Executive Summary
The Committee on the Medical Effects of Air Pollutants (COMEAP) Standards Advisory
Subgroup was asked by the Department for Environment, Food and Rural Affairs (Defra) to
review the UK air quality index (AQI) to ensure that it is fit for purpose. The current UK air
quality index has now been in operation essentially unchanged for a period of around 12 years.
Therefore, it is timely to review the index to determine its suitability, given the developments in
the field of air quality.
The air quality index is used to communicate information about real-time and forecast levels of
outdoor air pollution in the short term. Forecasted air quality information is reported in terms
of the air quality index and provides advanced warning of potentially health-damaging air
pollution events. With advanced warning of poor air quality, individuals who are sensitive to
the effects of air pollution can have the opportunity to modify their behaviour to reduce the
severity of their symptoms. The air quality index does not provide guidance on the effects of
long-term exposure to air pollution.
The pollutants included in the current index are particulate matter (PM10), ozone (O3), sulphur
dioxide (SO2), carbon monoxide (CO) and nitrogen dioxide (NO2). The index has four bands
indicating ‘Low’, ‘Moderate’, ‘High’ and ‘Very High’ levels of air pollution. These bands are
further divided into a ten-point scale to provide greater gradation of air pollution levels.
The current air quality index was developed by COMEAP and is based on health evidence. The
‘Low’ bands indicate air pollution levels where it is unlikely that anyone will suffer any adverse
effects of short-term exposure, including people with lung or heart conditions who may be more
susceptible to the effects of air pollution. The ‘Moderate’ band represents levels of air pollutants
at which there are likely to be small effects for susceptible people only. Values for the ‘High’
bands are associated with significant effects in susceptible people. At ‘Very High’ levels of air
pollution even healthy individuals may experience adverse effects of short-term exposure.
Approach to the review of the bandings
COMEAP sought to review the health evidence relating to the index pollutants to assess whether
the levels of the bands were appropriate. COMEAP looked at the coverage of the index and
whether additional pollutants should be included. The review also took into account the current
levels of pollutants, developments in European legislation and UK Air Quality Objectives.
COMEAP was keen to ensure that the review was centred on the requirements of the users of
the index, namely the general public – particularly those more at risk of the adverse health
effects of air pollution. In order to inform the review, dedicated research was commissioned to
investigate the general public’s current awareness and comprehension of air quality information,
and to assess the challenges that exist to understanding and interpreting such material.
COMEAP considered several possible approaches to assessing and evaluating pollutantspecific
evidence on health impacts that could be used in the revision of an index. We also took
other evaluations and additional information into account in our deliberations. An Expert
Group of the World Health Organization (WHO) undertook a thorough evaluation of the
evidence concerning air pollution and health effects, with the resulting revised WHO Air
Quality Guidelines published in 2006. In most cases, COMEAP proposes the adoption of the
WHO values as proposed breakpoints between the bands. However, in some cases, our
proposals do not adopt the WHO recommendations directly, for reasons which we explain.
The implications of the proposed changes to the bands, summarised below, will be an increase
in the number of Moderate and High pollution days, and a decrease in the number of Low days
reported across the year.
Summary of key recommendations
COMEAP recommends breakpoints between the bands of Low, Moderate, High and
Very High for each of the index pollutants. We recommend that the air quality index be
presented as a ten-point scale with colour coding to aid the interpretation of the index, as
detailed in the table below. With respect to the current air quality index, the proposed bandings
remain unchanged for sulphur dioxide (SO2). The breakpoints for a change in band for ozone
(O3), nitrogen dioxide (NO2) and particulate matter (of less than 10 µm in diameter, PM10) are
more stringent. Particulate matter of less than 2.5 µm in diameter (PM2.5) has been added to the
index, and carbon monoxide has been removed in view of the considerable reductions in
outdoor levels of this pollutant.
We recommend that the information to accompany the new air quality index comes in
three parts and includes additional advice for susceptible individuals, together with advice for
the general population:
We also recommend the use of ‘trigger’ values to complement the proposed new air quality
index and allow for the prediction of episodes of elevated air pollution in real time as they
emerge. With the averaging times* of 24 hours for particulate matter and 8 hours for ozone it
is not possible to provide public information about an unexpected pollution episode until it is
well established. Triggers have been derived to provide information to the public to warn of
exposure as it is taking place at Moderate, High or Very High levels. These triggers can be used
by organisations that operate real-time public information services.
Finally, we recommend that links to information on the long-term health effects of air
pollution are provided together with the index, such as the 2009 COMEAP report entitled
Long-Term Exposure to Air Pollution: Effect on Mortality (http://www.comeap.org.uk).
B Additional Information on the Short-term Effects of Air Pollution
The air quality index has been developed to provide advice on expected levels of air
pollution. In addition, information on the short-term effects on health that might be
expected to occur at the different bands of the index (Low, Moderate, High and Very
High) is provided here
Short-term effects of air pollution on health
Air pollution has a range of effects on health. However, air pollution in the UK does not rise
to levels at which people need to make major changes to their habits to avoid exposure;
nobody need fear going outdoors
Adults and children with lung or heart conditions It is known that, when levels of air
pollutants rise, adults suffering from heart conditions, and adults and children with lung
conditions, are at increased risk of becoming ill and needing treatment. Only a minority of
those who suffer from these conditions are likely to be affected and it is not possible to
predict in advance who will be affected. Some people are aware that air pollution
affects their health: adults and children with asthma may notice that they need to
increase their use of inhaled reliever medication on days when levels of air pollution are
higher than average
Older people are more likely to suffer from heart and lung conditions than young people
and so it makes good sense for them to be aware of current air pollution conditions
General population At Very High levels of air pollution, some people may experience a
sore or dry throat, sore eyes or, in some cases, a tickly cough – even healthy individuals
Children need not be kept from school or prevented from taking part in games. Children
with asthma may notice that they need to increase their use of reliever medication on
days when levels of air pollution are higher than average
Action that can be taken
When levels of air pollution increase it would be sensible for those who have noticed that
they are affected to limit their exposure to air pollutants. This does not mean staying
indoors, but reducing levels of exercise outdoors would be reasonable
Older people and those with heart and lung conditions might avoid exertion on High
pollution days
Adults and children with asthma should check that they are taking their medication as
advised by their health practitioner and may notice that they need to increase their use
of inhaled reliever medication
Adults with heart and circulatory conditions should not modify their treatment schedules
on the basis of advice provided by the air quality index: such modification should only be
made on a health practitioner’s advice
Some athletes, even if they are not asthmatic, may find their performance is less good
than expected when levels of a certain air pollutant (ground-level ozone) are High, and
they may notice that deep breathing causes some discomfort in the chest. This might be
expected in summer on days when ground-level ozone levels are raised. This does not
mean that they are in danger but it may be sensible for them to limit their activities on
such days
Chapter 1
Introduction
The air quality index (AQI) is used to communicate information about real-time and forecast
levels of outdoor air pollution. The pollutants included in the current index are particulate
matter (PM)1, ozone (O3), sulphur dioxide (SO2), carbon monoxide (CO) and nitrogen dioxide
(NO2). The index evolved through a series of iterations to become a ten-point scale divided
into four bands indicating ‘Low’, ‘Moderate’, ‘High’ and ‘Very High’ levels of air pollution. The
current UK index with related health information is presented in Annex 1.
The main objective behind the AQI is the prevention of adverse health effects from short-term
elevations in air pollution. Forecasted air quality information is reported in terms of the AQI
and provides forewarning of potentially health-damaging air pollution events. With advanced
warning of impending poor air quality, sensitive individuals can, in principle, modify their
behaviour to reduce their individual exposure to the pollution or reduce the severity of their
symptoms. The AQI can also be used
บทสรุปสำหรับผู้บริหารผลทางการแพทย์มาตรฐานอากาศสารมลพิษ (COMEAP) ที่ปรึกษาคณะกรรมการกลุ่มย่อยที่ถูกถาม โดยฝ่ายสิ่งแวดล้อม อาหาร และ กิจการชนบท (Defra) เพื่อตรวจสอบอังกฤษอากาศคุณภาพดัชนี (AQI) เพื่อให้แน่ใจว่า พอประสงค์ อากาศประเทศอังกฤษปัจจุบันตอนนี้มีดัชนีคุณภาพในการดำเนินการเปลี่ยนแปลงเป็นระยะเวลาประมาณ 12 ปีจึง มันเป็นเวลาทบทวนดัชนีเพื่อกำหนดความเหมาะสม ได้รับการพัฒนาในฟิลด์ของคุณภาพอากาศใช้ในการสื่อสารข้อมูลเกี่ยวกับระดับเวลาจริง และการคาดการณ์ของดัชนีคุณภาพอากาศมลพิษทางอากาศในระยะสั้น มีรายงานข้อมูลคุณภาพอากาศที่คาดการณ์ไว้ในเงื่อนไขดัชนีคุณภาพอากาศและคำเตือนขั้นสูงของอาจสุขภาพทำลายอากาศเหตุการณ์มลพิษ มีคำเตือนขั้นสูงของคุณภาพอากาศที่ดี ผู้ที่มีความไวต่อผลกระทบของมลพิษทางอากาศสามารถมีโอกาสที่จะปรับเปลี่ยนพฤติกรรมของตนเพื่อลดการความรุนแรงของอาการ ดัชนีคุณภาพอากาศให้คำแนะนำเกี่ยวกับผลกระทบของความเสี่ยงระยะยาวกับมลพิษทางอากาศสารมลพิษต่าง ๆ ปัจจุบันมีฝุ่นเรื่อง (PM10), โอโซน (O3), ซัลเฟอร์ไดออกไซด์ (SO2), คาร์บอนมอนอกไซด์ (CO) และก๊าซไนโตรเจนไดออกไซด์ (NO2) ดัชนีมี 4 วงระบุ 'ต่ำ' 'ปานกลาง' 'สูง' และ 'สูงมาก' ระดับของมลพิษทางอากาศ วงเหล่านี้ได้แบ่งเป็นขนาด 10 จุดให้ไล่ระดับสีที่มากกว่าระดับมลพิษทางอากาศThe current air quality index was developed by COMEAP and is based on health evidence. The‘Low’ bands indicate air pollution levels where it is unlikely that anyone will suffer any adverseeffects of short-term exposure, including people with lung or heart conditions who may be moresusceptible to the effects of air pollution. The ‘Moderate’ band represents levels of air pollutantsat which there are likely to be small effects for susceptible people only. Values for the ‘High’bands are associated with significant effects in susceptible people. At ‘Very High’ levels of airpollution even healthy individuals may experience adverse effects of short-term exposure. Approach to the review of the bandingsCOMEAP sought to review the health evidence relating to the index pollutants to assess whetherthe levels of the bands were appropriate. COMEAP looked at the coverage of the index andwhether additional pollutants should be included. The review also took into account the currentlevels of pollutants, developments in European legislation and UK Air Quality Objectives.COMEAP was keen to ensure that the review was centred on the requirements of the users ofthe index, namely the general public – particularly those more at risk of the adverse healtheffects of air pollution. In order to inform the review, dedicated research was commissioned toinvestigate the general public’s current awareness and comprehension of air quality information,and to assess the challenges that exist to understanding and interpreting such material.
COMEAP considered several possible approaches to assessing and evaluating pollutantspecific
evidence on health impacts that could be used in the revision of an index. We also took
other evaluations and additional information into account in our deliberations. An Expert
Group of the World Health Organization (WHO) undertook a thorough evaluation of the
evidence concerning air pollution and health effects, with the resulting revised WHO Air
Quality Guidelines published in 2006. In most cases, COMEAP proposes the adoption of the
WHO values as proposed breakpoints between the bands. However, in some cases, our
proposals do not adopt the WHO recommendations directly, for reasons which we explain.
The implications of the proposed changes to the bands, summarised below, will be an increase
in the number of Moderate and High pollution days, and a decrease in the number of Low days
reported across the year.
Summary of key recommendations
COMEAP recommends breakpoints between the bands of Low, Moderate, High and
Very High for each of the index pollutants. We recommend that the air quality index be
presented as a ten-point scale with colour coding to aid the interpretation of the index, as
detailed in the table below. With respect to the current air quality index, the proposed bandings
remain unchanged for sulphur dioxide (SO2). The breakpoints for a change in band for ozone
(O3), nitrogen dioxide (NO2) and particulate matter (of less than 10 µm in diameter, PM10) are
more stringent. Particulate matter of less than 2.5 µm in diameter (PM2.5) has been added to the
index, and carbon monoxide has been removed in view of the considerable reductions in
outdoor levels of this pollutant.
We recommend that the information to accompany the new air quality index comes in
three parts and includes additional advice for susceptible individuals, together with advice for
the general population:
We also recommend the use of ‘trigger’ values to complement the proposed new air quality
index and allow for the prediction of episodes of elevated air pollution in real time as they
emerge. With the averaging times* of 24 hours for particulate matter and 8 hours for ozone it
is not possible to provide public information about an unexpected pollution episode until it is
well established. Triggers have been derived to provide information to the public to warn of
exposure as it is taking place at Moderate, High or Very High levels. These triggers can be used
by organisations that operate real-time public information services.
Finally, we recommend that links to information on the long-term health effects of air
pollution are provided together with the index, such as the 2009 COMEAP report entitled
Long-Term Exposure to Air Pollution: Effect on Mortality (http://www.comeap.org.uk).
B Additional Information on the Short-term Effects of Air Pollution
The air quality index has been developed to provide advice on expected levels of air
pollution. In addition, information on the short-term effects on health that might be
expected to occur at the different bands of the index (Low, Moderate, High and Very
High) is provided here
Short-term effects of air pollution on health
Air pollution has a range of effects on health. However, air pollution in the UK does not rise
to levels at which people need to make major changes to their habits to avoid exposure;
nobody need fear going outdoors
Adults and children with lung or heart conditions It is known that, when levels of air
pollutants rise, adults suffering from heart conditions, and adults and children with lung
conditions, are at increased risk of becoming ill and needing treatment. Only a minority of
those who suffer from these conditions are likely to be affected and it is not possible to
predict in advance who will be affected. Some people are aware that air pollution
affects their health: adults and children with asthma may notice that they need to
increase their use of inhaled reliever medication on days when levels of air pollution are
higher than average
Older people are more likely to suffer from heart and lung conditions than young people
and so it makes good sense for them to be aware of current air pollution conditions
General population At Very High levels of air pollution, some people may experience a
sore or dry throat, sore eyes or, in some cases, a tickly cough – even healthy individuals
Children need not be kept from school or prevented from taking part in games. Children
with asthma may notice that they need to increase their use of reliever medication on
days when levels of air pollution are higher than average
Action that can be taken
When levels of air pollution increase it would be sensible for those who have noticed that
they are affected to limit their exposure to air pollutants. This does not mean staying
indoors, but reducing levels of exercise outdoors would be reasonable
Older people and those with heart and lung conditions might avoid exertion on High
pollution days
Adults and children with asthma should check that they are taking their medication as
advised by their health practitioner and may notice that they need to increase their use
of inhaled reliever medication
Adults with heart and circulatory conditions should not modify their treatment schedules
on the basis of advice provided by the air quality index: such modification should only be
made on a health practitioner’s advice
Some athletes, even if they are not asthmatic, may find their performance is less good
than expected when levels of a certain air pollutant (ground-level ozone) are High, and
they may notice that deep breathing causes some discomfort in the chest. This might be
expected in summer on days when ground-level ozone levels are raised. This does not
mean that they are in danger but it may be sensible for them to limit their activities on
such days
Chapter 1
Introduction
The air quality index (AQI) is used to communicate information about real-time and forecast
levels of outdoor air pollution. The pollutants included in the current index are particulate
matter (PM)1, ozone (O3), sulphur dioxide (SO2), carbon monoxide (CO) and nitrogen dioxide
(NO2). The index evolved through a series of iterations to become a ten-point scale divided
into four bands indicating ‘Low’, ‘Moderate’, ‘High’ and ‘Very High’ levels of air pollution. The
current UK index with related health information is presented in Annex 1.
The main objective behind the AQI is the prevention of adverse health effects from short-term
elevations in air pollution. Forecasted air quality information is reported in terms of the AQI
and provides forewarning of potentially health-damaging air pollution events. With advanced
warning of impending poor air quality, sensitive individuals can, in principle, modify their
behaviour to reduce their individual exposure to the pollution or reduce the severity of their
symptoms. The AQI can also be used
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