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Near-fatal and fatal asthma and air pollution: are we missing an opportunity to ask key questions?
  1. Deepa Varghese1,2,
  2. Tom Clemens3,
  3. Ann McMurray4,
  4. Hilary Pinnock2,5,
  5. Jonathan Grigg6,
  6. Steve Cunningham1
  1. 1Child Life and Health, University of Edinburgh, Edinburgh, UK
  2. 2Asthma UK Centre for Applied Research, University of Edinburgh, Edinburgh, UK
  3. 3School of GeoSciences, University of Edinburgh, Edinburgh, UK
  4. 4Department of Respiratory and Sleep Medicine, Royal Hospital for Children and Young People, Edinburgh, UK
  5. 5Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
  6. 6Centre for Child Health, Blizard Institute, Queen Mary University of London, London, UK, London, UK
  1. Correspondence to Dr Deepa Varghese, Child Life and Health, The University of Edinburgh, Edinburgh EH16 4TJ, UK; Deepa.varghese{at}


There is an increasing body of evidence supporting the link between asthma attacks and air pollution in children. To our knowledge, there has only been one reported case of a fatal asthma attack in a child associated with air pollution and this was in the UK. This article considers why there is a lack of evidence on fatal/near-fatal asthma and air pollution. We also explore three challenges. First, fatal and near-fatal asthma events are rare and not yet well understood. Second, measuring and interpreting personal exposure to air pollution with sufficient temporal and spatial detail are challenging to interpret in the context of individual fatal or near-fatal asthma attacks. Third, current studies are not designed to answer the question of whether or to what extent air pollution is associated with fatal/near-fatal asthma attacks in children. Conclusive evidence is not yet available and systems of data collection for both air pollution and fatal and near-fatal asthma attacks should be enhanced to ensure risk can be determined and impact minimised.

  • Respiratory Medicine
  • Child Health
  • Paediatrics

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  • Contributors All authors contributed to the research, analysis of the results and to the writing of the manuscript. All authors reviewed and revised interim drafts of the article and approved the final version. Coauthors—AM, TC, HP, JG and SC.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Commissioned; externally peer reviewed.