Today is Clean Air Day. As a children’s respiratory specialist, this year’s theme of protecting our children’s health from air pollution is particularly relevant for me.

I run the paediatric severe asthma service for Greater Manchester and the North West, and my research interests focus on asthma and allergic diseases. In my clinical role, I mostly look after children with severe asthma and try to improve their quality of life as much as possible. For most of them, asthma really impacts on their everyday life and prevents them from doing many of the things that children and young people usually do without thinking, such as playing football or going out with friends. Ultimately, we try to find treatment that will keep them in school and out of hospital.

The struggles my patients face day to day really highlight how important air quality really is. There is no doubt that traffic-related air pollution effects respiratory health by causing inflammation in our airways, particularly for those who are susceptible to asthma. What is less certain are the long-term impacts on children’s health. Air pollution clearly affects people with asthma but it is hard to gauge how much of a problem it is and how you measure it against everything else in their environment that impacts on their disease. Air pollution varies from day to day, at different times of day, and from place to place. A child may live in an area with low pollution levels but go to school in a more polluted location, or walk by a busy main road to get there. And how do we measure the impact of pollution along with other environmental factors, such as allergens and cigarette smoke?

Hospital admissions for children with asthma are higher in inner city areas. This could be due to air pollution, but inner-city areas also tend to be more deprived and we know that wider issues such as housing and family income can also impact on children’s health. So, unfortunately this further highlights the health inequalities that have been so apparent in our city-region during the current pandemic.

Evidence is emerging that the number of hospital admissions and asthma exacerbations was significantly reduced during the first ‘lockdown’. This could be down to a reduction in air pollution and chances are it did play a part, but it’s hard to quantify. There are lots of other factors at play, such as virus transmission which was also reduced. We know this often causes exacerbation in children. Now there’s much more traffic back on the roads, an easy way to reduce our exposure to air pollution is to avoid walking next to main roads and keep to the quieter residential streets. If that means we walk a little further, well that’s great for our daily step count!

So, what can we do to make our air cleaner? We can all do things to benefit our own communities and those around us right now. Walking and cycling instead of travelling by car helps to reduce air pollution and has other health benefits for us too, along with stopping smoking. If you do have to travel by car, an electric car produces less emissions but there are of course financial and practical considerations, so it’s not possible for everyone.

There are lots of things we can do as a health service too. Many of Greater Manchester’s NHS trusts are now using the Clear Air Hospital Framework, a strategy aimed at improving air quality in and around hospitals in order to create a healthier environment for patients and their families, staff, and the local community. It looks at key areas including travel, procurement and supply chain, local air quality, and communication and training. For example, reducing the emissions of our fleet vehicles, which are used for deliveries and such like, by replacing petrol and diesel vehicles with electric. Some trusts are currently working on improving their on-site charging facilities to make this easier. We can also promote the use of public transport and try to avoid the need for travel with more online meetings and appointments, which we’ve seen an increase in during the pandemic. Trusts are also supporting active travel with secure cycle storage and changing and showering facilities. There’s a lot to do but there is real motivation within Greater Manchester to make these kinds of changes.

More broadly, our innovative, joined up approach across different public services in Greater Manchester helps us to take effective action to improve both the environment and the health of our population. We have an ambitious target for our city region to be carbon neutral by 2038, delivering an annual average of 15% cuts in emissions. This includes retrofitting buildings to make them more environmentally friendly, introducing zero emissions buses, managing waste more sustainably and planting one million trees. Measures of this kind will help to address health inequalities and prevent ill health.




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