Comprehensive Health Research Centre (CHRC) and Department of Biology, University of Évora, Pólo da Mitra, Apartado 94, Évora 7002-554, Portugal; NuESA-Health and Environment Study Unit, Faculty of Health Sciences, University of Beira Interior, Avenida Infante D. Henrique, Covilhã 6200-506, Portugal.
NuESA-Health and Environment Study Unit, Faculty of Health Sciences, University of Beira Interior, Avenida Infante D. Henrique, Covilhã 6200-506, Portugal; Comprehensive Health Research Centre (CHRC), Department of Medical and Health Sciences, University of Évora, Colégio Luís António Verney, Rua Romão Ramalho, 59, Évora 7000-671, Portugal.
Pulmonology. 2022 Sep-Oct;28(5):376-395. doi: 10.1016/j.pulmoe.2021.12.007. Epub 2022 May 12.
To analyse the GARD perspective on the health effects of outdoor air pollution, and to synthesise the Portuguese epidemiological contribution to knowledge on its respiratory impact.
Ambient air pollution has deleterious respiratory effects which are more apparent in larger, densely populated and industrialised countries, such as Canada, Iran, Brazil and Portugal, but it also affects people living in low-level exposure areas. While low- and middle-income countries (LMICs), are particularly affected, evidence based on epidemiological studies from LMICs is both limited and heterogeneous. While nationally, Portugal has a relatively low level of air pollution, many major cities face with substantial air pollution problems. Time series and cross-sectional epidemiological studies have suggested increased respiratory hospital admissions, and increased risk of respiratory diseases in people who live in urban areas and are exposed to even a relatively low level of air pollution.
Adverse respiratory effects due to air pollution, even at low levels, have been confirmed by epidemiological studies. However, evidence from LMICs is heterogeneous and relatively limited. Furthermore, longitudinal cohort studies designed to study and quantify the link between exposure to air pollutants and respiratory diseases are needed. Worldwide, an integrated approach must involve multi-level stakeholders including governments (in Portugal, the Portuguese Ministry of Health, which hosts GARD-Portugal), academia, health professionals, scientific societies, patient associations and the community at large. Such an approach not only will garner a robust commitment, establish strong advocacy and clear objectives, and raise greater awareness, it will also support a strategy with adequate measures to be implemented to achieve better air quality and reduce the burden of chronic respiratory diseases (CRDs).
分析户外空气污染对健康影响的 GARD 观点，并综合葡萄牙在该领域呼吸道影响方面的流行病学研究成果。
环境空气污染对呼吸道具有有害影响，在加拿大、伊朗、巴西和葡萄牙等人口众多且工业化程度较高的国家更为明显，但也会影响生活在低暴露地区的人群。虽然低中等收入国家（LMICs）受到的影响尤其严重，但基于来自 LMICs 的流行病学研究的证据既有限又存在异质性。虽然葡萄牙全国的空气污染水平相对较低，但许多主要城市仍面临着严重的空气污染问题。时间序列和横断面流行病学研究表明，城市地区的呼吸道住院人数增加，以及暴露于相对低水平空气污染的人群患呼吸道疾病的风险增加。
流行病学研究证实了空气污染对呼吸道的不良影响，即使在低水平下也是如此。然而，来自 LMICs 的证据存在异质性且相对有限。此外，还需要进行旨在研究和量化暴露于空气污染物与呼吸道疾病之间关系的纵向队列研究。在全球范围内，综合方法必须涉及包括政府（在葡萄牙，即葡萄牙卫生部，它是 GARD-Portugal 的主办单位）、学术界、卫生专业人员、科学协会、患者协会和广大社区在内的多层次利益相关者。这种方法不仅将获得强有力的承诺，建立强有力的宣传和明确的目标，并提高认识，还将支持实施适当措施的战略，以实现更好的空气质量并减少慢性呼吸道疾病（CRD）的负担。
