Air pollution and trends in asthma

There is considerable concern about possible links between ambient air pollution and the upward trend in asthma. This chapter reviews the mechanistic and epidemiological evidence concerning air pollution and asthma and examines the hypothesis that trends in asthma could be explained by air pollution. It is concluded that existing evidence is not sufficient to link air pollution with the initiation of asthma in healthy subjects. Although there is better evidence that air pollution can provoke or aggravate asthma, it probably plays a minor role at a public health level, in comparison with other factors. It is therefore unlikely that trends in asthma could be explained by air pollution. Furthermore, correlations between some air pollutants and asthma over time are not consistent with the hypothesis. The possibility of a specific effect of motor vehicle pollution needs further investigation but this factor is unlikely to be the main cause of the worldwide increase in asthma.