AIR POLLUTION AND RESPIRATORY - PowerPoint Presentation

1. AIR POLLUTION AND RESPIRATORYDISEASES IN ASIA-PACIFIC REGIONMukhtar IkhsanDepartment of Pulmonology and Respiratory MedicineFaculty of Medicine, University of Indonesia/State Islamic University Syarif Hidayatullah Jakarta

2. Irritations of the eyes, which are caused by smoke, over-heating dust, or similar injury, are easy to heal; the patient being advised first of all to avoid the irritating causes ... For the disease ceases without any use of any kind of medicine, if only a proper way of living be adopted. Antiochenus (500-575 BC)Greek Writer

3. Sources of Air PollutionIndoorOutdoor

4. Major PollutantsSulfur oxides (SOX) especially sulfur dioxide are emitted from burning of coal and oil. Nitrogen oxide (NOx) especially nitrogen dioxide are emitted from high temperature combustion. Can be seen as the brown haze dome above or plume downwind of cities. Carbon monoxide is colourless, odourless, non-irritating but very poisonous gas. It is a product by incomplete combustion of fuel such as natural gas, coal or wood. Vehicular exhaust is a major source of carbon monoxide. Carbon dioxide (CO2), a greenhouse gas emitted from combustion and respiration. Volatile organic compounds (VOC), such as hydrocarbon fuel vapors and solvents Particulate matter (PM), measured as smoke and dust. PM10 is the fraction of suspended particles 10 micrometers in diameter and smaller that will enter the nasal cavity. PM2.5 has a maximum particle size of 2.5 µm and will enter the bronchies and lungs. Toxic metals, such as lead, cadmium, and copper. Chlorofluorocarbons (CFCs), harmful to the ozone layer emitted from products currently banned from use. Ammonia (NH3) emitted from agricultural processes. Odors, such as from garbage, sewage, and industrial processes Radioactive pollutants produced by nuclear explosions and war explosives, and natural processes, such as radonSource: Wikipedia

5. WHO, 2008Total 3 millions death/yearis due toair pollution

6. In ChinaChina’s economic revolution has not been without substantial cost to its environment and the health of itspeople, particularly children, who are most vulnerable.Heavy reliance on coal and policies focused principallyon economic development have left China facing risingrates of childhood asthma, neurodevelopmental disordersin children, cardiovascular disease, and cancer. In addition, increasing private automobile ownership has dramatically increased air pollution in China’s urban centers.Millman et al. Pediatric Vol.122, No. 3, September 2008

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8. https://www.google.com/search?hl=en&site=imghp&tbm=isch&source=hp&biw=1303&bih=665&q=air+pollution&oq=air+pollution&gs_l=img.12..0l10.4000.11495.0.15638.15.8.1.6.6.0.115.620.7j1.8.0....0...1ac.1.55.img..0.15.673.B3eRLzuviuQ#facrc=_&imgdii=_&imgrc=Og9ze8oOg4gB8M%253A%3BxKjODLvdhlc2LM%3Bhttp%253A%252F%252Findiagetgreenblog.files.wordpress.com%252F2013%252F05%252Faa-delhi-14feb-air_pollution.jpg%3Bhttp%253A%252F%252Findiagetgreenblog.com%252Ftag%252Fair-pollution%252F%3B900%3B444

9. Outdoor Air Pollution

10. http://www.mcqbiology.com/2013/04/multiple-choice-questions-on-air.html#.VDp9JBY43wk

11. Nature 2007;450;207

12. http://windenergypros.org/go-green-to-improve-present-day-ecological-crisis/

13. Greenhouse Gasses that Producedby Human ActivityWHO; Climate Change and Human Health 2003

14. Wikipedia

15. http://www.who.int/indoorair/health_impacts/burden/en/

16. http://www.who.int/indoorair/health_impacts/burden/en/

17. Asia Pacific Health Statistic 2014

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19. Urban air pollution in AsiaThe air in Asia's cities is amongst the most polluted in the world. Of the 15 cities in the world with the highest levels of particulate matter, 12 are located in Asia (ADB 1999). Furthermore, six of these cities also have the highest levels of atmospheric SO2. Levels of air pollution substantially exceed the international guidelines for air quality recommended by WHO. (World Bank 2001).

20. Urban air pollution in AsiaCities such as Beijing, Calcutta, Jakarta, New Delhi, Shanghai andTehran are notorious for high levels of suspended particulates, with New Delhi recording the maximum of 420 µg/m3 (ESCAP/ADB 2000 and ADB 2001). Tehran has also recorded SO2 levels four times the guidelines prescribed by WHO (World Bank 2001).

21. Particulate matterTiny particles of solid or liquid suspended in gasPM10  10m (respirable)PM2.5 2.5 m (gas-exchange)PM1 1 m Ultrafine  0.1m (cell membrane)Most Polluted World Cities by PM (2004) Particulatematter μg/m³ City169 Cairo, Egypt150 Delhi, India128 Kolkata, India125 Taiyuan, China123 Chongqing, China109 Kanpur, India109 Lucknow, India104 Jakarta, Indonesia101 Shenyang, China

22. Possible Mechanism of Pollutant-Associated Adverse Health EffectsPM-or ozone induced pulmonary inflammationFree radical and oxidative stress by metals and organic chemical compundsCovalent modification (enzyme)Biologic compounds: endotoxins, glucans, inflammation and innate immune effectsStimulate nervous system: airway reactivityAdjuvant effectProcoagulant activitySuppression of normal defense mechanism

23. Mechanism and Pathways of Particles Clearance within the Respiratory Tract Extrathoracic region (ET) Mucociliary transport Sneezing Nose wiping and blowing Dissolution and absorption into blood Swallowing Tracheobronchial region (TB) Mucociliary transport Coughing Endocytosis by macrophages/epithelial cells Dissolution and absorption into blood/lymph Alveolar region (A) Macrophages, epithelial cells Interstitial translocation Dissolution and absorption into blood/lymph McClellan ed. Concept in Inhalation Toxicology 1995:191-224

24. https://www.google.com/search?hl=en&site=imghp&tbm=isch&source=hp&biw=1303&bih=665&q=air+pollution&oq=air+pollution&gs_l=img.12..0l10.4000.11495.0.15638.15.8.1.6.6.0.115.620.7j1.8.0....0...1ac.1.55.img..0.15.673.B3eRLzuviuQ#facrc=_&imgdii=_&imgrc=O6-ccWJyF_XTWM%253A%3BeeekVopbrIL6aM%3Bhttp%253A%252F%252Fwp.vcu.edu%252Fmblock%252Fwp-content%252Fuploads%252Fsites%252F4029%252F2013%252F12%252FAir-Pollution-Impacts-Brain-Health-1.png%3Bhttp%253A%252F%252Fwp.vcu.edu%252Fmblock%252Fresearch-projects%252Fair-pollution-and-microglia%252F%3B4200%3B3195

25. TB and Indoor Air PollutionExposure to indoor air pollution is consistently associated with TB, regardless of the specific types of exposures and specific TB outcomes

26. Does it Matter to Live on Lower or Higher Grounds? An Analysis of TB Prevalence and Building Heights Results in Hong Kong: TB cases were more frequent among residents living at lower floors and decreasing trend was evident with increasing vertical heights. (p=0.00208) CT Low, PC Lai, et.al. Respirology (2012);17(Supp2):69-73

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28. Black Carbon (PM10) and Healthy ChildrenInverse relationship of carbon contents in airway macrophage and lung function in healthy childrenAn increase of 1.0m of carbon associated with 17% decrease of lung functionNEJM 2006;355;1:21

29. Tobacco Smoke:The most important risk factor for COPD is cigarette smoking.Pipe, cigar, and other types of tobacco smoking popular in manycountries are also risk factors for COPD.Other documented causes of COPD include:• Occupational dusts and chemicals (vapors, irritants, and fumes) when the exposures are sufficiently intense or prolonged.• Indoor air pollution from biomass fuel used for cooking and heating in poorly vented dwellings.• Outdoor air pollution, adds to the lungs total burden of inhaled particles, although its specific role in causing COPD is not well understood.RISK FACTORS: WHAT CAUSES COPD?The Global Initiative for Chronic Obstructive Lung Disease 2006

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31. Adverse Health Effects of Air Pollution Linked to COPDMortalityIncreased incidence of LRTIIncreased excacerbation of COPDLess daily activityIncrease hospitalizationIncrease emergency unit visitIncrease medicationReduction of lung functionIncrease prevalence of wheezingIncreased prevalence of chest tightnessIncreased prevalence of cough requiring medical attentionEur Respir J 2007;20(5):993

32. Study on the Prevalent Factor of COPDin Kunming City, ChinaObjective: To evaluate the prevalence rate and relevantfactor of COPD in Kunming City, ChinaConclusion:The prevalence of COPD was low in this area. Multivariate logistic regression analysis showed that age, sex, smoking, cooking, exposure to occupational dust, decorating living room, family history, frequent cough before age 14 are risk factors.Z.Xin, L.Ao. Respirology (2011),16;1-326

33. Asthma Attack in Children and Ozone Concentration Am J Respir Crit Care Med 1996;155:164

34. Respiratory Effects of Exposure to Diesel Traffic in Persons with Asthma (London) Walking on Oxford Street significantly reduced subject’s FEV1 (up to 6.1%;p=0.04) and FVC (up to 5.4%;p=0.01) in comparison with Hyde Park. The evidence of the assocation of diesel exposure with worsening of asthma. McCreanor J, Cullinan P, et.al NEJM 2007; 357:23:2348-2358

35. Respiratory Health Effects of Air Pollution: Update on Biomass Smoke and Traffic Pollution Visits for outpatient treatment of asthma at a Beijing Hospital. During the Olympics, the Chinese government endeavored to reduce air pollution by substantial amounts. They reported a reduction from 12.5 visits per day to 7.3 visits per day, a 41.6% reduction during the Olympic Games. Robert J. Laumbach,and Howard M. Kipen NEJM 2007; 357:23:2348-2358

36. A Survey on Respiratory HealthAmong Traffic Control Officers in Kandy, Sri LangkaResults:Symptomatic asthma and rhinitis were common among TCOs. Another substantial proportion washaving non spesific chronic cough and headache.Furthermore, metabolic syndrome and sleep disordered breathing appear to be prevalent among this population.Yasaratne D, Nandadeva D, Madegedara D.Respirology (2012);17 (Suppl 2):69-73

37. An Association Between Air Pollution and Mortality in Six U.S. Cities CONCLUSIONS These results suggest that fine-particulate air pollution, or a more complex pollution mixture associated with fine particulate matter, contributes to excess mortality in certain U.S. cities. Douglas W. Dockery, C. Arden Pope, Xiping Xu, et.al. N Engl J Med 1993; 329:1753-1759

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39. 1997`s Catastrophic Forest FireNASA`s TOMS imaging over IndonesiaOct 22, 1997 Forest fire: impact on stability of peatland During forest fire 1997: 0.79 Mha burned, consist of 0.73 Mha 91% peatland Release of 0.8-2.51 Gigatons Carbon release to atmosphere Equivalent to 13-40% of CO2 emission from fossil fuel Largest release CO2 concentration atmosphere since 1957 Nature 2002;40:61

40. The 1997 Haze Disaster in Indonesia: Its Air Quality and Health EffectsCarbon monoxide, carbon dioxide, sulfur dioxide, nitrogen dioxide, ozone, PM with diameters ≤ 10 μum, inorganic ions, and polycyclic aromatic hydrocarbons (PAH)was measured. The authors also interviewed 543 people and conducted lung-function tests. Concentrations of CO and PM with diameters ≤ 10 μum reached “very unhealthy” and “hazardous” levels, as defined by the Pollution Standards Index. Concentrations of the PAH were 6–14 times higher than levels in the unaffected area. More than 90% of the respondents had respiratory symptoms, and elderly individuals suffered a serious deterioration of overall health. In multivariate analysis, determined that gender, history of asthma, and frequency of wearing a mask were associated with severity of respiratory problems. The study demonstrate the need for special care of the elderly and for care of those with a history of asthma. In addition, the use of a proper mask may afford protection.DOI: 10.1080/00039890209602912Osamu Kuniiab, Shuzo Kanagawaa, Iwao Yajimac, Yoshiharu Hisamatsud, Sombo Yamamurae, Takashi Amagaif & Ir T. Sachrul Ismaila

41. Health Impact of the June 2013 South East Asian Haze in Singapore Peat forest fire, hot, dry weather and wind condition caused a severe South Esat Asian trans-national air pollution. In Singapore, during first week, the concentration of fine, aerosolized, harmful particulate matter (PM) of 2.5 um exceeded the usual safe levels by more than 10 x, pushing the pollution standard index (PSI) into hazardous category. There was an increase in haze related problems ilnesses presenting to the polyclinics and emergency rooms. T.K. Lim, Respirology (2013), 18 (Suppl)

42. Chronic effects of ambient air pollution onrespiratory morbidities among Chinese children:a cross-sectional study in Hong KongMethods: A cross-sectional study was conducted among 2,203 school children aged 8–10 in three districts with different air pollution levels in Hong Kong. Annual means for ambient PM10, SO2, NO2 and O3 in each district wereused to estimate participants’ individual exposure. Two questionnaires were used to collect children’s respiratory morbidities and other potential risk factors.Conclusions: Results have confirmed certain adverse effects on children’s respiratory health from long-term exposure to ambient air pollution. PM10 may be the most relevant pollutant with adverse effects on wheezing and phlegm in boys.Both PM10 and NO2 may be contributing to cough and phlegm in girls.Gao et al. BMC Public Health 2014, 14:105

43. Effect of Volcano Ash of Bromo Mountain on Pulmonary Function in Ngadas and Sukapura Village Population, East Java Indonesia This study was to evaluate the effect of volcano ash on pulmonary function during eruption in Bromo mountain in February 2014. There were each 30 subjects in exposure-group and non-exposure-group follow this study. There were 7 (23.3%) subjects with mild restriction and 23 (76.7%) subjects with normal function test in exposure group. There was a difference in pulmonary function test between subject was exposed by volcanic ash and non-exposed vulcanic ash. Koesoemoprodjo W, Retnowulan A. Respirology (2013), 18 (Suppl)

44. Airborne Particulate Matterand Respiratory Diseases in JapanIn conclusion, traffic-related air pollution may beof importance in the onset of asthma amongchildren and the short-term exposure to PM 2.5was shown to affect respiratory morbidity among asthmatic children. Shima M. Proceeding 18th APSR 2013

45. Department of Pulmonology and Respiratory MedicineSchool of Medicine, University of Indonesia Persahabatan Hospital JakartaStudyTraffic Policemen Lung Functionin South Jakarta 2012 Yunus F, Ikhsan M, Emilda S

46. Goal of Study To measure: * Standard of Air Pollution Index * Lung function abnormality Department of Pulmonology and Respiratory MedicineSchool of Medicine, University of Indonesia Jakarta

47. Result

48. Ambient Air Quality in South JakartaParameter Unit Result Standard NO2 ug/Nm3 13.5 400 SO2 ug/Nm3 32.0 900 CO ug/Nm3 2131.8 26000 O3 ug/Nm3 1176.0 200 TSP ug/Nm3 113.1 230Measured in Pasar Minggu

49. Conclusion of the StudyFrom 81 subjects, nine subjects haveabnormality consist of 5 mild obstruction and 4 mild restriction.No significant relationship betweenthe age, nutritional status, smoking,length of service, using mask andair quality index with lung function.

50. Indoor Air pollution

51. http://sanmarcousa.wordpress.com/2010/08/15/sick-building-syndrome-sbs/

52. http://www.nocoenergysolutions.com/homeowners/indoor-air-quality/Indoor Air Pollution

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54. http://www.uis.unesco.org/Library/Documents/statistical-yearbook-asia-pacific-country-profiles-education-2013-en.pdf

55. ﺨ National Cancer Association released results of a 15-year study concluding that women who work in the home are at a 54% higher risk of developing cancer than women who work outside the home. ﺨ Chemicals get into body through inhalation, ingestion and absorption.

56. Five-year EPA study (Surveyed 600 homes in six cities)ﺨ Indoor air pollution is one of the nation's most pressing personal health concerns. ﺨ Peak concentrations of 20 toxic compound were 200 to 500 times higher inside some homes than outdoorsEnvironmental Protection Agency

57. Study in Jakarta (2008) A study by the University of Indonesia’s Community Health Faculty, the Indonesian Community Health Expert Association and PT Bayer Indonesia revealed that 50 percent of people who work in office buildings in Jakarta suffer from what is known as “Sick Building Syndrome”.

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59. Clinical Advances in Hematology & Oncology Volume 10, Issue 3 March 2012

60. Household Stove Improvement and Risk of Lung Cancer in Xuanwei, ChinaA long-term reduction in lung cancer incidence was noted after stove improvement. In Cox models, RR for lung cancer after stove improvement were 0.59 (95% CI= 0.49 to 0.71) in men and 0.54 (95% CI = 0.44 to 0.65) in women (for both, P<.001). Incidence reduction became unequivocal about 10 years after stove improvement. Levels of indoor air pollution during burning with chimneys were less than 35% of levels during unvented burning.Qing Lang, et al. Journal of the National Cancer Institute, Vol. 94, No. 11, 2002

61. Association between Six Environmental Chemicals and Lung Cancer Incidence in the United StatesOur results suggest that environmental exposure to chromium, formaldehyde, and nickel from toxic release inventory sites may increase population risk of lung cancer. Juhua Luo et al. Journal of Environmental and Public HealthVolume 2011, Article ID 463701,

62. Radon and Lung Cancer ﰂ Radon exposure is the second leading cause of lung Ca, following tobacco smoke. ﰂ Radon is not only an independent risk factor; it also increases the risk of lung Ca in smokers. ﰂ Estimated 21,000 lung Ca deaths attributable to radon in the United States annually Clinical Advances in Hematology & Oncology Vol. 10, 3; 2012

63. COALIndoor emissions from household combustion of coal, which are widely prevalent throughout China and are also present in other Asian countries, havebeen deemed carcinogenic to humans.IARC. Household Use of Solid Fuels and High-temperature Frying. Monographs on the Evaluation of the Carcinogenic Risks to Humans. 2010.

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65. Recent evidence suggests that lung cancer risk associated with household coal use may vary up to 25-fold based on the geographical location of the mines, even within a relatively small area.Lan Q et al. Variation in lung cancer risk by smoky coal subtype in Xuanwei, China. Int J Cancer 2008;123:2164–69.

66. 4.3 million people a year die from the exposure to household air pollutionhttp://www.who.int/indoorair/en/

67. Burden of disease from Household Air Pollution for 2012 Globally, 4.3 million deaths were attributable to household air pollution (HAP) in 2012, almost all in low and middle income (LMI) countries. The South East Asian and Western Pacific regions bear most of the burden with 1.69 and 1.62 million deaths, respectively. http://www.who.int/indoorair/en/

68. TB and Indoor Air PollutionExposure to indoor air pollution is consistently associated with TB, regardless of the specific types of exposures and specific TB outcomes

69. Risk of TB in SmokersPLos Medicine 2007;4:e20

70. Smoking, Indoor Pollution and Risk of TuberculosisPLos Medicine 2007;4:e20

71. CONCLUSION* Trend of air pollution in Asia-Pacific region increased * Air pollution (indoor and outdoor) increase the risk for the evidence of respiratory disease.

72. Thank you