arep gurme section 6 health effects. arep gurme 2 section 6 – health effects a brief history of pm

AREPGURME

Section 6Health Effects

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Section 6 – Health Effects

A Brief History of PM

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The Houses of Parliament, Stormy Sky

Claude Monet, 1904

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Air Pollution Disasters

1930 Meuse River Valley, BelgiumA three-day episode of severe air pollution makes 6,000 ill and kills 63.

1948 Denora, PAOct. 26 to 31: air pollution episode

leaves 20 dead out of 14,000 persons.

1952 London, EnglandDec. 4 to 9: “Killer Fog” leaves three

to four thousand people dead.

London buses are escorted by lantern at 10:30 in the morning.

Donora, PA at noon on Oct. 29, 1948

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Human LungHuman LungHuman LungHuman Lung

Air conducting•Trachea•Bronchi•Bronchioles

Gas exchange•Respiratory bronchioles•Alveoli

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Mouse lung exposed to Diesel Exhaust

Diesel Exhaust Particles (DEP) augment inflammation by increasing receptors for bacterial lipopolysaccharide. The effect is to make the lungs highly sensitive to the presence of normal levels of bacteria. This results in greatly heightened production of pro-inflammatory mediators from the

cells.

Normal mouse lung Exposed mouse lung

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Schwartz, 1994

Mortality attributed to London Smog

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Outdoor Air PollutionRegulatory Categories

Criteria Pollutants • Present everywhere• Ambient air quality standards•Widely monitored

Air toxics• Long list (>180)•Many carcinogens• Less frequent ambient measurements

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Criteria Pollutants

•Particulate matter– PM10 (PM < 10 microns)– PM2.5 (PM < 2.5 microns)– (PM10-PM2.5 = coarse fraction)

•Nitrogen dioxide (NO2)•Sulfur dioxide (SO2)•Ozone (O3)•Carbon monoxide• Lead

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Disease and environmental factors

Estimates of the burden of disease attributable to environmental factors vary depending on

– Type of disease– Vulnerability– Genetics– Population group– Socioeconomic aspects

Large differences between people living in– Industrialized/developing countries– East/West of Europe– and others

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Major health impacts and their association with environmental factors

Cancer: air pollution, mainly PM 2.5 and smaller, PAHs, metals (AS Cd Cr)

Cardiovascular disease: air pollution (CO, O3, PM, Pb)

Respiratory diseases: SO2, NO2, PM10 and PM 2.5, O3

Developmental disorders: Pb, Hg, Cd

Nervous system disorders: Pb, PCBs, Methyl Hg, Mn

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Air pollution is the environmental factor with the greatest health impact in Europe!

Effect is expressed by number of deaths (mortality rates), and by DALYs:

– “Disability-Adjusted Life Years”– An indicator of “burden of disease”, – Gives an indication how disease can alter the ability of people

to live a normal life compared with those with no disease. Expresses years of lost life.

Effect also expressed as morbidity, such as increased frequency of chronic bronchitis, respiratory hospital

admissions, restricted activity days.

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Disease and environmental factorsWHO estimates for Europe (51 countries)

• Children age 0-4 years: 1.8 – 6.4 % of deaths from all causes due to outdoor air pollution

• Mild mental retardation due to lead exposure: 4.4 % of all DALYs

In a selection of European cities each year: • Air pollution responsible for 100 000 deaths and • 725 000 years of lost life (DALYs)

European Commission estimates in CAFÉ:• 350 000 premature deaths in 2000 due to outdoor air pollution of

PM2.5 alone =• Average loss of life expectancy of 9 months for each European

citizen

Ozone causes 20 000 premature deaths annually

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Heat waves cause excess deaths; however, large portion due to air pollution

Heat wave in Europe summer 2003, in United Kingdom:• 2045 excess deaths 4-13 August (compared with

1998-2002 average)• Deaths due to air pollution:

– 225 – 593 due to ozone– 207 due to PM10– Above represent 21 – 38 % of the excess deaths (John R. Stedman)

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Strength of association between environmental factors and selected diseases, corresponding population impact and prevention possibilities (EEA and IPCC)• Neurodevelopment (Pb): very likely 90-99 %, moderate, high• Neurodevelopment (Hg): very likely 90-99 %, low, high• Respiratory diseases (air pollution): very likely 90-99 %,

high, moderate• Asthma causation (air pollution): medium likelihood 33-66 %,

high, moderate

Many examples show that respiratory health and life quality improves with improved air quality.

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Strength of association between environmental factors and selected diseases, corresponding population impact and prevention possibilities (EEA and IPCC)

Neurodevelopment (Pb): very likely 90-99 %, moderate, high

Neurodevelopment (Hg): very likely 90-99 %, low, high

Respiratory diseases (air pollution): very likely 90-99 %, high, moderate

Asthma causation (air pollution): medium likelihood 33-66 %, high, moderate

Many examples show that respiratory health and life quality

improves with improved air quality.

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PM is derived from many different sources

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Ultra Fine

10 um1 um0.1 um

Anthropogenic:SulfatesNitratesAmmoniaCarbonLead Organics

CoarseFine

Natural: Soil Dust Seasalt Bioaerosols

2.5 um

Particulate Matter Sizes and Composition

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PM relative to hair cross section

Human Hair PM10(10 m)

PM2.5(2.5 m)

Hair cross section (60 m)

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Particles Affect the Lungs

Respiratory system effects: Respiratory symptoms – irritation of

airways, cough Decreased lung function Airway inflammation Asthma attacks, bronchitis Chronic bronchitis

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Public Health Risks Are Significant

Particles are linked to: Premature death from heart and lung

diseases Aggravation of heart and lung diseases,

with increased:•Hospital admissions•Doctor and ER visits•Medication use• School and work absences

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Some Groups Are More at Risk

People with heart or lung disease

Greater deposition with chronic obstructive pulmonary disease (COPD)

Older adultsGreater prevalence of heart and lung disease

Children• More likely to be active• Breathe more air per kg• Bodies still developing

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Nitrogen dioxide (NO2)

Emissions from high temperature combustion processes: motor vehicle exhaust and stationary sources for power production

Exposures indoors due to (unvented) gas appliances and infiltration of ambient NO2

(Complex atmospheric chemistry – can be transformed to HNO3 and nitrate particles)

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Nitrogen dioxide (NO2) effects

Strong oxidant and respiratory irritant (forms nitrous and nitric acids in contact with water)

NO2 irritates the nose, throat and lungs especially in people with asthma.

Lowers resistance to respiratory infections such as influenza.

Contributes to ozone formation (and thus to ozone effects indirectly).

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Sulfur dioxide (SO2)

Irritant gas resulting mainly from combustion of sulfur-containing fossil fuels (power plants, large industrial facilities, diesel vehicles) and metal smelting.

(Is oxidized/hydrated to form sulfuric acid particles)

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SO2 Effects

Usually short-term concentration peaks

SO2 reduces lung function:

Constricts breathing passages, causing wheezing, shortness of breath and coughing, happens quickly.

Lung function returns to normal about an hour after exposure ends.

Causes above in healthy subjects and asthmatics; latter are substantially more sensitive

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Ozone (O3)

Ubiquitous exposure - formed by natural processes as well as human activities

Principal constituent of photochemical smog – not emitted directly

Highly reactive, but poorly soluble, allowing deep lung penetration

Acute toxicity is related to dose = Concentration x Ventilation Rate x Time – increased risk from outdoor exertion

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Ozone Irritates Airways

Symptoms:•Cough• Sore or scratchy throat• Pain with deep breath, or chest pain• Fatigue

Rapid onset, but effect is greater 24 hours after exposure

Similar symptoms for people with or without asthma

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Ozone is linked to:• Aggravation of lung diseases, increased•Hospital admissions•Doctor and ER visits•Medication use• School and work absences

Permanent lung changes

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Respiratory hospital admissions by daily maximum ozone level, lagged one day

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106

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Ozone concentration (ppm)Ozone concentration (ppm)

Res

pira

tory

Adm

issi

ons

Res

pira

tory

Adm

issi

ons

.01 .02 .03 .04 .05 .06 .07 .08 .09 .1.01 .02 .03 .04 .05 .06 .07 .08 .09 .1

(Burnett et al, 1994)(Burnett et al, 1994)

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Some Groups Are More at Risk

Children and adults who are active outdoors

People with lung diseases, such as asthma

People who are unusually sensitive to ozone

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Air Quality Index

Descriptors Cautionary Statement

Good 0 – 50 No message

Moderate 51 – 100 Unusually sensitive individuals

Unhealthy for Sensitive Groups

101 - 150

Identifiable groups at risk - different groups for different pollutants

Unhealthy

151 - 200

General public at risk; sensitive groups at greater risk

Very Unhealthy

201 - 300

General public at greater risk; sensitive groups at greatest risk

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Use AQI to Reduce Risk

Dose = Concentration x Ventilation rate x Time• Reduce concentration – schedule

activities when pollution levels lower• Reduce ventilation rate by taking it easier• Reduce time spent in vigorous outdoor

activities

Pay attention to symptoms

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Health advisories make a difference

Roper 2002 survey of 2000 people across the US:• 52 % had heard of AQI “Code Orange” or

“Code Red” air quality days• Of those, 46 % have reduced exposure to

air pollution

UCLA – Neidell et al.:• 4 to 7 % reduction in pediatric hospital

admissions for asthma attributable to advisories

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Will It Matter if Air Pollution Decreases?

The Dublin Experience

• Dublin’s air quality deteriorated in the 1980s after a switch from oil to cheaper bituminous coal for heating.

• In 1990 the Irish Government banned the use of bituminous coal within the city of Dublin, resulting in a reduction in PM concentrations.

• Change in age-standardized total, cause-specific, and age-specific mortality rates for Dublin County Borough for 72 months before and after ban of sale of coal in Dublin: decrease from 4.5 to 15.5 % depending on the specific group.

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The Utah ValleySteel mill closed due to a labor dispute

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1985 1986 1987 1988

Steel Mill Closed

PM

(g

/m3 )

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1985 1986 1987 1988

Mo

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Steel Mill Closed

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Example of Action

Phasing out leaded gasoline

Mental retardation due to lead exposure was estimated to be nearly 30 times higher in regions where leaded gasoline was still being used compared with regions where leaded gasoline had been completely phased out.

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Information sources

Talks by:• Susan Lyon Stone, Michael Lipsett• Robert Devlin, John R Stedman

Guidelines on Biometeorology and Air Quality Forecasts, WMO, Public Weather Service

Environment and Health, EEA Rep No 10/2005

Preventing disease through healthy environments, WHO, 2006

EPA (US), AIRNow: www.airnow.gov

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Need Chemical Weather Forecasting

PORT PHILLIP BAY

260 280 300 320 340 360

EASTING (km)

DND

BRI

FTSPSY

PTC

MTC ALP

PTHGLS

GVD

PLP BXH

5740

5760

5780

5800

5820

5840

NORTHIN

G(km)

LIGHT

MODERATE

HEAVY

AIR QUALITY FORECAST-MELBOURNE

AIR QUALITY FORECASTAIR QUALITY FORECAST--MELBOURNEMELBOURNE

NORTH EAST

HOUR

IND

EX

NORTH EAST

HOUR

IND

EX

Tomorrow will be fine and sunnyTomorrow will be fine and sunny--with moderate to heavy air pollutionwith moderate to heavy air pollution

PORT PHILLIP BAY

260 280 300 320 340 360

EASTING (km)

DND

BRI

FTSPSY

PTC

MTC ALP

PTHGLS

GVD

PLP BXH

5740

5760

5780

5800

5820

5840

NORTHIN

G(km)

LIGHT

MODERATE

HEAVY



PORT PHILLIP BAY

260 280 300 320 340 360

EASTING (km)

DND

BRI

FTSPSY

PORT PHILLIP BAY

260 280 300 320 340 360

EASTING (km)

DND

BRI

FTSPSY

PTC

MTC ALP

PTHGLS

GVD

PLP BXH

5740

5760

5780

5800

5820

5840

NORTHIN

G(km)

LIGHT

MODERATE

HEAVY



NORTH EAST

HOUR

IND

EX

NORTH EAST

HOUR

IND

EX NORTH EAST

HOUR

IND

EX

NORTH EAST

HOUR

IND

EX

Tomorrow will be fine and sunnyTomorrow will be fine and sunny--with moderate to heavy air pollutionwith moderate to heavy air pollution

arep gurme section 6 health effects. arep gurme 2 section 6 – health effects a brief history of pm

Documents

health effects slide

arep gurme section

health effects disease

health effects schwartz

respiratory health

health effects human

air pollution episode

health effects mouse