To breathe or not to breathe: Inhalational exposure to heavy metals and related health risk

This study reviewed scientific literature on inhalation exposure to heavy metals (HMs) in various indoor and outdoor environments and related carcinogenic and non-carcinogenic risk. A systematic search in Web of Science, Scopus, PubMed, Embase, and Medline databases yielded 712 results and 43 articles met the requirements of the Population, Exposure, Comparator, and Outcomes (PECO) criteria. Results revealed that HM concentrations in most households exceeded the World Health Organization (WHO) guideline values, indicating moderate pollution and dominant anthropogenic emission sources of HMs. In the analyzed schools, universities, and offices low to moderate levels of air pollution with HMs were revealed, while in commercial environments high levels of air pollution were stated. The non-carcinogenic risk due to inhalation HM exposure exceeded the acceptable level of 1 in households, cafes, hospitals, restaurants, and metros. The carcinogenic risk for As and Cr in households, for Cd, Cr, Ni, As, and Co in educational environments, for Pb, Cd, Cr, and Co in offices and commercial environments, and for Ni in metros exceeded the acceptable level of 1 × 10^-4. Carcinogenic risk was revealed to be higher indoors than outdoors. This review advocates for fast and effective actions to reduce HM exposure for safer breathing.