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Air Pollution in the World and in Turkey. Prof. Dr. Fatma Evyapan Pamukkale University School of Medicine. Main topics. Introduction Historical perspective Effects of air pollution on cardiorespiratory morbidity and mortality Air polution in Turkey Concluding remarks. - PowerPoint PPT Presentation
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1
Air Pollution in the World and in Turkey
Prof. Dr. Fatma Evyapan
Pamukkale University School of Medicine
2
Main topics
• Introduction
• Historical perspective
• Effects of air pollution on cardiorespiratory morbidity and mortality
• Air polution in Turkey
• Concluding remarks
3
WHO
Clean air is considered to be a
basic requirement of human health and well-being
WHO
4
Agent Population at risk Clinical consequence
NO2Healthy adults
Asthmatic children
BHR ↑
symptoms ↑,pulmonary infections ↑, PFT ↓
Ozon Healthy children and adults
Asthma COPD vs
PFT↓, BHR↑
Respiratory symptoms↑
Exer cap ↓
Hospitalization ↑
CO Healthy adults
İHD patients
Exercise capacity ↓
Exercise capacity ↓, angina pectoris mortality ↑
SO2Healthy adults
COPD patients
PFT ↓
Resp mortality ↑
Hospitalization ↑ hospital admissions ↑
Acid aerosols
Healthy adults and children
Asthmatic and other pats
Mucocilliary clearance ↓ Pulmonary diseases ↑
PFT ↓, hospitalization ↑
PM10Children
Chronic cardiorespiratory dis
Asthmatic children
Respiratory symptoms ↑pulmonary disorders ↑
PFT ↓
Mortality ↑
Asthma exacerbations ↑
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History
• Throught history man has known that polluted air may be detrimental to health
• Greeks and Romans were aware of the adverse effect of polluted air in, e.g. Crowded cities and mines
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Fatal Air Pollution Episodes
• December 1-4 1930 Meuse Valley, Belgium:– İn 2 days > 60 deaths 10 fold increase
in mortality rate ↑• October 27-30 1940:Pensylvannia
Donnora:– 6 fold increase in mortality rate ↑
• December 5-9 1952 London:– 3000 excess death 3 fold increase in
mortality rate ↑– Mortality rate remained high during first
three months of 1953• Even in 1990s althought below the
national or international standardized limits air pollution still affects cardiorespiratory morbidity and mortality
7
Particulate Air Pollution in the World
8http://www.wunderground.com/health/pollution.asp
9
10
NO2 Pollution in the World
http://www.bnsc.gov.uk/6433.aspx
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Studies of Cardiorespiratory Mortality and Morbidity:
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Air Pollution and Morbidity : North America
City Results Reference
Seattle (1989-1990) PM10↑ >65y HEAasthma↑
PM10 (4) ↑ HEAasthma↑
Scwartz et al Am J Respir Dis 1993:826-831
Birmingham Alabama (1986-1989)
PM10↑ HA COPD↑
PM10↑ HB pneum↑
O3 (2) ↑ HACOPD↑
O3↑ HBpneu↑
Schwartz et al
Am J Epidemiol
1994;139:589-598
Los Angeles (1992-1995) NO2 ↑HAcardiopul↑
PM10 ↑HBcardiopull ↑
CO ↑HBcardiopul ↑
O3 ø HBcardiopul
Linn et al Environ Health Perpect 2000 108:427-434
Anchorage (1992-1995) PM10 ↑ Med adasthma ↑
░ PM10 ↑Medadasthma ↑ ↑
PM10 ↑ Med ad asthma ↑
Chodury et al Arch Environ Health 1997 52:113-117
13
Air Pollution and Mortality North AmericaCity Results Reference
USA 6 cities
Harvard 6 cities study (1979-1988)
PM2,5 earth,heathing,traffic
PM2,5 traffic↑Mortality ↑↑
PM2,5heating↑Mortality↑
Laden F Environ Health Perspect 2000 108:941-947
USA 20 cities PM↑TM↑MCV↑MR↑
☼ O3↑M↑ (☼) ø
CO, SO2,NO2 øM
Samet N Eng J Med
2000 343: 1742-1749
Canada: low level pollution 8 cities
PM2,5↑Mor↑↑
SO4,Fe, Ni, Zn↑ Mortality↑
O3,NO2,CO,SO2,COH øM
Burnett et al Inhal Toxicol 2000 12 (Suppl 4):15-39
Vancouver
1994-1996
☼O3 ↑RM↑KVM↑
NO2 ↑ TM ↑
PM, SO2 CO,COH øM
Vedal et al Environ Health Perspect 2003111 (1):45-51
Mexico City (Meksica)
1994
PM↑TSM↑Mcopd↑
PM↑Melderly non-hospitalized↑↑
Eur Respir J 2000 16:391-396
14
Air Pollution and Mortality: Other RegionsCity Results Reference
Shenyang (Çin)
1992
TSP↑Mkv↑
SO2↑Mcopd↑
Xu et al Arch Environ Health 2000 55:115-120
Beijing SO2 ↑ T M ↑☼
Mcopd ↑
TAP ↑ T M ↑☼
Mcopd
Chen et al Toxicology 2004; 198:: 291-300
Shangai NO2 ↑ M KR ↑
SO2 ↑ M CR ↑
O3 ↑ MCR ↑ ↑
PM10 ↑ MCR ↑ ↑M İCD ↑
Xu et al Arch Environ Health 2000 55:115-120
Brisbane (Avustralya)
1987-1993
PM10↑M↑
O3↑ M↑
O3↑Myaş>65↑↑
Simpson et al
Arch Environ Health 1997 52 (6):441-454
15
APHEA (Air Pollution and Health: a European Approach) Project
• Held in 10 european countries with different socioeconomical status and different air pollution levels
• Aims:– To show the short term effects of air pollution on
health• Daily deaths, cause specific deaths, urgent hospital
admissions– Analysis of large data profile;– Standardized approach to epidemiological time-series
analysis Katsouyanni et al Eur RespirJ 1995:1030-1038
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APHEA Project :Results(Lon,Ams,Par, Rot, Mi)
• Age groups :16-64; >65;• Pollutants
– Gas: SO2,O3,NO2,– Particulate: PM (TAP, BS)
• Other factors which may affect the results:Seasonal changes, temperature, humidity, social events (strike etc..holydays etc..)
• Hospital admissions (HA) for COPD, asthma, respiratory infections:– SO2 no relationship;– BS↑ HA ↑– NO2 ↑ HA borderline association ↑– O3 ↑HA ↑ >65 ↑ ↑
• The effect of pollutant didn’t show seasonal difference Spix C Arch Environ Health 1998 53 (1):54-64
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APHEA-2 PROJESİ(Barse, Birm,Lond,Mil, Holl, Par,Ro, Stok)
• PM10,PM13, BS, TAP Hospital Emergency Admission (HEA) – asthma (0-14y, 15-64y) – COPD + asthma (>65y) – tüm solunum yolu hastalıkları (>65 y)
• 0-14 yr :PM10↑ HAB↑• 15-64 yr: BS ↑ HEA ↑
PM 10↑ HEA ↑ PM13 ↑HEA ↑ TAP ↑HEA↑
• >65 yr: COPD +asthma BS ↑ HB ↑ TAP ↑ PM10 ↑>65 yr: PM10 ↑ all respiratory diseases ↑ Atkinson R Am J Respir Crit Care Med 2001 164:1860-1866
18
Air Pollution and Mortality: European Results
City Results Ref
Milano (1980-1989) TSP↑ DM↑
SO2↑ DM↑
Vigotti et al J Epidemiol Comm Health 1996 50:(Suppl 1): s71-s75
Cracow Lodz Poznan
Wroclaw(1977-1989)
BS↑DTMLc ↑
SO2↑DTMLc ↑
BS SO2ø SM
Wojtyniak et al JEpidemiol Comm Health 1996 (Suppl 1):
S36-s42
Köln 1975-1985 TSP↑DM↑
SO2↑DM↑
NO2 øDM
PM7 øDM
Spix et al J Epidemiol Comm Health 1996 (Suppl 1): s52-s58
Barcelona (1985-1991) BS↑TM↑CVM↑RM↑
SO2↑TM↑CVM↑RM↑☼:TM↑↑
O3 NO2 øTM KVM SM
Sunyer J et al J Epidemiol Comm Health 1996 (Suppl 1): s76-s80
Paris( 1987-1990) PM13↑RM↑
BS↑TM↑
SO2,O3,NO2 øRM,
Dal et al J Epidemiol Comm Health 1996 (Suppl 1): s42-s46
Bratislava (1987-1991) SO2 ø TM
TSP ø TM
Bacharova et al 1996 50:(Suppl 1): s19-s21
19
Air Pollution and Mortality: European ResultsBölge Sonuç ø↓↑ Kaynak
Hollanda(1986-1994) O3↑<65yTM↑KOAHM↑
PM10↑<65yMPnö↑
CO↑<65yMPnö↑
NO2↑<65yMPnö↑
O3↑BS↑SO2↑NO2↑CO↑>75yM↑
O3↑BS↑SO2↑NO2↑CO↑ 65-74yaşTM↑Mp↑,Mkv↑Mkoah↑
Fischer et al Eur Respir J 2003 21:suppl 40:34s-38s
Hollanda 1986-1994 BSm↑ NO2m↑ (trafik)55-59 yaşKVM↑(ana yola yakın)
Hoek et al Lacet 2002 1203-1209
Atn,Bdp,Ldz,Lnd,Mad,Pa,PrR,Stck,TA
(1990-1997)
PM10↑ (40) TM↑ Zanobetti et al Epidemiology 2002 13:87-89
Atn,Bdp,Ldz,Lnd,Mad,Pa,PrR,Stck,TA
(1990-1997)
PM10↑ (40) MS ↑MKV ↑ Zanobetti et al Environ Health Perspect 2003 1188-1193
20
21
WHO Air Quality GuidelinePM2,5 10 g/m3 annual mean
25g/m3 24 hours mean
PM10 20mg/m3 annual mean
50 mg/m3 24 hours mean
O3 100g/m3 8 hours mean
NO2 40g/m3 annual mean
200g/m3 one hour mean
SO2 20 g/m3 24 hours mean
500g/m3 10 minutes mean
WHO air quality guideline 2005
22
Air Pollution in Turkey
23
Historical Perspective
• Air pollution first occured in Ankara in 1970s;• In 1980 it became a widespread problem in many
cities especially in winter• Since 1984 Ministery of Health has been assessing
main pollutants (BS and SO2) in majority of the cities• In the first half of 1990s air pollution has increased to
the health threatening levels in many cities • Since 1991 those results has been published by
State Statistics Institute.• Since 2006 PM10 measurements have been
performed by Minister of Environment
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DİE 2002 yıllığı
<50g/m3 50-100g/m 3 > > 100g/m3 2008
25
The Most Polluted Cities in 2008
SO2 g/m3 PM10 g/m3
Kars 87 Van 147
Bitlis 83 K. Maraş 136
Çanakkale 69 Iğdır 129
Siirt 68 Mardin 117
Aydın 65 Kütahya 114
Isparta 64 Karabük 111
Kütahya 49 Isparta 110
Van 48 Düzce 108
Zonguldak 48 Konya 107
Nevşehir 47 Karaman 107
26
Effects Of Air Pollution on Respiratory System: Turkey Data
27
City Aim Results Ref
İstanbul Effect or air pollution in 0-2 yr children on HA for respiratory diseases
Pollution HABronchitis SinusitisPneumonia
Olgun Ç Uzmanlık tezi İstanbul 1996
İstanbul Effect of air pollution on HA for acute respiratory diseases
PM HA Dağlı E, Erk M., Karakoç F. Toraks Derneği yıllık kongresi 1996
İstanbul Effect of winter air pollution on hospitalization in children
Air pollution in winterHospitalization
Bebek Ö. Aile Hk Uzmanlık tezi 1996
İstanbul Air pollution and rhinits prev (1994 ve 1996)
High air pollution levels rhinitis prevalence
Keles et al Arch Eviron Health 1999
28
City Aim Results Ref
İstanbul Air pollution and allergic rhinits symptoms
Pollution Symptoms
Keles et al Am J Rhinol 1999
İzmir Effects Various climatologic pollution levels on nasal resistance
PM SO2 NR
Özüer MZ et al KBB ve Baş Boyun Cerr Der 1999
Eskişehir Air pollution and respiratory emergency admmissions
SO2 UAILAICOPDCor pulmonale
Ünsal et al Tüberküloz ve Toraks 1999
Ankara SO2 ve PM kons. İle astım acil başvuruları
Son bir haftanın SO2 ve PM kons ile kor. Bağıl nem ile pozitif, ısı ve rüzgar hızı ile neg kor
Berktaş et al Tüberküloz ve Toraks Dergisi 2003
29
City Aim Results Ref
İzmit Asthma admissions and meteorological parameters
PM Relative humidity Asthma admissions
TÜSAD XXV: Ulusal Kongresi Bildiri kitabı 1999
İstanbul TAP and mortality TAP last 3-5 days
Mortalite
Şahin Ü. Doktora tezi İstanbul 2000
İzmir Hava kirliliği ile KOAH hast yatışları ve ex ilişkileri
Hava kirliliği yatış sayılarında ex ile ilişki görülm
Çelikten E.Toraks Derneği 2. Kongresi Özet kitabı 1998
Gaziantep Air pollution and health quality of moderate asthmatics
Pollution rescue med nocturnal symptoms
Bozkurt Aİ Toraks Derneği 2. Kongresi Özet kitabı 1998
Denizli Air pollution paramters and COPD emergency admissions
SO2 ↑ COPD HEA ↑
BS ↑ COPD HEA ↑Evyapan F Eur Respir J (Suppl 30) 1999
Denizli Air pollution and asthma emergency admissions
SO2 (5)↑ asthma emergency admission ↑
Evyapan F Eur Respir J Vol 16 (Suppl 2) 2000
30
SO2 (g/m3) PM (g/m3)
Annual Mean 60 60
Winter Season Mean (October-March)
120 120
Maximum 24 hours mean
150 150
Maximum 1 hour 450 -
Ministery of Environment and Forestry:Guidline for the Protection of Air Quality
TC Çevre orman bakanlığı (www.cevreorman.gov.tr)
31
Concluding Remarks
• Air pollutants even in low levels have impact on the health
• Particular pollutants have greater impact on cardiorespiratory mortality and morbidity, the effect is more prominent at lower diameter (i.e.PM2,5)
• The accumulated scientific evidence has forced the WHA to review air quality guideline values for air pollutants
• It should be kept in mind that guidline values can not fully protect human health
• In Turkey air pollution is the second leading cause of environmental pollution. Limit values of national air quality guideline is much higher than the WHO limits
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Global Warning!
33
Thank You