26 October 2021
PREVENT, - Air Quality

On 22 September, the World Health Organisation (WHO) published the updated global Air Quality Guidelines, the most prominent and respected document charting the damaging effects of air pollution on human health. The recommendations are crucial for people with allergy, asthma and chronic obstructive pulmonary disease (COPD), as respiratory patients are among the most affected by air pollution.

EFA issued a press statement to welcome the update of the guidelines.

This landmark update takes stock of the hundreds of new scientific research studies demonstrating that air pollution has more damaging and devastating effects for human health that what was referred to and recommended in the previous guidelines, dating from 2005.

Every year, air pollution is responsible for around 7 million premature deaths worldwide, and 400,000 of them are in Europe. It is also linked to the onset and exacerbation of chronic diseases, such as allergy, asthma and COPD. Patients bear a disproportionate share of the burden such as increased wheezing and breathlessness symptoms, more visits to the emergency room and hospitalisations, and more deaths.

Key outcome and what it means for Europe

While not legally mandatory, the recommendations made by the Air Quality Guidelines are widely seen as a key reference point and tool for policymaking on air quality worldwide.

The updated science is unequivocal: the levels of most pollutants need to be lowered further down to live in healthy environments that do not compromise human health and wellbeing.

This is a wake-up call for Europe, where most countries fail to respect the WHO air quality recommendations. The pressure for better health protection is even bigger within the European Union, which has entered the process of revising the current EU legal air quality standards. Based on the 2005 WHO Guidelines, the current EU standards allow for even more exposure than what the science recommended at that time.

EFA’s review of the WHO Air Quality Guidelines

As members of the WHO Air Quality Guidelines External Review Group (ERG), EFA was invited to review the draft guidelines in December 2020. The revision process counted on 13 external organisations part of the ERG, including the Health and Environment Alliance (HEAL), the European Respiratory Society (ERS), and the European Environment Agency (EEA). WHO Air Quality Guidelines lists patients as one of the three main target audiences of the document and EFA participated in the consultation providing the European allergy and airways diseases patient perspective.

Our comments advised WHO to broaden the scope of the guidelines but also to be more specific in certain sections and areas. In general, our comments addressed the following areas:

Health effects:

  • Apart from data on mortality, the guidelines should reflect morbidity considerations for long- and short-term exposure to all pollutants
  • Include studies that also focus on the short-term effects of exposure leading to worsening of symptoms for diseases that are not mentioned, such as allergy and other inflammatory conditions


  • Propose a ‘Good Practice Statement’ for Volatile Organic Compounds
  • Increase the visibility of pollen as an outdoor air pollutant, and focus on the combination of health risks between pollen and air pollution
  • Highlight the role of domestic heating as an outdoor air pollution source (in addition to indoor)
  • Develop an exhaustive list of sources of pollution in urban microenvironments

Monitoring and information:

  • Add a reference to low-cost monitors and citizen science as a powerful tool to help implement the levels proposed by the Guidelines
  • Set indicative minimum requirements for monitoring stations to optimise the validity of air quality data
  • Reinforce risk communication with references to the role of governments to monitor and inform through public alerts during pollution peaks
  • Guide Member States to improve the information to the public with real-time specific, transparent and accessible messaging based on the example of the Canadian Air Quality Health Index
  • Include an assessment on how effective communication and engagement can vary by socio-economic status


  • Include an exhaustive list of sectors contributing to air pollution, so that the guidelines are cascaded at national level taking all actors and cross-sectoral policies into account. We proposed to include references to agriculture, industry and the buildings when addressing implementation
  • Add a reference on how different sectors of the economy (e.g. transport, agriculture, industry) could contribute to the recommended values

What role for patients in the communication and implementation of the Guidelines?

EFA is delighted to see the final WHO Global Air Quality Guidelines include aspects that have arisen by our community. These include:

  • the acknowledgement of pollen and multi-pollutant exposures as promising areas of future research;
  • the reference to citizen science and usability of low-cost air pollution monitors; and
  • the explicit mention to aeroallergens in microenvironments and indoor spaces which are only some of the points that can directly benefit our patient community.

However, when looking at the big picture there are questions that remain: when will science be able to address air pollution independently of the source, including natural and climate change related pollution, on top of industrial emissions? For the moment, WHO chose to not have a Good Practice Statement for Volatile Organic Compounds (VOC). Yet, when will the guidelines be holistic and define global recommendations for indoor air quality and the interlinks with outdoor air pollution?

As one of the 3 main target groups of the Guidelines (along with policymakers and academia), patients are seen as key in communicating and implementing the Guidelines. WHO counts on patient groups and networks at the national level to increase outreach, specifically to vulnerable communities – while steering actions that showcase the health implications of air pollution for their chronic condition.

From an implementation perspective, WHO hopes that the Guidelines can be used by patient organisations for the promotion of cost-effective solutions to reduce air pollution, accompanied with tailored messaging and campaigning.

EFA and its whole community, representing patients living with allergy, asthma and COPD, is ready to work closely with WHO in the coming months and years to ensure proper dissemination and implementation of the Guidelines, thus safeguarding our right to clean, healthy air.

You can read EFA’s official review of the draft WHO Air Quality Guidelines here.

You can read EFA’s press statement on the global launch of the guidelines “Patients demand Europe to comply with the updated WHO Ambient Air Quality Guidelines” here.

You can access the full document of the WHO Air Quality Guidelines here.

An executive summary can be found here.