Asthma inquest told: no link between girl's hospital admissions and higher pollution

Scientist says no evidence to support theory Ella Kissi-Debrah’s condition worsened when air pollution rose

A leading scientist has told an inquest there is no evidence that a nine-year-old girl was admitted to hospital with acute asthma complications when levels of air pollution were higher.

Paul Wilkinson, a professor of environmental epidemiology at the London School of Hygiene and Tropical Medicine, told a coroner he had analysed levels of nitrogen dioxide and particulate matter on the days during her lifetime when Ella Kissi-Debrah had contact with, or was admitted to, hospital.

He told the hearing at Southwark coroner’s court he had found no evidence to support the theory that Ella’s condition worsened to the point of requiring hospitalisation at times when air pollution was higher.

“It’s a complicated thing to determine, no thing is entirely unequivocal,” he said “… What I set out to test was whether days of hospital admission were also days of higher air pollution.

“Because if ambient pollution were a prominent driver of her condition you would expect to see that she was more likely to go to hospital when air pollution levels were high and less likely when air pollution levels were low.

“The bottom line is there was no clear evidence that days of hospital admission or contact had higher concentrations or higher pollution than other days.”

He concluded: “It doesn’t exclude the fact that air pollution may have been a contribution to some degree but it wasn’t a very determining effect.”

Wilkinson said there was no doubt that Ella, who lived 25 metres from the South Circular road in London, was being exposed to higher than average levels of pollutants during her lifetime.

“The South Circular is a busy road and she was within 30 metres of it. And levels from a main road by 30 metres are still above background levels,” he said. “So she was likely to be having above average [exposure] even within London.”

Wilkinson said at the time Ella was ill – between 2010 and 2013 – it was clear and not disputed scientifically that air pollution was a factor in the exacerbation of the disease from day to day. “That has been recognised for probably about 15 years.”

But he said it was a less dominant factor than allergens and respiratory infections. Air pollution, he said, was a stronger influence for some people than others, but it was not possible to identify which asthma sufferers would be more sensitive to air pollution than others.

“Looking very carefully at the levels [of air pollution] there was nothing there in her case,” Wilkinson said.

The inquest has heard that illegal levels of air pollution in the area where Ella lived and died should have been treated as a public health emergency.

In a landmark legal case, the coroner Philip Barlow is being asked to rule that air pollution caused the death from an acute asthma attack of the primary school pupil in February 2013, a finding that would make legal history. It has never been identified as a cause of death before in the UK and this is thought to be the first case of its kind in the world.

Ella’s mother, Rosamund, told the hearing on Monday that had she known about the impact of air pollution on her daughter’s illness, she would have moved house immediately.

The hearing continues.


Sandra Laville

The GuardianTramp

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