Cited by 224COVID-19 impact on air qualityAir Quality and Health ImpactsInfection Control and Ventilation

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The impact of outdoor air pollution on COVID-19: a review of evidence from in vitro , animal, and human studies

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Bourdrel, Thomas, Annesi-Maesano, Isabella, Alahmad, Barrak, Maesano, Cara N., Bind, Marie-Abèle·2021·European Respiratory Review

DOI 10.1183/16000617.0242-2020PMC PMC7879496

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Abstract

Studies have pointed out that air pollution may be a contributing factor to the coronavirus disease 2019 (COVID-19) pandemic. However, the specific links between air pollution and severe acute respiratory syndrome-coronavirus-2 infection remain unclear. Here we provide evidence from in vitro , animal and human studies from the existing literature. Epidemiological investigations have related various air pollutants to COVID-19 morbidity and mortality at the population level, however, those studies suffer from several limitations. Air pollution may be linked to an increase in COVID-19 severity and lethality through its impact on chronic diseases, such as cardiopulmonary diseases and diabetes. Experimental studies have shown that exposure to air pollution leads to a decreased immune response, thus facilitating viral penetration and replication. Viruses may persist in air through complex interactions with particles and gases depending on: 1) chemical composition; 2) electric charges of particles; and 3) meteorological conditions such as relative humidity, ultraviolet (UV) radiation and temperature. In addition, by reducing UV radiation, air pollutants may promote viral persistence in air and reduce vitamin D synthesis. Further epidemiological studies are needed to better estimate the impact of air pollution on COVID-19. In vitro and in vivo studies are also strongly needed, in particular to more precisely explore the particle–virus interaction in air.

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FIGURE 1 Target organs and the main diseases that coronavirus disease 2019 (blue) and air pollution (green) share. ARDS: acute respiratory distress syndrome.CC BY-NC · PubMed Central

FIGURE 2 Air pollutants/virus interaction according to atmospheric conditions. Relative humidity plays a role in the desiccation or hydration of viral droplet and, thus, influences the size of the droplet and the persistence of respiratory viruses in the air. Solar ultraviolet (UV) radiations have in vitro antiviral activity and lead to an increase in vitamin D synthesis. Atmospheric air pollutants may lead to decreased UV penetration leading to reduced vitamin D synthesis. Temperature influences the size of the viral droplet. In addition, low temperatures decrease the functioning of airways ciliated cells, while high temperatures may have antiviral activity. Droplet nuclei refers to viral droplets ≤5μm, it is also called viral airborne or viral aerosol. In addition to the common effect of air pollutants, which lead to a decrease in immune respiratory defence, particulate matter (PM) may be involved in respiratory virus transport. AMP: antimicrobial proteins and peptides; ELF: epithelial lining fluid; RASS: renin-angiotensin-aldosterone system; AT1R: angiotensin 2 receptor type 1.CC BY-NC · PubMed Central

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Authors: Bourdrel, T., Annesi-Maesano, I., Alahmad, B., Maesano, C. N., & Bind, M.-A.
Affiliations: Hôpitaux Universitaires de Strasbourg (FR)
Harvard University (US)
Inserm (FR)
Corresponding author: Bourdrel, Thomas
ORCID: Alahmad, Barrak
Maesano, Cara N.
Bind, Marie-Abèle
Venue: European Respiratory Review
Publisher: European Respiratory Society (ERS)
Published: 2021-02-09
Volume: 30
Issue: 159
Pages: 200242
ISSN: 0905-9180 (ISSN-L)
1600-0617
DOI: 10.1183/16000617.0242-2020
PMC: PMC7879496
OpenAlex: W3128253629
Cited by: 224
References: 119
Citations by year: 2026: 9 · 2025: 25 · 2024: 29 · 2023: 41 · 2022: 70 · 2021: 50
FWCI: 4.12
Type: journal article
Language: en
Open access: diamond
doi.org
Licence: cc-by-nc
creativecommons.org/licenses/by-nc/4.0/ (vor)
Locations: European Respiratory Review (publishedVersion, cc-by-nc)
PubMed Central (publishedVersion, cc-by-nc)
PubMed (publishedVersion)
HAL (submittedVersion, other-oa)
DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders: National Institutes of Health (DP5OD021412)
Topics: Physical Sciences › Environmental Science › Global and Planetary Change › COVID-19 impact on air quality
Physical Sciences › Environmental Science › Health, Toxicology and Mutagenesis › Air Quality and Health Impacts
Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Infection Control and Ventilation
Keywords: outdoor air pollution, COVID-19 pandemic, SARS-CoV-2, air pollutants, immune response, vitamin D synthesis, ultraviolet radiation, relative humidity, weather conditions, cardiopulmonary disease, diabetes mellitus, COVID-19 mortality, COVID-19 severity
MeSH terms: COVID-19, SARS-CoV-2, Air Pollutants, Air Pollution, Animals, Environmental Exposure, Humans, Prognosis, Risk Factors, Severity of Illness Index, Risk Assessment, Host-Pathogen Interactions

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The impact of outdoor air pollution on COVID-19: a review of evidence from in vitro , animal, and human studies

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