According to the World Health Organisation (WHO) statistics and the International Respiratory Coalition’s ‘Lung facts’ research from 2019, asthma hampers the lives of 43.5 million people across Europe. Worryingly, over 11.8 million of these cases impact young people between the ages of 0 -17 years old. Whilst asthma is just one form of respiratory disease, on the whole respiratory diseases are appearing as a serious public health burden for the EU with rising levels of disease spreading throughout the bloc.
Policymakers and experts from the health industry gathered in the European Parliament for a timely discussion, organised by the European Respiratory Society (ERS) and the MEP Lung Health Group, focused on childhood respiratory health and the impact of respiratory diseases on the younger population.
Explaining the focus on childhood respiratory health, Prof Barbara Hoffmann, ERS Advocacy Council Chair reminded attendees that 25% of the EU population is between the ages of 0 -17. This young generation relies on older generations to take a stand for them, as without this, they remain unheard in debates. With developing bodies and immune systems, young people are amongst the weakest in society. Prof Hoffmann reminded participants that “the greatest burden of disease always lies on the weakest in society”, this is why shining a light on their issues is of paramount importance to prevent future public health crises.
“We must face the reality: air pollution is a public health crisis” - MEP Patrizia Toia (S&D, Italy)
Two key factors are known to be causing this uptick in respiratory diseases in Europe. The first, air pollution, has long been closely linked to respiratory diseases. A BAMSE study followed the lives of 4000 neonates born between 1994 and 1996 in Stockholm, Sweden, from birth until the age of 24. Amongst several key results, it was discovered that the level of air pollution where a child grows up severely impacts lung growth.
“We must face the reality: air pollution is a public health crisis” MEP Patrizia Toia (S&D, Italy) stated. Prof Zorana J Andersen, ERS Environment and Health Committee Chair, presented the results of the 2021 research from the WHO global air quality guidelines, which found that 97.5% of the EU population exist near air which is designated as risky to human health. This is a clear issue which unfairly impacts children, with schools often situated in areas of higher pollution, where children’s exposure to pollutants particles increases the risk of having health problems.
Certain members of society are unfairly impacted by these factors. “Social inequality causes a greater proportion of respiratory diseases than any other illness” MEP Romana Jerković (S&D, Croatia) told the room. Research has found that those in lower social classes are up to 14% more likely to have respiratory diseases than those in higher classes. MEP Toia reinforced this point, highlighting how children in socioeconomic disadvantage areas face higher risks of respiratory disease due to insufficient access to healthcare resources.
Climate change has more recently entered discussions as a second key cause of respiratory disease. Prof Hoffmann discussed how COP28 was the first time that climate change and health was a topic central to the discussions. Children are also more susceptible to climate change driven issues. “Children breathe more rapidly and take in more air per body mass than adults, so they are likely to breathe in more pollutants and allergens” Prof Andersen told the room.
With European temperatures rising at twice the speed of other areas of the world, Prof Andersen warned that the burden of climate change on children will continue to increase. “Accelerating climate change impacts poses new challenges for children’s health that demand new research and more urgent actions”.
Europe is struggling to deal with these challenges and lacks the ability to treat younger patients. Prof Marielle Pijnenburg shocked attendees by explaining how each year over 100 children are admitted to intensive care due to life threatening asthma attack in her hospital alone, with some children sadly not surviving the impacts of their attacks. “Asthma is not an innocent disease” Prof Pijneburg reiterated. She told attendees how asthma medication is available to prevent and stop asthma attacks, however there is still a lack of studies on the potential of this medication on children under 12, which hinders its commercialisation.
“The greatest burden of disease always lies on the weakest in society” - Professor Barbara Hoffmann, Advocacy Council Chair of the European Respiratory Society
“A 40-year-old obese woman’s asthma cannot be compared to asthma of a highly allergic child with eczema. Therefore, we cannot simply extrapolate data from adult studies to children” Prof Pijnenburg explained.
Ed Powell, Chair of the European Lung Foundation Youth Group, provided a personal account of dealing with respiratory disease. At just 5 months old, he was presented to a doctor with a wheezing cough. Three years later, his parents were told that Ed would grow out of the condition, but nothing worked to fight the pain. At the age of 7, after many tests, he was diagnosed with Bronchiectasis. As a result of the condition, Ed suffered from frequent infections, and he was unable to live a life like his friends playing sport and camping due to issues with cold air and damp. This diagnosis should have been the beginning of the end of his journey; however, he faced many issues around medication not made for children of his young age, leaving him to be treated with off-licensed drugs. Now, Ed lives a relatively normal life thanks to physio and medication, and is able to play the trumpet, sing in choirs and run. But his illness still has to be managed.
What needs to be done to protect children from being adversely impacted by respiratory diseases? Steps in the right direction have been taken to address air pollution. The EU’s Ambient Air Quality directive was praised as a positive move forward, but attendees were quick to warn that one piece of legislation will not be enough to overcome the air quality crisis. Calls for a greater plan and a focus on the health implications of air pollution and climate change were made, and a need to also focus on health within the Green Deal was underlined.
The most promising results of the BAMSE study showed that relocating to areas with improved air quality was associated with increased lung function levels regardless of the level of exposure to air pollution in the first year of life. Improving air quality makes a difference.
On a medicinal level, Prof Pijnenburg stressed she can and will continue to treat children as much as possible, but unless safe and effective medicines become available, and the air they breathe is not improved, these same problems will continue to occur on a regular basis. “Treating children early will pay off during adult life” reiterated Prof Pijnenburg. Central to this was a call to focus on prevention, something Prof Hoffmann labelled as “one of the best therapies”. One thing that all could agree on was that as a society, Europeans have a duty to change for the good of their children.