Despite continuous efforts of regional governmental agencies, air pollution remains a major threat to public health worldwide. In January 2017, a severe episode of
smog similar to the Great
Smog of 1952 occurred in London. The longest episode of Chinese haze also developed in Beijing, during which levels of particulate matter < 2.5 μm rose to 500 μg/m3. European
smog and Chinese haze are associated with large numbers of premature deaths each year, at 400,000 and 1.2 million, respectively, primarily from
respiratory diseases,
cerebrovascular diseases, and
ischemic heart diseases. In addition to air pollution, some are exposed to other harmful environmental factors, such as
secondhand smoke. For countries with large populations of smokers, such as China, India, the United States, and Russia, surviving both
smog and
smoke is a serious problem. With novel genomic and epigenomic studies revealing air pollution- and smoking-induced mutational signatures and epigenetic editing in diseases such as
lung cancer, it has become feasible to develop precision strategies for early intervention in the disease-causing pathways driven by the specific mutations or epigenetic regulations, or both. New
therapies guided by gene-drug interactions and genomic
biomarkers may also be developed. We discuss both perspectives regarding the urgent need to manage the toxic effects of
smog and
smoke for the benefit of global health and the novel concept of precision intervention to protect the exposed individuals when exposure to
smog and
secondhand smoke cannot be voluntarily avoided or easily modified.