Transcript Air Quality and Your Health Susan Lyon Stone Clean Air Partners August 29, 2006 [email protected].

Air Quality and Your Health
Susan Lyon Stone
Clean Air Partners
August 29, 2006
[email protected]
Human Lung
• Air conducting
– Trachea
– Bronchi
– Bronchioles
• Gas exchange
– Respiratory
bronchioles
– Alveoli
Ozone Irritates Airways
• Symptoms
– Cough
– Sore or scratchy throat
– Pain with deep breath
– Fatigue
• Rapid onset
• Similar symptoms - people with and
without asthma
FEV1, % CHANGE
Ozone Reduces Lung Function
0
-20
-40
-60
BASELINE
M-10
2HR
4HR
M-1c
Ozone 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
Respiratory Admissions
Respiratory Hospital Admissions by
Daily Maximum Ozone Level, Lagged
(Burnett et al, 1994)
One Day
D-8a
114
112
110
108
106
104
102
.01 .02 .03 .04 .05 .06 .07 .08 .09 .1
Ozone concentration (ppm)
California Children’s Health Study
CHS: 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)
CHS: Ozone and New-onset Asthma
McConnell at al., 2002
New Evidence from Current Review of
Ozone 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
New Evidence from Current Review of
Ozone Standard
•
•
•
•
Hospital admissions
Emergency room visits
School absences
Increased symptoms and medication
use in asthmatic children
New Evidence from Current Review of
Ozone Standard - Mortality
• 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
Sensitive Groups for Ozone
•
•
•
•
People with lung disease
Children
Older adults
People who are active outdoors
Air Pollution Disasters
Donora, PA at noon on
Oct. 29, 1948
London buses are escorted by
lantern at 10:30 in the morning
Particle pollution is
a complex mixture
derived from
many sources
Particle 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
Association Between Long Term
Exposure to PM and Mortality
Harvard Six-Cities Adult Cohort
•
•
•
Purpose was to study the association
between pulmonary changes and long term
exposure to sulfates and sulfur dioxide
Enrollment 1974 – 1977
8,111 white men and women
About 1,300 in each of six cities
Age range 25 to 74 years
Followed until 1991 (now 1999)
14 to 17 years of follow-up
111,076 person-years
1,430 death
i
i
i
i
i
i
Dockery et al., 1993
Particle 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
And 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.
It’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.
Living Within 300 Meters of Local
Roadways Affects FEV1
Brunekreef et al., 1997
CHS: Low FEV1 at Age 18 vs.
Pollution
Gauderman et al., 2004
Particles Trigger Heart Attacks
1.6
1.6
1.4
1.4
Odds Ratios
Odds Ratios
772 MI patients who survived 24 hours
and completed interview
1.2
1.0
0.8
1.2
1.0
0
1
2
3
4
0.8
5
Hours before onset of MI
Peters et al., 2001
0
1
2
3
4
Days before onset of MI
5
150
*
100
*
50
*
0
2.9
47.2
107.8
206.7
Average CAPS Concentration (m/m3)
4
Air
Ratio CAPS / Pre
PMNs (x10,000)
PM May Cause Effects in Healthy People
3
CAPS
2
*
1
*
0
SDNN PNN50 LF
Ghio et al., 2003
HF
Total
Devlin et al., 2003
Ratio
Mechanisms of PM effects on the
cardiovascular system
Ambient PM
Pulmonary Reflexes
Pulmonary Inflammation
Autonomic Nervous
System
Systemic Inflammation
Endothelial Cell
Dysfunction
Conduction/Repolarization
Heart Rate
Cardiac Rhythm
Cardiac
Disruption
Platelet
Activation
Clotting
Factors
Plaque Rupture
Sudden
Cardiac
Death
Thrombosis
Viscosity
Can We Link PM Effects with Specific
Sources of Pollution?
Speciation monitoring of airsheds of differing
composition may enable identification of
components, and sources of those components, that
contribute to adverse health outcomes
100%
80%
60%
40%
20%
0%
% Increase in Daily Deaths
Residual
Mn
Salt
Metals
Fuel Oil
Coal
Mobile
Crustal
15
10
*
5
*
0
-5
Crustal Coal Traffic Fuel Oil
Laden et al., 2000
Monthly Asthma Admissions
The Utah Valley
150
Steel Mill Closed
PM (mg/m3)
125
100
75
50
25
0
1985
1986
1987
1988
80
Steel Mill Closed
60
40
20
0
1985 1986
1987
1988
Sensitive Groups for PM
•
•
•
•
People with heart disease
People with lung disease
Older adults
Children
Air Quality Index
Descriptors
Cautionary Statement
Good
No message
0 – 50
Moderate
51 – 100
Unhealthy for
Sensitive Groups
101 - 150
Unhealthy
151 - 200
Very Unhealthy
201 - 300
Unusually sensitive individuals
Identifiable groups at risk - different groups
for different pollutants
General public at risk; sensitive groups at
greater risk
General public at greater risk; sensitive
groups at greatest risk
Number of Days
0
5
10
15
20
25
30
35
40
45
50
55
60
65
70
75
24-Hr PM2.5 Concentrations (µg/m3)
t
Typical concentrationresponse
relationship
A. Birmingham, AL
Estimated Mortality
PM Risk Assessment
Typical PM2.5 distribution
5
10 15 20 25 30 35 40 45 50 55 60 65
B. 0Cincinnati,
OH
24-Hr PM-2.5 Concentrations (µg/m3)
70
1.10
1.15
Typical risk distribution
1.10
1.05
1.05
1.00
1.00
20
40
60 80 100 120 140
PM 10
Mortality risk; Schwartz, 1993
20
Majority of risk from days with
low-to mid-range concentrations,
40 60 80 100 120 140
not peak concentrations
Total Suspended Particulates
75
Use 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
AIRNow - www.airnow.gov
Web Page for Health Care Providers
www.airnow.gov/health-prof
Ozone Web Course
for Health Care Providers
Medical
Poster
Asthma Factsheet
Particle Pollution and Your Health
Review Process for NAAQS
Ozone NAAQS
Scientific studies on
health and
environmental effects
Scientific peer review
of published studies
EPA Criteria
Document
Reviews by CASAC
and the public
EPA Staff Paper
Reviews by CASAC
and the public
PM
NAAQS
Final
decision
Public hearings and
comments on
proposals
Proposed
decision
Timeline 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/