- William Phin, six, has a problem which may be triggered by pollution
- At one, he was left dependent on oxygen cylinders to help him breathe
- William, from Whitley Bay, north of Newcastle, has obliterative bronchiolitis
- A lung transplant is the only cure
At six, William Phin has already had to deal with a deadly fight for breath – a problem which, thanks to worsening air quality, affects an increasing number of adults and children. Shortly after his first birthday, William was struck down by a mystery lung infection. He was left dependent on oxygen cylinders to help him breathe until he was almost three. William has obliterative bronchiolitis (OB), a disease that causes inflammation in the lungs, and a build-up of fibrous scar tissue that stops oxygen being absorbed. A lung transplant is the only cure.
‘William has 38 per cent of the lung capacity of a healthy child of his age,’ says his father Duncan, 42, a data analyst, who lives with his wife Fiona, 41, and William in the seaside resort of Whitley Bay, north of Newcastle, a place where air quality would not normally be an issue. ‘We couldn’t believe how fast he went from being a chubby baby to being emaciated. The doctors didn’t know what it was and the longer it went on without us knowing, the more worried we were about what was going to happen to him.’
Obliterative bronchiolitis is thought to be an abnormal reaction to a common cold virus among people with a particular genetic make-up – or it may be triggered by exposure to pollution. Whatever the cause, experts say the condition is exacerbated by pollution. William is just one of the millions of people of all ages who are affected by life-limiting breathing and other health problems linked to pollution, including heart disease, stroke and diabetes. Pollution contributes to 40,000 deaths a year, according to a report this week by the Royal College of Physicians and the Royal College of Paediatric and Child Health.
Indeed, average life expectancy is reduced by about nine months because of air pollution, according to the World Health Organisation, which estimates 29,000 deaths in Britain are directly caused every year by air contaminated with by-products of aircraft and vehicle engines. The issue was laid bare last year when it was revealed that despite safety claims, virtually all diesel cars exceed emission limits and air quality routinely breaches international pollution regulations.It’s not simply that pollution makes breathing problems worse, it can trigger conditions such as asthma, says Jonathan Grigg, a professor of paediatric respiratory and environmental medicine at Bart’s Health NHS Trust in London, and a co-author of the new report, Every Breath We Take.
‘Contrary to earlier reports linking asthma to dust mites and domestic furnishings, pollution is the real culprit,’ he says. ‘From the Seventies, onwards there was a big increase in asthma, especially in pre-school children. If you live next to a busy road there are consequences for your child.’
Indeed, a study published in 2004 suggested someone walking down London’s Marylebone Road would breathe in the equivalent pollution of one cigarette in 48 minutes. But it’s not just outdoor pollution that poses a health risk. According to the new report, pollution inside the home – caused by everything from boiler fumes to air fresheners – is a risk too. As well as faulty boilers, fly sprays, air fresheners, DIY and cleaning products all affect the quality of air indoors.
One of the culprits are so-called Volatile Organic Compounds (VOCs) – one, limonene, used to give products a citrus smell – is dangerous to inhale on its own. It can react with air to create toxic formaldehyde, which causes lung irritation and, in large quantities cancer, and potentially fatal inflammation of other body tissue. The harm from outdoor pollution such as car exhausts occurs as tiny particles from it penetrate deep into the lungs and collect in the tiny air sacs (alveoli) where oxygen enters the bloodstream.
These particles set up damaging lung inflammation as the body reacts to the foreign invasion. The toxins within them travel into the blood, damaging blood vessel walls, interfering with signals about blood sugar levels, or setting up cell changes that can lead to cancer. As well as these particles, damage is caused by gases such as nitrogen dioxide, sulphur dioxide and ozone which irritate the airways and interfere with oxygen absorption, worsening symptoms for those with pre-existing lung disease. Also to blame is carbon monoxide, which prevents supply of oxygen to the heart.
Most urban dwellers are breathing contaminated air. In London three-quarters of kerbside tests for pollution found nitrogen dioxide levels exceeded EU safety limits, with seven test sites registering concentrations double the permitted limit. Similar nitrogen dioxide blackspots and other high levels of pollutants have been found in Birmingham, Manchester, Bristol and other towns and cities around the country, according to figures compiled by the Air Pollution Information System.
Another worrying pollutant is ozone, a toxin at high levels and which is produced when sunshine reacts with car exhaust fumes. Several UK studies have shown regular spikes in the daily death rates on hot summer days, particularly from heart disease. As Frank Kelly, a professor of environmental health at King’s College London, explains: ‘Chemical toxins dissolve within the lungs or pass through the lungs into the blood. ‘These chemicals interact with blood vessel walls and cause damage that can lead to heart attacks,’ he says. ‘That’s why people living in big cities have a lower life expectancy.’ There is evidence that people living next to busy roads anywhere have the poorest health, adds Claire Holman, chairman of the Institute of Air Quality Management. ‘If you know anything about air pollution you choose to live as far away from busy roads as possible.’
Pollution levels are now routinely included in weather forecasts and increasing numbers of people say poor air quality often imprisons them in their homes. It is a problem Carole Whitbread, 56, from the Isle of Grain on the Thames estuary in Kent, knows only too well. Although her home faces the open sea, she is regularly crippled by breathing difficulties. Formerly a competitive horsewoman, cross-country runner and netball player, she had to give it all up along with her career in the Metropolitan Police based in Croydon, South London, because of chronic obstructive pulmonary disease, diagnosed six years ago.
She is slim and says she tries to live as healthily as possible. She smoked until her late 40s and recognises cigarettes are the main cause of her problems. However, it is car fumes and other types of air pollution that now trigger breathing problems. ‘On days when the air is bad I just have to stay indoors and try not to get out of breath,’ she says. ‘There’s nothing else I can do. ‘The condition came on so quickly, they couldn’t work out what it was. ‘I was absolutely devastated to have to give up work. The police force was my life. Now I can’t really go into London to visit my friends because of the bad air, so they always have to come here.’
A divorcee with two grown-up sons, she shares her home with two border terriers Oscar and Bonnie. ‘Even though the air is much better by the sea it can still be very bad even here. ‘Once the lining of the lungs is inflamed by any kind of pollution they don’t work and you cannot breathe. It isn’t the condition itself that kills you. Because you are struggling to breathe, you end up having a fatal heart attack. The only answer is to keep as busy as you can and do as much as possible.’
About half the population are current or ex-smokers, and many of them face problems like Carole’s. For others it’s also indoor pollution that is a problem. Caroline Morland, 39, who is married with no children and works as an office administrator in Northampton, developed asthma in her mid-20s. Air fresheners and cleaning products are a particular trigger.
‘I don’t use them at home but if I go into a hotel room that’s just been cleaned it can trigger as asthma attack lasting half an hour to an hour,’ she says. ‘My chest goes tight, I cough and I can’t breathe, it’s horrible.’
The role of pollution – as a cause or trigger – in William Phin’s condition is still poorly understood. However, experts say obliterative bronchiolitis is being diagnosed more frequently in adults as well as children. Professor Andrew Bush, a specialist in children’s lung diseases at the Royal Brompton Hospital in London, thinks there are hundreds of undiagnosed cases around the country, with many wrongly treated as asthma. ‘We don’t know what causes it, but the more you are exposed to pollution the worse your lung function becomes,’ he says.
William’s problems all started with a runny nose just before Christmas 2010. ‘He just got more and more poorly,’ says Duncan. ‘By New Year’s Eve, he was in A&E at North Tyneside hospital. From there he was transferred to paediatric respiratory specialists at Newcastle’s Royal Victoria Infirmary. ‘He was on constant oxygen and receiving intravenous antibiotics.’
At first he was diagnosed with bronchiectasis where the airways are permanently dilated so you get a build up of mucus and then infection which is hard to shift. Then in January he underwent a CT scan – the scarring of the lungs revealed it was bronchiolitis, with his left lung extremely damaged. William was on nightly oxygen until just before his third birthday when it was decided he was strong enough to breathe unaided, but he has been re-admitted to hospital five times since, for average stays of two weeks as doctors have treated a series of other lung infections.
His outlook remains uncertain. ‘He can go swimming, he does PE and football, but he’s becoming aware that when it comes to things that need prolonged exercise, he’s not able to keep going with other children,’ says Duncan. ‘He gets tired so when we’re out we have to give him time to catch his breath. There are questions about how much lung capacity he will retain. When he gets to adolescence he might have a downturn in his capacity to provide the amount of oxygen his body needs.’
Last month the first international meeting to focus on obliterative bronchiolitis took place in Frankfurt, Germany. Its organiser lung expert Martin Rosewich of the Goethe University in Frankfurt, said one of its purposes was to get specialists to pool information and case reports. ‘We know it may be caused by toxic gases in pollution but at the moment we have no idea which ones they are,’ he told Good Health.
The Royal College of Physicians is calling for local authorities to be given the power to close or divert roads to reduce volume of traffic, particularly near schools, when pollution levels are high – as well as tougher legislation to force polluters to reduce their harmful emissions.
Dr Penny Woods chief executive of the British Lung Foundation, says the air pollution problem is actually affecting all of us without us knowing.’It has the greatest impact on the most vulnerable – children, the elderly and people with conditions such as asthma,’ she says. ‘Given the severity of the problem, we are calling for immediate action by the government. It is costing thousands of lives and cannot be allowed to continue.’