Work

The Impact of Air Pollution on the Incidence and Progression of Upper Respiratory Tract Diseases in Urban Populations – Narrative Review

Year: 2026

Type: review

Abstract: Background Air pollution remains a major environmental health factor in urban populations, with sustained exposure to particulate matter and gaseous pollutants. The upper respiratory tract is directly exposed to inhaled pollutants and represents a primary site of interaction between environmental factors and mucosal inflammation. Aims To provide a clinically oriented analysis of the association between urban air pollution and upper respiratory tract diseases, including chronic rhinosinusitis, allergic rhinitis, and acute sinusitis, with assessment of clinical outcomes, pathophysiological mechanisms, vulnerable populations, and limitations of the current evidence base. Methods A narrative review with a structured literature search was conducted using PubMed, Google Scholar, and ResearchGate. The search covered studies published between 2016 and 2025, with inclusion of selected earlier landmark studies. Eligible studies included cohort, case control, time series studies, randomized trials, as well as systematic reviews and meta analyses evaluating incidence, progression, and clinical outcomes of upper respiratory tract diseases in relation to ambient air pollution. A total of 44 studies were included in the final synthesis after screening and eligibility assessment. Results Consistent associations were identified between exposure to particulate matter and gaseous pollutants and increased incidence, symptom severity, and healthcare utilization in chronic rhinosinusitis and allergic rhinitis. Effect estimates for particulate matter were generally modest, with odds ratios around 1.2 for PM10, while nitrogen dioxide showed stronger associations in selected analyses. Short term exposure to PM2.5 and NO2 was linked to increased outpatient visits and symptom exacerbations, particularly in children. Long term exposure was more consistently associated with disease persistence and severity, including increased likelihood of surgical interventions in chronic rhinosinusitis. Evidence for acute sinusitis remains limited and heterogeneous. The main sources of variability across studies include differences in exposure assessment, diagnostic criteria, and control of confounding factors. Conclusions Urban air pollution is a clinically relevant factor associated with the burden and course of selected upper respiratory tract diseases, particularly chronic rhinosinusitis and allergic rhinitis. The strength of evidence is highest for chronic rhinosinusitis, moderate for allergic rhinitis, and limited for acute sinusitis. Current data support consideration of environmental exposure in clinical interpretation of disease dynamics, while remaining insufficient to justify direct modification of standard treatment algorithms. Further prospective and interventional studies with standardized methodology are required to clarify causal relationships and improve clinical applicability.

Source: Archiv Euromedica

DOI: 10.35630/2026/16/iss.2.3