EC Pulmonology and Respiratory Medicine

Environmental pollution represents the largest global cause of disease and death, yet traditional research approaches have examined air and water contamination as separate domains. This literature review synthesizes evidence from peer-reviewed studies to establish a comprehensive framework for understanding air-water-lung pollution pathways and their implications for respiratory health. The review identifies two primary cross-media pathways: water-to-air transmission, including bioaerosol emissions from wastewater treatment plants dispersing pathogens over distances exceeding 3 kilometers and harmful algal bloom toxins becoming aerosolized concentrations 125-fold above safety guidelines; and air-to-water pathways, where atmospheric nutrient deposition promotes eutrophication and subsequent algal bloom formation. Evidence from Mendelian randomization studies demonstrates causal relationships between PM2.5, PM10, and NO₂ exposure and lung function decline, while developmental research establishes that prenatal pollution exposure creates lasting respiratory vulnerability. The airway microbiome emerges as both a mediator and modifier of environmental health effects. Engineering solutions including biofiltration systems and risk-based monitoring frameworks offer promising approaches for cross-media pollution control. This review concludes that effective protection of respiratory health requires integrated environmental engineering strategies that recognize the fundamental interconnectedness of air quality, water quality, and human health outcomes.

Keywords: Air Pollution; Water Pollution; Respiratory Health; Bioaerosols; Environmental Engineering; Cross-Media Pollution; Wastewater Treatment

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