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Health Impacts of Polluted Air. Paul T. Kubic, M.D. Children’s Respiratory & Critical Care Specialists, P.A. Air Pollution. Definition: Polluere L.-to defile Lutum L.-mud Lytem GK.-dirt Acute—911, volcanoes, etc. Chronic exposure—particulates, chemicals, biologicals

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health impacts of polluted air

Health Impacts of Polluted Air

Paul T. Kubic, M.D.

Children’s Respiratory &

Critical Care Specialists, P.A.

air pollution
Air Pollution
  • Definition:
    • PolluereL.-to defile
    • Lutum L.-mud
    • Lytem GK.-dirt
  • Acute—911, volcanoes, etc.
  • Chronic exposure—particulates, chemicals, biologicals
  • Particulate matter—NOx, ozone, carbon monoxide, CO2, sulfur dioxide, lead, etc.
  • Particles deposit in airway and air sacs (alveoli) – changes occur acutely and over time
air pollution size matters
Air Pollution—Size Matters
  • Large particles deposit in airways
  • Small particles effect air sacs
  • Nanoparticles – new field
susceptible individuals
Susceptible Individuals
  • Prenatal and infant exposure
  • Healthy children and adults
  • Pre-existing conditions—asthma, other airway disease, COPD, cardiovascular disease.
  • Elderly patients
  • Pregnant women
pollution effects on pulmonary health
Pollution Effects on Pulmonary Health
  • Pulmonary function test data
  • Mortality and morbidity
  • Air pollution inordinately effects those with pulmonary and cardiac disease
  • Controlled exposure data
air pollution and disease causation
Air Pollution and Disease Causation
  • Proof of causation is difficult
  • Temporal relationship, repetition, dose dependence, scientific plausibility
  • Asthma – strong evidence
  • Cardiovascular disease – good evidence
  • COPD – less evidence
pollution effects on pre existing pulmonary patients
Pollution Effects on Pre-existing Pulmonary Patients
  • Pulmonary function test data
  • Morbidity and mortality data
  • Asthma and COPD - ↑ ED, hospital visits and medication use with ↑ pollution
  • ↑ BA and COPD death significantly associated with pollution levels
scientific mechanisms air pollution and respiratory disease
Scientific Mechanisms: Air Pollution and Respiratory Disease
  • Airway and alveolar inflammation and injury occur
  • Pollution alters immune status—innate and adaptive immunity
  • Sensitive populations—(genetic susceptibility) less able to self-protect
  • Susceptibility genes—antioxidants, innate and adaptive immune abnormalities
  • Experimental evidence—mouse model
  • Complex issue, good evidentiary base
air pollution effects in cardiac patients
Air Pollution Effects in Cardiac Patients
  • Coronary artery disease, heart failure, heart rhythm abnormalities
  • Air pollution associated with increased heart attacks, heart failure, ED and hospital visits
  • Increased biomarkers of atherosclerosis
  • Association with vehicular and diesel particulate matter and gases, residence near roadways
  • Air pollution as cause of heart disease in healthy patients problematic
scientific mechanisms air pollution and cardiac disease
Scientific Mechanisms: Air Pollution and Cardiac Disease
  • Cardiac muscle inflammation—CRP, IL6
  • Oxidative stress and injury
  • Increased heart rate and EKG changes with higher pollution
  • Increased atherosclerosis—carotid artery studies
  • Very impressive evidentiary base
air pollution health and epigenetics
Air Pollution, Health, and Epigenetics
  • Epigenetics—functional change in genetic expression—no mutation
  • Epigenetic changes inherited—grandparent to grandchild
  • Air pollutants chemically alter DNA and associated proteins (histones, etc.)
  • Results of DNA change—increased inflammatory mediators, decreased protective molecules
  • Airway, alveolar damage, changes in heart muscle cells
air pollution in children a special case
Air Pollution in Children: A Special Case
  • Increased outdoor time and activity
  • Higher respiratory rate and volume of air in and out of lungs
  • Immature immune system
  • Airways and alveoli (air sacs) still developing
  • Lung tissue changes may be both current and persistent
intervention improving air quality
Intervention: Improving Air Quality
  • Air quality change in polluted communities—improves health, especially in patients with BA, CVD
  • Movement from polluted to nonpolluted communities—improves health
  • Follow-up data—decreased symptoms, hospital and emergency visits
  • Change improves health—intervention is effective
  • Air pollution alters health
  • Air pollution disproportionately affects children
  • Air pollution exacerbates pulmonary and cardiovascular disease
  • Air pollution may be a causative factor in pulmonary and cardiac disease
  • Altering air pollution improves health
  • Brook, R.D. etal Particulates air pollution and cardiovascular disease. Circulation 2010; 121:2331-78.
  • Ho, S.M. Environmental epigenetics of asthma. J Allergy ClinImmunol 2010; 126:453-65.
  • Patel, P., Miller, R. Air pollution and childhood asthma. Current Opinions in Pediatrics 2009; 21:235-242.
  • Ko, F.W.S., Hui, D.S.C. Effect of air pollution on lung health. Amer Family Physician 2010; 81:175-81.