A 9-year-old girl's death certificate will be 'the first in the world' to list air pollution as a cause after a fatal asthma attack

• Air pollution was a cause of 9-year-old Ella Kissi-Debrah's death, a UK coroner ruled Wednesday.
• She died of an asthma attack in 2013.
• It's the first time air pollution will be listed on a death certificate.
• Nitrogen dioxide emissions and harmful airborne particles where Kissi-Debrah lived exceeded legal limits. These pollutants can exacerbate asthma.

Seven years after 9-year-old Londoner Ella Kissi-Debrah suffered a fatal asthma attack, her death is making history.

On Wednesday, coroner Philip Barlow ruled that air pollution killed the little girl.

"Her death certificate will now become the first in the world to list air pollution as a cause of death," the British Lung Foundation tweeted.

London mayor Sadiq Khan called it a "landmark moment."

Kissi-Debrah's mother, Rosamund, waged a long fight to get justice for her daughter and highlight the UK's air pollution problem. In 2014, experts determined that Ella had died of acute respiratory failure. But Rosamund pushed for another inquiry into her child's death, and her lawyers submitted evidence that air pollution levels where the family lived exceeded limits set by the European Union. This pollution, they maintained, played a role in Ella's fatal health problems.

The coroner agreed: Barlow intends to list acute respiratory failure, severe asthma, and air pollution exposure as her causes of death, PA Media reported.

"Air pollution was a significant contributory factor to both the induction and exacerbation of her asthma," Barlow said at the conclusion of the inquiry, according to CNN. He noted car and truck exhaust as the primary source of pollutants.

Seizures, hospital visits, and crippling health problems

When Ella was six, Rosamund rushed her to the hospital during a coughing fit. Doctors had to put Ella in a medically induced coma for three days. Over the next three years, Ella visited the hospital 26 more times for acute asthma and seizures.

Rosamund said her daughter was disabled by 2012 and had to be carried piggyback-style to get around, the BBC reported. Ella died on February 5, 2013.

According to Stephen Holgate, a respiratory physician at Southampton General Hospital, the girl's asthma episodes were worse in the winter, when pollution levels spiked near her home on South Circular Road - one of the busiest roads in south London.

He told the Southwark Coroner's Court, which oversaw the inquiry into Ella's death, that the cumulative effect of continuously breathing in toxic air caused her fatal asthma attack, the Guardian reported.

'Unlawful levels of air pollution'

In a 2018 report, Holgate found that air pollution levels at a monitoring station one mile from Kissi-Debrah's home consistently exceeded legal limits set by the European Union and the World Health Organization between 2010 and 2013.

Holgate's report said "that without unlawful levels of air pollution, Ella would not have died."

That finding informed Barlow's assessment, CNN reported.

"During the course of her illness between 2010 and 2013, she was exposed to levels of nitrogen dioxide and particulate matter in excess of WHO guidelines," Barlow concluded, according to CNN.

He added that the failure to get those levels below legal limits during the three years before Kissi-Debrah's fatal asthma attack may have contributed to her death.

London mayor Sadiq Khan tweeted that Barlow's decision should be "a turning point" in the city's push to curb emissions, adding that "toxic air pollution is a public-health crisis."

Air pollution kills 8.8 million people per year

Factories and gas-powered vehicles produce air pollutants like nitrogen oxide, sulfur dioxide, and hydrocarbons. These chemicals can react with sunlight to create smog, which lowers air quality to unhealthy levels.

Kissi-Debrah is not the first person to die from air pollution - it causes an estimated 8.8 million deaths annually worldwide. One study showed that nearly 800,000 Europeans died from air pollution-related issues in 2015 alone.

As of last year, 91% of the world's population lived in places where the air quality did not meet the WHO's safety standards.

Studies conducted in China and Canada show that children who breathe poor air are more likely to have breathing difficulties and asthma. A study involving New York City schoolchildren also found that kids who breathe unhealthy air are more likely to need academic intervention.

Research in the US shows that dementia and cognitive decline rates are higher in places with more air pollution as well.

Most air pollution comes in the form of methane and carbon-dioxide emissions from burning coal, oil, and natural gas. These fossil fuels can also emit pollutants like benzene, a chemical linked to childhood leukemia and blood disorders, and formaldehyde, which is a carcinogen.

When sunlight interacts with pollutants, chemical reactions can create ground-level ozone, a type of ozone that can trigger a variety of breathing problems, particularly for children and the elderly, according to the Environmental Protection Agency.

Breathing in ground-level ozone can reduce a person's lung function and harm lung tissue, exacerbating conditions like emphysema and asthma.