Particulate and Lung Disease David Brown Sc'D' EHHI

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Particulate and Lung DiseaseDavid Brown
Sc.D.EHHI

• How should the Public Health system work with
  uncertain but plausible health hazards?

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Can We Assume That Compliance With Federal Clean
Air Standards Protects Against Short Term Health
Impacts?

• Standards are set by expert committees
• There are safety factors built in standards
• Standards must have a bright line for attainment
• Compliance is monitored

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How particles increase exposure of irritants to
the deep lungs
DIESEL PARTICLE PM 2.5 RANGE
WATER ADSORBED
Irritant gases
Deep lung exposure to irritants
IRRITANT GAS ABSORBED IN WATER
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Results from the Harvard Six-cities study All
Cause Mortality Rates most exposed to least
exposed City Fine Particles

• All cause death 1.26 (1.08-1.47)
• Lung Cancer 1.37 (0.81-2.31)
• Cardio pulmonary 1.37 (1.11-1.68)
• Other causes 1.01 (0.79-1.30)
• Range of exposure 11-29.6 ug/m3
• Dockery, NEJM 1993 329 1753-1759

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Health actions from exposures of 2 hours or less.

• Peters etal. pm 2.5 myocardial infarction
• 1.48 odds ratio 2 hr after 25ug/m3 increase
• 1.69 odds ratio 1 day after 20ug/m3 increase
• Gent etal. Severe asthma O3, pm 2.5
• 35 increase wheeze 1 hr after 50ppb O3 inc.
• 47 increase in chest tightness 1 hr after.
• 1.24 odds ratio Chest tightness 12-18ug/m3 pm

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Moral stewardship in search of an intellectual
framework.

• Theories of Deontology and Utilitarianism
• 1) Value of an act is found within the act.
• 2) The value of an act is found in the
  outcome.
• Four ideas 1600-1700
• Bacon..A new science
• NewtonReductionism a new approach
• Kant.The whole is more than the sum of the
  parts
• Bentham.Charity- science serves the needs of
  men.

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Uncertainty paradox of Good Science in Public
Health

• Science- Assume something is not true until
  proven at a level of statistical certainty.
• Preferred action is to collect more data
• Public Health- Assume something may be true based
  on suggestive but statistically inconclusive
  evidence
• Preferred action is to intervene to prevent
  potential health effect.

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Result of application of Good Science is loss
of time, lives and treasure

• Smoking
• Dioxin
• Asbestos
• Chordane
• Mercury
• Particulate
• Asthma at the end of the 20th century

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Health events that occur to students and teachers
in schools

• Accidents
• Colds, flu and headaches
• Asthmatic attacks/ treatment
• Others
• Could any of these be environmental?

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Health events are rarely linked with
environmental exposures

• Most health events have multiple causes
• Only a small part of the group responds
• The exposures are not known sufficiently
• Investigations are complex and data is sparse
• The cause of the effect is other than
  environmental but there may be an environmental
  role

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But there are environmentally induced diseases
and responses

• Some are related to molds and other factors in
  buildings
• Some have been found to be related to 6 to 12
  pollutants found in outside air
• Two agents, Ozone and PM, are linked to short
  term asthmatic and cardiac responses
• How do we respond to these agents?

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It is necessary to understand the following

• The Health Effects that are related to air
  quality
• Pollutant sources
• Movement of air into and within the school
• Ways to reduce the potential for exposures

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Bad Air Quality

• Ozone
• Particulate Matter
• Nitrogen Dioxide
• Sulfur Dioxide
• Hazardous Air Pollutants (Toxins)
• Lead
• Carbon Monoxide

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Ozone

• Adverse effects following low-concentration
  exposure
• chest pains,
• coughing,
• nausea,
• throat irritation, and
• congestion.
• It also can worsen bronchitis, heart disease,
  emphysema, and asthma, and reduce lung capacity.

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• Studies conducted in the northeastern United
  States and Canada that show that ozone air
  pollution may be associated with 10-20 percent of
  all of the summertime respiratory-related
  hospital admissions.
• US Environmental Protection Agency, Criteria
  Document in support of proposed 8-hour ozone
  standard

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Particulate Matter

• Premature death
• Respiratory related hospital admissions and
  emergency room visits
• Aggravated asthma
• Acute respiratory symptoms
• Chronic bronchitis
• Decreased lung function and
• Work and school absences.

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Particulate Matter

• EPA has revised the primary (health-based) PM
  standards by adding a new annual PM2.5 standard
  set at 15 micrograms per cubic meter (µg/m3) and
  a new 24-hour PM2.5 standard set at 65 µg/m3.
• EPA is retaining the current annual PM10 standard
  of 50 µg/m3 and adjusting the PM10 24-hour
  standard of 150 µg/m3 by changing the form of the
  standard.

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What does this mean?

• Air exposures induce plausible health risks from
  short term elevation during regulatory attainment
  of clean air standards.
• Science should be brought to the legal decision
  making.
• Investigation of the quantitative health risk
  from localized short term air exposures is
  needed.

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Question How to use existing information to
assess environmental exposures?

• Attainment model approach
• Evoked response model approach
• Statistical analyses
• Expected spatial distributions
• Expected temporal distributions
• S plus approach
• Cluster analysis
• Edge theory analysis

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As part of the process to determine whether an
area meets the EPA particulate matter standard,
this 3-month long series of hourly observations
would be collapsed to a single value 9.2 ug/m3
Totally obscuring any structure or other
content within the data set (Carmine
Dibattista, CT DEP).
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PM 2.5 New Haven, Hartford and Waterbury (ug/m3)
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Fine particles, or haze, restrict our ability to
see long distances
Unadjusted Hourly conc. of fine particles 4
?g/m3
Hartford Oct. 8, 2002 4 p.m. EDT
Unadjusted Hourly conc. of fine particles 24
?g/m3
Hartford Oct. 2, 2002 4 p.m. EDT
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33 Air Toxics in Connecticut
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Consider the different sources of toxics in
outdoor air separately

• Transport from other regions
• Fossil fuel and ozone
• Transport from the within the region
• Utilities, fossil fuel and transportation
• Local sources such traffic and area sources
• Transportation, off road commercial
• Immediate sources near the buildings
• Vehicles diesel, pesticides and construction

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School child exposure, continuous nephelometer15
minute averages
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School child exposure, continuous nephelometer
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School Child Exposure Continuous Nephelometer
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Comparing ambient pm with School and Buses
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Compare Bus to School and Ambient monitor for PM.
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Difference in amount of exposure between times of
day
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Actual inhaled dose varies between day, time of
day, activity and location for child
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Buildings have memories of outside exposures A
400 ppm diesel particulate emission from a bus
that idles for one hour next to the school
exposes the students for over 3 hours
One half the volume in each hour
One half the volume out each hour
School
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Possible diurnal influence on school air
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Possible diurnal influence on school air
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Comparison of PM2.5 24-hr avg and 3-hr max avg
for New Haven CT site, 2001
Analyzing fine PM data by comparing 3-hr exposure
distributions to daily and annual averages
reveals significant underestimation of potential
health risk.
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Effect of morning decrease in local wind-speed
and mixing volume during sun rise
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Local air quality events that are seen inside the
school

• Buses idling
• Morning traffic
• Commercial vehicles
• Construction
• Sun rising and sun setting
• Nocturnal Jet
• Sun rising and sun setting
• Changes in the weather
• Pesticide applications

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Information from existing data

• Vt. monitoring data shows 11 compounds drive most
  of risk.
• Using CEP and NATA, EPA characterized types of
  risk and sources at county levels.
• Multi-city studies determine level of health
  risks from PM and ozone nationally.
• Levy shows local and regional risk from two power
  plants.

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Fine ParticulatesPM2.5 Spatial Distribution in NE

• Current monitoring network analyses average away
  PM2.5 variability.
• Are spatial and temporal factors (local sources,
  unique terrain, meteorology) influencing
  concentrations and creating PM gradients?
• If so, micro-scale exposure assessments must be
  refined.
• May reveal downward bias of health effects
  estimates are missing populations at risk?

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Lessons learned or hints

• Short term local exposures are disproportionate,
  5 to 15 of days in NE.
• Sources of variability are
• Location
• Season
• Time of day
• Sources
• Meteorology, weather patterns in NE

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Six ways to reduce the potential for exposures

• Identify sources near the building
• Restrict emissions during periods of poor air
  mixing
• Reduce idling of engines during the 3 hours prior
  to student occupancy of building
• Increase make up air during clean periods
• Prevent stagnation of air within the school
• Adjust student activities

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Conclusions

• A more robust reporting statistic is needed in
  addition to attainment levels.
• The weather variable is discontinuous existing in
  4 forms in the NE.
• National analyses do not characterized NE risk.
• Averaging time is critical for understanding
  health risk
• Health outcome should drive the risk analysis