Asthma UK and British Lung Foundation (AQU0029)

1. Introduction
    

1.1. Building on existing collaboration, in January 2020, Asthma UK and the British Lung Foundation merged to become the Asthma UK and British Lung Foundation Partnership. Both retain individual identities and have different service channels to obtain insights from the lived experience of beneficiaries living with a lung condition.

1.2. Every 10 seconds someone has a potentially life-threatening asthma attack and three people die every day. Tragically the majority of these could be prevented, whilst others suffer with asthma so severe current treatments do not work. This must change. That is why Asthma UK (AUK) exists. We work to stop asthma attacks and, ultimately cure asthma by funding world leading research and scientists, campaigning for improved care and supporting people with asthma to reduce their risk of a potentially life-threatening asthma attack.

1.3. The British Lung Foundation (BLF) offers hope, help and a voice for people with all lung conditions, including COPD, bronchiectasis, and pulmonary fibrosis. Our research finds new treatments and cures. We help people who struggle to breathe to take control of their lives. And together, we are campaigning for better lung health so that one day everyone can breathe clean air with healthy lungs.

2. Air Pollution and Health
    

2.1. Tens of thousands of early deaths every year are linked to air pollution.[1]
 

2.2. Air pollution is linked to a wide range of health problems, including lung disease, heart disease, stroke, and cancer.[2] [3]
 

2.3. Air pollution disproportionately effects certain groups, including babies in the womb, children, people with existing lung or heart conditions and older people.[4] From increased risk of an asthma attack, to reduced lung function in children, it’s clear that our current levels of air pollution constitute a public health crisis.
 

2.4. Air pollution is bad for everyone, but for the 12 million people in the UK who live with a lung condition, such as asthma or chronic obstructive pulmonary disease (COPD) it poses a real and immediate threat to their health. A spike in air pollution levels can lead to symptoms getting worse, flare-ups and even the risk of hospitalisation.[5]
 

2.5. As one person living with a lung condition told us: “Last year I collapsed and was hospitalised. Doctors told me air pollution had inflamed my lungs and put pressure on my heart. I was starved of air. Air pollution is now increasingly trapping me in my own home, and there’s nothing the best doctors in the world can do about it.”[6]
 

2.6. There is robust evidence of a clear link between high levels of air pollution and increased numbers of patients with breathing problems presenting at hospitals and GP surgeries. A BLF-funded study at the University of Dundee found that on days when air pollution levels spiked there was a large increase in the number of people admitted to hospitals and visiting GPs with breathing problems.[7]
 

2.7. Air pollution can worsen existing health inequalities. People living in the poorest areas are often the most exposed to air pollution - reinforcing unequal health outcomes for deprived communities.[8] [9] It can also contribute to health inequalities later in life, with children living in highly polluted areas more likely to have reduced lung function in adulthood.[10]
 

2.8. In October 2018, we revealed that more than 2,000 health centres are in areas with levels of PM2.5 above World Health Organization (WHO) guidelines, putting at risk the health of millions of patients and staff.[11]

 

3. The 2019 Air Quality Strategy
    

3.1. The strategy was a welcome step forward from the government, but it lacked the ambition that this public health crisis demands and left much more to be done.
 

3.2. We need to see an updated strategy, with a national plan to protect children, older people and people living with a lung condition in addition to action to drive down pollutants from all sources.
 

3.3. This needs to include improvements to our monitoring network, and changes to the way people can access data and protect their health. The provision of accurate, timely and localised data on air pollution is critical for enabling people to protect their own health.
 

3.4. We also need to see a national public health campaign on the dangers of air pollution, as well as targeted public health funding.
 

3.5. As part of this, we need tailored interventions around schools and nurseries. Thousands of schools are in areas with PM2.5 levels above WHO guidelines and illegal levels of NO2, so it is clear a national comprehensive plan to protect children as they travel to school and while they’re at school is urgently needed. This should include air quality audits, traffic exclusion zones and promoting and enabling walking, cycling and public transport; and a proactive alert system for high pollution events with guidance and support on how to protect children from air pollution throughout the year.
 

4. Clean Air Zones (CAZs)
    

4.1. The implementation of CAZs and public consultations on CAZ proposals have been put on hold in some cities due to the Covid 19 pandemic. These must be restarted as soon as possible. AUK_BLF are particularly concerned that Manchester have indicated that they might not fully implement their CAZ until 2023.[12]

4.2. We need the rapid implementation of a network of charging CAZs across the UK’s most polluted towns and cities as soon as possible. The government’s own research shows that charging Clean Air Zones can be the quickest way to bring NO2 pollution down, and the Ultra-Low Emission Zone in London, with 44% reductions in NO2, shows how successful they can be.[13]
 

4.3. CAZs implemented under the CAZ framework should all be Class-D, that is they should include private cars. To support this measure investment is needed in low cost, low emission public transport and active travel measures such as cycling and walking. 
 

4.4. Clean Air Zones should include targeted and time limited exemptions or support for people with reduced mobility to allow them to adapt to the changes.
 

5. The Environment Bill
    

5.1. AUK-BLF welcomed the Bill at its introduction to the House of Commons, and believe it provides a potentially useful framework to set legally binding targets on air quality.
 

5.2. We were pleased to see a recognition of the health impact of PM2.5 pollution with an annual mean target for PM2.5 specifically featured.
 

5.3. However, there need to be changes to the Bill before the government can say it is a world leader in the fight against air pollution. The framework itself does not provide any ambition to commend.  
 

5.4. Defra have made it clear that they want to have “most ambitious environmental programme of any country on earth”[14] yet the Environment Bill does not state what the PM2.5 target will be.

5.5. Further, the Bill as currently drafted allows Defra to wait until 2022 to set targets.
 

5.6. The scale of the air quality health crisis demands faster and more ambitious action than the Bill currently promises. To match the stated level of ambition the government must commit to setting a new legally binding limit for PM2.5 in line with World Health Organization (WHO) guidelines, and to commit to reaching it by 2030 at the latest.
 

5.7. We have a much stronger knowledge of air quality than the other areas outlined in the Bill. Experts at the WHO have already set a recommended guideline for PM2.5, so we do not need to wait until 2022 to set potentially lifesaving limits. The Bill should be amended to bring forward the deadline for setting the new PM2.5 target.
 

5.8. We also urgently needed to establish new binding commitments to reduce people’s exposure to pollution, with a requirement to prioritise pollution reduction around schools, nurseries, playgrounds, care homes and hospitals. We believe that the government should commit to including exposure reduction targets as part of secondary legislation.
 

6. Current and emerging risks and opportunities for air quality
    

6.1. Due to the sharp decline in traffic levels across the UK during the initial ‘lockdown’ phase of the Covid 19 pandemic led to significant reductions in levels of N02. It is clear from Defra’s weekly reported traffic data that levels are now returning to normal.[15] Government must act to avoid this.

6.2. Measures taken by local authorities across the UK to support and promote active travel choices, such as temporary cycle lanes, are welcome and it is important that these are now made permanent. There is a risk that the public will continue to avoid public transport due to social distancing and therefore it is imperative that government increase public confidence in its use.

6.3. There has never been a more crucial time to tackle air pollution in the UK. As the government continues to tackle the COVID-19 pandemic, it is important to note that an emerging body of research from academics across the world has shown a possible relationship between higher levels of air pollution and increased risk of dying from COVID- 19.[16] [17] [18]
 

6.4. Some of this research even suggests that coronavirus may be able to ‘piggyback’ on the particulate matter as a route into the lungs.[19]
 

6.5. It must be said, in both areas, this is a very early-stage research and is not yet conclusive. However, we do know that people with health conditions that are caused or worsened by air pollution – such as asthma, and COPD – are more vulnerable to worse symptoms or death from COVID-19.
 

6.6. AUK-BLF surveyed over 14,000 people living with a lung condition about their experiences of lock down, and 1 in 6 reported having reduced symptoms, likely due to the reductions in air pollution over this period.[20]
 

6.7. AUK-BLF are undertaking research with people recovering from COVID-19, and early survey data shows that, of people who told us they were experiencing problems linked to coronavirus weeks after their recovery, 90% were still having difficulty breathing.[21]  Therefore the rapid implementation of measures to support clean air are essential to their recovery.

The Asthma UK and British Lung Foundation Partnership is a company limited by guarantee 01863614 (England and Wales). VAT number 648 8121 18. Registered charity in England and Wales (326730), Scotland (SC038415) and the Isle of Man (1177). Registered office: 18 Mansell Street, London, E1 8AA.