AIR & HUMAN HEALTH

Department of Public HealthFaculty of Medicine - Padjadjaran

UniversityBandung

Learning Objective To describe the importance of air

quality as a determinant of health To describe the nature & extent of air

pollution-related diseases To list the major sources of air pollution To describe how air quality criteria are

developed To discuss the various approaches to

prevention of air-related environmental health problems

Anthropogenic emissions of air pollutant(Source: UNEP, 1992)

0 20 40 60 80 100 120 140 160 180 200

OECD countries Rest of world

CO

SPM

NOx

SOx

1970

1980

1990

1970

1980

1990

1970

1980

1990

1970

1980

1990

Emissions (million tons/year)

The accumulation of active compounds in atmosphere

Affected by: Land features

- valleys- nearby mountain ranges- the lack of open space

Atmospheric movements (e.g. stagnant air)

View of Bandung (from North) - 1

View of Bandung (from North) - 2

Aerosols Small solid or liquid particles (fine drops or

droplets) that are suspended in air form a mixture

Dust: particles in the solid phase Up in the air: suspended particulate matter (SPM)Smoke: particles in both solid & sometimes liquid phase &

the associated gases that result from combustionAsh: the solid phase of smoke, particularly after it settles

into a fine dustFumes: polydispersed fine aerosols consisting of solid

particles that often aggregate togetherFibers: longer & thinner particlesDroplets: liquid-phase particlesMist: a cloud or dense collection of droplets

The most important characteristics

Aerosols: Size (& shape) CompositionGases: Water solubility Chemical reactivity

0.00050.001

0.0050.01

0.050.1

0.51

510

50100

5001000

Oil smoke Fly ash

Tobacco smoke

Pollens

Bacteria

TobaccoMosaicvirus

Insecticide dusts Plant spores

Pulverized coal

Cement dust

Sulfuric acid mist

Flour mill dust

Foundry dustAmmonium chloride fumes

Smelter dust & fumes

Metallurgical dust & fumes

Particle size (m)

Type

s of

Par

ticle

Dep

osite

d

Range of particle diameters from airborne dusts & fumes

Aerodynamic diameter the diameter of a sphere w/ a density of 1

100 m

20 m

10 m

2.5 m

0.1 m

inhalable fraction

thoracic fraction

coarse particles

fine particles

ultrafine particles

nasal cavity

trachea

respirable range

The degree to which particles enter the blood, are circulated & delivered to the body’s tissues depends on:

The concentration inhaled Duration of exposure Solubility in blood & tissue Reactivity of the compound Respiratory rate

Asphyxiants

Simple asphyxiants Substances that dilute or displace the oxygen in air

without any other effect

e.g. carbon dioxide, nitrous oxide, nitrogen, hydrocarbons

Chemical asphyxiants Substances that block the transfer of oxygen to the

tissues or the utilization of oxygen once it reaches the tissues

e.g. carbon monoxide, hydrogen cyanide

Common conditions to which air pollution exposure may contribute

Disease or condition How air pollution may affect condition Associated factors/comments

Acute bronchitisDirect irritative effects of SO2, soot, & petrochemical pollution

Cigarette smoking may have a more than additive interaction

Acute respiratory infections Increased risk in young children Poverty, malnutrition, exposure to infectious agents

Asthma Aggravation from respiratory irritation, possibly on reflex basis

Usually pre-existing respiratory allergy or airway hyperreactivity

Chronic bronchitisAggravation (increase in frequency or severity) of cough or sputum associated with any sort of pollution

Cigarette smoking, occupation

Deaths Fine particulate increases mortality in heart & lung disease; mechanism is unknown Pre-existing hearth & lung disease

Eye irritation

Specific effect of photochemical oxidants, possibly aldehydes, or peroxyacetyl nitrates, particulate matter (fly ash) acts as a foreign body

Susceptibility differs

Headache Carbon monoxide sufficient to lead to more than 10% carboxyhemoglobin

Smoking may also increase carboxyhemoglobin, but not enough to lead to headache

Lead toxicity Adds to body burden Close proximity to lead source, exposure at home

Health effects of specific pollutants

Ozone Highly reactive & unstable compound Symptoms of exposure: nasal discharge, throat

irritation, cough, wheeze, chest pain, headache, fatigue Short period: effects are cumulative After several days: people become tolerant, their

breathing becomes more normal, but persons with asthma may still develop airflow obstruction. Persons whose asthma is triggered by allergies more susceptible to the allergen.

Sulfur Dioxide Major components of the London Fog Main effect: bronchoconstriction Persons with asthma: susceptible & suffer more than

the general public Capable of froming acid, causing acid rain Can be deeply deposited in the distal lung & air space Combine with ozone: appear to provoke airways

responses in an additive or synergistic manner

Oxides of Nitrogen NO: produced by combustion NO2: created by the oxidation of NO under conditions of

sunlight, or formed directly by higher temperature combustion in power plants or indoors from gas stoves

The full effects of NO2 not known In animals: cancerous metastases from the lung much

more likely to appear elsewhere in the body, although NO2 itself does not cause cancer

Potential human effects of nitrogen dioxide

Health effect Mechanism

Increased incidence of respiratory infection

Reduced effectiveness of lung defenses

Increased severity of respiratory infections

Reduced effectiveness of lung defenses

Respiratory symptoms Airways injury & bronchospasm

Reduced lung function Airways & possible alveolar injury

Worsening of the clinical status of persons w/ asthma, COPD, or other chronic respiratory conditions

Airways injury & reduced effectiveness of host defences

Particles Assoc. w/ an elevated risk of mortality & morbidity, esp. among

asthmatic & elderly Larger particles included in PM10 consist mostly of carbon-

containing material & produced from combustion, some produced by wind blowing soil into the air. The larger particulates: not seem to have as much effect on human health as the smaller particulates

Particulates in the fraction PM2.5 contain a proportionately larger amount of water & acid-forming chemicals

PM2.5, CO, sulfate & ozone cannot be easily separated b/c they tend to occur together in urban air pollution. PM2.5 & sulfate (& probably ozone): assoc. w/ an increase higher rates of deaths from & complaints about lung & heart diseases, but not yet known which is the predominant factor

Carbon monoxide Produced mainly by the incomplete burning of fossil fuels Odorless, colorless, & slightly heavier than air, tends to

collect in confined spaces As CO concentrations go up, the oxygen-carrying

capacity of the blood goes down. The CO molecule’s bond to hemoglobin is 200-300 times stronger than the hemoglobin-oxygen bond

Normal amounts in the blood: + 1%. Smokers: + 3 - 5% Low levels of exposure: fatigue, headaches, dizziness; 3-

5%: impaired vision, disturbed coordination, nausea, or death

Human health effects assoc. w/ low-level CO exposure: lowest observed adverse effect levels

COHb Concentration (%) Effects

2.3 – 4.3 Statistically significant decrease (3 – 7%) in the relation b/w work time & exhaustion in exercising young, healthy men

2.9 – 4.5Statistically significant decrease in exercise capacity (i.e., shortened duration of exercise before onset of pain) in patients w/ angina & increase in duration of angina attacks

5 – 5.5 Statistically significant decrease in maximal oxygen consumption & exercise time in young, healthy men during strenuous exercise

< 5.0 No statistically significant vigilance decrements after exposure to carbon monoxide

5.0 – 7.6 Statistically significant impairment of vigilance tasks in healthy experimental subjects

5.0 – 17.0 Statistically significant diminution of visual perception, manual dexterity, ability to learn, or performance in complex sensorimotor tasks (e.g., driving)

7.0 – 20.0 Statistically significant decrease in maximal oxygen consumption during strenuous exercise in young, healthy men

Maximum permitted CO exposure(WHO, 1987)

100 mg/m3 for < 15 min 60 mg/m3 (50 ppm) for < 30 min 30 mg/m3 (25 ppm) for < 60 min 10 mg/m3 (9 ppm) for 8 hr

Volatile Organic Compounds (VOC)

Among other compounds, include benzene, chloroform, methanol, carbon tetrachloride, & formaldehyde

May originate from household products, e.g. painting supplies, dry cleaning establishments, refineries, gasoline stations

Can cause irritation to the respiratory tract, headaches & other non-specific complaints

At high concentrations: toxic effects

Industrial Air PollutionTypes: Reducing air pollution

Caused by the emissions of SO2 & particulates, substances that are chemical reducing agents in the atmosphere

Photochemical air pollutionResults from complicated chemical reactions in the atmosphere that are driven by the energy in sunlight

Point-source emissionsAffects the immediate vicinity of the plant but does not usually involve atmospheric reactions to any great extent

Effective control of industrial & urban air pollution requires: Identifying & measuring the pollutants

that are most responsible for the problem Reducing or preventing their emissions at

the source

To set targets for the control of air pollution

to set standards or guidelines

Standard: a set of laws or regulations that limit allowable emissions or that do not permit degradation (deterioration) of air quality beyond a certain limit

Standards may take form as: Ambient air quality standards

Levels of general air quality in the region that the jurisdiction responsible cannot allow to be exceeded

Emissions standardsSet the amount of pollution that is allowed to come from a particular source

Air Quality Standards, US, 1989

Pollutant

Primary Standards

Average Time Health Effects

CO9 ppm (10 mg/m3)35 ppm (40 mg/m3)

8 hr1 hr

Aggravation of coronary artery disease

Lead 1.5 g/m3 Quarterly average Development effects on children

NO2 0.053 ppm (100 g/m3) Annual (arithmetic mean Increased respiratory infections, risk of acute lung disease

Ozone 0.12 ppm (235 g/m3) 1 hr Decrements in lung function, possibly chronic lung disease

PM10

150 g/m3

50 g/m3

24 hrAnnual (arithmetic mean)

Chronic respiratory disease, altered lung function in children, increased mortality

SO2

0.14 ppm (365 g/m3)0.03 ppm (80 g/m3)

24 hrAnnual (arithmetic mean)

Exacerbation of asthma

WHO Air Quality Guidelines for Europe (Revised 1999)

Compound Guideline Value Averaging Time

CO

100 mg/m3

60 mg/m3

30 mg/m3

10 mg/m3

(90 ppm)(50 ppm)(25 ppm)(10 ppm)

15 min30 min1 hr8 hr

Lead 0.5 g/m3 n.a 1 year

NO2

200 g/m3

40 mg/m3

(0.11 ppm)(0.021 ppm)

1 hrAnnual

Ozone 120 g/m3 (0.06 ppm) 8 hr

Particulate Matter n.a n.a n.a

SO2

500 g/m3

125 g/m3

50 g/m3

(0.174 ppm)(0.044 ppm)0.017 ppm)

10 min24 hrAnnual

n.a. : not applicable

Control of ambient air pollution

Control of emissions Transportation policy Energy policy Policy on placement of facilities

INDOOR AIR POLLUTION Rural people in developing countries may

receive + 2/3 of the global exposure to particulates (women & children: the greatest)

Source: inefficient & smoky fuels burned for cooking & heating

Contaminants: tobacco smoke, radon decay products, formaldehyde, asbestos fibres, combustion products (e.g. NOx, SOx, CO, CO2, & PAHs) & other household chemicals, molds, fungi, viruses, bacteria, algae, pollen, spores, & their derivatives

Sick building syndrome

UDARA DAN KESEHATAN MANUSIA

Definisi : Polutan / PencemaranAdalah sesuatu yang berpengaruh

jelekterhadap lingkungan sehingga

lingkunganmengalami penyimpangan akibatpencemaran

Pencemaran UdaraPencemaran Udara dalam jumlah kecil tidak terasaPencemaran udara dalam jumlah besar,

Lama Manusia akan merasa akibatnya

Biasa untuk mengatasi akibat pencemaran mahal 70% dari udara yang ada di bumi dihasilkan dari proses Foto sintesa, setiap kali manusia bernafas dan menghabiskan 1 Kg O2

BENTUK POLUSI UDARA1. Polusi udara yang berhubungan

dengan setiap orang (Personal Air Polution) Merokok

2. Polusi Udara akibat Pekerjaan (Occupational Air Polution) misal pengaruh uap dan gas

3. Polusi Udara di tempat umum (Community Air Polution) polusi ini paling komplek akibat menyangkut dari berbagai sumber

Beberapa zat kimia dapat menyebabkan polusi udara antara lain :

SO2, H2S, HF, HCl, CO2, NO, NO2, O3 Debu-debu logam : Seng, timah, Arsen,

Silica Debu-debu kapas : debu asbes Tepunsari dan spora tumbuhan Mahkluk hidup : Virus, Bakteri

Sumber Polusi Udara1. Sumber Polusi Udara alamiah

Atmosfer tercemar secara alamiah misal oleh karena

Debu ditiup angin Asap Mikro organisme Kabut Gas dan Bau yang berasal dari rawa-

rawa

Jenis Polutan dari sumber pencemar alamiah antara lain :

SO2 : Gunung apiH2S : Gunung api, reaksi biologis didaerah

rawaCO : Kebakaran hutanNO, NO2 : Reaksi bakteri-bakteri di tanahCH2 : Proses biologisCO2 dan O3 (Ozon)

2. Sumber polusi buatan karena ulah manusia terutama adalah transportasi. 60% dari polutan yang dihasilkan adalah CO. 15% adalah Hidrokarbon

BERBAGAI JENIS POLUTAN YANG PENTING

Polutan udara primer adalah polutan yang

mencakup 90% dari jumlah polutan udara

seluruhnya

TERDAPAT LIMA KELOMPOK POLUTAN PRIMER:

1. Karbonmonoksida (CO)2. Nitrogen Oksida (NOx)3. Hidrocarbon (HC)4. Sulfur Dioxida (SOx)5. Partikel

Toksitas Relatif Polutan

Polutan Toksitas Relatif

COHCSOxNOx

Partikel

1,002.0728,077,8106,7

Konsentrasi COHb - Kesehatan

Konsentrasi COHb dalam darah (%)

Pengaruh Terhadap Kesehatan

<1,0

1.0 – 2,0

2,0 – 5,0

≥ 5

10 - 80

Tidak ada pengaruh

Penampilan agak tidak normal

Pengaruhnya terhadap sistem syaraf sentral reaksi pancaindra tidak normal benda terlihat agak kabur

Perubahan fungsi jantung dan pulmo

Kepala pening, mual, berkunang-kunang, pingsan, sukar bernafas, kematian

Partikel dikelompokan menjadi :1. Debu yang menyebabkan fibrosis

didalam paru-paru ( Silica, Asbes)2. Debu karbon3. Debu yang menimbulkan reaksi

alergis (debu biji-bijian dan debu kayu)

4. Debu yang bersifat iritan : asam alkali

Partikel

Pengaruh partikel / debu pada manusia

Pneumoconiosis, adalah segolongan penyakit kelainan paru-paru yang berupa penimbunan debu

Pengaruh partikel / debu pada manusia

Pneumoconiosis di bagi :1. Silicosis : debu oleh SO2 bebas2. Asbesiosis : debu oleh debu

asbes3. Berryliosis : debu Berrylium4. Byssinosis : debu kapas5. Stanosis : debu biji timah6. Siderosis : debu Fe2O37. Anthracosis : debu Anthrasit

Secara klinis pneumoconiosis tidak dapat dibedakan hanya dapat dilakukan secara radilogi dan pemiriksaan patalogi anatomis