Air Quality and Your HealthAir Quality and Your Health

Susan Lyon StoneSusan Lyon Stone

Clean Air Partners Clean Air Partners

August 29, 2006August 29, 2006

stone.susan@epa.govstone.susan@epa.gov

Human LungHuman Lung

• Air conductingAir conducting– TracheaTrachea– BronchiBronchi– BronchiolesBronchioles

• Gas exchangeGas exchange– Respiratory Respiratory

bronchiolesbronchioles– AlveoliAlveoli

Ozone Irritates AirwaysOzone Irritates AirwaysOzone Irritates AirwaysOzone Irritates Airways

• SymptomsSymptoms– CoughCough– Sore or scratchy throatSore or scratchy throat– Pain with deep breathPain with deep breath– FatigueFatigue

• Rapid onsetRapid onset• Similar symptoms - people with and Similar symptoms - people with and

without asthmawithout asthma

Ozone Reduces Lung FunctionOzone Reduces Lung FunctionOzone Reduces Lung FunctionOzone Reduces Lung Function

BASELINE 2HR 4HR

FE

V1,

% C

HA

NG

E

-60

-40

-20

0

M-10

M-1c

Ozone Causes InflammationOzone Causes InflammationOzone Causes InflammationOzone Causes Inflammation

• Ozone reacts completely in surface layer - forms reactive oxygen molecules

• Influx of white blood cells • Damages cells that line the airways• Effect is greater 24 hours after exposure• Increases airway reactivity• Concern about repeated exposures – permanent

structural changes

Respiratory Hospital Admissions by Respiratory Hospital Admissions by Daily Maximum Ozone Level, Lagged Daily Maximum Ozone Level, Lagged One DayOne Day

114

112

110

108

106

104

102

Ozone concentration (ppm)

Res

pir

ato

ry A

dm

issi

on

s

.01 .02 .03 .04 .05 .06 .07 .08 .09 .1

D-8a

(Burnett et al, 1994)(Burnett et al, 1994)

California Children’s Health StudyCalifornia Children’s Health Study

CHS: School AbsencesCHS: School Absences

• 20 ppb increase in O3 associated with an 83% increase in school absences for acute respiratory disease (Gilliland et al., 2001)

• Large economic impact of pollution-related school absences (Hall and Lurmann, 2003)

CHS: Ozone and New-onset AsthmaCHS: Ozone and New-onset Asthma

McConnell at al., 2002

New Evidence from Current Review of New Evidence from Current Review of Ozone StandardOzone Standard

• Physiological bases of increased sensitivity of people with asthma– Larger decreases lung function– Increased occurrence and duration

nonspecific airway responsiveness– Increased airway responsiveness to

allergens– Increased inflammatory responses

New Evidence from Current Review of New Evidence from Current Review of Ozone StandardOzone Standard

• Hospital admissions

• Emergency room visits

• School absences

• Increased symptoms and medication use in asthmatic children

New Evidence from Current Review of New Evidence from Current Review of Ozone Standard -Ozone Standard - MortalityMortality

• Study done in Vancouver, BC with statistically significant results has 98 and 99 percentile values below 0.06 ppm O3

• US multi-city time-series studies provide strong evidence of association between short-term O3 exposure and mortality

• Effects robust to confounding by copollutants

Sensitive Groups for OzoneSensitive Groups for Ozone

• People with lung disease

• Children

• Older adults

• People who are active outdoors

Air Pollution DisastersAir Pollution Disasters

London buses are escorted by lantern at 10:30 in the morning

Donora, PA at noon on Oct. 29, 1948

Particle pollution is a complex mixture

derived from many sources

Particle pollution is a complex mixture

derived from many sources

Particle DepositionParticle Deposition

• Larger particles (> PM10) deposit in the upper respiratory tract

• Inhalable particles (< PM10) penetrate into lungs

• Some particles (e.g., less than 0.1 um) may enter bloodstream

• Particles may react, accumulate, be cleared or absorbed

Association Between Long Term Association Between Long Term Exposure to PM and MortalityExposure to PM and Mortality

Harvard Six-Cities Adult CohortHarvard Six-Cities Adult Cohort

• Purpose was to study the association between pulmonary changes and long term exposure to sulfates and sulfur dioxide

• Enrollment 1974 – 19778,111 white men and women About 1,300 in each of six citiesAge range 25 to 74 years

• Followed until 1991 (now 1999)14 to 17 years of follow-up111,076 person-years1,430 death

Dockery et al., 1993

Particle Pollution Affects the LungsParticle Pollution Affects the Lungs

You are exposed to particle pollution simply by breathing polluted air.

Exposure increases when you exercise, because you breathe more vigorously and deeply than usual.

Respiratory effects include:

• airway irritation

• cough

• phlegm

• decreased lung function

• airway inflammation

• asthma attacks

• bronchitis

• chronic bronchitis

And Particle Pollution Affects the HeartAnd Particle Pollution Affects the Heart

Particle pollution has been linked to changes that indicate your heart isn’t as healthy as it should be. Those include:

• Arrhythmias and changes in heart rate.

• Changes in the variability of your heart rate.

• Blood component changes

•C-reactive protein

•Fibrinogen

•Plasma viscosity

•Some studies indicate that particle exposure may cause heart attacks. And particles are linked with death from heart disease.

Particle exposure has been linked to heart attacks.

It’s a Public Health ConcernIt’s a Public Health Concern

• When particles aggravate heart and lung diseases that means increases in:

Hospital admissions Doctor and emergency room visits Medication use Absences from work or school

• Particulate matter is linked to significant public health risks – including premature death from heart and lung disease.

Living Within 300 Meters of Local Living Within 300 Meters of Local Roadways Affects FEVRoadways Affects FEV11

Brunekreef et al., 1997

CHS: Low FEVCHS: Low FEV11 at Age 18 vs. at Age 18 vs.

PollutionPollution

Gauderman et al., 2004Gauderman et al., 2004

Particles Trigger Heart AttacksParticles Trigger Heart AttacksO

dds

Rat

ios

Hours before onset of MI

0 1 2 3 4 5

1.6

1.4

1.2

1.0

0.8

Days before onset of MI

0 1 2 3 4 5

1.6

1.4

1.2

1.0

0.8

Odd

s R

atio

s

Peters et al., 2001

772 MI patients who survived 24 hours and completed interview

PM May Cause Effects in Healthy PeoplePM May Cause Effects in Healthy People

*

*

SDNN PNN50 LF HF Total Ratio0

1

2

3

4

Air

CAPS

Rat

io C

AP

S /

Pre

**

*

2.9 47.2 107.8 206.70

50

100

150

PM

Ns

(x

10

,00

0)

Average CAPS Concentration (/m3)

Devlin et al., 2003Ghio et al., 2003

Mechanisms of PM effects on the Mechanisms of PM effects on the cardiovascular systemcardiovascular system

Ambient PM

Clotting Factors

Viscosity

Pulmonary Inflammation

Systemic Inflammation

Endothelial CellDysfunction

PlateletActivation

Thrombosis

Plaque Rupture

Pulmonary ReflexesPulmonary Reflexes

Autonomic NervousSystem

Cardiac Rhythm

CardiacDisruption

Heart Rate

Conduction/Repolarization

SuddenCardiacDeath

Can We Link PM Effects with Specific Can We Link PM Effects with Specific Sources of Pollution?Sources of Pollution?

% In

crea

se in

Dai

ly D

eath

s-5

0

5

10

15

Crustal Coal Traffic Fuel Oil

*

*

0%

20%

40%

60%

80%

100%

Bosto

nSt L

ouis

Knoxv

illePor

tage

Steube

nville

Tope

ka

ResidualMnSaltMetalsFuel OilCoalMobileCrustal

Laden et al., 2000

Speciation monitoring of airsheds of differing composition may enable identification of components, and sources of those components, that contribute to adverse health outcomes

The Utah ValleyThe Utah Valley

0

25

50

75

100

125

150

1985 1986 1987 1988

Steel Mill Closed

PM

(g

/m3 )

0

20

40

60

80

1985 1986 1987 1988

Steel Mill Closed

Mo

nth

ly A

sth

ma

Ad

mis

sio

ns

Sensitive Groups for PMSensitive Groups for PM

• People with heart disease

• People with lung disease

• Older adults

• Children

Air Quality IndexAir Quality IndexDescriptors Cautionary Statement

Good 0 – 50 No message

Moderate

51 – 100

Unusually sensitive individuals

Unhealthy for Sensitive Groups

101 - 150

Identifiable groups at risk - different groups for different pollutants

Unhealthy

151 - 200

General public at risk; sensitive groups at greater risk

Very Unhealthy

201 - 300

General public at greater risk; sensitive groups at greatest risk

t

Est

ima

ted

Mo

rta

lity

0 5 10 15 20 25 30 35 40 45 50 55 60 65 70 75

24-Hr PM-2.5 Concentrations (µg/m3)

Nu

mb

er

of D

ays

0 5 10 15 20 25 30 35 40 45 50 55 60 65 70 75

24-Hr PM2.5 Concentrations (µg/m3)

Majority of risk from days with low-to mid-range concentrations, not peak concentrations

Typical PM2.5 distribution

Typical concentration-response relationship

Typical risk distribution

PM Risk AssessmentPM Risk Assessment

Mortality risk; Schwartz, 1993

Use AQI to Reduce RiskUse AQI to Reduce Risk

Dose = Concentration x Ventilation Rate x Time• Reduce these factors to reduce dose• Pay attention to symptoms• People with asthma – follow asthma action

plan• Coaches – rotate players frequently• People with heart disease – check with your

doctor

AIRNowAIRNow - www.airnow.gov - www.airnow.gov

Web Page for Health Care ProvidersWeb Page for Health Care Providerswww.airnow.gov/health-profwww.airnow.gov/health-prof

Ozone Web Course Ozone Web Course for Health Care Providersfor Health Care Providers

MedicalMedicalPosterPoster

Asthma FactsheetAsthma Factsheet

Particle Pollution and Your HealthParticle Pollution and Your Health

Review Process for NAAQSReview Process for NAAQS

Scientific studies on health and environmental effects

EPA Criteria Document

EPA Staff Paper

Scientific peer review of published studies

Reviews by CASAC and the public

Reviews by CASAC and the public

Public hearings and comments on proposals

Proposed decision

Final decision

PM NAAQS

Ozone NAAQS

Timeline for NAAQS ReviewsTimeline for NAAQS Reviews

• Under a consent agreement for the PM and Ozone Reviews– PM Milestones

• Proposed decision - December 20, 2005• Final decision - September 27, 2006

– Ozone Milestones• February 2006 – final Criteria Document• October 2006 - final Staff Paper• March 2007 – proposed decision for public comment• December 2007 – final decision

– Technology Transfer Network (TTN) for NAAQS review documents: http://www.epa.gov/ttn/naaqs/