Health Under Haze: Symptom Burden Among Adult Outpatients During the 2024–2025 Winter Smog Season in Lahore, Pakistan
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Ali, MAF
Iftikhar, B
Haider, SZ
Ikram, A
Masood, A
Ali, G
Wilkie, ED
Alao, JO
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Wiley
Abstract
Background: Severe urban air pollution is a major public health challenge in many low- and middle-income countries. Lahore experiences recurrent winter smog episodes with pollution levels far exceeding international guidelines, but hospital-based evidence on associated symptom burden remains limited. Methods: We conducted a cross-sectional study of 400 adult outpatients attending a tertiary hospital in Lahore between October 2024 and January 2025, during a period of sustained severe air pollution. A structured questionnaire collected data on demographic characteristics, behavioural factors, occupational exposure proxies, medical history and respiratory and non-respiratory symptoms. Symptom burden was analysed using descriptive statistics and multivariable regression models, including an exploratory composite vulnerability index. City-level air quality index (AQI), PM2.5, PM10, carbon monoxide (CO), and temperature data were summarised relative to World Health Organization guidelines to contextualise environmental conditions. Results: In this health-seeking outpatient sample, 98% of participants reported at least one symptom. The most common complaints were shortness of breath (74%), eye irritation (56%), cough (53%) and sore throat (50%). PM2.5 and PM10 exceeded WHO 24-h guideline values on all monitored days. Mean AQI was 180, mean PM2.5 was 96 µg/m3, and mean CO was 979, indicating sustained multi-pollutant exposure. Higher cumulative vulnerability was associated with greater symptom counts (p < 0.01), and current smoking was associated with increased symptom burden (incidence rate ratio [IRR] 1.15, 95% CI 1.00-1.32). Routine mask use was not significantly associated with lower symptom burden (IRR 0.96, 95% CI 0.84-1.09). Perceived worsening air quality showed limited concordance with vulnerability and symptom patterns. Conclusion: During Lahore's 2024–2025 winter smog season, adult outpatients reported substantial multisystem symptom burden. These findings support strengthened environmental control measures and public health responses in heavily polluted urban settings.
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air pollution, air quality, environmental exposure, particulate matter, respiratory tract diseases, urban health, 41 Environmental Sciences, 4105 Pollution and Contamination, Health Disparities, Climate-Related Exposures and Conditions, Health Disparities and Racial or Ethnic Minority Health Research, Social Determinants of Health, Respiratory, 11 Sustainable Cities and Communities
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Public Health Challenges, ISSN: 2769-2450 (Print); 2769-2450 (Online), Wiley, 5(3), n/a-n/a. doi: 10.1002/puh2.70349
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© 2026 The Author(s). Public Health Challenges published by John Wiley & Sons Ltd. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
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Except where otherwise noted, this item's license is described as Creative Commons Attribution License