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Health Effects of Particulate Air Pollution

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Respiratory exacerbations (asthma, COPD, bronchitis, emphysema) ... Asthma and COPD exacerbations, decreased lung function, bronchitis sx, effects ... – PowerPoint PPT presentation

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Title: Health Effects of Particulate Air Pollution


1
Health Effects of Particulate Air Pollution
  • Stuart L. Abramson, M.D., Ph.D.
  • November 10, 2004
  • Shell Center for Sustainability at Rice University

2
www.epa.gov/nheerl/research/pm
  • Research indicates that air pollution in the
    form of particulate matter, or PM, at
    concentrations currently allowed by national
    standards (the National Ambient Air Quality
    Standards, or NAAQS) is linked to thousands of
    excess deaths and widespread health problems.
    Part of the EPAs mission is to protect human
    health by strengthening the scientific basis of
    air quality regulations.

3
PM Health Effects
  • Some effects are known, others likely
    unknownconsider the precautionary
    principlemay be more effects seen with
    ultrafine particles (lt0.1 microns)
  • Political and economic implications to be
    considered

4
Questions to answer
  • Who? is affected
  • Where? does exposure take place
  • What? characterizes the particles involved
  • When, Why and How? are certain health effects
    seen (morbidity and mortality)

5
Who is most sensitive to effects of PM?
  • The youngest
  • Minute ventilation standardized for body mass is
    significantly greater in infancy (400 ml/min/kg)
    and early childhood than in adults (150
    ml/min/kg) radii of developing airways are
    smaller and have less mature anti-oxidant and
    detoxification capacity
  • The oldest
  • Often due to chronic underlying disease (e.g.
    lung, heart, diabetes) also less active repair
    mechanisms in response to lung injury
  • Those of any age with chronic disease
  • All in-between have been in the youngest category
    and many will reach the oldest categorysoITS
    EVERYONES PROBLEM

6
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7
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8
Locations of PM exposure
  • Outdoors
  • Indoors
  • Miscellaneous indoor exposures (cigarettes,
    candles, wood-burning stoves, fireplaces, etc.)
  • In vehicle in traffic
  • Occupational exposures
  • Hobbies

9
Characterization of PM
  • PM10 (coarse primarily oxides or salts of
    elements found in dirte.g. Fe, Ca, Si, Al)
  • PM2.5(fine sulfates, nitrates, ammonium,
    organic and elemental carbon, acid aerosols)
  • Ultrafine (lt100 nm)
  • How does PM composition (including diesel exhaust
    particles) in Houston differ from other areas?

10
Heath Effects Indices
  • General morbidity and mortality absenteeism, EC,
    hospitalizations
  • Respiratory exacerbations (asthma, COPD,
    bronchitis, emphysema)
  • Cardiovascular rhythm disturbances, vascular
    changes (atherosclerosis, heart attacks)
  • Immunological/Cancer rates (HAPs, PAHs)
  • Neuropsychological
  • Reproductive (low birth weight)/Endocrinological

11
Factors involved in the development of health
effects
  • Amount of exposure
  • Duration of exposure
  • Co-exposures combinatorial effects?
  • Constitutional factors (age, sex, ethnicity)

12
Symptoms of PM exposure
  • Shortness of breath
  • Chest tightness
  • Chest pain
  • Palpitations
  • Coughing
  • Wheezing
  • Fatigue
  • Eye irritation
  • Nasal irritation
  • Throat irritation
  • Headache
  • Others (e.g. cognitive impairment)

13
Health effects of particulate matter (PM) air
pollution
  • Based on epidemiological studies others (e.g.
    animal studies)
  • Respiratoryincrease in asthma attacks, COPD
    exacerbations, decreased lung function,
    bronchitis, and more allergic sensitization
  • Cardiovascularincreased risk of heart attack,
    rhythm disturbances, vascular changes (increase
    risk of stroke--Kuenzli et al. AHA Scientific
    Session, November 20004, New Orleans)
  • Cancerincreased risk of lung cancer

14
PM health effects
  • Asthma and COPD exacerbations, decreased lung
    function, bronchitis sx, effects on lung
    development
  • Brunekeef B and ST Holgate, Lancet, 2002
  • Gauderman WJ et al. N Eng J Med, 2004prevalence
    of FEV1lt80 predicted was 4.9x greater in
    subjects with high PM2.5 exposure from ages 10-18
    years

15
Selected Criteria Air Pollutants(with similar
effects on respiratory disease)
  • Ozone
  • Sulfur dioxide
  • Nitrogen dioxide
  • PM (2.5 or 10 microns)
  • effects on asthma may include
  • increased bronchial reflexes, analogous to
    histamine or methacholine
  • increased inflammation
  • enhancement of early or late phase response
  • enhancement of sensitization to allergens

16
Asthma Pathophysiology
Airway lumen narrowing
Epithelial damage
Mucous gland hypertrophyand hyperplasia
Airway smooth- muscle hypertrophy, hyperplasia,
and bronchoconstriction
Edema
Inflammatory cell infiltration
Mucushypersecretion
Vascular dilation
Thickening of basement membrane
Goblet cellhyperplasia
Adapted from Expert Panel Report. Guidelines for
the Diagnosis and Management of Asthma. NIH,
NHLBI. 1991. NIH publication 91-3042.
17
Mechanisms for Effect of Cigarette Smoking on
Asthma
  • Decreased airway caliber
  • Decreased level of lung function
  • Allergy
  • Increased airway responsiveness
  • Increased inflammatory markers
  • Gene by environment interactions

18
Cigarette smoke exposure
  • Firsthand unfiltered toxic gaseous exposureget
    rid of secondhand or passive label

19
Emphysemamarked thinning of alveoli
20
Rhinitis (allergic and other) may be associated
with the development of other diseases due to
common passageways
21
PM health effects, cont.
  • Increased heart rate, arrhythmias, cardiovascular
    mortality
  • Dockery DW, Environ Health Perspect, 2001

22
PM may narrow arteries
  • Kuenzli et al. (2004) looked at a sample of 800
    adults (at least 40 years old) via ultrasound of
    carotid arteries
  • For every 10 point increase in PM2.5, carotid
    arteries were 4 narrower
  • For women over 60, every 10 point increase led to
    more than 15 narrowing
  • The above data suggest increased risk for stroke
    with increased PM2.5 exposure

23
www.epa.gov/pmresearch
24
PM Health Effects--Numbers of interest
  • In a 151 city study, a 10 microgram/cubic meter
    increase in mean particulate matter resulted in a
    4 increase in overall mortality, 6 increase in
    cardiopulmonary mortality, and an 8 increase in
    lung cancer mortality (Pope CA et al., JAMA 2002)
  • Comparative findings in a 20 city study, showing
    0.51 increase in the relative rate of death from
    1987-1994 for all causes and 0.68 increase in
    death from cardiovascular and respiratory causes
    for the same incremental increase in PM (Samet JM
    et al., N Eng J Med, 2000)

25
PM health effects, cont.
  • Increased allergic sensitization (DEP)
  • Reproductive effects (PAHs with low birth weight,
    premature birthsmall effects)
  • Sram RJ Perera FP et al., Environ Health
    Perspect, 1999

26
Diesel Exhaust Particles and Asthma
  • The combination of diesel exhaust particles and
    specific allergens is synergistic in the
    development of allergic sensitization and asthma
    (Saxon and Diaz-Sanchez, Immunopharmacology,
    2000)

27
Polycyclic Aromatic Hydrocarbon Metabolism
Casillas et al. , Annals of Allergy, Asthma,
Imm, 1999
28
Typical diesel exhaust particle Casillas et
al., Ann All Asthma Immunol 1999
29
Health Effects Reference for Houston,TX
  • Assessment of Information Needs for Air
    Pollution Health Effects Research in Houston,
    Texas (2003) Report by BRIDGES to
    Sustainability and Mickey Leland National Urban
    Air Toxics Research Center to the Texas Council
    on Environmental Technology, 67 pages.
  • www.bridgestos.org

30
Environmental Health
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