Air Pollution and its Health Effects CART Presentation Nov 12th , 2004 David R. Pepper, M.D., M.S. with input from Kevin D. Hamilton RRT, John Telles MD, and Tom Cahill PhD

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Air Pollution andits Health EffectsCART
PresentationNov 12th , 2004David R. Pepper,
M.D., M.S. with input from Kevin D. Hamilton
RRT, John Telles MD, and Tom Cahill PhD
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Central Valley, is it

• The Lobster in the Pot ? or

• The Canary in the Cage?

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Its National News

• Business Week
• Not good for Business or other living things
• Now the worst air in the nation 4/14/04

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Can you see the air?
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Summer Fine Aerosols downwindYosemite NP
Visibility at 90th percentile
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Yosemite NP Visibility at 10th percentile
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How Bad is it?

• SMOG - Fresno 1 in the Nation
• We are 1 for 8 hour exceedances
• 1 in Particulate ppm exceedance days
• 3 for 1 hour exceedances (ozone)
• Asthma - Fresno 3 in the Nation
• 16 of our Children

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What about our schools?Reported by us to
CDC in 2000
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AEMPs Patients
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SJV Costs - Asthma

• 300,000 (10) Asthmatics
• 1,200 pp/py
• Compliant
• 0.25 x 1,000 (chronic medications)
• Non-compliant
• 0.15 x 3 x 200 (unintended PCP visit)
• 0.15 x 1,000 (ER visits)
• 0.05 x 10,000 (Hospitalization)
• Total 360 Million for Asthma alone
• Plus Days missed (school and work)

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And.is Asthma the tip of the Iceberg?

• Asthma 5-7 Nation-wide
• 11 average Valley wide. (higher in pediatrics)
• Up to 30 in select populations
• The Future - - - ?????
• Emphysema, Cancer, Heart Disease
• Birth Defects, learning disorders

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Bad Effects - How?

• Acute
• O3 and PM trigger cytokine/histamines
• Inflammation and Vasospasm in arteries and
  airways (Nose to Lung)
• Asthma/Bronchitic Flares
• Sudden Cardiac Death
• Chronic
• Emphysema? Cancer? Heart Dz
• Air Pollution Kills 60,000 a year in US, 1,300 in
  Valley

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What are the Sources?

• Business/Industry
• Energy
• Home

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Sources - Ag
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Sources Mobile
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Valleys - trap and magnify
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Pollution Transport Within and Between Air Basins
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AQI

• 100 Max accepable
• Who sets 100? (D. Jones, Evan Ship)
• What 100 are we using?

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What is in Dirty Air?

• Invisible
• VOC, NOX, ROG, SOX
• Ozone
• CO, Pb,
• Visible
• Smoke and Soot
• Particulates (PM)

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Ozones Effects

• 0.06 ppm rats cant clear asbestos fibers
• 0.08 ppm subjects tested in chamber 5 6 hrs
• - inflammatory mediators released
• - PFTs show ?lung function
• 0.15 ppm - shortening of cilia
• - necrosis of lung epithelium
  cilia
• 0.15 ppm - California Health Advisory
• 0.20 ppm - Stage I Smog Alert

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Ozone Trends - SJV
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Is Ozone the real culprit?
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Particulate Matter

• The real bad actor
• Ozone is old news
• C. Arden Pope PhD - Utah
• Pope Mosley MD New Mexico

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PM 2.5 CV Effects

• Vasoconstriction
• Perturbed autonomic nervous system
• Increase inflammatory cytokines
• Increase defibrillator discharges
• Progression of CAD
• Promotion of plaque rupture
• Increasing risk of acute MI (heart attack)

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Smaller More concern

• Hair is 70 microns
• Particles 10 microns or less
• bypass bodys defenses and enter lung
• Coarse fraction (gt2.5-10 mm)
• deposits mostly in the airways,
• plus deep lung
• Fine fraction (lt2.5 mm)
• penetrates to deep lung
• crosses alveolar membrane

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Particulate Loadtpd

• Unpaved roads 24
• Tilling (farms) 17
• Paved Roads 13
• Wind/dust 11
• Ag burning 9
• Wildfires 2

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SJV PM-10 Exceedances
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Over 90 of Californians Still Breathe Unhealthy
Air at Times
Days Over State Ozone Standard
Days Over State PM10 Standard
Based on 2000 Monitoring Data
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Asthma

• Overlaps?
• Fresno gt16
• CHIS data
• ? Other factor

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California Pesticides

• Central Valley
• Specialty crops
• Perfect food

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Solutions ?

• Modify our exposure (the way we live)
• Summer avoid mid-day outside
• Winter avoid early AM outside
• Filter the Air? (HEPA filters, Green Screen)
• Or.change.

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Atlantas Experiment

• 1996 summer Olympics 2 weeks
• Big increase in public transport x 2 wks
• Traffic congestion down 22
• Acute asthma visits down 42 in kids
• (Medicaid population)
• Friedman,M.S.,et.al.JAMA 285 897-905, 2001

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Solutions - change

• (Reduce) what we make (and use)
• Less burning (Fireplaces, Ag, etc)
• Mass Transit eg Trainsgt Light Railgt Buses gt
  Carpools gt Cars gt SUVs
• Drive less cars (and more bikes) or better mpg
  cars (hybrids)
• Alternative Fuels Natural Gas, Fuel Cell,
  Hydrogen, Electric (avoid Diesel)
• More dense population (avoid sprawl)

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Or Solutions Change

• EPA, APCD, Valley Air Quality rules
• Wood burning (eg gasgt stoves)
• Leaf Blowers and 2 stroke engines?
• Diesel Engines getting cleaner
• Farms and Dairies and Pesticides
• what are the best targets?

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Extreme solutions?

• 4/gallon for gas (indirect source fees)
• Air toll booths for those passing through
• Blended Bio-diesel, no Diesel, Gasahol
• Alternative Technology (LPG, Fuel Cells)
• Organic farming (and buying)
• Impound severe smokers (cars)
• Move ?

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Costs of Clean up?

• 1 cent a gallon tax
• How much for health insurance premiums? Per
  person? For all of Chevron/Texaco?
• How much is
• a life worth?
• your life worth?
• one year of your life?

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Why Clean Air ???Thank
you..drpepper_at_ucsfresno.edu
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VMT - Our Car CultureOne gallon 12 lbs of Air
Pollution
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NOX Nitric Acid Forming Agents
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ROG (or VOC) what you smell
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How do the components vary with particle size?
Coarse
Fine
Nitrates Sulfates Ammonia Carbon Metals Organics
Soil Salts Brake Dust Tire Rubber
0.1
10 mm
2.5
1
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• QUESTION The life span of people who live in
  areas as polluted as the San Joaquin Valley is
  reduced by
• a.) 0 years
• b.) 1-2 years
• c.) 4-6 years
• d.) 8- 10 years

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• ANSWER b
• The life span of people who live in areas as
  polluted as the San Joaquin Valley is reduced by
• a.) 0 years
• b.) 1-2 years
• c.) 4-6 years
• d.) 8- 10 years