Air Quality and Your Health
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Transcript of Air Quality and Your Health
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Air Quality and Your HealthAir Quality and Your Health
Susan Lyon StoneSusan Lyon Stone
Clean Air Partners Clean Air Partners
August 29, 2006August 29, 2006
[email protected]@epa.gov
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Human LungHuman Lung
• Air conductingAir conducting– TracheaTrachea– BronchiBronchi– BronchiolesBronchioles
• Gas exchangeGas exchange– Respiratory Respiratory
bronchiolesbronchioles– AlveoliAlveoli
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Ozone Irritates AirwaysOzone Irritates AirwaysOzone Irritates AirwaysOzone Irritates Airways
• SymptomsSymptoms– CoughCough– Sore or scratchy throatSore or scratchy throat– Pain with deep breathPain with deep breath– FatigueFatigue
• Rapid onsetRapid onset• Similar symptoms - people with and Similar symptoms - people with and
without asthmawithout asthma
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Ozone Reduces Lung FunctionOzone Reduces Lung FunctionOzone Reduces Lung FunctionOzone Reduces Lung Function
BASELINE 2HR 4HR
FE
V1,
% C
HA
NG
E
-60
-40
-20
0
M-10
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M-1c
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Ozone Causes InflammationOzone Causes InflammationOzone Causes InflammationOzone Causes Inflammation
• Ozone reacts completely in surface layer - forms reactive oxygen molecules
• Influx of white blood cells • Damages cells that line the airways• Effect is greater 24 hours after exposure• Increases airway reactivity• Concern about repeated exposures – permanent
structural changes
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Respiratory Hospital Admissions by Respiratory Hospital Admissions by Daily Maximum Ozone Level, Lagged Daily Maximum Ozone Level, Lagged One DayOne Day
114
112
110
108
106
104
102
Ozone concentration (ppm)
Res
pir
ato
ry A
dm
issi
on
s
.01 .02 .03 .04 .05 .06 .07 .08 .09 .1
D-8a
(Burnett et al, 1994)(Burnett et al, 1994)
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California Children’s Health StudyCalifornia Children’s Health Study
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CHS: School AbsencesCHS: School Absences
• 20 ppb increase in O3 associated with an 83% increase in school absences for acute respiratory disease (Gilliland et al., 2001)
• Large economic impact of pollution-related school absences (Hall and Lurmann, 2003)
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CHS: Ozone and New-onset AsthmaCHS: Ozone and New-onset Asthma
McConnell at al., 2002
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New Evidence from Current Review of New Evidence from Current Review of Ozone StandardOzone Standard
• Physiological bases of increased sensitivity of people with asthma– Larger decreases lung function– Increased occurrence and duration
nonspecific airway responsiveness– Increased airway responsiveness to
allergens– Increased inflammatory responses
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New Evidence from Current Review of New Evidence from Current Review of Ozone StandardOzone Standard
• Hospital admissions
• Emergency room visits
• School absences
• Increased symptoms and medication use in asthmatic children
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New Evidence from Current Review of New Evidence from Current Review of Ozone Standard -Ozone Standard - MortalityMortality
• Study done in Vancouver, BC with statistically significant results has 98 and 99 percentile values below 0.06 ppm O3
• US multi-city time-series studies provide strong evidence of association between short-term O3 exposure and mortality
• Effects robust to confounding by copollutants
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Sensitive Groups for OzoneSensitive Groups for Ozone
• People with lung disease
• Children
• Older adults
• People who are active outdoors
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Air Pollution DisastersAir Pollution Disasters
London buses are escorted by lantern at 10:30 in the morning
Donora, PA at noon on Oct. 29, 1948
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Particle pollution is a complex mixture
derived from many sources
Particle pollution is a complex mixture
derived from many sources
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Particle DepositionParticle Deposition
• Larger particles (> PM10) deposit in the upper respiratory tract
• Inhalable particles (< PM10) penetrate into lungs
• Some particles (e.g., less than 0.1 um) may enter bloodstream
• Particles may react, accumulate, be cleared or absorbed
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Association Between Long Term Association Between Long Term Exposure to PM and MortalityExposure to PM and Mortality
Harvard Six-Cities Adult CohortHarvard Six-Cities Adult Cohort
• Purpose was to study the association between pulmonary changes and long term exposure to sulfates and sulfur dioxide
• Enrollment 1974 – 19778,111 white men and women About 1,300 in each of six citiesAge range 25 to 74 years
• Followed until 1991 (now 1999)14 to 17 years of follow-up111,076 person-years1,430 death
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Dockery et al., 1993
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Particle Pollution Affects the LungsParticle Pollution Affects the Lungs
You are exposed to particle pollution simply by breathing polluted air.
Exposure increases when you exercise, because you breathe more vigorously and deeply than usual.
Respiratory effects include:
• airway irritation
• cough
• phlegm
• decreased lung function
• airway inflammation
• asthma attacks
• bronchitis
• chronic bronchitis
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And Particle Pollution Affects the HeartAnd Particle Pollution Affects the Heart
Particle pollution has been linked to changes that indicate your heart isn’t as healthy as it should be. Those include:
• Arrhythmias and changes in heart rate.
• Changes in the variability of your heart rate.
• Blood component changes
•C-reactive protein
•Fibrinogen
•Plasma viscosity
•Some studies indicate that particle exposure may cause heart attacks. And particles are linked with death from heart disease.
Particle exposure has been linked to heart attacks.
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It’s a Public Health ConcernIt’s a Public Health Concern
• When particles aggravate heart and lung diseases that means increases in:
Hospital admissions Doctor and emergency room visits Medication use Absences from work or school
• Particulate matter is linked to significant public health risks – including premature death from heart and lung disease.
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Living Within 300 Meters of Local Living Within 300 Meters of Local Roadways Affects FEVRoadways Affects FEV11
Brunekreef et al., 1997
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CHS: Low FEVCHS: Low FEV11 at Age 18 vs. at Age 18 vs.
PollutionPollution
Gauderman et al., 2004Gauderman et al., 2004
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Particles Trigger Heart AttacksParticles Trigger Heart AttacksO
dds
Rat
ios
Hours before onset of MI
0 1 2 3 4 5
1.6
1.4
1.2
1.0
0.8
Days before onset of MI
0 1 2 3 4 5
1.6
1.4
1.2
1.0
0.8
Odd
s R
atio
s
Peters et al., 2001
772 MI patients who survived 24 hours and completed interview
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PM May Cause Effects in Healthy PeoplePM May Cause Effects in Healthy People
*
*
SDNN PNN50 LF HF Total Ratio0
1
2
3
4
Air
CAPS
Rat
io C
AP
S /
Pre
**
*
2.9 47.2 107.8 206.70
50
100
150
PM
Ns
(x
10
,00
0)
Average CAPS Concentration (/m3)
Devlin et al., 2003Ghio et al., 2003
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Mechanisms of PM effects on the Mechanisms of PM effects on the cardiovascular systemcardiovascular system
Ambient PM
Clotting Factors
Viscosity
Pulmonary Inflammation
Systemic Inflammation
Endothelial CellDysfunction
PlateletActivation
Thrombosis
Plaque Rupture
Pulmonary ReflexesPulmonary Reflexes
Autonomic NervousSystem
Cardiac Rhythm
CardiacDisruption
Heart Rate
Conduction/Repolarization
SuddenCardiacDeath
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Can We Link PM Effects with Specific Can We Link PM Effects with Specific Sources of Pollution?Sources of Pollution?
% In
crea
se in
Dai
ly D
eath
s-5
0
5
10
15
Crustal Coal Traffic Fuel Oil
*
*
0%
20%
40%
60%
80%
100%
Bosto
nSt L
ouis
Knoxv
illePor
tage
Steube
nville
Tope
ka
ResidualMnSaltMetalsFuel OilCoalMobileCrustal
Laden et al., 2000
Speciation monitoring of airsheds of differing composition may enable identification of components, and sources of those components, that contribute to adverse health outcomes
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The Utah ValleyThe Utah Valley
0
25
50
75
100
125
150
1985 1986 1987 1988
Steel Mill Closed
PM
(g
/m3 )
0
20
40
60
80
1985 1986 1987 1988
Steel Mill Closed
Mo
nth
ly A
sth
ma
Ad
mis
sio
ns
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Sensitive Groups for PMSensitive Groups for PM
• People with heart disease
• People with lung disease
• Older adults
• Children
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Air Quality IndexAir Quality IndexDescriptors 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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t
Est
ima
ted
Mo
rta
lity
0 5 10 15 20 25 30 35 40 45 50 55 60 65 70 75
24-Hr PM-2.5 Concentrations (µg/m3)
Nu
mb
er
of D
ays
0 5 10 15 20 25 30 35 40 45 50 55 60 65 70 75
24-Hr PM2.5 Concentrations (µg/m3)
Majority of risk from days with low-to mid-range concentrations, not peak concentrations
Typical PM2.5 distribution
Typical concentration-response relationship
Typical risk distribution
PM Risk AssessmentPM Risk Assessment
Mortality risk; Schwartz, 1993
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Use AQI to Reduce RiskUse AQI to Reduce Risk
Dose = Concentration x Ventilation Rate x Time• Reduce these factors to reduce dose• Pay attention to symptoms• People with asthma – follow asthma action
plan• Coaches – rotate players frequently• People with heart disease – check with your
doctor
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AIRNowAIRNow - www.airnow.gov - www.airnow.gov
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Web Page for Health Care ProvidersWeb Page for Health Care Providerswww.airnow.gov/health-profwww.airnow.gov/health-prof
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Ozone Web Course Ozone Web Course for Health Care Providersfor Health Care Providers
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MedicalMedicalPosterPoster
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Asthma FactsheetAsthma Factsheet
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Particle Pollution and Your HealthParticle Pollution and Your Health
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Review Process for NAAQSReview Process for NAAQS
Scientific studies on health and environmental effects
EPA Criteria Document
EPA Staff Paper
Scientific peer review of published studies
Reviews by CASAC and the public
Reviews by CASAC and the public
Public hearings and comments on proposals
Proposed decision
Final decision
PM NAAQS
Ozone NAAQS
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Timeline for NAAQS ReviewsTimeline for NAAQS Reviews
• Under a consent agreement for the PM and Ozone Reviews– PM Milestones
• Proposed decision - December 20, 2005• Final decision - September 27, 2006
– Ozone Milestones• February 2006 – final Criteria Document• October 2006 - final Staff Paper• March 2007 – proposed decision for public comment• December 2007 – final decision
– Technology Transfer Network (TTN) for NAAQS review documents: http://www.epa.gov/ttn/naaqs/