Respiratory health impacts of coal-fired power plant emissions with transboundary environmental complexities

This interdisciplinary longitudinal study examines the association between PM_2.5 levels at sites downwind of a coal-fired thermal power plant (TPP) near the India-Bangladesh border and respiratory health in the exposed population, assessed using spirometry and fractional exhaled nitric oxide levels. Pulmonary function tests indicate significantly worse lung health at downwind sites in both India and Bangladesh compared with an upwind location. With averaged forced expiratory volume in one second (FEV₁) values < 80% of predicted, evidence of preserved ratio impaired spirometry (PRISm), and significantly lower forced expiratory flow between 25% and 75% of vital capacity (FEF_25-75), the population at the Indian downwind site is clearly at risk of developing obstructive pulmonary and related diseases. Although PM_2.5 concentrations decline sharply during the monsoon across all sites, this does not translate into a recovery in lung health at the downwind location, consistent with chronic, irreversible effects potentially related to long-term exposure to TPP-associated PM_2.5. Moreover, poorer socioeconomic conditions and exposure to emissions from biomass-based indoor cooking are associated with exacerbated respiratory effects. Overall, the study advocates transitioning to cleaner fuels for power generation and household use and recommends locating power plants away from densely populated areas to minimize health impacts.