LAHORE: In Pakistan, air pollution claimed the lives of 256,000 including 68,000 under the age of five in 2021, accordingly to the state of Global Air Report 2024. The report, published by US- based Health Effects Institute (HEI) in partnership with UNICEF. The report said the air pollution was the second most risk factor of death in 2021. It was the second leading risk factor for death among children under five in 2021, after malnutrition. This State of Global Air report presents the latest comprehensive estimates of exposures to fine particulate matter (PM2.5), nitrogen dioxide (NO2), and ozone and their impacts on human health around the world. According to report 58 % deaths from ambient PM, 38 % deaths from household air pollution and 6 % deaths from OZONE in 2021. It further said that 28% of deaths from ischemic heart disease. 30% of deaths from lower respiratory infections. 48% of deaths from chronic obstructive pulmonary disease. Over many decades, scientific studies have documented a wide range of health effects from air pollution. While high-pollution days can have short-term effects, like aggravating asthma symptoms, and lead to temporary spikes in hospitalizations for heart or lung problems, the most severe impacts are caused by long-term exposures. Breathing polluted air for months or years can lead to illness and early death from heart and lung diseases and diabetes as well as increase the likelihood of adverse birth outcomes, including preterm births, stillbirths, and miscarriages. Taken together, air pollution from PM2.5 and ozone was estimated to contribute to 8.1 million deaths [95% UI: 6.7–9.5] — about 12% of the total global deaths — in 2021. In fact, PM2.5 (both ambient and household together) is the largest contributor to the air pollution disease burden worldwide, accounting for 7.8 million deaths, or more than 90% of the total air pollution disease burden. Overall, 2021 saw more deaths linked to air pollution than were estimated for any previous year, indicating the disease burden of air pollution has continued to rise. Nearly 490,000 (95% UI: 107,000–837,000) deaths were attributable to ozone. Countries in South Asia and East, West, Central, and Southern Africa experience the largest burden of disease linked to air pollution. With populations over 1 billion each, India (2.1 million deaths) and China (2.3 million deaths) together account for 54% of the total global disease burden. Other countries with high impacts include Pakistan (256,000 deaths), Myanmar (101,600 deaths), and Bangladesh (236,300 deaths) in South Asia; Indonesia (221,600 deaths), Vietnam (99,700 deaths), and the Philippines (98,209 deaths) in Southeast Asia; and Nigeria (206,700 deaths) and Egypt (116,500 deaths) in Africa. PM2.5 air pollution is the largest driver of air pollution’s burden of disease worldwide. Long-term exposure to PM2.5 pollution is associated with illness and early death from diseases, including heart disease, lung cancer, COPD, stroke, type 2 diabetes, lower respiratory infections (such as pneumonia), and adverse birth outcomes. It is estimated that ambient PM2.5 and household air pollution (i.e., household PM2.5) together contributed to 7.8 million deaths globally in 2021, with ambient PM2.5 accounting for 4.7 million [95% UI: 3.5–5.8] deaths and household air pollution accounting for 3.1 million [95% UI: 1.9–5.2].Of all the deaths attributable to ambient PM2.5 in 2021, heart-disease-related deaths were linked to 19% of the total deaths, ~1.5 million. Overall, the regions that bear the highest burden from ambient PM2.5 include Southeast Asia, East Asia, and Oceania (91.4 deaths/100,000 people); South Asia (85.1/100,000); and North Africa and the Middle East (103/100,000). With respect to deaths, air pollution takes its greatest toll on people ages 50 and older, who suffer the highest burden from non-communicable diseases related to air pollution, such as COPD, diabetes, stroke, and heart disease. When considering household air pollution, the burden also heavily impacts the youngest children, newborns, and children under five. Short-term exposure to ozone is linked to asthma exacerbation and other respiratory problems. Long-term exposure to ground-level ozone is linked with the development of COPD in adults, a progressive and debilitating disease that makes breathing harder; COPD is a major global cause of death and disability. In 2021, long-term exposure to ozone contributed to an estimated 490,000 deaths (95% UI: 107,200–837,000) from COPD worldwide, accounting for 13% (95% UI: 2.9%–22%) of all COPD deaths globally In 2021, nearly 50% of all ozone-related COPD deaths were in India (237,000 deaths) followed by China (125,600 deaths) and Bangladesh (15,000 deaths) In 2021, a total of 709,000 (95% UI: 539,400–899,300) deaths in children under five were linked to air pollution; this represents 15% of all global deaths in children under five. Of these, most (507,500 [95% UI: 365,700–694,400]) were linked to household air pollution from cooking with solid fuels, and 201,000 were linked to ambient PM2.5 (95% UI: 112,700–309,300). Among children 5–14 years of age, air pollution was linked to 16,600 deaths (95% UI: 2,400–27,600). In 2021, 572,000 neonatal deaths (95% UI: 480,000–681,000) were linked to air pollution, representing 26% of the total newborn deaths. 72% of this burden was due to exposure to household air pollution from cooking with solid fuels. In 2021, India (169,400 deaths), Nigeria (114,100 deaths), Pakistan (68,100 deaths), Ethiopia (31,100 deaths), and Bangladesh (19,100deaths) saw the largest numbers of air pollution–related deaths among these children.