Air pollution and respiratory disease

Air pollution, both outdoor and indoor, is a major risk factor for respiratory disease. COPD is the most common cause of respiratory preventable deaths and burden of disease attributable to air pollution exposure, followed by asthma (EEA, 2023a). Whereas COPD has both a high burden in terms of premature mortality and morbidity, including quality of life, the burden of disease of asthma is largely related to its impact on morbidity and quality of life. More information on the air pollution burden of disease is available here. Ambient air pollutants known to contribute to respiratory disease include particulate matter (PM), nitrogen oxides (NOx) and ozone (O₃), among others.

Airways are the first line of contact with air pollutants. Some pollutants can initiate immediate reactions, such as oxidative stress and inflammation, which can cause respiratory symptoms or aggravate pre-existing conditions like asthma or COPD. Long-term exposure to air pollution can also cause asthma and COPD. Research clearly shows that long-term exposure to air pollutants including PM_2.5, PM₁₀, and NO₂ increases the risk of COPD, particularly in individuals with high genetic risk and an unhealthy lifestyle (Sin et al., 2023; Wang et al., 2022). These same pollutants also increase the risk of developing asthma, particularly in children, where an increase of 1 μg/m³ in concentrations of PM_2.5 is associated with a 3% increase in the risk of developing Asthma (Khreis et al., 2017) .

Almost 14% of chronic respiratory deaths in EEA member and cooperating countries are due to air pollution (outdoor and indoor), mostly from COPD. The fraction attributed to the environment is overall higher in south-eastern and eastern Europe, with the highest proportion of attributable CRD deaths in Bosnia and Herzegovina (almost 28%). Northern European countries generally have lower values, with the lowest fraction of CRD cases due to air pollution observed in Finland (2.7%) (see Figure 3). More information on the non-fatal burden of disease from air pollution can be found in this EEA briefing.

Trends and health impacts of exposure to air pollution in Europe

Emissions of all key air pollutants in the EU-27 declined between 2000 and 2022. Though less emissions do not translate automatically into reduced air pollution, this decline has led to a decrease in concentrations of all major air pollutants, except for O₃. Lower levels of exposure have translated into a decrease in health impacts from air pollution, including respiratory disease. However, despite progress, there remains a significant shortfall in achieving safe air quality levels across Europe. Air pollution remains a major health concern for European residents. In 2021, EU Member States saw 253,000 deaths from exposure to PM_2.5; 52,000 from exposure to NO₂; and 22,000 from short-term exposure O₃. These deaths could have been avoided by meeting WHO recommendations on air pollution; see this EEA briefing for more information.

What the EU is doing about air pollution

The EU bases its clean air policy on three main pillars: (1) the National Emission reduction Commitments (NEC) Directive (EU, 2016); (2) legislation for key sources of air pollution (EC, 2022a); and (3) the ambient air quality directives (AAQDs) (EU, 2004, 2008), which set air quality standards. Under the European Green Deal’s zero pollution action plan, the European Commission set the interim 2030 goal of reducing the number of premature deaths caused by PM_2.5 by at least 55%, compared with 2005 levels. The ultimate objective is for air pollution to have no significant impact on health by 2050.

To this end, the Commission published a proposal to review the ambient air quality directives in 2022. The revised directive was adopted in October 2024.  It sets new air quality standards for pollutants to be reached by 2030 which are more closely aligned with the WHO air quality guideline levels. In the international context, EU Member States work closely with other UN Economic Commission for Europe (UNECE) member countries to control international air pollution under the Convention on Long-Range Transboundary Air Pollution. Moreover, under the European Climate Law, EU countries must cut greenhouse gas emissions by at least 55% by 2030. Since most CO₂ comes from the same sources as other air pollutants, efforts to reduce CO₂ will contribute to improving air quality.