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| - An expert on Tuesday said a nine-year-old London girl who died after a spate of chronic asthma attacks was at high risk because of her condition and her home near a busy, congested road. Stephen Holgate, a professor of immunopharmacology, said Ella Adoo-Kissi-Debrah had an "exceptionally rare" condition and was "living on a knife edge" because of her surroundings. A coroner's inquest is seeking to determine whether air pollution may have contributed to her death in February 2013, in what would be a legal first in Britain. A first inquest in 2014 determined that Ella, who had been taken to hospital 30 times with breathing difficulties and seizures, died of acute respiratory failure brought on by severe asthma. But a new hearing was ordered after Holgate noticed a "striking link" between levels of nitrogen dioxide (NO2) and harmful particulate matter at the times she was admitted. The expert, from the University of Southampton, told Southwark Coroner's Court in south London: "I've used the term 'Ella was living on a knife edge'. "What that really means is that... a very small change can lead to a dramatic event." He said "hyper-secretion" of mucus in the young girl's lungs induced prolonged coughing fits which had worsened towards the end of 2012. "During these winter months, when air pollution was getting worse in her neighbourhood... this is when she would be experiencing her worse exposures," he told the hearing. "I believe that is why (Ella's condition) was most accentuated during that time, whereas in the summer months, where the air pollution levels as a whole drop, her airway is able to get itself together again. "Clearly she had a strong genetic susceptibility second to almost none." Ella and her family lived near the South Circular road in Lewisham, south London. Her mother, Rosamund, said she would have moved had she known poor air quality was a factor. Holgate's 2018 report into Ella's death found air pollution levels one mile (1.6 kilometres) from the family home consistently broke lawful EU limits three years before she died. Air pollution has been a known factor in worsening asthma, including in children, for at least four decades, he added. Paul Wilkinson, professor of environmental epidemiology at the London School of Hygiene and Tropical Medicine, said the young girl would have been exposed to above average pollution levels. The inquest, which concludes this week, has been told that air pollution is thought to have contributed to between 28,000 to 36,000 deaths each year in Britain. phz/am/pvh
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