[1] https://www.propublica.org/article/clean-air-act-exemptions-trump-emails

https://theconversation.com/when-you-dont-have-the-facts-argue-the-law-how-trumps-epa-is-limiting-its-own-ability-to-protect-public-health-far-into-the-future-282351

[2] https://www.pbs.org/newshour/science/trump-calls-climate-change-threat-to-public-health-a-scam-but-scientific-findings-show-otherwise 

[3] “Hundreds of thousands of visitors climb The Monument's 311 spiral steps each year, and are rewarded with one of the best views of London from the public viewing platform.”

[4] “Throughout her illness Ella had been treated in five separate hospitals but no medical professional had ever explained that air pollution could be making her asthma worse.”

[5] “The disease is caused by mutation of a gene that encodes a chloride-conducting transmembrane channel called the cystic fibrosis transmembrane conductance regulator (CFTR), which regulates anion transport and mucociliary clearance in the airways. Functional failure of CFTR results in mucus retention and chronic infection and subsequently in local airway inflammation that is harmful to the lungs.”

[6] “Stasis of lung secretions in CF eventually leads to mucus plugging, chronic bacterial infection and inflammation, and eventually, airway damage”

[7] “Asthma is a chronic disease of the air passages characterized by inflammation and narrowing of the airways. Symptoms of asthma include shortness of breath, cough, and wheezing.”

[8] “Inhaled corticosteroids (ICSs) … are the most effective anti-inflammatory medications available for the treatment of asthma and represent the mainstay of therapy for most patients with the disease.”

[9] “Ella used to say her medicine wasn’t working – and much later after her death, Stephen explained this would have been true. But at the time we just thought she wasn’t taking her inhaler properly. I still feel bad about how we didn’t listen to her.” - Rosamund Adoo-Kissi-Debrah

[10] “The syndrome of cough syncope … is characterized by paroxysmal cough, facial congestion, cyanosis, and loss of consciousness, which typically occurs within seconds followed by rapid recovery”

[11] “Of the 90 articles comprising our database, 74 reported a total of 430 adult cases of cough syncope. Six of the papers did not provide the gender of the patients described, thus leaving 68 articles reporting 392 patients, of whom 362 (92.3%) were men, and 30 (7.7%) women. Since the majority of these patients were reported between 1876 and 1968, we examined more recently published data. In the past 25 years (1988–2013), 40 articles reported and provided gender data for a total of 83 patients with cough syncope, 76 (91.6%) male and 7 (8.4%) female, an almost identical gender distribution.”

[12] “By the mid-19th century, a very consistent profile of the typical cough syncope patient had emerged, that being of a middle-aged, overweight male smoker with obstructive lung disease.” “A typical profile of the cough syncope patient emerging from the literature is that of a middle-aged, large-framed or overweight male with obstructive airways disease.”

[13] “Patients with cough syncope are predominantly muscular, overweight, middle-aged men who are current or ex-smokers and who tend to overindulge in alcohol. The vast majority of these patients have a chronic cough, bouts of severe coughing, and evidence of obstructive lung disease."

[14] From a review article on cough syncope: “Six studies reported a total of 33 pediatric cases of cough syncope... Five of those papers provided gender data for 30 children, 16 (53.3%) male and 14 (46.7%) female. Thus, although the number of children reported is much less than that of adults, the significant gender difference is not observed in this age group. Of the 31 children for whom a diagnosis was provided, 28 (90.3%) were asthmatic, consistent with the common association of obstructive lung disease described in the adult population.” “A large, male subject with obstructive airways disease would be more likely to generate extremely high intrathoracic pressures with coughing than would a woman or a child. When cough syncope has been reported in the pediatric population, the condition was noted to occur almost exclusively in children with asthma”

[15] “One of our favourite doctors at Great Ormond Street said to Ella she would be in the medical books. She was a bit of a science bod, so she was really excited about that!” - Rosamund Adoo-Kissi-Debrah

[16] E.g. (examples include mentions of Ella’s case in medical and health-related journals, broadly defined)  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8051372/ ; https://www.bmj.com/content/364/bmj.l192 ; https://erj.ersjournals.com/content/58/6/2102447 ;
http://shura.shu.ac.uk/28258/3/Swallow-AllNursesShouldUnderstand%28AM%29.pdf ; https://www.thelancet.com/journals/lanchi/article/PIIS2352-4642(21)00269-8/fulltext ;
https://www.magonlinelibrary.com/doi/full/10.12968/bjon.2021.30.16.982 ;
https://rke.abertay.ac.uk/en/publications/simple-traffic-measures-significantly-reduce-the-exposure-of-prim ; https://www.magonlinelibrary.com/doi/abs/10.12968/johv.2020.8.2.70 ;
Mentions of the case also can be found in publications of other fields, such as education (https://www.tandfonline.com/doi/abs/10.1080/09518398.2021.1930246) and spatial information (https://somaesthetics.aau.dk/index.php/gfp/article/view/642)

[17] https://www.cdc.gov/asthma/triggers.html 

https://www.aafa.org/asthma-triggers-causes/

[18] “The 1991, 1997, and 2007 National Institute of Health Guidelines on Asthma (NIH Guidelines) define asthma as follows: ‘Asthma is a chronic inflammatory disorder of the airways… In susceptible individuals, this inflammation causes recurrent episodes of wheezing, breathlessness, chest tightness, and coughing… The inflammation also causes an associated increase in the existing bronchial hyperresponsiveness to a variety of stimuli. Reversibility of airflow limitation may be incomplete in some patients with asthma.’ ” (sci-hub)

[19] “Asthma episodes are the result of airway narrowing that occurs through 3 main mechanisms: swelling, secretions, and muscle constriction of the bronchi. … Asthma episodes and worsening of inflammation can be initiated by triggers that can vary over time and between asthmatics. Common triggers include upper or lower respiratory tract viral infections, tobacco smoke, allergens, particulate pollution, ozone, change in temperature (usually cold), excitement, stress, nonsteroidal inflammatory medicines, or exercise” (sci-hub)

[20] http://ellaroberta.org/about-ella// “Ella died at 03:27 on 15 February 2013.”

[21] https://www.gov.uk/after-a-death/when-a-death-is-reported-to-a-coroner 

[22] An inquest into Ella’s death at Southwark Coroner’s Court on September 26, 2014 concluded that her death was caused by acute respiratory failure and severe asthma / NYT: “The coroner who originally investigated Ella’s death ruled she had died of acute respiratory failure, but made no mention of pollution. Ms. Adoo-Kissi-Debrah did not know then what diesel fumes can do to young lungs. It was more than a year after Ella’s death that she first learned dirty air is a known asthma trigger.”

https://chambers.com/articles/extraordinary-landmark-inquest-rules-air-pollution-contributed-to-death-of-ella-adoo-kissi-debrah 

26 September 2014

First Inquest into Ella’s death takes place at Southwark Coroner’s court before Assistant Coroner, Phillip Barlow. The cause of death was recorded as Acute Respiratory failure caused by severe asthma. The first inquest into her death did not investigate the role of air pollution.

[23] e.g. "Hither Green mum's battle to solve asthma 'medical mystery' that killed 9-year-old daughter" 13th February 2014,

https://www.newsshopper.co.uk/news/11009486.hither-green-mums-battle-to-solve-asthma-medical-mystery-that-killed-9-year-old-daughter/

[24] https://www.southampton.ac.uk/medicine/about/staff/sth.page

[25] "the size of a fingernail but only about 4 microns thick" - Stephen Holgate interview grab

[26]  Most (80%) of her columnar ciliated cells in the respiratory epithelial lining had been replaced by a different kind of cell (goblet cells) that produce copious mucus. Her airways had been remodeled as a result of the chronic disease process. - Erica comms with Holgate. For description, see, e.g., https://www.ncbi.nlm.nih.gov/books/NBK541061/ 

[27] “Airway mucus traps inhaled toxins and transports them out of the lungs by means of ciliary beating and cough (Fig. 1). Paradoxically, although a deficient mucous barrier leaves the lungs vulnerable to injury, excessive mucus or impaired clearance contributes to the pathogenesis of all the common airway diseases” (Sci-Hub, final publication)

[28] “Mucociliary clearance in conducting airways, reduction of surface tension in the alveoli, and maintenance of near sterility have been accommodated by the evolution of a multi-tiered innate host-defense system.”

[29] “At the time of Ella’s tragic death there were diffusion tubes monitoring NO2 levels at 47 sites and 4 automatic monitoring stations measuring, variously NO2, PM10 and SO2 levels.”

[30]  Catford monitoring site link: https://www.londonair.org.uk/london/asp/publicdetails.asp?region=0&site=LW1&details=location&mapview=All&la_id=&network=All&MapType=Google. (This is part of a network of monitoring sites, of which there are several in the vicinity and along the road.)

[31] “When nitrogen dioxide is inhaled at high enough levels, it reacts with and damages lung cells, including those cells that fight infection.”

[32] “During the course of her illness between 2010 and 2013 she was exposed to levels of nitrogen dioxide and particulate matter in excess of World Health Organization Guidelines.”

[33] “[Coroner Philip] Barlow said that Ella had been exposed to levels of two air pollutants, nitrogen dioxide (NO2), a toxic gas largely emitted by diesel cars, and particulate matter, in excess of World Health Organization guidelines, which are stricter than the UK and EU’s limits. ‘The level of air pollution she was exposed to was therefore excessive,’ he said.” Also in the Coroner's report "During this period there was a recognized failure to reduce the level of nitrogen dioxide to within the limits set by EU and domestic law which possibly contributed to her death"

[34] Compare monthly NO2 concentrations in Lewisham from 2012 and 2013 (Figure 2 in both reports). Monthly NO2 levels rose steadily throughout fall/winter 2012, peaking in January 2013 for roadside sites, and not dropping considerably until March 2013. (The reports do not provide daily data.) Both reports downloaded from https://lewisham.gov.uk/myservices/environment/air-pollution/check-air-quality-levels 

[35] “Ella died from acute respiratory failure, asthma, and air pollution exposure—the first time ever that a coroner has found air pollution as a contributory cause of illness and death”

[36] “Ella lived next to the South Circular Road and for most of her short life had been exposed to excessively high levels of a traffic-derived mix of nitrogen dioxide (NO2) and particulate matter (PM) less than 10 microns in aerodynamic diameter (PM10—the inhalable fraction), and the non-exhaust sources of PM such as tyre and brake wear.”

[37] “The nature of her asthma with severe damage to the lining cells of her airways and a massive increase in mucus secretion pointed to chemical damage in a highly genetically susceptible Individual.” - Professor Sir Stephen Holgate

[38] “Consistently breathing toxic air pollution at illegal levels played an important role in initiating her asthma and its ongoing severe expression, especially in the winter when pollution was worse.” - Professor Sir Stephen Holgate

[39] “PM2.5 polluters disproportionately and systemically affect people of color in the United States”

[40] “redlining, a nearly 80-year-old racially discriminatory policy, continues to shape systemic environmental exposure disparities in the United States”

[41] “In 2010, on average nationally, racial/ethnic minority populations were exposed to higher average levels of transportation-related air pollution (CO, NO2) and particulate matter (PM2.5, PM10) than were non-Hispanic White populations.” (a US study)

[42] “On average, non-Hispanic whites experience a “pollution advantage”: They experience ∼17% less air pollution exposure than is caused by their consumption. Blacks and Hispanics on average bear a “pollution burden” of 56% and 63% excess exposure, respectively, relative to the exposure caused by their consumption” (a US study)

[43] “We show that areas with higher-than-average white and Native American populations have been consistently exposed to average PM2.5 levels that are lower than areas with higher-than-average Black, Asian and Hispanic or Latino populations.” (a US study)

[44] 2019 review: In England, “higher exposure levels are found where the population has higher proportions of income support recipients or non-white populations. Neighborhoods with greater than 20% non-white populations had significantly higher levels of PM10 (4.2 µg/m3 ) NO2 (13.5 µg/m3) in England”

[45] “areas graded as C or D often hosted industrial facilities, railroads, and other pollution sources. We find that, within HOLC-mapped areas, D-grade neighborhoods are more likely to be near industrial sources and that the average number of sources nearby increases from A to D (Figure S8). Additionally, the portion of people living near railroads and primary roadways increases monotonically by HOLC grade from A to D (Figure S9). While U.S. rail infrastructure was largely constructed before the 1930s, limited-access highways were constructed almost entirely after the 1930s and were preferentially constructed through Black and brown communities in U.S. cities.”

[46] “A prevailing expectation is that subpopulations of lower socioeconomic position are exposed to higher levels of air pollution, due to the proximity of homes to various pollutant sources such as hightraffic roads or industrial facilities. In particular in North America studies have shown higher exposures with lower socioeconomic position … In Europe results are more mixed … Reasons for these non-linear or negative associations have been discussed in the literature. One possible explanation is the gentrification of inner cities. People of higher social class might tolerate higher levels of air pollution in inner city areas for the multitude of benefits association with inner city living”

[47] "Understanding how environmental inequality is created may help explain air pollution and inequality research and has implications for policy. It has been hypothesized that low SES [socioeconomic status] communities with limited political power and influence are unable to stop locally undesirably land uses (LULU), such as factories and roads, from being built in their communities. That is, poor communities lack social capital, a necessary prerequisite for mounting an effective campaign against placing a LULU in one’s community. On the other hand, it has been suggested that industry is motivated solely by economic factors: building a LULU on cheap land is economically prudent."

[48] Out of London's 32 boroughs, by some quick calculations, Lewisham in 2012 was 3rd highest in terms of the number and percentage of Black residents, and 12th in terms of the number and percentage of nonwhite residents. (Using this data: https://data.london.gov.uk/dataset/ethnic-groups-borough )

[49] (Scroll down to “Ethnicity| Lewisham”) Lewisham’s projected Black, Asian and Minority Ethnic (BAME) population for 2020 was reported at 48.3%, which is higher than London overall (43.5%). The population segments with Black African (11.6%) and Black Carribean (9.6%) heritage were notable and higher than for London as a whole. (The only larger single category in Lewisham was “Other White,” at 12.9%.)

[50] “Ella's mother was not given information by health professionals about the health risks of air pollution and its potential to exacerbate asthma.”

[51] “She said medics never raised the issue of air pollution while she was visiting hospitals. If they did her family would have taken the decision to move from the area, where Rosamund first came 20 years ago, when “there was less traffic and the air was not so polluted”.”

[52] 1997 study (Sci-Hub, https://www.atsjournals.org/doi/abs/10.1164/ajrccm.155.2.9032209) “Summer haze pollutants were found to be significantly and consistently correlated with asthma exacerbations, chest symptoms, and lung function decrements in children attending a summer asthma camp.”

[53] 2002  https://erj.ersjournals.com/content/erj/19/4/699.full.pdf  “The effect of daily ambient air pollution was examined within a cohort of 846 asthmatic children residing in eight urban areas of the USA…  In single pollutant models, each pollutant was associated with an increased incidence of morning symptoms: (odds ratio (OR)=1.16 (95% CI 1.02–1.30) per IQR [interquartile range] increase in 4-day average ozone, OR=1.32 (95% CI 1.03–1.70) per IQR increase in 2-day average SO2, OR=1.48 (95% CI 1.02–2.16) per IQR increase in 6-day average NO2 and OR=1.26 (95% CI 1.0–1.59) per IQR increase in 2-day average PM10. … This longitudinal analysis supports previous time-series findings that at levels below current USA air-quality standards, summer-air pollution is significantly related to symptoms and decreased pulmonary function among children with asthma.”

[54] e.g. “At an asthma camp in rural Connecticut conducted in the early 1990s, the number of asthma exacerbations in children requiring physician-prescribed rescue medication increased in direct proportion to the ambient O3 level, as shown in Fig 1.29 In a study in Paris in which 82 asthmatic children were followed for 3 months and had every exacerbation of asthma evaluated by a physician, O3 levels were shown to be associated with an increase in the occurrence of asthma attacks, respiratory infections, and reductions in peak flow rate.”

[55] “Viral infections are the major cause of asthma exacerbations. … High exposure to NO2 in the week before the start of a respiratory viral infection, and at levels within current air quality standards, is associated with an increase in the severity of a resulting asthma exacerbation.”

[56] 2013 Review: See Table 1. Chemical pollutants and their impact on allergy and asthma. “The increase in cases of asthma and allergies has become an important health issue throughout the globe. … Exposure to environmental (both outdoor and indoor) pollutants may partially account for the prevalence of such diseases.”

[57] "Thirty-seven untreated allergic children with mild persistent asthma were recruited from a highly polluted urban environment and relocated to a less polluted rural environment. … One week after relocation to the rural environment, we measured, on average, a fourfold decrease in nasal eosinophils and significant decrease in fractional exhaled nitric oxide. We also noted an improvement in lower airway function, reflected by highly significant increase in peak expiratory flow. … Better air quality is associated with a rapid reduction of airway inflammation in allergic asthmatic children." Sci-Hub,  https://www.publications.aap.org/pediatrics/article-abstract/123/3/1051/71768/Less-Air-Pollution-Leads-to-Rapid-Reduction-of?redirectedFrom=fulltext

[58] “We estimate about 12,000 excess deaths occurred from December 1952 through February 1953 because of acute and persisting effects of the 1952 London smog.” “Although the excess deaths reported here cannot be conclusively linked to air pollution, it is highly likely the true tally of this episode is much higher than earlier reported.”

[59] “Evolution of the Clean Air Act” (US) https://www.epa.gov/clean-air-act-overview/evolution-clean-air-act:  “The Air Pollution Control Act of 1955 was the first federal legislation involving air pollution. This Act provided funds for federal research in air pollution. The Clean Air Act of 1963 was the first federal legislation regarding air pollution control. It established a federal program within the U.S. Public Health Service and authorized research into techniques for monitoring and controlling air pollution. In 1967, the Air Quality Act was enacted in order to expand federal government activities… As part of these proceedings, the federal government for the first time conducted extensive ambient monitoring studies and stationary source inspections....The enactment of the Clean Air Act of 1970 (1970 CAA) resulted in a major shift in the federal government's role in air pollution control. This legislation authorized the development of comprehensive federal and state regulations to limit emissions from both stationary (industrial) sources and mobile sources...The adoption of this very important legislation occurred at approximately the same time as the National Environmental Policy Act that established the U.S. Environmental Protection Agency (EPA).”

[60] UK: “Clean Air Act, 1956. The CAA focused on controlling domestic and industrial emissions. The main sections under the CAA of 1956 included; Dark smoke, Smoke from furnaces, Grit and dust from furnaces, Smoke control areas, Smoke nuisances”

[61] “The national effort to control this automobile pollution can be traced to the 1970 Clean Air Act, which required a 90 percent reduction in CO, HC and NOx emissions from automobiles. … The United States Clean Air Act required a 75% decrease in emissions of all the new model vehicles after 1975, a decrease to be carried out with the use of catalytic converters.”

[62] “The table below shows that emissions of the common air pollutants and their precursors have been reduced substantially since 1980.” (Refers to Percent Change in Emissions table) https://www.epa.gov/air-trends/air-quality-national-summary 

[63] For the US: “Emissions of sulfur, mainly from coal-burning power plants, and oxidized nitrogen, originating mainly from motor vehicles and power plants, have decreased continuously and substantially across the United States in recent decades (Fig. 1A). While changes in technology and the economy undoubtedly contribute to these trends, reductions in sulfur and nitrogen pollution have been primarily attributed to emissions controls associated with the Clean Air Act, its amendments, and other rules and legislation (U.S. EPA, 2009a).”

[64] For the UK: “a new petrol car emits less than one-twentieth of the levels of nitrogen oxides emitted by cars made in 1992, before catalytic converters were required. There have also been huge cuts in CO and hydrocarbons (VOCs) in petrol exhausts”

[65] For Europe: “It is now over 20 years since vehicle emissions legislation was introduced in Europe… Ambient measurements show that concentrations of CO and HC [hydrocarbons] have decreased by around an order of magnitude over the past 20 years, providing clear evidence of the effectiveness in both the legislation and emissions control technology (EEA, 2012).”

[66] In the US, “Plants with FGD equipment [flue gas desulfurization scrubbers] generated 58% of the total electricity generated from coal in 2010, while producing only 27% of total SO2 emissions.”

[67] For the US: “The 1990 amendments of the CAA [Clean Air Act] established additional regulation for these facilities. The Acid Rain Program (ARP) required the reduction of emissions from SO2 and NOx to decrease the occurrence of acid rain (EPA, 2018b). Specifically, a cap and trade program was established for SO2 (EPA, 2018b). EGUs [ electricity generating units] had to reduce emissions through systems such as installing scrubbers, shifting to alternative fuel methods, or purchasing pollution credits from other facilities to cover their emissions. Scrubbers reduce EGU emissions by converting the pollutants to safe byproducts (Buecker, 2009).”

[68] For the UK: “In contrast to petrol engines, the technology applied to clean up diesel vehicles has not yielded significant improvements in emissions of nitrogen oxides, and the proportion of NO2 in diesel exhaust has actually increased.”

[69] “NO2 primarily gets in the air from the burning of fuel. NO2 forms from emissions from cars, trucks and buses, power plants, and off-road equipment.”

[70] For the UK: “Overall it is found that only petrol fuelled vehicles have shown an appreciable reduction in total NOx emissions over the past 15–20 years. Emissions of NOx from diesel vehicles, including those with after-treatment systems designed to reduce emissions of NOx, have not reduced over the same period of time.”

[71] “Here we show that across 11 markets, representing approximately 80 per cent of global diesel vehicle sales, nearly one-third of on-road heavy-duty diesel vehicle emissions and over half of on-road light-duty diesel vehicle emissions are in excess of certification limits.”

[72] “Primary particles are those that are emitted directly to the air and include PM [particulate matter] generated during fossil fuel combustion, brake and tyre wear, and resuspended road dust.”

[73] “Concerns about black smoke and air acidification (sulphur dioxide, SO2) from coal burning have been replaced by new concerns about particle pollution and nitrogen dioxide (NO2) from transport, and the air pollution that forms through chemical reactions between other pollutants in the atmosphere.”

(full report available at https://www.rcplondon.ac.uk/projects/outputs/every-breath-we-take-lifelong-impact-air-pollution)

[74] “NO2 primarily gets in the air from the burning of fuel. … Breathing air with a high concentration of NO2 can irritate airways in the human respiratory system. Such exposures over short periods can aggravate respiratory diseases, particularly asthma, leading to respiratory symptoms (such as coughing, wheezing or difficulty breathing), hospital admissions and visits to emergency rooms. Longer exposures to elevated concentrations of NO2 may contribute to the development of asthma and potentially increase susceptibility to respiratory infections. People with asthma, as well as children and the elderly are generally at greater risk for  the health effects of NO2. NO2 along with other NOx reacts with other chemicals in the air to form both particulate matter and ozone. Both of these are also harmful when inhaled due to effects on the respiratory system.”

[75] “Each year in the UK, around 40,000 deaths are attributable to exposure to outdoor air pollution which plays a role in many of the major health challenges of our day. It has been linked to cancer, asthma, stroke and heart disease, diabetes, obesity, and changes linked to dementia. The health problems resulting from exposure to air pollution have a high cost to people who suffer from illness and premature death, to our health services and to business. In the UK, these costs add up to more than £20 billion every year.”

[76] “With the growing recognition that air pollution can cause harm to many, if not all, organs of the body (Figure 6), and is associated with diseases in these organs such as diabetes and chronic kidney disease, it is likely that we are still underestimating the levels of morbidity and mortality caused by air pollution.”

[77] “Evidence for impacts on cardiovascular disease is most consistent for PM [particulate matter], which is responsible for the vast majority of the disease burden via its impacts on ischemic heart disease [4,5,6], and stroke [7], as well as lung cancer, COPD, lower respiratory infections, Type 2 diabetes, pregnancy outcomes and related infant mortality [8]. Time series studies conducted in hundreds of urban areas globally indicate a consistent association between short-term variability in PM and cardiovascular disease deaths [9], while large cohort studies from both high and lower income settings demonstrate increased cardiovascular disease incidence and mortality in association with PM levels [10]. Further, PM air pollution has been associated with progression of atherosclerosis [11].”

[78] “Many pollutants can induce inflammation and oxidative damage in the lung, the mediators of which pass into the circulation to cause adverse effects on the cardiovascular system…  air pollutants may alter cardiovascular function through changes in neural activity and circulating blood factors”

[79] “studies have shown that exposure to diesel exhaust causes an immediate and transient increase in arterial stiffness in healthy volunteers.” “Our findings show for the first time the detrimental effect of air pollution on walking at a normal pace. We document the beneficial cardiorespiratory benefits of walking in healthy volunteers aged 60 years and older, an effect that is lost when walking in a polluted environment. Our results show that this similar phenomenon is happening in participants with COPD and ischaemic heart disease, although the cardiac medication taken by the ischaemic heart disease participants might be protecting them against the detrimental cardiovascular effects of air pollution.”

[80] (2025) CVD https://www.sciencedirect.com/science/article/pii/S2666602225000497

(2024) CVD https://www.frontiersin.org/journals/endocrinology/articles/10.3389/fendo.2024.1321323/full

[81] “Air pollution has been a focus of several studies on cognitive impairment and dementia risk. There is evidence that tiny air pollution particles can enter the brain, but at this time we can’t say if they play a role in the development of dementia. There is a strong case for further research into the effect of air pollution on brain health.” “A study of brain tissue from people in Mexico City and Manchester conducted in 2016 … confirmed that fine particulate material can pass into the brain via the blood stream or directly through the thin lining of the nose.”

[82] “Airborne magnetite pollution particles < ∼200 nm in size can access the brain directly via the olfactory and/or trigeminal nerves, bypassing the blood-brain barrier. Given their toxicity, abundance in roadside air, and nanoscale dimensions, traffic-derived magnetite pollution nanoparticles may constitute a chronic and pernicious neurotoxicant, and hence an environmental risk factor for AD [Alzheimer’s disease], for large population numbers globally.” “Air pollution NPs [nanoparticles] can be internalised efficiently through inhalation and transfer via the blood circulation and/or, in the case of the brain, directly transported through the axons of the olfactory … or trigeminal nerves.” (Full text of manuscript)

[83] “We find that long-term exposure to air pollution impedes cognitive performance in verbal and math tests. We provide evidence that the effect of air pollution on verbal tests becomes more pronounced as people age, especially for men and the less educated. … Cognitive decline or impairment are risk factors of Alzheimer’s disease and other forms of dementia for elderly persons.”

[84] “We have found evidence of a positive association between residential levels of air pollution across London and being diagnosed with dementia, which is unexplained by known confounding factors.”

[85] “Long-term PM2.5 exposure was associated with increased Alzheimer’s disease pattern similarity scores… Our findings illustrate the continuum of PM2.5 neurotoxicity that contributes to early decline of immediate free recall/new learning at the preclinical stage, which is mediated by progressive atrophy of grey matter indicative of increased Alzheimer’s disease risk, independent of cerebrovascular damage.”

[86] “we show the contribution of particulate air pollutants to neurodegenerative changes… Overall, the evidence supports the schema that airborne PM accelerates neurodegenerative processes of ADRD through multiple pathways… In summary, we provide clear evidence that the hazards of particulate air pollutants for brain health extend to dementia risk in a US-wide sample of older women”

[87] (2025) Dementia https://www.thelancet.com/journals/lanplh/article/piis2542-5196(25)00118-4/fulltext

[88] “In sum, long-term exposure to nitrogen oxides was associated with prevalent diabetes while NOx and O3 exposures were associated with incident diabetes.” (refers to type 2 diabetes)

[89] “Meta-analyses showed significant associations of PM2.5 with T2D [type 2 diabetes] incidence… and prevalence..., of PM10 with T2D prevalence… and incidence… , and of NO2 with T2D prevalence”

[90] (2025) T2D https://www.sciencedirect.com/science/article/pii/S0013935125001367

[91] “The retina is one of the highest oxygen-consuming tissues in the human body and resides in an environment that is primed for the generation of reactive oxygen species (ROS) and resultant oxidative

damage… Oxidative damage increases with age, resulting in retinal dysfunction and cell loss… Participants exposed to higher levels of PM2.5 concentration were 8% more likely to have self-reported AMD… Age-related macular degeneration (AMD) is the leading cause of irreversible blindness in adults 50 years and above in high income countries.” [article published here]

[92] “In this study, chronic exposure to the highest quartile of ambient NO2 or CO significantly increases the risk for AMD [age-related macular degeneration].” [Sci-hub]

[93]“After adjusting for covariates, the AMD [age-related macular degeneration] risk increased by 19% (95% confidence interval 1.13–1.25) for a 10 μg/m3 PM2.5 increase.”

[94] Pollution is also linked to another cause of blindness: Glaucoma “Lower socio-economic level, older age, female, higher ambient ultraviolet radiation and higher level of air pollution were significantly associated with higher burden of glaucoma.”

[95] “Increased PM2.5 is associated with glaucoma and IOP [intraocular pressure]. These associations should be confirmed using longitudinal data and potential mechanisms should be explored”.. “Our results are in agreement with a few studies. In the United Kingdom, Chua et al.12 reported that people living in areas with higher PM2.5 were more likely to report glaucoma,... Sun et al.11 also reported an association between PM2.5 and a diagnosis of glaucoma…. Min and Min39 found an association between particulate matter < 10 µg and childhood glaucoma”

[96] 

(2025) https://www.aao.org/eye-health/news/poor-air-quality-risk-amd-macular-degeneration

(2025) https://www.ajo.com/article/S0002-9394(25)00121-7/fulltext

(2025) https://www.sciencedirect.com/science/article/pii/S2162098925000763

[97] “Although the placenta has a barrier function to filter out substances harmful to the fetus, several pollutants, such as heavy metals and fine particles (PM2.5 and smaller), are able to cross the placental barrier1 and have the potential to cause injury to the fetus and its developing organs.”  

“Some pollutants, when breathed by the mother, can cross through the placenta to the developing

baby. Particulates and heavy metals are two examples.”

“Air pollution can affect growth of the unborn baby and may be linked to premature birth.” (see full report)

[98] “One possible explanation is that airway cells, such as alveolar macrophages, are stimulated by inhaled pollutants to release mediators, which then enter the systemic circulation and affect the developing fetus. Another, although not mutually exclusive, explanation is that a small amount of toxic inhaled PM translocates via the systemic circulation and directly damages both the placenta and the developing fetus.”

[99] “the two fractions of PM predominantly implicated in CNS [central nervous system] effects are PM2.5 and UFPM [utrafine particulate matter] Both are inhaled on a regular basis due to air pollution, are acutely toxic to lung and cardiovascular tissue, and cross blood-air barrier of the lungs, gaining access to peripheral circulation and the brain. … However, the mechanism responsible for PM entry to the brain is a source of debate, where active transport, a leaky blood-brain barrier, and translocation along the olfactory nerve into the olfactory bulb have been proposed.”

[100] “Ambient air pollution was associated with lower lung function and increased COPD prevalence in this large study.”

“We identified 17 articles eligible for the review. Of these, 11 focused on PM2.5, five on PM10, and one on both. These studies suggested a significant positive association between PM2.5 exposure and the risk of lung cancer.”

Long-term ambient PM2.5 exposure is associated with lung cancer incidence even at concentrations below current EU limit values and possibly WHO Air Quality Guidelines.

[101] Epidemiological and clinical studies have confirmed the link between air pollution and COPD. Both short- and long-term exposure to air pollution has a negative effect on the occurrence and development of COPD.

[102] “Both PM2.5 and PM10 air pollution concentrations have a marked and close association with adverse health effect, such as heart disease, stroke, blood pressure, and cardiovascular diseases. …Air pollution is an important public health issue, causing cardiovascular and pulmonary diseases worldwide.”

[103] “Higher long-term exposure to traffic is associated with incidence of CHD [coronary heart disease], independent of other risk factors.”

[104] Scihub  https://pubmed.ncbi.nlm.nih.gov/20585255/  “The cohort comprised all residents aged 45–85 years who resided in metropolitan Vancouver during the exposure period and without known CHD [coronary heart disease] at baseline (n  450,283). … Compared with the subjects consistently living away from road traffic (>150 m from a highway or >50 m from a major road) during the 9-year study period, those consistently living close to traffic (<or=150 m from a highway or <or=50 m from a major road) had the greatest risk of CHD mortality (relative risk [RR] = 1.29 [95% confidence interval = 1.18-1.41]).” That is, “the risk of CHD mortality increased by 29%”

[105] “Since WHO’s last 2005 global update, there has been a marked increase of evidence that shows how air pollution affects different aspects of health. For that reason, and after a systematic review of the accumulated evidence, WHO has adjusted almost all the AQGs [WHO Global Air Quality Guidelines] levels downwards, warning that   exceeding the new air quality guideline levels is associated with significant risks to health.” (dated Sept 21, 2021)

[106] "Since 1997, EPA has evaluated thousands of new studies on PM and, in September 2006, EPA revised the PM standards by lowering the level of the 24-hour PM2.5 standard to 35 μg/m3"; "On December 14, 2012, EPA finalized an update to the National Ambient Air Quality Standard for PM2.5. The annual standard was reduced from 15 μg/m3 to 12 μg/m3."https://www.epa.gov/system/files/documents/2024-02/pm-naaqs-overview.pdf

2024:

[107] “Almost the entire global population (99%) breathes air that exceeds WHO air quality limits, and threatens their health. A record number of over 6000 cities in 117 countries are now monitoring air quality, but the people living in them are still breathing unhealthy levels of fine particulate matter and nitrogen dioxide, with people in low and middle-income countries suffering the highest exposures.”

[108] “An astonishing 99 per cent of the world’s population breathes polluted air that exceeds internationally approved limits, with negative health impacts kicking in at much lower levels than previously thought, UN medical scientists said on Monday.” (dated Apr 4, 2022)

[109] See, for example, graph of “Percentage of children ages 0 to 17 years living in counties with pollutant concentrations above the levels of the current air quality standards, 1999-2019”

[110] We found that nearly half of American children (46%, or 33.5 million people under the age of 18) live in counties that received a failing grade for at least one measure of air pollution. Ten percent of children (7.3 million people under age 18) live in counties with failing grades for all three measures.

[111] “If Kissi-Debrah succeeds, it will be the first time that air pollution has ever been explicitly linked to a named individual’s death – with potentially far-reaching implications.”  https://www.unep.org/news-and-stories/story/new-inquest-death-london-girl-could-boost-air-pollution-fight 
"The first time air pollution has been listed as a cause of death. Ella Adoo-Kissi-Debrah, a young girl living in London, died in 2013. An inquest found air pollution was the cause of her death and this was listed on her death certificate" full report, p35  https://www.who.int/publications/i/item/9789240036727

[112] “We find that pollution remains responsible for approximately 9 million deaths per year, corresponding to one in six deaths worldwide.”

[113] “Every year, exposure to air pollution is estimated to cause 7 million premature deaths and result in the loss of millions more healthy years of life.”

[114] “The inquest into the death of Ella Roberta Adoo Kissi-Debrah on 15/02/2013 is to be held before Deputy Coroner Philip Barlow at 160 Tooley Street, London SE1 2QH from Monday 30th November to 11th December 2020.”

[115] Right now, a Google search on "kissi debrah" "death" "pollution", restricted to News, yields 3,590 hits. (For all hits, it's ~18,800.) For just the year or so after the 2nd inquest and the new coroner's report, it's 415 results for News items, and ~2,770 hits in general. (Based on a search restricted to Nov 1, 2020 - Dec 31, 2021.)

[116] https://www.hindustantimes.com/world-news/air-pollution-caused-london-girl-s-death-says-coroner-in-historic-ruling/story-KyUXSSjwdYJjVGwJHzJnDL.html 

[117] https://www.abc.net.au/news/2020-12-17/uk-girls-death-linked-to-air-pollution-in-landmark-ruling/12993020 

[118] https://www.judiciary.uk/wp-content/uploads/2021/04/Ella-Kissi-Debrah-2021-0113-1.pdf 
“On 17 December 2019 I re-opened an investigation into the death of Ella Adoo Kissi-Debrah. The investigation concluded at the end of the inquest on 16 December 2020.

The conclusion of the inquest was: Medical cause of death:

1a) Acute respiratory failure 1b) Severe asthma 1c) Air pollution exposure Narrative conclusion: Died of asthma contributed to by exposure to excessive air pollution.”

[119] “It has also improved due to technology and social media, so that the London Borough of Lewisham is able to promote airTEXT, the Imperial College London Air webpage, the GLA air quality web page/alerts, and even its own air quality App.”

[120] “Physicians to be better trained on effects of air pollution on health, says college"

[121] "Following the inquest into Ella’s death, NICE [UK National Institute for Health and Care Excellence] carried out an exceptional surveillance review of its guideline on asthma to assess whether the link between air pollution and asthma was appropriately covered. As a result of this process, the decision was made to amend the NICE guideline on asthma: diagnosis, monitoring and chronic asthma management NICE guideline (NG80) to acknowledge the link between air pollution and asthma. Amendments to the guideline were made in March 2021."

https://www.judiciary.uk/wp-content/uploads/2021/04/2021-0113-Response-from-National-Institute-for-Health-and-Care-Excellence-Redacted.pdf

[122] “Toxic air pollution is a public health crisis, especially for our children, and the inquest underlined yet again the importance of pushing ahead with bold policies such as expanding the Ultra Low Emission Zone to inner London.” - Sadiq Khan, the Mayor of London

[123] “Most vehicles need to meet the ULEZ [Ultra Low Emission Zone] emissions standards or you must pay a £12.50 daily charge to drive inside the zone.” The heaviest vehicles are subject to a separate LEZ emissions standard (https://tfl.gov.uk/modes/driving/ultra-low-emission-zone).

[124] Rosamund quotes in this March 2022 Mayoral press release on Ultra Low Emission Zone (ULEZ): ”In the inquest into my daughter’s death the coroner was very clear that the pollution on the south circular is what started Ella’s asthma and ultimately contributed to her death. By taking action and expanding the ULEZ to include the south circular and the whole of London, people will be encouraged to get rid of their dirty vehicles, and children like Ella will breathe more easily and have a better quality of life.”

[125] “The zone now covers all areas within the North and South Circular Roads. The North Circular (A406) and South Circular (A205) roads are not in the zone.”

[126] All phases of the ULEZ have had an impact on improving air quality across the capital. In 2024, compared to a scenario without the ULEZ, harmful roadside NO2 concentrations are estimated to be: 27 per cent lower across the whole of London than they would have been without the ULEZ and its expansions. … Cumulatively over a six-year period (2019 – 2024), air pollutant and carbon emissions across London are lower due to all phases of the ULEZ, compared to a scenario without the ULEZ. Specifically:  NOX emissions are estimated to be 24 per cent lower. PM2.5 exhaust emissions are estimated to be 29 per cent lower. CO2 emissions are estimated to be two per cent lower.

[127] 2014: “The idea that outdoor air pollution can cause exacerbations of pre-existing asthma is supported by an evidence base that has been accumulating for several decades, with several studies suggesting a contribution to new-onset asthma as well.”

[128] Oct 2021: The WHO COP26 special report on climate change and health “In memory of Ella Kissi-Debrah – and all other children who have suffered and died from air pollution and climate change.” pg3

[129] [Comms w/SH: “the Mayor of London held a Health Summit earlier this year that I chaired at the RCP at which Jo Churchill (Air pollution Minister, DEFRA) and Sir Christopher Whitty (CMO) were present along with 20 heads of health organisations along with Ella's Mother, Rosamund Kissi-Debrah … At this meeting all the organisations signed up to a 6-point air improvement plan”]

https://www.london.gov.uk/press-releases/mayoral/mayor-convenes-government-for-clean-air-summit

[130] Mayor’s report: “On 17 February, I hosted the London Clean Air and Health Summit, convening leaders from national and local government, health experts and campaigners to agree actions to raise

awareness of air pollution and health. The summit was chaired by Professor Sir Stephen

Holgate. Attendees included … Rosamund Adoo-Kissi-Debrah. We discussed a complete review of the messaging and distribution of existing alerts systems, guidance for medical professionals to speak about the impact of pollution with their patients and the steps the NHS and wider health system can take to raise awareness”

[131] “ ‘Medical professionals have a vital role to play in raising awareness of the serious health impacts of air pollution & the need for urgent action to tackle its sources,’ says RCP special adviser on air quality Prof Sir Stephen Holgate, chairing @MayorofLondon 's Clean Air Summit” https://twitter.com/RCPhysicians/status/1494305692601262082, Feb 17, 2022

[132] “My name is Rosamund and I am Ella Roberta’s mum. I am the Co-Founder of  the Ella Roberta Family Foundation that was set up after the death of my beloved daughter in 2013 from a rare and severe form of asthma. The aim of the Foundation is to improve the lives of children affected by asthma in South East London by raising awareness of asthma, campaigning for better treatment of asthma and campaigning for clean air as it is everyone’s fundamental right to breathe clean air.”

[133] “The mother of a nine-year-old girl who became the first person to have air pollution listed as a cause of their death is part of an international group of mothers taking to the streets of Glasgow this week for a series of mass protests being staged to coincide with COP26. NYT: ”https://www.nytimes.com/2021/11/05/world/europe/cop26-mothers-pollution.html: “‘Justice for my daughter’: Parents issue a plea on air pollution.”

[134] “Dr. Blight: Here comes breakfast now. a bus drives past emitting fumes Diesel fuel a la school bus. Mmm! I love the smell of pollution!.” From “The Littlest Planeteer,” air date November 24, 1990

[135] e.g., the “DRIVE Clean scenario”: “By 2050, EVs constitute 97% of all on-road vehicles. In this scenario, all coal-fired power plants retire by 2030, no new natural gas plants are built, and the electric grid reaches a national 90% clean electricity share by 2035”; “The DRIVE Clean scenario avoids 150,000 premature deaths due to air pollution through 2050”

[136] We find that since at least 2016, wildfire smoke has influenced trends in average annual PM2.5 concentrations in nearly three-quarters of states in the contiguous USA, eroding about 25% of previous multi-decadal progress in reducing PM2.5 concentrations on average in those states, equivalent to 4 years of air quality progress, and more than 50% in many western states.

[137] On the global scale, population exposure to fire air pollutants increased, especially for PM2.5, between 2000 and 2019,3 following the positive trends of fire emissions.

[138] (Prediction model) Here we show that from 2010–2014 to 2095–2099, fire carbon emissions are projected to increase by 23% under Shared Socio-economic Pathway 2-4.5. Increased fire-related aerosols reduce the 0.06 W m−2 cooling effect north of 60° N. Projections show a surge in the number of premature deaths from wildfire smoke, reaching 1.40 (95% confidence interval = 0.66–2.25) million people annually during 2095–2099—roughly six times higher than current levels.

[139] “When the benefits to air quality, health, and climate change are all included, there can be progress on reducing nitrogen oxide and ozone concentrations by transitioning from coal burning power plants to renewable electricity from wind and solar energy and from diesel to electric buses in many parts of the world.” “Because vehicle emissions are important sources of nitrogen oxides and VOCs, actions to reduce these emissions are very important.”

[140] Guardian Jan 2026 “Rosamund Adoo-Kissi-Debrah is suing three government departments for compensation for personal injury arising from the illness and premature death of her daughter Ella. The Department for Environment, Food and Rural Affairs, the Department for Transport and the Department of Health and Social Care have all been named as defendants in the claim. Her lawyers said she hoped the action would further her broader campaign to establish the “right to clean air”.”

[141] Guardian Oct 2024 “The mother of a nine-year-old girl who became the first person in the UK to have air pollution cited on their death certificate will receive an undisclosed settlement from the government in compensation for her daughter’s untimely death.” … “The statement from ministers with the three departments reads: “On behalf of the government departments who were party to the claim, we again take this opportunity to say we are truly sorry for your loss and to express our sincerest condolences to you as Ella’s mother, to her siblings, and to everyone who knew her. “Your words, both in this litigation and in your public campaigning, have made a considerable impact. “Young children like Ella should not have to suffer because of our air. We are grateful to you for your tireless work, and we very much hope that, working together in the years to come, more can be achieved in improving not only the quality of the air we breathe, but also in raising awareness of the health implications of air pollution.””

[142] https://www.ellaroberta.org/campaigns/ellas-law-is-published

https://www.sianberry.org.uk/news/ellas-law-published/ “The proposals in the Clean Air (Human Rights) Bill enshrine the human right to breathe clean air into UK law and would require the Government to achieve clean air throughout England by 1 January 2030, setting out a pathway to bring the country in line with World Health Organisation air pollution guidelines.”

[143] Clean Air (Human Rights) Bill: https://publications.parliament.uk/pa/bills/cbill/59-01/0279/240279.pdf

[144] Propublica: Within two weeks, executives across major industries began flooding an inbox set up to receive and funnel requests from the Environmental Protection Agency to the White House. They asked that their facilities be excused from expensive Clean Air Act requirements, relief that would save their companies money but pollute the air breathed by millions of Americans.

https://hsph.harvard.edu/news/trump-administration-plans-to-roll-back-epa-regulations-could-harm-health/

https://theconversation.com/when-you-dont-have-the-facts-argue-the-law-how-trumps-epa-is-limiting-its-own-ability-to-protect-public-health-far-into-the-future-282351

[145] EPN The rollback of the Endangerment Finding – and the associated removal of the greenhouse gas vehicle emissions standards – will result in thousands of additional premature deaths, millions of asthma attacks, billions of dollars in lost health benefits, higher gasoline prices, and lost jobs in the automotive industry over the coming decades.