CPH601 Chapter 5 Air. University of Kentucky. From the SelectedWorks of David M. Mannino. David M. Mannino

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1 University of Kentucky From the SelectedWorks of David M. Mannino 2013 CPH601 Chapter 5 Air David M. Mannino Available at:

2 Air Pollution (Outdoor and Indoor) David M. Mannino, M.D. Director, Pulmonary Epidemiology Research Laboratory Department of Preventive Medicine and Environmental Health Division of Pulmonary and Critical Care Medicine University of Kentucky, College of Medicine

3 Exposure and Health Effects Volume of Space Ventilation Removal Concentration Exposure of Individual Breathing Rate Airway Geometry Susceptibility Factors: Age, Underlying Disease Metabolism Elimination Dose Source Health Effects Biologically Effective Dose Jaakkola et al, Eur Resp J 1997; 10:

4 Historic Air Pollution Episodes 1) Meuse Valley, Belgium ) Donora, Pennsylvania ) London, England 1952 These episodes provided the impetus for regulations to reduce emissions, and associated air quality improvements.

5 Common Features of these Pollution Episodes Temperature inversions Confining topography (in two of three episodes)

6 Historic Air Pollution Episodes Meuse Valley, Belgium, December 1-5, 1930 Narrow river valley Temperature inversion to 90 m Elderly and those with heart and lung disease most affected 63 deaths on Dec. 4-5 Specific pollutants were not identified Meuse Valley on a Clear Day

7 Historic Air Pollution Episodes Donora, Pennsylvania, October 25-31, 1948 Temperature inversion Narrow river valley 20 deaths on Oct. 30 Specific pollutants were not identified not identified Donora, 1948 October 29th, 12:00 noon

8 Historic Air Pollution Episodes London, England, December 5-9, 1952 Temperature Inversion to 90m Pollutants measured at 12 locations Ambient particulates measured to be 5 times higher than normal London, 1952 Police officer escorting a bus through smog at 10:30 am.

9 Average Weekly Number of Deaths, London England, November-December, 1951 and 1952 Deaths SO 2 12/6-12/13 12/14-12/21 12/22-12/ SO 2, PPM Deaths SO 2, PPM SO 2 12/6-12/13 12/14-12/21 12/22-12/

10 Ambient/Outdoor Air Pollution

12 Criteria Air Pollutants Ozone Particulate Matter Carbon Monoxide Sulfur Dioxide Nitrogen Oxides Lead

14 Primary Air Pollutants Sulfur Dioxide Carbon Monoxide Particulate Matter Nitrogen Oxides Lead

15 Ozone Secondary Air Pollutants VOC + NOx + Heat + Sunlight = Ozone Some Particulate Matter

17 Ozone Can irritate lung airways and cause inflammation much like a sunburn. wheezing, coughing, pain when taking a deep breath, and breathing difficulties during exercise or outdoor activities. Repeated exposure to ozone pollution for several months may cause permanent lung damage. Anyone who spends time outdoors in the summer is at risk, particularly children and other people who are active outdoors. National standard: ppm (4th highest 8-hour daily maximum) (averaged over 3 years)

18 Ozone EPA, 2012, Health Risk and Exposure Assessment for Ozone (First External Review Draft)

19 Good versus Bad Ozone Good Bad

20 Ozone Levels in Northeast US

21 Ozone levels in Augusta

22 3-year average of the annual 4th highest daily maximum 8-hour O3 concentration

23 4th Highest 8 hour O3 Level, annually

24 Ozone Data

25 Particulate Matter Associated with increased hospital admissions and emergency room visits for people with heart and lung disease. aggravates asthma increases in respiratory symptoms like coughing and difficult or painful breathing chronic bronchitis decreased lung function premature death, especially due to cardiovascular effects non-fatal cardiovascular events Settles on soil and water and harms the environment by changing the nutrient and chemical balance. Causes erosion and staining of structures

26 Particulate Matter Direct Formation Indirect Formation

27 Particular Matter PM10 (larger/coarse particulates) carbon-containing material produced from combustion National standard: 150 µg/m3 (24-hour, not to be exceeded more than once per year on average over 3 years) PM2.5 (fine particulates) tend to be uniformly distributed water and acid-forming chemicals, e.g. sulfate nitrate, and trace medals National standards: 12.0 µg/m3 (annual mean, 3-year average, effective March 18, 2013); 35.0 ppm (24-hour, 98th percentile, 3-year average)

30 Smoke as an Air Pollutant PM 10 Le evel Cotinine Level

31 PM10 Why Particulates Matter? Increase in Daily Mortality % change per 10 µg/m3 increase in Total deaths 1.0 % Respiratory Deaths 3.4 % Cardiovascular deaths 1.4 % Increases in Respiratory Symptom Reports Lower respiratory 3.0 % Upper respiratory 0.7 % Cough 1.2 % Source: (Dockery and Pope, 1994)

32 PM2.5 Why Particulates Matter? Increase in Daily Mortality % change per 10 µg/m3 increase in Total Deaths 1.21% (95% CI 0.29, 2.14%) Respiratory Deaths 1.78% (95% CI 0.20, 3.36%) Cardiovascular Deaths 0.94% (95% CI -0.14, 2.02%) Stroke Deaths 1.03% (95% CI 0.02, 2.04%) Source: (Franklin, Zeka, and Schwartz, 2007)

33 Why Particulates Matter? Source: (Dominici, Peng, Bell, Pham, McDermott, Zeger, and Samet, 2006)

35 Figure 15. Annual Average and 24-hour (98 th percentile of 24 hour concentrations) PM2.5 concentrations in ug/m 3, 2008

37 Average Annual PM10 Level

40 Possible Interactions Pollutants can have an additive or synergistic effect PM and sulfur dioxide, sulfates and nitrogen dioxide chronic exposure to SO2 causes mucus hyper-secretion and airway narrowing a thicker protective mucus barrier and potentially make it more likely that co-exposure to particles would involve more central deposition and more rapid clearance PM and Ozone Ozone (increase lung permeability and bronchial hyperresponsiveness) - combined exposure with PM expected a more than additive effect Several animal studies with PM show an increase in response with co-exposure to ozone Pre-exposure to ozone could up-regulate antioxidant enzymes and thus partially protect against oxidative injury elicited by PM PM (especially diesel particles) and allergens PM and gases (alter gas composition and hence toxicity)

41 Carbon Monoxide Low Concentration Fatigue (healthy people) Chest pain (people with heart disease) High Concentration Impaired vision and coordination Headaches Dizziness Confusion Nausea Flu-like symptoms that clear up after leaving home Can affect the central nervous system. Fatal at very high concentrations. Acute effects are due to the formation of carboxyhemoglobin in the blood, which inhibits oxygen intake. National standards: 9 ppm (1-hour) and 35 ppm (8-hours) (Not to be exceeded more than once per year)

42 Sources of Carbon Monoxide

43 2nd maximum non-overlapping 8-hour average CO

44 Carbon Monoxide-Related Mortality Over Time

45 Effect of Oxy-fuels on Ambient Carbon Monoxide Levels

46 Sulfur Oxides Can cause temporary breathing difficulty especially for people with asthma and aggravate existing heart disease. Reacts with other chemicals in the air to form tiny sulfate particles increased respiratory symptoms and disease, difficulty in breathing, and premature death. Sulfate particles are the major cause of reduced visibility in many parts of the U.S. SO 2 and nitrogen oxides react with other substances in the air to form acids, which fall to earth as rain, fog, snow, or dry particles. National standards (SO 2 ): 75 ppb (1-hour) (99th percentile of 1- hour daily maximum concentrations, averaged over 3 years)

47 Sources of Sulfur Oxides

48 Average Annual SO 2 Level

49 Nitrogen Oxides One of the main ingredients involved in the formation of ground-level ozone, ozone can trigger serious respiratory problems. Reacts to form nitrate particles, acid aerosols, as well as NO 2 causing respiratory problems. Contribute to formation of acid rain. Contribute to atmospheric particles visibility impairment most noticeable in national parks. Contributes to global warming National standard: 100 ppb (1-hour) (98th percentile, averaged over 3 years); 53 ppb (Annual) (Annual Mean)

50 Sources of Nitrogen Oxides

51 Average Annual NO 2 Level

52 Lead Causes damage to the kidneys, liver, brain and nerves, and may also lead to osteoporosis (brittle bone disease) and reproductive disorders. Can cause seizures, mental retardation, behavioral disorders, memory problems, and mood changes. Can cause high blood pressure and heart disease, especially in men, and lead to anemia. National standard 0.15 µg/m 3 (Rolling 3 month average) (Not to be exceeded)

53 Trends in Lead Emissions and Sources

54 Average quarterly Lead Level

58 Trends of Common Air Pollutants

60 Changes in Mean Levels of Air Pollutants

61 US Emissions

63 National Ambient Air Quality Standards (NAAQS)

64 Air Quality Index (AQI)

65 Summer

66 Winter

67 Nonattainment Areas

68 Nonattainment Areas

69 AQI Days > 100

70 US Population Living in Nonattainment Areas 2010

71 Changes in Acid Rain Deposition

72 Predicted Changes in Ozone Levels to 2050

73 Other Air Pollution

74 Hazardous Air Pollutants Volatile Organic Compounds (VOCs) Metals Aldehydes Semivolatile Organic Compounds (SVOCs) Diesel Exhaust 188 total

76 Toxic Air Pollutants

77 Greenhouse Gas Emissions

78 Visibility

79 Air Pollution Interventions Source control (reduce emissions) Most effective intervention KEY Emission Standards Bubble Concept reducing emission results in new emission Administrative mechanism Ensure compliance PPE Masks? (not shown to be effective) Education Go inside (clean rooms used in some events) Cleaner transportation (buses, subways, bikes) Public surveillance Natural air pollutions Pray for rain (in forest fires)

80 Indoor Air Pollution

81 Indoor Air Pollution In developed world- 90+ % of time is spent indoors Exposures to smoke, chemicals, solvents, mold, allergens, radon, etc. In developing world, less time spent indoors but exposures can be much higher Biomass smoke used for heating/cooking

82 Smoke as an Air Pollutant PM 10 Le evel Cotinine Level

83 Spousal smoking and lung cancer: men RR (95% CI) in lifelong nonsmokers smoking vs nonsmoking spouse Relative ris sk % Increase Case control studies 1 Correa et al. (1983) 2 Buffler et al. (1984) 3 Kabat et al. (1984) 4 Akiba et al. (1986) 5 Lee et al. (1986) 6 Jockel (1991) 7 Kabat et al. (1995) Cohort studies 8 Hirayama et al. (1984) 9 Cardenas et al. (1997) All pooled Hackshaw et al. BMJ 315:980-88; From the Johns Hopkins SPH Smoking and Health Resource Kit

84 Pollutant Levels in Bars Repace. JOEM 2004;46:

85 Pollutant Levels in Bars Repace. JOEM 2004;46:

86 Adults Asthma Emergency Department Visits in Lexington From Ellen Hahn Mannino 2/21/2008 Slide # 85

87 Biomass Fuel and COPD in China Liu et al, Thorax 2007;62: Mannino 2/21/2008 Slide # 86

88 Formaldehyde (FA) exposure and lower respiratory tract infections in infants in Paris, France Source: Célina Roda. et. al., 2011

Health Effects Associated with Stack Chemical Emissions from NYS Natural Gas Compressor Stations:

Health Effects Associated with Stack Chemical Emissions from NYS Natural Gas Compressor Stations: 2008-2014 A Technical Report Prepared for the Southwest Pennsylvania Environmental Health Project D.O.