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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.