Particulate Health Effects Particulate Health Effects Research UpdateResearch Update

Coleen Baird Weese, MD, MPHColeen Baird Weese, MD, MPH

USACHPPMUSACHPPM

Anticipated Acute Health Anticipated Acute Health Effects Effects Based on the Based on the Literature Literature Increased cardio-respiratory mortalityIncreased cardio-respiratory mortality

Increased respiratory visits for asthma,Increased respiratory visits for asthma,respiratory complaintsrespiratory complaints

Decreases in pulmonary functionDecreases in pulmonary function

Measurable cardiac changes (HR, etc)Measurable cardiac changes (HR, etc)

  

Acute Health Effects Acute Health Effects ObservedObserved

Statistically significant association between URI Statistically significant association between URI ratios and PM10 weekly maximums from ratios and PM10 weekly maximums from BosniaBosnia

High PM exposures resulted in increased visits High PM exposures resulted in increased visits for URI with a few day lag in Kuwait (not for URI with a few day lag in Kuwait (not OEF/OIF)OEF/OIF)

  

Acute Health Effects Acute Health Effects ObservedObservedRecent analysis/logistic regression indicates Recent analysis/logistic regression indicates

that PM level has little impact on weekly that PM level has little impact on weekly respiratory DNBIrespiratory DNBI

Cross-sectional pulmonary function tests have Cross-sectional pulmonary function tests have not indicated widespread findings not indicated widespread findings

Use of specific ICD-9 codes should provide Use of specific ICD-9 codes should provide better information better information

  

PM10 and Respiratory Illness Doha Clinic

05

10152025303540

15-Apr 22-Apr 29-Apr 6-May

Cases/1000

0100200300400500600700800ug/m3

Respiratory

PM10 USEPA 24 hr Hazardous Level

PM10 USEPA 24 hr Standard

PM10, Doha Clinic (Weekly Average)

PM Exposure Concentrations and Respiratory Disease Rates for Site F

0

50

100

150

200

250

300

1 2 3 4 5 6 7 8 9 10

Weeks

Co

nce

ntr

atio

n

(mic

rog

ram

s/cu

bic

m

eter

)

0

2

4

6

8

10

12

Concentration

Rate

Anticipated Long-term Health Anticipated Long-term Health Effects Based on the Literature Effects Based on the Literature

Increased Cardio respiratory MortalityIncreased Cardio respiratory Mortality

Potential acceleration of heart diseasePotential acceleration of heart disease

Chronic obstructive pulmonary diseaseChronic obstructive pulmonary disease

  

Overall, no unusual trends in patients from PGW Overall, no unusual trends in patients from PGW 1, OEF and OIF 1, OEF and OIF

Medical evacs for chest painMedical evacs for chest pain

No significant increase in No significant increase in respiratory/cardiovascular visits pre deployment respiratory/cardiovascular visits pre deployment versus post deploymentversus post deployment

No significant increases in No significant increases in respiratory/cardiovascular visits with multiple respiratory/cardiovascular visits with multiple deploymentsdeployments

  

Top Three-Digit Primary Outpatient Top Three-Digit Primary Outpatient Diagnoses among Single Deployers—Diagnoses among Single Deployers—RespiratoryRespiratory

11

4 4

36

17

107 5 6

18

44

812

17

Per

cen

tPre-deployment (n=5,355) Post-deployment (n=4,907)

Top Three-Digit Primary Outpatient Top Three-Digit Primary Outpatient Diagnoses among Multiple Deployers—Diagnoses among Multiple Deployers—RespiratoryRespiratory

115 3

36

915

85 5

18

46

712

17

Per

cen

tPre-deployment (n=1,645) Post-deployment (n=1,499)

Top Three-Digit Primary Outpatient Top Three-Digit Primary Outpatient Diagnoses among Single Deployers—Diagnoses among Single Deployers—CirculatoryCirculatory

7

43

10 9

16

47

11

17

Per

cen

t

Pre-deployment (n=834) Post-deployment (n=1,087)

Top Three-Digit Primary Outpatient Top Three-Digit Primary Outpatient Diagnoses among Multiple Deployers—Diagnoses among Multiple Deployers—CirculatoryCirculatory

7

44

11 9

18

44

13

17per

cen

t

Pre-deployment (n=220) Post-deployment (n=407)

Ongoing EffortsOngoing Efforts

• Enhanced PM Surveillance linked to Enhanced PM Surveillance linked to analysis of coded visits at these sites analysis of coded visits at these sites for outcomes of interestfor outcomes of interest

• Analysis of multiple deployment Analysis of multiple deployment trends by specific condition trends by specific condition

Respiratory Health Assessment Team Respiratory Health Assessment Team

• Protocol for pre/during/post assessment still Protocol for pre/during/post assessment still at IRBat IRB

• In-theatre component may be too difficult to In-theatre component may be too difficult to sell without other findingssell without other findings

• Several units evaluated in theatre with PFTs Several units evaluated in theatre with PFTs are beind followed with repeat post are beind followed with repeat post deploymentdeployment

Avoid all physical activity outdoors.

Remain indoors and keep activity levels low

Hazardous301-500

Avoid prolonged or heavy exertion

Avoid all physical activity outdoors

Very Unhealthy

201-300

Reduce prolonged or

heavy exertion

Avoid prolonged or heavy exertion

Unhealthy151-200

 Reduce prolonged or

heavy exertion

Unhealthy for Sensitive

Groups101-150

 Consider reducing prolonged or heavy

exertionModerate51-100

  Good0-50

All OthersPersonnel at High RiskLevel of Health

Concern

Dust Concentration

g/m3

Yellow Dust Activity Restriction Recommendations

Predictions for Yellow Dust in the Korean peninsula will be notified to the USFK public through command channels and Armed Forces Network Korea. Contact DCSFHP at 736-3025 (duty hours) and 011-9179-1645 (other times) for specific dust concentrations at your location during a yellow dust storm.

Heavy exertion• Walking hard surface at 3.5 mph > 40 lb load• Walking loose sand at 2.5 mph with load• Field assaults• Running

Personnel at High Risk:

Young children

Elderly

With heart disease

With lung disease such as asthma

Commanders should:

Include Yellow Dust conditions in risk assessment for training events

Identify Soldiers at high risk and take additional protective measures

Current dust concentration at your location is also available at 18th MEDCOM website: http://www.seoul.amedd.army.mil

For information on the Health Effects For information on the Health Effects Research Workgroup, Proceedings of the Research Workgroup, Proceedings of the Meeting, and Presentations from the Meeting, and Presentations from the Symposium, go to:Symposium, go to:

http://chppm-www.apgea.army.mil/doem/EMhttp://chppm-www.apgea.army.mil/doem/EMP.aspxP.aspx

CHPPM HOME/DOEM/ Program 64CHPPM HOME/DOEM/ Program 64