home > Pediatric Asthma, a major public health concern in Europe

Pediatric Asthma, a major public
health concern in Europe

WHO and the European Environment Agency (EEA) together have launched the monograph "Children’s health and environment: a review of evidence". 
This publication shows that European governments and institutions can collaborate to protect children from environmental threats. This goal lies at the very heart of sustainable development and is a challenge for the future of today’s and tomorrow’s generations.

It is estimated that up to 40% of the global burden of disease is caused by environmental factors on children under the age of 5. As developing organisms, children are particularly vulnerable to the impact of environmental pollution. This is due to several reasons, which include the following:

• early exposure has long-term consequences;
• children have a unique susceptibility to specific chemicals, and are exposed to substances in their immediate environment (such as soil and toys), particularly through their practice of picking things up and putting them into their mouths; and
• in proportion to their body weight, children breathe, drink and eat more than adults, with a consequently higher uptake of potentially toxic substances.

Further, children have no choice about the factors which they are exposed to. They are also likely to be the most “sensitive indicators” for the environmental health of populations.
On this basis, European ministers at the Third Ministerial Conference on Environment and Health in 1999 made a strong commitment to protect children and to develop key indicators for children’s health and the environment.

The European Union is setting the issue of children’s environment and health high on the political agenda. The link between environmental degradation and poor health is clearly established, but we need further research in order to improve our understanding of these complex issues. The union EAA-WHO publication is therefore a very welcome contribution in our efforts to prepare policy responses to the threats that a bad environment poses to children’s health,” remarks Ms Margot Wallström, European Commissioner for the Environment.
In the WHO European Region, the rise of hazards in the settings where children live, learn and play is increasing concern about the effects on children’s health of the deterioration and contamination of the physical environment.

“Children are at risk of exposure to more than 15 000 synthetic chemicals, almost all developed in the last 50 years, and to a variety of physical agents, such as polluted indoor and outdoor air, road traffic, contaminated food and water, unsafe buildings, contaminants in toys, radiation and environmental tobacco smoke,” points out Domingo Jiménez-Beltrán, EEA Executive Director.

The spread of disorders possibly associated with environmental factors (asthma, injuries, neurodevelopmental disorders, cancer, and food- and waterborne diseases) is reaching unacceptably high levels in many cases. “Close cooperation between environmental and health organizations is vital, not least to minimize duplication of efforts,” adds Mr Jiménez-Beltrán.

Monograph presents Paediatric asthma like a major public health concern in Europe. Asthma represents an enormous burden on family and society, spends healthcare resources, produces social costs like absentees from school, caregiver costs... 
The economic costs associated with asthma are estimated to exceed those of HIV and tuberculosis (Worlwide estimation, WHO)
Document is available in full text (PDF), see at the left of this section.

Asthma in this document

Document devotes 22 pages to review asthma and related factors. 
Key points:

• asthma is a genetic disease
• Atopy is the main risk factor for asthma
• Natural history of asthma and natural history of atopic diseases. Monograph describes the "atopic march" (early onset of sensitisation to food allergens in infancy, potentially manifests itself as atopic dermatitis, and may progress to sensitisation to inhalant allergens that may manifest as asthma in a subset of the sensitised children). Document establishes, like an important question for public health, what the determinants and predictors of the ‘atopic march’ are, and which factors may prevent the development and progression of atopic diseases in childhood.

Once the rol of the genetics and allergy in asthma has been stablished , the document reviews the environmental and constitutional aspects which determine the early development of asthma, its severity and its persistence or not in later ages:

• tobacco
• diesel particles
• Indoor and outdoor pollution
• allergens exposure 
• hygiene hypothesis
• Early exposure to infections or sibship size
• the kind of habitat (rural or urban)
• nutrition
• socio-economic factors
   

Document recommendations

• prenatal and postnatal avoidance of environmental tobacco smoke
• exclusive breastfeeding for four to six months combined with avoidance of solid food
• promotion of a health indoor environment, including design and construction of well-ventilated
• free-allergen house
• measures to prevent indoor air pollution 
• avoidance of allergens such as animal dander, house dust mites and moulds
• avoidance of substances that cause irritation on contact with the skin and metals used in ear-piericing, etc
• measures to control (avoid) outdoor air pollution

Suggestions for research

• Relationship between environmental factors and modulation of immune response TH1-TH2.
• Evaluation of the effectiveness of measures aimed at reducing indoor and outdoor air pollution (including the assesment of these measures in children with asthma).