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Salvi Pollution Talk Iaapc 21-12-13

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ECRD.IN
http://www.crfindia.com
AIR POLLUTION AND
HEALTH
Dr SUNDEEP SALVI MD, DNB, PhD, FCCP
Chest Research Foundation
Pune, INDIA
ssalvi@crfindia.com
ECRD.IN
LUNGS: THE AMAZING ORGAN
Oxygen – 420 Lts
Carbon 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
ECRD.IN
The Telegraph
2nd Sept. 2011
Indian Lungs are
30% weaker than
European/American
Lungs
• Ethnic
• Nutritional
• Quality of air we breathe
(Lancet Resp Med 2013)
ECRD.IN
GLOBAL MORTALITY DUE TO
CHRONIC RESPIRATORY DISEASES
Mortality due to Chronic respiratory diseases, Global Health Observatory Data Repository,
World Heath Organisation (WHO), viewed 4th November, 2011
ECRD.IN
888 cities and
towns across India
13,225 doctors across
India
- General Physicians
- General Practitioners
- Pediatricians
1st February 2011
2,04, 912 patients
WHAT AILS INDIA?
ECRD.IN
0%
10%
20%
30%
40%
50%
60%
36%
19%
10%
3%
51%
25%
13%
9%
7% 6% 6%
18%
Prevalence(%)
Prevalence of Different symptoms in Indian
Population
MOST COMMON SYMPTOMS FOR WHICH A PATIENT VISITS
A DOCTOR (NON-SPECIALIST) IN INDIA
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Salvi Pollution Talk Iaapc 21-12-13

  • 1. ECRD.IN http://www.crfindia.com AIR POLLUTION AND HEALTH Dr SUNDEEP SALVI MD, DNB, PhD, FCCP Chest Research Foundation Pune, INDIA ssalvi@crfindia.com
  • 2. ECRD.IN LUNGS: THE AMAZING ORGAN Oxygen – 420 Lts Carbon 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
  • 3. ECRD.IN The Telegraph 2nd Sept. 2011 Indian Lungs are 30% weaker than European/American Lungs • Ethnic • Nutritional • Quality of air we breathe (Lancet Resp Med 2013)
  • 4. ECRD.IN GLOBAL MORTALITY DUE TO CHRONIC RESPIRATORY DISEASES Mortality due to Chronic respiratory diseases, Global Health Observatory Data Repository, World Heath Organisation (WHO), viewed 4th November, 2011
  • 5. ECRD.IN 888 cities and towns across India 13,225 doctors across India - General Physicians - General Practitioners - Pediatricians 1st February 2011 2,04, 912 patients WHAT AILS INDIA?
  • 6. ECRD.IN 0% 10% 20% 30% 40% 50% 60% 36% 19% 10% 3% 51% 25% 13% 9% 7% 6% 6% 18% Prevalence(%) Prevalence of Different symptoms in Indian Population MOST COMMON SYMPTOMS FOR WHICH A PATIENT VISITS A DOCTOR (NON-SPECIALIST) IN INDIA
  • 8. ECRD.IN (Times of India, 5th May 2009) Pune city 2003 – 2.9% 2008 – 5.4% Ms Maria Cheraghi CRF, Pune
  • 9. ECRD.IN 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
  • 10. ECRD.IN (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
  • 11. ECRD.IN (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)
  • 12. ECRD.IN   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)
  • 13. ECRD.IN EXPOSURE TO DIESEL EXHAUST FOR 1 HOUR: EFFECTS ON HUMAN LUNG
  • 14. ECRD.IN Exposure to diesel exhaust for 1 hour increases histamine release in the airways of healthy human volunteers (Salvi S et al, AJRCCM 1999; 159: 702-709)
  • 15. ECRD.IN EFFECTS OF DIESEL EXHAUST ON INFLAMMATORY CELL NUMBERS IN BRONCHIAL TISSUE (Healthy subjects) Air Diesel p value (median, IQR) (median, IQR) Mast cells Epithelium 0.0 (0.0 – 0.44) 0.0 (0.0 – 0.0) ns Sub-mucosa 8.8 (7.7 – 14.9) 32.7 (14.7 – 46.2) < 0.005* Blood vessels Vascular exudation – edema/swelling Smooth muscle Contraction Mucus glands Hypersecretion HISTAMINE Mast cell (Salvi S et al, AJRCCM 1999; 159: 702-709)
  • 16. ECRD.IN CYTOKINE UPREGULATION IN THE BRONCHIAL EPITHELIUM FOLLOWING SHORT-TERM EXPOSURE TO DIESEL EXHAUST Air Diesel exhaust IL-5, IL-8, GRO-alpha, IL-13 (Salvi S et al, Am J Respir Crit Care Med 2000; 161(2): 550-557
  • 17. ECRD.IN 323 traffic policemen; 122 non- traffic policemen SUSCEPTIBLE INDIVIDUALS 250 bus drivers
  • 18. ECRD.IN Symptom University Staff (%) PMT drivers (%) Odds ratio (CI) Blocked / Runny nose 7.33 28.13 4.95 (2.5-9.7) Chest tightness 5.33 12.11 2.45 (1.1-5.5) Wheeze 6.67 14.84 2.44 (1.2-5.0) Cough 10.67 13.67 1.33 (0.7-2.5) RESPIRATORY SYMPTOMS IN BUS DRIVERS AND UNIVERSITY STAFF MEMBERS (Chest Research Foundation, 2005)
  • 19. ECRD.IN 0 0.5 1 1.5 2 2.5 3 3.5 0.767 2.04 3.06 Non-traffic policemen Traffic policemen PMT bus drivers Exhaled CO as a marker of oxidative stress in traffic policemen and bus drivers (Chest Research Foundation, Pune 2004-2005) eCO (ppm) Non-smokers
  • 20. ECRD.IN WHICH MODE OF TRANSPORT EXPOSES YOU TO MORE AIR POLLUTANTS? Autorickshaw Bus Motor cycle Station to Kothrud Deccan to Hadapsar (Chest Research Foundation, 2007)
  • 21. ECRD.IN 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(inppm) Bus Rickshaw Bike AUC value for CO levles for 3 different transportation Mode from Pune station - Kothrud 319.88 643.13 663.50 0.00 100.00 200.00 300.00 400.00 500.00 600.00 700.00 Bus Rickshaw Bike COlevels CARBON MONOXIDE (Chest Research Foundation, 2007)
  • 22. ECRD.IN 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 SO2levels(inppm) Bus Rickshaw Bike 0.00 1.23 1.05 0.00 0.30 0.60 0.90 1.20 1.50 AUCvalues Bus Rickshaw Bike Difference in AUC values for SO2 for 3 different transportation mode from Station - Kothrud SULPHUR DIOXIDE (Chest Research Foundation, 2007)
  • 24. ECRD.IN 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 Charcoal Sulphur
  • 25. ECRD.IN MEAN CHANGES IN SO2 LEVELS (ppm) Before Diwali During Diwali After Diwali -1 0 1 2 3 4 5 6 SO2levels(inppm) Before Diwali During Diwali After Diwali Ambient SO2 levels reached values 200 times above the safety limits recommended by WHO
  • 26. ECRD.IN 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)
  • 27. ECRD.IN (Liu W, EHP 2003; 111: 1454-1460) 1 Mosquito coil = 100 cigarettes INDOOR AIR POLLUTION AND RESPIRATORY IMPACT
  • 28. ECRD.IN 0 500 1000 1500 2000 2500 1 21 41 61 81 101 121 141 161 181 201 221 241 261 281 301 321 341 361 381 PM2.5(µg/m³) Time in Minutes Mean Indoor PM 2.5 levels for 3 different coil. Mosquito Coil A Mosquito Coil B Mosquito Coil C WCDC WODOWODC
  • 29. ECRD.IN -2.0 0.0 2.0 4.0 6.0 8.0 10.0 12.0 1 21 41 61 81 101 121 141 161 181 201 221 241 261 281 301 321 341 361 381 COLevels Time in Minutes Mean Indoor CO levels for 3 different coil Mosquito Coil A Mosquito Coil B Mosquito Coil C WCDC WODC WODO
  • 30. ECRD.IN (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, Muscat 2441 children 10 yrs (Wang IJ et al, Eur Respir J 2011; 37(6): 1371-1377)
  • 31. ECRD.IN 50 Pujaris in Pune Spirometry: 25% showed presence of Obstructive Airways Disease OBSTRUCTIVE AIRWAYS DISEASE IN PUJARIS
  • 32. ECRD.IN EXPOSURE TO BIOMASS SMOKE AND THE RISK OF CHRONIC RESPIRATORY DISEASES 2 billion Kg of biomass burnt every day world-wide 0 0.5 1 1.5 2 2.5 3 3.5 Smokers BMF-exposed 1.1 billion 3 billion (Salvi S et al, Lancet 2009; 374: 733-743 Salvi S et al, Chest 2010; 138: 3-6) Poor lung growth Respiratory tract infections Asthma Asthma, COPD Respiratory tract infections Lung Cancer
  • 33. ECRD.IN LEADING RISK FACTORS (DALYs) IN SOUTH ASIA (Global Burden of Disease, Lancet Dec, 2012)
  • 34. ECRD.IN http://www.crfindia.com THANK YOU Dr SUNDEEP SALVI MD, DNB, PhD, FCCP Chest Research Foundation Pune, INDIA ssalvi@crfindia.com