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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. 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

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  1. Health Impacts of Polluted Air Paul T. Kubic, M.D. Children’s Respiratory & Critical Care Specialists, P.A.

  2. 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

  3. Air Pollution—Size Matters • Large particles deposit in airways • Small particles effect air sacs • Nanoparticles – new field

  4. Susceptible Individuals • Prenatal and infant exposure • Healthy children and adults • Pre-existing conditions—asthma, other airway disease, COPD, cardiovascular disease. • Elderly patients • Pregnant women

  5. 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

  6. 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

  7. 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

  8. 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

  9. 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

  10. 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

  11. 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

  12. 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

  13. 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

  14. Summary • 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

  15. Bibliography • 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.

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