{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T14:56:47Z","timestamp":1790607407129,"version":"4.1.0"},"reference-count":36,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T00:00:00Z","timestamp":1786924800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T00:00:00Z","timestamp":1786924800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Public Health Challenges"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Severe urban air pollution is a major public health challenge in many low\u2010 and middle\u2010income countries. Lahore experiences recurrent winter smog episodes with pollution levels far exceeding international guidelines, but hospital\u2010based evidence on associated symptom burden remains limited.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We conducted a cross\u2010sectional 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\u2010respiratory symptoms. Symptom burden was analysed using descriptive statistics and multivariable regression models, including an exploratory composite vulnerability index. City\u2010level air quality index (AQI), PM\n                      <jats:sub>2.5<\/jats:sub>\n                      , PM\n                      <jats:sub>10<\/jats:sub>\n                      , carbon monoxide (CO), and temperature data were summarised relative to World Health Organization guidelines to contextualise environmental conditions.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      In this health\u2010seeking 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%). PM\n                      <jats:sub>2.5<\/jats:sub>\n                      and PM\n                      <jats:sub>10<\/jats:sub>\n                      exceeded WHO 24\u2010h guideline values on all monitored days. Mean AQI was 180, mean PM\n                      <jats:sub>2.5<\/jats:sub>\n                      was 96\u00a0\u00b5g\/m\n                      <jats:sup>3<\/jats:sup>\n                      , and mean CO was 979, indicating sustained multi\u2010pollutant exposure. Higher cumulative vulnerability was associated with greater symptom counts (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.01), and current smoking was associated with increased symptom burden (incidence rate ratio [IRR] 1.15, 95% CI 1.00\u20101.32). Routine mask use was not significantly associated with lower symptom burden (IRR 0.96, 95% CI 0.84\u20101.09). Perceived worsening air quality showed limited concordance with vulnerability and symptom patterns.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>During Lahore's 2024\u20132025 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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/puh2.70349","type":"journal-article","created":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T02:22:49Z","timestamp":1787019769000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Health Under Haze: Symptom Burden Among Adult Outpatients During the 2024\u20102025 Winter Smog Season in Lahore, Pakistan"],"prefix":"10.1002","volume":"5","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3230-3984","authenticated-orcid":false,"given":"Mirza Ameer Faizan","family":"Ali","sequence":"first","affiliation":[{"name":"Pathology Department, Azra Naheed Medical College Superior University  Lahore Pakistan"},{"name":"Institute of Molecular Biology and Biotechnology The University of Lahore  Lahore Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bushra","family":"Iftikhar","sequence":"additional","affiliation":[{"name":"Institute of Molecular Biology and Biotechnology The University of Lahore  Lahore Pakistan"},{"name":"Biochemistry Department, Azra Naheed Medical College Superior University  Lahore Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1165-9084","authenticated-orcid":false,"given":"Syed Zeeshan","family":"Haider","sequence":"additional","affiliation":[{"name":"Institute of Molecular Biology and Biotechnology The University of Lahore  Lahore Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7292-6134","authenticated-orcid":false,"given":"Aqsa","family":"Ikram","sequence":"additional","affiliation":[{"name":"Institute of Molecular Biology and Biotechnology The University of Lahore  Lahore Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ayesha","family":"Masood","sequence":"additional","affiliation":[{"name":"Pathology Department University College of Medicine and Dentistry, The University of Lahore  Lahore Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ghaniya","family":"Ali","sequence":"additional","affiliation":[{"name":"Pathology Department Al\u2010Aleem Medical College, The University of Health Sciences  Lahore Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eunice Damilola","family":"Wilkie","sequence":"additional","affiliation":[{"name":"Microbiology Department Adeleke University  Ede, Osun State Nigeria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8575-2070","authenticated-orcid":false,"given":"Jude Oluwapelumi","family":"Alao","sequence":"additional","affiliation":[{"name":"School of Science Auckland University of Technology  Auckland New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,17]]},"reference":[{"key":"e_1_2_13_2_1","volume-title":"State of Global Air 2025","author":"Health Effects Institute","year":"2025"},{"key":"e_1_2_13_3_1","unstructured":"Copernicus CAMS Global System Tracks Exceptional Air Pollution Episode in South Asia(European Commission 2024) https:\/\/atmosphere.copernicus.eu\/cams\u2010global\u2010system\u2010tracks\u2010exceptional\u2010air\u2010pollution\u2010episode\u2010south\u2010asia."},{"key":"e_1_2_13_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cpcardiol.2023.102199"},{"key":"e_1_2_13_5_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11869\u2010017\u20100464\u20101"},{"key":"e_1_2_13_6_1","volume-title":"Toxic Smog in Pakistan Is so Bad You Can See It From Space","author":"Regan H.","year":"2024"},{"key":"e_1_2_13_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140\u20106736(24)02601\u20101"},{"key":"e_1_2_13_8_1","unstructured":"berkeleyearth.org. 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