Atmen: Luftschadstoffe und Gesundheit – Teil I

 

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Zusammenfassung

Die Exposition gegenüber Luftschadstoffen wird von der Weltgesundheitsorganisation weltweit als eine führende Gesundheitsgefährdung und als der wichtigste umweltbedingte Risikofaktor mit besonders hoher Krankheitslast in Ländern mit niedrigem und mittlerem Einkommen angesehen.

Die Luftschadstoffbelastung besteht aus hochkomplexen Gemischen verschiedenster organischer und anorganischer Bestandteile natürlichen oder anthropogenen Ursprungs, die lokal entstehen oder durch Ferntransport über hunderte von Kilometern regional eingebracht werden können. Zusätzlich wird die Schadstoffkonzentration durch die regionalen, meteorologischen Verhältnisse beeinflusst. Dementsprechend können Schadstoffkonzentration und Zusammensetzung an einem Ort deutlich variieren, zeigen aber typischerweise einen Tages-, Wochen- und Jahresgang.

Mittels gesetzlicher Grenzwerte wie in der „Air Quality Directive“ der Europäischen Union festgelegt, soll eine Gesundheitsgefährdung der Bevölkerung durch die Schadstoffe minimiert werden. Allerdings weichen die Grenzwerte der Europäischen Union von den Empfehlungen der WHO insbesondere für Feinstaub deutlich nach oben ab.

Zur Abschätzung der Luftschadstoffbelastung wird auf einzelne Indikatoren zurückgegriffen, die die partikuläre, wie Feinstaub bis 2,5 µm (PM_2.5) bzw. bis 10 µm aerodynamischen Durchmesser (PM₁₀), und die gasförmige Belastung, wie Stickstoffdioxid (NO₂) und Ozon (O₃), charakterisieren. Für die meisten Luftschadstoffe wurden über die letzten Jahrzehnte in der westlichen Welt abfallende Konzentrationen beobachtet, sodass hier v. a. die Gesundheitsgefährdung bei geringerer Schadstoffbelastung im Vordergrund steht. Insbesondere Ballungsgebiete in Deutschland leiden aber noch unter erhöhter Luftverschmutzung.

Zahlreiche Studien haben in den letzten Jahrzehnten schädliche Auswirkungen von Luftschadstoffen auf die Gesundheit der Bevölkerung belegt. Die Auswirkungen betreffen v. a. den Atemtrakt und das kardiovaskuläre System und reichen von unspezifischen Atemwegs- und kardiovaskulären Symptomen über Beeinträchtigungen der Lungenfunktion, vermehrter Medikamenteneinnahme und akuter Exazerbation von vorbestehenden Lungenerkrankungen, Herzinfarkten und Schlaganfällen bis hin zu Todesfällen. Neuere Studien weisen auf weitere Gesundheitsendpunkte, wie z. B. Atherosklerose, Einschränkungen des fetalen Wachstums, der kognitiven Funktion und neuronalen Entwicklung, Diabetes mellitus sowie auf ein verbessertes Verständnis der zugrundeliegenden pathophysiologischen Mechanismen hin.

In der „Global Burden of Disease Study“ von 2015 wird die Bedeutung der Luftschadstoffbelastung für Mortalität und Morbidität v. a. durch chronische Erkrankungen quantifiziert. Bei der vorzeitigen Mortalität, v. a. aufgrund von kardiovaskulären Todesursachen, lag PM_2.5 in der Außenluft weltweit auf Rang 5, unmittelbar hinter den allgemeinen Risikofaktoren erhöhter Blutdruck, Rauchen sowie erhöhte Glukose- und Cholesterinwerte. In Deutschland liegt die Krankheitslast durch Luftverschmutzung an zehnter Stelle der Risikofaktoren und ist damit auch hierzulande der wichtigste umweltbezogene Risikofaktor. Entsprechend zeigen Studien, dass der Einfluss von Luftschadstoffen die Sterblichkeit in Europa erhöht und die mittlere Lebenserwartung um etwa ein Jahr reduzieren kann.

In dem hier vorgestellten Positionspapier fasst die Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin den aktuellen Wissensstand zu den Gesundheitseffekten von Luftschadstoffen zusammen und leitet daraus Empfehlungen für einen umweltbezogenen Gesundheitsschutz ab. Der hier vorgestellte erste Teil fokussiert sich auf allgemeine Grundlagen und die Wirkungen im Atemtrakt.

Abstract

According to the World Health Organisation (WHO), environmental air pollution is among the leading risks for noncommunicable diseases worldwide in terms of the global disease burden and the leading environmental cause of disease and death particularly in low- and middle-income countries.

Air pollution is a highly complex mixture of various organic and inorganic components from natural and anthropogenic sources, occurring locally or being introduced by long-range transport of pollutants. Moreover, air pollution is modified by regional meteorological conditions. Accordingly, levels and composition of air pollution can vary substantially at a site, nevertheless typically showing a diurnal, weekly and annual cycle. Regulatory limits, as defined by the “Air Quality Guidelines” of the European Union, are enforced to minimize air pollution associated health hazards for the population. However, legal limits of the European Union clearly exceed the guideline values of the WHO, especially with regard to particulate matter.

The burden of ambient air pollution is monitored by means of different indicator pollutants, especially particulate matter up to 2.5 µm (PM_2.5) or 10 µm (PM₁₀) in aerodynamic diameter, and gases such as nitrogen dioxide (NO₂) or ozone (O₃). In recent decades, in the western world, decreasing levels of air pollution have been achieved so that the main focus is nowadays on health hazards caused by low concentrations of pollutants. However, in Germany, especially urban areas are still suffering under higher levels of air pollution.

In recent decades, a large number of studies have highlighted the harmful effects of air pollution on public health. Primarily, the respiratory and the cardiovascular system are targeted with exposure to higher levels of air pollution being associated with reduced lung function, unspecific respiratory symptoms, increased use of medication and acute exacerbations of lung diseases, myocardial infarction, stroke and even death. Further negative health outcomes such as atherosclerosis, reduced fetal growth, diabetes and limitations of cognitive function and neuronal development are supported by recent studies. Moreover, these studies have substantially improved our understanding of the underlying pathophysiological mechanisms.

The 2015 “Global Burden of Disease Study” underlined the significance of air pollution for public health, particularly in relation to increased morbidity and mortality resulting from chronic diseases. As causal factor for premature death, particularly cardiovascular death, ambient PM_2.5 is the number 5 risk factor, well behind the commonly known risk factors elevated blood pressure, smoking, and increased blood levels of glucose and cholesterol. Ambient air pollution is the number 10 risk factor for the disease burden and also the leading environmental risk factor in Germany. Different studies have estimated that ambient air pollution increases mortality and may decrease life expectancy on average by about one year in the European Union.

State of the art knowledge on the negative health effects of ambient air pollution and recommendations for environmental safety and health are introduced by this statement of the German Respiratory Society (Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin). General concepts and health effects concerning the respiratory system are described in the first part of this statement.

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