Wood Smoke and Health

1
Wood Smoke and Health August 23, 2007
2
Wood Smoke and Health

• Judy Bardin, ScD
• Wood Smoke Work Group
• August 23, 2007
• Dept. of Ecology NW Regional Office

3
Composition of Wood Smoke

• Gases and fine particles suspended in air
• Visible and invisible components
• Inhalable particulate matter
• Carbon Monoxide
• Nitrogen oxides
• Volatile organic compounds
• benzoapyrene, benzene, formaldehyde (Known or
  probable human carciongens)

4
Particulate Matter (PM)

• One of the biggest human health concerns from
  smoke, indoors or outdoors comes from PM
• The size of the particle is linked to their
  potential to cause health effects.
• The smaller the size the bigger the health risk.

EPA, fact sheet, Healthier Home Cleaner
Environment, 2007
5
Fine PM (PM 2.5)

• Size less than 2.5 microns (called PM 2.5)
• Strongest association with health effects
• Adsorb and carry other toxic chemicals deep into
  the lung.
• Very small stay airborne, travel indoors

6
What is PM2.5?
The health risks from particulates are due in
part to the small size. The smaller the size, the
bigger health risk. PM2.5 stays in the air much
longer than PM10, taking days to weeks to be
blown away.
British Columbia Ministry of the Environment
7
Respiratory and Cardiovascular Disease (CVD)

• CVD heart disease and stroke
• A large body of research has shown
• Both short term and long term exposure to PM is
  linked to increases in illness and death from
  respiratory and CVD diseases

EPA, PM Criteria Document, 2004
8
PM and CVD Effects

• A number of potential harmful effects
• Heart rate (how fast heart beats) increased or
  decreased
• Abnormal heart rhythms
• Heart rate variability (how well heart reacts to
  stress) changes
• Blood pressure increases
• Blood coagulation and clot formation increases
• Inflammation
• Those with pre-existing medical conditions
  (especially heart and lung disease) may have the
  most serious health outcomes with these effects

EPA, PM Criteria Document, 2004
9
Womens Health Initiative Study

• Miller, et al., Joel Kaufman( Principle
  Investigator), Univ. Washington
• Women enrolled in the study at age 50-79
• No previous CVD
• 36 US metropolitan areas
• From 1994-1998 .
• Air Monitoring EPA AIRS pollution data base
  closest monitor (not 30 miles)
• Long term annual average PM2.5 exposure

NEJM, 2/1/2007, 356447-58
10
Women Health Initiative CVD Findings

• Each increase in 10 ug/m3 was linked to
• 24 increased risk of a CVD event
• 76 increase in risk of death from CVD

11
Respiratory Effects of PM

• Increased lung injury and inflammation
• Decreased pulmonary function
• Increased airway reactivity
• Increased respiratory symptoms
• Exacerbation of Asthma
• Increased susceptibility to infection

EPA, PM Criteria Document 11/04
12
Lung Cancer

• Several large cohort studies have shown
  associations between long term exposure to PM
  2.5-10 or PM2.5 and lung cancer
• The American Cancer Society cohort study found a
  13 increased risk of lung cancer death per long
  term 10 ug/m3 PM2.5 exposure

EPA, PM Criteria Document 11/04
13
Fine PM Level Rises Result In

• More people with respiratory or cardiac symptoms
• Decreased activity, school absences, loss work
  days
• Increased health care provider visits
• Increased emergency department visits
• Increased hospitalizations
• Increased deaths (especially, heart, lung and
  stroke diseases)

EPA, PM Criteria Document 11/04
14
Emergency Department (ED) Visits
Slide courtesy of Dr. Jane Koenig
15
Loss of Life expectancy

• Life expectancy how long people are expected to
  live
• Overall studies show that long term exposure to
  PM2.5 results in a loss of life expectancy of
  1 year or more of life.

EPA, PM Criteria Document 11/04
16
Summary of wood smoke effects in Seattle

• Increased symptoms in children with asthma (Yu et
  al,1999 Slaughter et al 2003)
• Increased visits to Emergency Depts. (Schwartz et
  al 1993 Norris et al 1999)
• Decrements in lung growth in children with asthma
  (McKown et al. 2006)
• Increased airway inflammation in children with
  asthma and adults with Respiratory disease
  (Koenig 2003, Jansen 2005

Slide Courtesy Dr Jane Koenig
17
Some People Are More Sensitive to Smoke

• Infants and young children
• Elderly (age 65 and older)
• Those with lung and cardiovascular disease (heart
  disease and stroke)

18
WA Young and Elderly(Percentage Statewide)

• Young (infants and young children)
• 8, 5 years and younger
• 13, 9 years and younger
• Elderly
• 11 age 65 and older

19
Children

• They breathe in more air in relation to body
  weight
• Lungs still developing
• Spend more time outdoors

20
Elderly

• Those 65 and older
• Pre-existing heart, lung, and other medical
  conditions
• Weaker immune systems
• Less able to take preventative measures

21
Lung Cardiovascular Diseases

• May experience symptoms earlier and at lower
  levels
• Lung Disease
• Asthma, emphysema, bronchitis, chronic
  obstructive pulmonary disease (COPD)
• Cardiovascular Disease
• Previous heart attack, angina, coronary artery
  disease, stroke

22
WA State Asthma in Children

• 11 of household with children report that they
  have at least on child with asthma
• 2006 Behavioral Risk Surveillance Survey (BRFSS)
• As reported by adult in household
• 12.9 of 10th graders report that they have
  current asthma
• Report they used asthma medication or had an
  asthma attack in the last year
• 2006 Healthy Youth Survey

23
WA State Asthma in Adults

• 8.9 report they have current asthma
• 14.3 report they ever had asthma

24
WA StateCardiovascular Disease (CVD)

• Report having CVD (2006 BRFSS)
• 7 of all adults
• 24 of adults age 65 and older

25
Overview

• One in ten people in WA report they have asthma
• One in four adults 65 and older report having CVD

26
Diabetes

• New evidence - diabetics at risk when PM levels
  rise
• Many diabetics have underlying CVD
• 7 of Washington residents report having diabetes

27
Overall

• Large segments of our population are at risk from
  breathing smoky air
• Reduction of exposure to smoke would help prevent
  illness and death in WA

28
References

• United States Environmental Protection Agency.
  (2004) Air Quality for Particulate Matter, volume
  II. Retrieved August 10, 2007, from
  http//cfpub2.epa.gov/ncea/cfm/recordisplay.cfm?de
  id87903.
• Miller, K.A., Siscovick, S.S., Sheppard, L.,
  Shepherd, K, Sullivan, J.H. Anderson, G.L., et
  al. (2007). Long-term exposure to air pollution
  and incidence of cardiovascular events in women.
  The New England Journal of Medicine, 356,447-458.
• Pope, C.A. III, Burnet, R.T., Thun, M.J., Calle,
  E.E., Krewski, D. et al. (2002). Lung cancer,
  cardiopulmonary mortality, and long-term exposure
  to fine particulate air pollution. The Journal of
  the American Medical Association, 287, 1132-1141.
• USEPA Healthier Homes Cleaner Environment.
  Retrieved August 10, 2007 fromhttp//www.epa.gov/
  woodstoves/healthier.html
• Washington State Behavioral Risk Factor
  Surveillance System (BRFSS) Data 2006 data
  weighted to reflect county over-sample, November
  2006 June 2007.
• Washington Healthy Youth Survey Office of the
  Superintendent of Public Instruction, Washington
  State Departments of Health, Social and Health
  Services, and Community, and Trade and Economic
  Development, the Family Policy Council, and RMC
  Research, 2006.
• The burden of heart disease and stroke in
  Washington State, (2004), Washington State
  Department of Health, Community and Family
  Health.
• Washington State Population Counts U.S. Census
  provided through Washington State Office of
  Financial Management (OFM)

29
References

• Slaughter JC, Lumley T, et al (2003). Effects of
  ambient air pollution on symptom severity and
  medication use in children with asthma. Ann
  Allergy Asthma Immunol 91(4) 346-53.
• Yu O, Sheppard L, Lumley T, Koenig JQ, Shaprio
  GG. 2000. Effects of ambient air pollution on
  symptoms of asthma in Seattle-area children
  enrolled in the CAMP study. Environ Health
  Perspect 1081209-1214.
• Schwartz J, Slater D, Larson TV, Pierson WE,
  Koenig JQ. Particulate air pollution and hospital
  emergency room visits for asthma in Seattle. Am
  Rev Respir Dis. 1993 Apr147(4)826831.
• G Norris, S N YoungPong, J Q Koenig, T V Larson,
  L Sheppard, J W Stout. An association between
  fine particles and asthma emergency department
  visits for children in Seattle. Environ Health
  Perspect. 1999 June107(6)489-493.
• J.Q. Koenig, K. Jansen, T.F. Mar, T. Lumley J.
  Kaufman, C.A. Trenga, J. Sullivan,1 L.-J.S. Liu,1
  G.G. Shapiro,3 and T.V. Larson. Measurement of
  offline exhaled nitric oxide in a study of
  community exposure to air pollution. Environ
  Health Pespect. 2003 October111(13) 1625-1629.
• TF. Mar, K Jansen, K Shepherd, T Lumley, TV.
  Larson, JQ. Koenig. Exhaled nitric oxide in
  children with asthma and short-term PM2.5
  exposure in Seattle. Environ Health Perspect.
  2005 December113(12)1791-1794.

30

• Judy Bardin
• Epidemiologist
• Washington State Department of Health, Office of
  Environmental Health Assessments, 360-236-3193
• Judy.bardin_at_doh.wa.gov

31
(No Transcript)