air pollution and health · diwali festival 6.10% 13.30% 31.20% 45.50% 0% 10% 20% 30% 40% 50%...
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AIR POLLUTION AND HEALTHDr SUNDEEP SALVI MD, DNB, PhD, FCCP
Chest Research FoundationPune, INDIA
ssalvi@crfindia.com
LUNGS: THE AMAZING ORGAN
Oxygen – 420 LtsCarbon Dioxide – 350 Lts
600 million air sacs
Very thin membrane (0.3 micron)
100-200 million branching tubes
Need to remain patent all the time
10,000 liters air every day
10,000 liters blood every day
The world is becoming more urbanized..And the Air is becoming more foul….
0
200
400
600
800
1000
1200
1400
1600
1800
1950 1970 1990 2000 2020
Motor vehicle fleet
Urban population
Total population
Growth rate
(World Bank, 1990)
No. of Motor vehicles in India
1951 0.3 million
1997 37.2 million
2012 100 million
WORLD GROWTH INDIAN SCENARIO
Remote sensing of air pollution from space
(Van Donkelaar et al. Environ Health Perspect 2010; 118(6): 847 DOI: 10.1289/ehp.0901623)
(Indian Inst. of Tropical Meterology)
(http://www.ewg.org/reports/bodyburden2/execsumm.php)
Environmental Working Group, July 2005
287 pollutants, chemicals, pesticides identified in the umbilical cord blood
10 newborn babies randomly selected by Red Cross from USA
DO POLLUTANTS INHALED BY THE MOTHER ENTER INTO THE GROWING FETUS?
Cord blood collected and sent for analysis for different pollutants
RUDOLF DIESEL
(1858-1913)
Pollutant Petrol Diesel
Carbon dioxide ++++ +Carbon monoxide +++ ++Benzene +++ ++
Nitrogen oxides + ++Hydrocarbons ++ +++Aldehydes ++ +++Sulphur dioxide + ++++PAHs + ++++Particulate matter* + ++++
Diesel vehicles produce 1500-times more particles than Petrol vehicles
IgE IgE
(Knox et al, Clin Exp Allergy 1997
Takenaka et al, J Allergy Clin Immunol 1995; 95: 103-115)
Diesel exhaust particles increase allergenicity by up to 50-fold
Pollen become more allergenic when these trees grow in an urban environment
(Bryce M et al., Int Arch Alergy Immunol 2010; 151: 45-65)
Residential Proximity to main roads during Pregnancy and Risk of Asthma
Japanese Birth Cohort Study, 756 pregnant mothers, Babies followed for 2 yrs after birth
<50 mts versus >200 mts
Doctor diagnosed asthma: 4.0 (1.4-11.2)
Doctor diagnosed eczema: 2.3 (1.1-4.6)
(Miyake Y et al, Pediatr Allergy Immunol 2010; 21: 22-28)
Maternal exposure to vehicular pollutants during pregnancy is strongly associated
with early childhood asthma
(Brunekreef B et al, Environ Health Perspect 2009; 117: 1791-1798)
IS THERE ANY ASSOCIATION BETWEEN TRUCK TRAFFIC DENSITY AND CHILDHOOD ASTHMA?
Current wheeze vs Truck traffic on street of residence
(n = 513,087; 98 countries, 238 centers)
*Wheeze*Rhinoconjunctivitis
*Eczema
Truck traffic density
Pune and Nagpur(16,000 school children)
0
5
10
15
20
25
30
35
Low traffic Heavy traffic Heavy traffic + low
socioeconomic
%age
Traffic density around school and prevalence of Asthma amongst school children
11.5%
19.3%
31.1%
(Paramesh H. Indian J Paed 2002; 69(4): 309-312)
(n = 6550; Bangalore, India)
2-fold increase in prevalence
WHICH MODE OF TRANSPORT EXPOSES YOU TO MORE AIR POLLUTANTS?
Autorickshaw Bus Motor cycle
Pune Station to Kothrud
Deccan to Hadapsar
(Chest Research Foundation, 2007)
Difference between CO levels for 3 different
transportation modes from station - kothrud
0
10
20
30
40
50
60
70
1 6 11 16 21 26 31 36
Time points (in mins)
CO
(in
pp
m)
Bus
Rickshaw
Bike AUC value for CO levles for 3 different transportation Mode
from Pune station - Kothrud
319.88
643.13663.50
0.00
100.00
200.00
300.00
400.00
500.00
600.00
700.00
Bus Rickshaw Bike
CO
le
ve
ls
CARBON MONOXIDE
(Chest Research Foundation, 2007)
WHO safety limit
Mean difference in SO2 levels for 3 different transportation
mode from Station - Kothrud
-0.1
0
0.1
0.2
0.3
0.4
1 6 11 16 21 26 31 36 41
SO
2 le
ve
ls (
in p
pm
)
Bus
Rickshaw
Bike
0.00
1.23
1.05
0.00
0.30
0.60
0.90
1.20
1.50
AU
C v
alu
es
Bus Rickshaw Bike
Difference in AUC values for SO2 for 3 different transportation
mode from Station - Kothrud
SULPHUR DIOXIDE
(Chest Research Foundation, 2007)
WHO safety limit
0
0.5
1
1.5
2
2.5
3
3.5
4
Smoking Physical
Inactivity
Diabetes Anger High
Cholesterol
Spending 1
hr in traffic
2.8 1.4 1.8 3.1 3.7 3.9
RELATIVE RISK OF SUDDEN HEART ATTACK
(Peters, New Engl J Med Oct 2004)
IMPACT OF AIR POLLUTION IN DIABETIC PATIENTS FROM PUNE CITY
Is there any association between ambient air pollution and serum inflammatory mediators in Type II diabetic patients from Pune city?
Blood C-Reactive Proteins Ambient Air Pollution LevelsMPCB data
Vs
1392 Type II Diabetic patients GPS Mapping of residence Correlations with SOX, NOX, PM10 studied
(Khafaie M et al, Diabetes Care 2013; 36: 625-630)
Lithium and Strontium salts
Calcium salts
Incandescence of iron (with carbon), charcoal, or lampblack
Sodium compounds
Barium compounds
Copper compounds
Burning aluminum, titanium, or magnesium powder or flakes
CHEMISTRY OF FIREWORKS COLORS
FIREWORK FUEL
CharcoalSulphur
MEAN CHANGES IN SO2 LEVELS (ppm)
Before Diwali
During Diwali
After Diwali
-1
0
1
2
3
4
5
6
SO2
leve
ls (
in p
pm
)
Before Diwali During Diwali After Diwali
Ambient SO2 levels reached values 200 times above the safety limits recommended by WHO
Symptom Pre-existing
Prevalence (%)
New symptoms
Prevalence (%)
Total Prevalence
(%)
Cough 4.2 26.3 31.2
Breathlessness 2.5 10.8 13.3
Wheeze 1.8 4.3 6.1
PREVALENCE OF RESPIRATORY SYMPTOMS DURING THE DIWALI FESTIVAL
6.10%
13.30%
31.20%
45.50%
0%
10%
20%
30%
40%
50%
Wheeze Breathlessness Cough None
Percentages of complaining wheeze, breathlessness &
cough during Diwali festival
n = 510
Irritation in
Eyes
Runny Nose Allergic
Symptoms
Itchy Skin
26.1% 9% 5.7% 4.1%
4.10% 5.70%
9.00%
26.10%
51.00%
0%
10%
20%
30%
40%
50%
60%
Itching of
skin
Allergy Runny Nose Irritation of
eyes
None
(Chest Research Foundation, India, 2008)
(Liu W, EHP 2003; 111: 1454-1460)
1 Mosquito coil = 100 cigarettes
(Dr Sahasrabuddhe T, ERS 2010)
Acute Laryngo-tracheo-bronchitis
INDOOR AIR POLLUTION AND RESPIRATORY IMPACT
MOSQUITO NETS
(Al-Rawas et al, BMC Pulm Med 2009; 9: 23)
Aromatic woods, herbs, flowers, essential oils, perfumes
PAH, Benzene, CO, Isoprene
INCENSE BURNING AND ASTHMA
40% of asthmatic children reported
worsening of symptoms due to incense burning
Oman, Muscat2441 children 10 yrs
(Wang IJ et al, Eur Respir J 2011; 37(6): 1371-1377)
50 Pujaris in Pune
Spirometry:25% showed presence of Obstructive Airways Disease
OBSTRUCTIVE AIRWAYS DISEASE IN PUJARIS
The Telegraph2nd Sept. 2011
Indian Lungs are 30% weaker than
European/American Lungs
http://www.crfindia.com
THANK YOUDr SUNDEEP SALVI MD, DNB, PhD, FCCP
Chest Research FoundationPune, INDIA
ssalvi@crfindia.com
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