gaining notoriety with increasing evidence of its nefarious effects on health, especially respiratory diseases. Where do we stand on the solidity of this data and is there room for improvement? Objectives: Evaluate this evidence for incongruities or heterogeneity in this field of research. How is the exposure assessment conducted, where does Portugal stand in this field, and what can be improved? Health deterioration concerning asthma, chronic obstructive pulmonary disease (COPD), and acute respiratory distress syndrome (ARDS) are analysed. Methods: A review of 1735 studies was conducted through PubMed and Google Scholar engines for the past two decades. We identified 59 eligible studies and included an array of variables, including O3 measurements, number of air-quality monitoring stations used, relative risks, odds ratios, hazard ratios, number of hospital admissions, visits, or mortality, and size of population dataset used. Results: Approximately 83% of data in this review presents significant correlations of ozone with asthma, COPD, and ARDS. Studies that report negative or not significant associations mention a lack of data or topographic differences as the main issue with these divergent results. Studies consistently report summer as a period of particular concern. Portuguese data in this field is lacking. Conclusions: This research field is growing in interest and there is evidence that ozone plays a non-negligible role in health deterioration. The few Portuguese studies in this field seem aligned with the literature reviewed but more research is needed. Suggested improvements are more and better data through denser air-quality networks to accurately depict personal exposure to ozone. Homogenization of the exposure assessment concerning averaging times of ozone to daily maximum 8 h averages whenever possible. Risk increments based on 10 ppb instead of interquartile ranges. Lastly, contrary to some studies in this review, the topographic effect on concentrations and health deterioration should not be underestimated and seasonality should always be checked.
Highlights
In 1952, a severe air pollution event took place in London named “the great smog of1952”
In this review we focus our attention on asthma, chronic obstructive pulmonary disease (COPD), and acute respiratory distress syndrome (ARDS)
RQ2: If so, does this research show evidence of O3 causing health deterioration? RQ3: Is the evidence proven globally, or is it localized? RQ4: Are there any Portuguese studies? How do they relate to studies elsewhere? RQ5: According to the available evidence, which age groups are the most affected? RQ6: How does seasonality impact O3 and consequent health deterioration? RQ7: Is the monitoring of the exposure to O3 adequate? Where do we stand on studies regarding short-term and long-term morbidity and mortality for asthma and COPD? RQ8: What are the research gaps and possible improvements?
Summary
In 1952, a severe air pollution event took place in London named “the great smog of1952”. Our knowledge of air pollution’s insidious impacts on health and the environment [2], require standards to be continuously adjusted and applied by global and local organizations Most notoriously, these measures include enforcing the most stringent regulations on road transport through the Certification and Compliance for Vehicles and Engines and the Euro Emission Standards through directives 2008/50/EC and 2004/107/EC. Health impacts from particulate matter have been extensively researched; secondary pollutants such as ground-level ozone are usually not the focus of health-pollution correlation studies [3–5]. Studies of this nature are often complex due to confounding factors that may or may not influence health risk assessment. Contrary to some studies in this review, the topographic effect on concentrations and health deterioration should not be underestimated and seasonality should always be checked
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