Letter From the Sri Lanka College of Pulmonologists

Air pollution, defined as contamination of the indoor or outdoor environment by chemical, physical, or biological agents that alter the natural characteristics of the atmosphere, has been recognized as a threat to human health since ancient times. The major medically important air pollutants include particulate matter (PM2.5 and PM10), carbon monoxide (CO), nitrogen oxides (NOx), ozone (O3), and sulphur dioxide (SO2). In addition, microbial agents, heavy metals, and microplastics have emerged as air pollutants with significant adverse health effects. Rapid motorization, industrialization, intensive use of petroleum products, and the associated increase in energy consumption have resulted in substantial levels of air pollution in Sri Lanka, similar to many other developing countries. Achieving an appropriate balance between these essential human activities and the preservation of acceptable ambient air quality remains a major national challenge. Addressing this challenge requires robust infrastructure, a practical and enforceable legislative framework, effective monitoring mechanisms, widespread public awareness and attitude change, and a clear national strategy with strong multi-stakeholder engagement. Household air pollution is a less visible, yet equally devastating public health problem in the country. Poor housing structures, high indoor population density, unregulated use of biomass fuels, and the burning of other solid materials are key contributors to deteriorating indoor air quality. Although limited, available studies have demonstrated clear adverse health effects associated with exposure to indoor air pollution. Trend analyses of ambient air quality data in Sri Lanka have demonstrated a strong correlation with urbanization and vehicle traffic congestion, particularly in densely populated cities such as Colombo, Kandy, and Gampaha, where pollutant levels frequently exceed World Health Organization (WHO) guideline limits during peak hours. Across the island, elevated air pollution concentrations are often observed during the inter-monsoon months due to dry weather conditions and stagnant atmospheric circulation that limit pollutant dispersion. Gaseous pollutants, particularly SO2 and NO2, exhibit clear monthly variation, with higher concentrations at the beginning of the year, a decline towards mid-year, and a subsequent increase towards the end of the year. This seasonal pattern is consistent with local wind dynamics and enhanced accumulation of pollutants during the North-East monsoon period (November–February) 1. In addition, Sri Lanka is influenced by transboundary air pollution during this period, when polluted air masses from the Indian subcontinent are transported across the Bay of Bengal. However, the magnitude and health impacts of these transboundary contributions remain insufficiently understood, highlighting the need for more comprehensive monitoring and source apportionment studies. In 2019, disability-adjusted life years (DALYs) attributable to outdoor air pollution were estimated at 801 per 100,000 population, primarily driven by chronic respiratory diseases, ischemic heart disease, and stroke 2. Although this burden was lower than that observed in several South Asian countries, it remained substantially higher than in developed nations. Household air pollution related to cooking fuel and other indoor activities, despite its well-recognized health implications, remains an understudied area. An ongoing survey among urban and suburban populations in the Kandy district revealed that liquefied petroleum gas (LPG) was the predominant cooking fuel (74%), followed by firewood. Analysis of cooking-time PM2.5 concentrations by stove type showed that traditional firewood clay stoves (Figure 1) generated the highest daily average PM2.5 (53.85 μg/m3), followed by traditional firewood stoves (47.72 μg/m3) and improved Anagi firewood stoves (39.47 μg/m3), while LPG stoves demonstrated the lowest daily average concentrations (34.59 μg/m3). Based on cooking-time PM2.5 measurements, 53.2% of households exceeded 35.5 μg/m3, falling into the WHO “unhealthy” and “very unhealthy” exposure categories 3. In 2024, the authors conducted a multi-stakeholder engagement meeting involving representatives from key institutions responsible for air quality monitoring, legislative drafting, and law enforcement in Sri Lanka. The meeting focused on identifying gaps in existing air quality legislation, infrastructure deficiencies, and implementation challenges. Major areas of concern included motor traffic–related air pollution, industrial emissions, and open burning of solid waste. Although Sri Lanka has implemented several regulatory measures, such as gazetting ambient air quality standards and fuel quality standards, discontinuing two-stroke engines, restricting the importation of older vehicles, and mandating annual vehicle emission testing, many of these regulations require timely revision and strengthening. Fuel adulteration with substandard chemicals remains a significant concern, particularly within the private transport sector. The vehicle emission testing program requires modernization through advanced technology, improved infrastructure, and enhanced capacity for real-time testing. Monetary fines and penalties for air-pollution-related offences also need updating to ensure meaningful deterrence. Furthermore, stronger legislation is required to curb agricultural land burning and domestic garden waste burning. Sri Lanka must adopt broader measures to reduce traffic congestion, transition away from fossil fuels, and minimize public exposure to air pollutants in urban settings. Policy initiatives promoting renewable energy, lowering import taxes for electric vehicles, allocating budgetary support for environment friendly public transport system, and improving infrastructure for alternative transport modes such as cycling would substantially reduce traffic-related emissions. Public awareness campaigns on optimal vehicle maintenance and compliance with emission testing programs are equally essential. Establishing low-traffic zones and time restrictions near schools, implementing traffic diversion strategies, and relocating schools and offices to low-congestion areas could further reduce exposure. Traditional cooking practices remain the principal contributor to indoor air pollution, particularly in suburban and rural regions of the country. Transitioning from firewood to cleaner energy sources represents the most effective long-term intervention; however, cost remains a major barrier for many households. Interim measures such as improving kitchen infrastructure with chimneys and adequate ventilation and the use of outdoor cooking facilities may offer practical alternatives during the transition period. Public education on the health impacts of burning incense sticks, mosquito coils, and other solid materials, as well as open burning of household waste, is also critically important. The Sri Lanka College of Pulmonologists (SLCP), the professional body representing respiratory specialists in the country, remains firmly committed to addressing the health impacts of air pollution in Sri Lanka. The College actively conducts public education and awareness programmes to commemorate important global events such as World Lung Day, World Environment Day, and World Clean Air Day. Representatives of the College collaborate with policymakers by actively participating in stakeholder meetings convened by the Departments of Non-Communicable Diseases and Environmental Health, contributing to the development of national guidelines and health policies aimed at reducing air pollution and its associated health risks. In addition, the College works hand in hand with community organizations to promote tree-planting campaigns, advocate for the adoption of green energy solutions, and foster environmentally responsible practices among the public. The new Sri Lankan Government has launched its flagship initiative “Clean Sri Lanka”, a nationwide programme aimed at creating a cleaner, greener, healthier, and more sustainable country through environmental action, public participation, and broader social and governance reforms 4. “Environmental protection and sustainability” form a central pillar in this initiative, with a strong focus on effective waste management, emission control, transition to clean energy, and enhancing public environmental awareness and responsibility. It is vital that all stakeholders, including the Central Environmental Authority, National Building and Research Organization, Vehicle Emission Testing program, Environmental and Traffic police, Ministries of Environment and Health, researchers, academics, clinicians, professional associations, and public support groups, remain committed and coordinated to achieve meaningful and sustainable improvements in air quality. The time for Sri Lanka to act decisively towards clean air is now. The authors have nothing to report. The authors declare no conflicts of interest.