Health Effects of Particulate Air Pollution

1
Health Effects of Particulate Air Pollution

• Kevin P. Fennelly, M.D., M.P.H.
• Assistant Professor of Medicine
• Center for Emerging Pathogens
• Division of Pulmonary Critical Care Medicine
• New Jersey Medical School-UMDNJ
• Newark, NJ
• fennelkp_at_umdnj.edu

2
(No Transcript)
3
Cough-generated aerosols of M. tuberculosis
- Fennelly KP et al. Am J Resp Crit Care Med
2004 169 604-9
4
Particle Sizes of Cough-generated Aerosols in TB
- Fennelly KP et al. Am J Resp Crit Care Med
2004 169 604-9
5
London Air Pollution Disaster
6
Particulate Air Pollution

• Cardiovascular hospitalizations, death
• Pulmonary hospitalizations, death
• Cancer
• Asthma exacerbations
• Biological mechanism(s) unclear oxidant injury,
  inflammation, alterations of heart rate
  variability.
• Small risks but distributed in large populations
• (0.5 increase in mortality per 10 mcg m-3
  increase in PM10)
• - Pope CA et al. JAMA 2002 Mar 6287(9)1132-41

7
Hospital Admissions with Secondary Diagnoses in
Denver

• No significant effects for primary pulmonary
  diagnoses
• Cardiac admissions associated with 100 mcg
  increase in PM10 significant only if included
  pulmonary secondary diagnosis (RR 1.21
  1.10,1.33)
• Similar increase in circulatory cancers deaths
  in NYC 1985-94, but only for adults 75 y.o.
• De Leon SF et al. Am J Respir Crit Care Med
  20031671117

8
We live in an aerosol solution, breathing
7,000-15,000 L/day

• Gases Solvent
• Nitrogen
• Carbon dioxide
• Oxygen
• Trace gases
• Pollutant gases
• CO
• Ozone
• Nitrogen oxides
• Therapeutic gases
• Oxygen
• Helium-oxygen (Heliox)

• Particles Solutes
• Crustal elements
• Combustion products
• Elemental Carbon
• Organic Carbon
• Metals
• Bioaerosols
• Microbes
• Pollens, spores
• Toxins
• Fomites / insect parts
• Anything from living matter

9
Threats Aerosols Therapies

• Cigarette smoke
• Particulate air pollution
• Smoke/accidents (WTC)
• Indoor combustion prod
• Household aerosols
• Indooroutdoor allergen
• Pollen, spores, antigens
• Influenza, TB, other resp pathogens
• Fungi (e.g., Stachybotrys)
• Whole organism/antigens
• Mycotoxins
• Anthrax
• Plague, smallpox, other BT agents

• Bronchodilators
• Beta-agonists
• Anitcholinergics
• Cromolyn sodium
• Corticosteroids
• Interferon-gamma
• Muco-lytics, -kinetics
• Pulmozyme, NAC, dextran
• HS-SI
• Mch mannitol bronchoprovocation tests
• TOBI inhd antibiotics
• Alpha-1-antitrypsin
• Ilioprost (prostacyclin)
• Insulin (Pfizer)
• Vaccines (?) genes (?)

10
Mechanisms of Particle Deposition
Impaction inertia larger Particles-proximal
airways Andersen impactors
Water soluble
Diffusion small particles esp. alveoli,
bronchioles Airborne infections
HOH
Electrostatic precipitation usu. minor in vivo
Plastic spacers, air
samplers, respirators, filters
Sedimentation due to gravity low velocities
larger particles Inspiratory pause with meds
Interception esp. fibers edge of particle
touches wall Filters, respirators
Lipid soluble
11
-Scheuch G. From Transgenic Sheep to Aerosols.
ATS Annual Meeting Symposium, 2001
12
Mechanisms of Particle Clearance
Esophagus (70)
Mucociliary clearance
Cough surface tension
beta-agonists ? elasticity mucolytics?
Lymph Blood
propanolol (beta-blockers?) age ciliary
defects influenza, RSV
Lymph Nodes
13
Ultrafkine
Ultrafine
14
Particle Size Efficacy of Drugs
- Rees PJ et al. Eur J Resp Dis 1982
15
Pulmonary Retention of Bacillus subtilis Spores

• No change in counts of 1 microns particles at 24
  hours, but larger particles cleared
• Tergitol detergent treatment increased upper
  airway deposition and delayed clearance
• - Harper GJ, Morton JD. J Hygiene 195351372

16
Irritant aerosols are associated with immediate
(
17
COPD Patients Have Increased Deposition More
Heterogeneous
-Scheuch G. From Transgenic Sheep to Aerosols.
ATS Annual Meeting Symposium, 2001
18
(No Transcript)
19
Recommendations

• Action
• Decrease automobile and truck traffic
• Surveillance of relevant health outcomes
• Daily ED visits
• Asthma, Congestive Heart Failure, COPD, sudden
  infant deaths
• Research
• Need to understand underlying biological
  mechanisms