Effect of Air Pollution, Contamination and High Altitude on Bronchial Asthma

Epidemiological studies have shown that the prevalence of asthma has risen dramatically worldwide and evidence suggests that environmental factors have an important role in the etiology of the disease. Most respiratory diseases are caused by airborne agents. Our lungs are uniquely vulnerable to contamination from the air we breathe. Air pollution exposure is associated with increased asthma and allergy morbidity and is a suspected contributor to the increasing prevalence of allergic conditions. Observational studies continue to strengthen the association between air pollution and allergic respiratory disease.
The effects of air pollution should be viewed in two different groups: healthy people and people with chronic heart or lung disease. Although the fundamental causes of asthma are not completely understood, the strongest risk factors for developing asthma are inhaled asthma triggers. These include: indoor allergens (for example house dust mites in bedding, carpets and stuffed furniture, pollution and pet dander), outdoor allergens (such as pollens and moulds), tobacco smoke and chemical irritants in the workplace. Other triggers can include cold air, extreme emotional arousal such as anger or fear, and physical exercise. Even certain medications can trigger asthma such as aspirin and other non-steroid anti-inflammatory drugs, and beta-blockers. Urbanization has also been associated with an increase in asthma; however the exact nature of this relationship is unclear. Medication is not the only way to control asthma.
 It is also important to avoid asthma triggers - stimuli that irritate and inflame the airways.Prevalence of asthma is generally low within the Middle East, although high rates have been recorded in the Kingdom of Saudi Arabia, Kuwait, Lebanon, and Israel.
The prevalence of asthma and asthma-related symptoms is high among 16- to 18-year-old adolescents in Saudi Arabia, and the symptoms are more common in boys than in girls, associated with a high rate of rhinitis symptoms and hay fever. In addition to bronchial asthma, prevalence of allergic diseases in a sample of  Taif citizens assessed by an original Arabic questionnaire (phase I) evidenced a high prevalence of allergic diseases as Urticaria, allergic rhinitis with or without other co-morbidities, and atopic dermatitis. Effect of high altitude on bronchial asthma is controversial; at high altitudes, the concentrations of the allergens are reduced due to the reduced amounts of vegetation, animal populations and human influences, high UV light exposure and low humidity could be contributing factors to the benefits of high altitude other than allergen avoidance. On the contrary, Lower altitudes have significant beneficial effects for bronchial asthma patients but lessen with increasing altitudes; the mountain climate can modify respiratory function and bronchial responsiveness of asthmatic subjects.
 Hypoxia, hyperventilation of cold and dry air and physical exertion may worsen asthma or enhance bronchial hyper-responsiveness while a reduction in pollen and pollution may play an important role in reducing bronchial inflammation. Increasing attention has to be paid to the potential of urban air toxics to exacerbate asthma. Continued emphasis on the identification ofstrategies for reducing levels of urban air pollutants is warranted to reduce respiratory diseases and other diseases related to pollution. Efforts for reducing the asthma burden must focus on primary prevention to reduce the level of exposure of individuals and populations to common risk factors, particularly tobacco smoke, frequent lower respiratory infections during childhood, and environmental air pollution (indoor, outdoor, and occupational).