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Air Pollution and its Effects on Human Health

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Presentation made by Dr Manas Ranjan Ray, Former Assistant Director and Officer-in-Charge (Research), Chittaranjan National Cancer Institute, Kolkata at a workshop in Pune focusing on review and critique of the draft National Clean Air Programme.

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Air Pollution and its Effects on Human Health

  1. 1. AIR POLLUTION AND ITS EFFECTS ON HUMAN HEALTH Dr. Manas Ranjan Ray Former Assistant Director and Officer-in-Charge (Research) Chittaranjan National Cancer Institute, Kolkata
  2. 2. AIR POLLUTION URBAN Ambient Vehicular Industrial Thermal power Stations Biomass Burning RURAL Indoor & ambient NOx, SOx, CO, PM, VOCs, PAHs, trace metals CO, SOx, NOx, PM, trace metals NOx, SOx, CO, PM, VOCs, PAHs trace metals Pesticides OC, OP, C
  3. 3. Air pollution in Indian cities •Mean annual concentrations of PM10 in most of the Indian cities are far above the NAAQS •Vehicular emission contribute 50-70% of urban pollution; 10-20% by industrial emissions (e.g. TPS) •PM2.5 are more potent for respiratory and cardiovascular disease compared to PM10 •UFPs with diameters ≤ 0.1 µm are highly toxic due to increased surface area and other characteristics
  4. 4. • Carbon dioxide andCarbon monoxide • Oxides of sulfur (SO2) • Oxides of nitrogen (NO2) • Particulate matter- PM10, PM2.5, UFP • Heavy metals- Pd, Cr, Cd, Fe, Cu, Hg, Mn • Polyaromatic hydrocarbons [ PAHs, e.g. B(a)P] • Volatile organic compounds [ VOCs, e.g. Benzene] • Secondary pollutant Ozone (O3) [ VOC + NOx + Sunlight]
  5. 5. • ‘Coarse’ particles (>2.5 m diameter) • ‘Fine’ particles (<2.5 m diameter) • ‘Ultrafine’ particles (<0.1 m diameter) How do they differ? Source /origin Chemical composition Respiratory tract deposition Health effects
  6. 6. Naso-oropharangeal region Large and water-soluble PMs are removed Tracheo-bronchial region Smaller percentages of PM10 and PM2.5 are deposited Alveolar region PM10, PM2.5 and UFPs are deposited; a fraction of UFPs migrate to circulation PM Deposition in Lungs and the Airways
  7. 7. Particulate Matter (PM): pollutant of prime concern PM10 : diameter < 10 microns PM2.5 : diameter < 2.5 microns Ultra fine particles (UFPs) : diameter < 0.1 microns Smaller the size, greater the health risk
  8. 8. PFT of Children
  9. 9. 4 3.1 2.4 5.2 87.5 9.5 8.5 17.5 19.5 0 5 10 15 20 25 Sinusitis Running/Stuffy nose Sneezing Sore throat Common cold & Fever %ofindividuals Upper Respiratory Symptoms Control Exposed
  10. 10. 5.8 10.4 1.5 4.9 7.6 16.5 19.9 5.8 22.4 15.9 0 5 10 15 20 25 Dry cough Cough with phlegm Wheeze Breathlessness Chest discomfort %ofindividuals Lower Respiratory Symptoms Control Exposed
  11. 11. 18.7 25.7 39.8 43.5 0 5 10 15 20 25 30 35 40 45 50 Adult Children %ofindividuals Control Exposed
  12. 12. 7.2 7 5.5 9.8 7.4 5.4 0 50 100 150 200 250 0 3 6 9 12 Winter Summer Monsoon microgram/m3 %ofchildren Dry cough Cough with phlegm PM10 9.2 7.9 4.3 0 3 6 9 12 Low Medium High %oftotal Wet Cough Inverse relation with SES SES Dry cough Wet cough High 1 1 Medium 2.31* (1.96-2.73) 1.72* (1.48-2.01) Low 3.34* (2.83-3.95) 2.20* (1.89-2.57)
  13. 13. 0 10 20 30 40 50 60 70 80 90 Asthma Eye Irritation Headache
  14. 14. Air Pollution and Asthma  Asthma is exacerbated by ozone and other pollutants  Significant associations of chronic pollution exposure with asthma in children and adults  Greater prevalence of asthma in the polluted cities (3.8% vs. 2% in control)
  15. 15. Chronic air pollution exposure Lung injury Inflammation Oxidative stress and Lung disease
  16. 16. COPD  Chronic obstructive pulmonary disease (COPD) is a progressive life-threatening disease  It consists of two conditions- Chronic bronchitis and emphysema  Chronic air pollution exposure increases the risk of COPD  Three-fold increase in COPD in never-smoking women of Kolkata and Delhi after adjusting for possible confounders  Women and people with low socioeconomic status are more vulnerable
  17. 17. 1.6 4.9 0 4 8 %individuals Control Exposed
  18. 18. Elastase 42 73 0 15 30 45 60 75 90 elastase+veAM(%) Control Kolkata
  19. 19. Iron in AM
  20. 20. Elastase
  21. 21. Target cells and poikilocytosis- Anemia and liver problem Neutrophilia and Toxic granulation- Infection, inflammation Eosinophilia -Allergy Hematological changes
  22. 22. CD4+ cells CD8+ cells CD19+ cells CD16+56+ cells 0 200 400 600 800 1000 1200 0 200 400 600 800 0 200 400 600 800 0 200 400 600 800 cells/µlcells/µlcells/µl Rural Urban CD4 (FL2) 48% CD8 (FL1) 53%
  23. 23. “It is not just the lungs and lower respiratory tract, the cardiovascular system is also affected by air pollution” Dr. Alfred Munzer American Lung Association Air Pollution Increases Heart Diseases
  24. 24. 4.7 1.4 6.7 3.5 10.1 5.3 23.7 14.5 0 5 10 15 20 25 Systolic hypertension Diastolic hypertension Systolic + Diastolic hypertension Tachycardia Hypertension(%) Control Exposed
  25. 25. 1.2 1.5 1.4 4.8 7.9 6.2 0 2 4 6 8 10 Boys Girls Total %ofchildren Rural Urban 8.6 9.8 9.3 31.8 26.4 29.4 0 7 14 21 28 35 Boys Girls Total %ofchildren Rural Urban 0 3 6 9 12 9-11 years 12-14 years 15-17 years %ofchildren Control Delhi Hypertension Pre-hypertension
  26. 26. 0 350 700 ng/l sP-selectin (GMP 140) 0 5 10 15 %ofCD62P+Platelets P-selectin (CD62P) Control Exposed * *
  27. 27. 47.4 160.9 0 85 170 OxLDL PlasmaOxLDL(U/ml) Control Exposed
  28. 28. 2.4 5.6 0 1 2 3 4 5 6 ImpairedLFT(%) Control Exposed 1.2 2.6 0 1 2 3 4 5 6 ImpairedKFT(%) Control Exposed
  29. 29. • Traffic related air pollution increases the risk of type 2 diabetes in 50+ age group • Women are more vulnerable • People under insulin treatment are more at risk of CVD during air pollution exposures Kramer et al., Environ Health Perspect, May 2010 Rioux et al., 2011
  30. 30. Changes in menstrual cycle and reproductive outcome Hormonal changes like low serum estrogen and progesterone, high serum prolactin and LH associated with •Short, long or too irregular menstrual cycle •Infertility • Spontaneous Abortion •Pre-term baby • Stillbirth • Underweight baby (< 2.5 kg) • Congenital birth defects
  31. 31.  Inhaled UFPs translocate from lungs to blood, adsorbed on RBCs, transported to all major organs  They can invade the blood-brain barrier causing microvascular damage, blood clots (brain stroke)  Neuroinflammation, death of nerve cells  Progressive neurodegeneration leading to:  Alzheimer‘s and Parkinson's disease Lung to Blood to Brain
  32. 32. 0 10 20 30 40 50 60 Depression (BDI-II score>=14) Rural Urban
  33. 33.  PM exposures decrease cognitive scores and memory in school-age children  NO2 and PM10 are associated with poor mental performance  Prenatal exposure to PAHs causes attention problems, anxiety and depression in children  Air pollution increases ADHD-related symptoms- hyperactivity, inattention, aggression, conduct problems Air Pollution, developing brain, and children behavior
  34. 34. IARC Group I Human Carcinogens, 120 agents •Arsenic Auramine production, Alcoholic beverages, Areca nut, Asbestos , Inorganic Acid mists, •Benzene. Benzidine dyes, Benzo[a]pyrene, Betel quid with or without tobacco, 1,3-Butadiene, Beryllium •Cadmium, Chromium (VI), Coal-tar pitches, Coal-tars, Coke (fuel) production, household combustion of Coal •Diesel engine exhaust •Formaldehyde •Haematite mining (underground) Iron and steel founding •Mineral oils, Phenacetin •Nickel, 4-(N-Nitrosomethylamino)-1-(3-pyridyl)-1-butanone (NNK) •Silica dust as quartz2, 3,7,8-Tetrachlorodibenzo-para-dioxin, ortho- Toludine, •Vinyl chloride, Polychlorinated biphenyls (PCB) •Ultraviolet Radiation, X-Radiation and Gamma radiation •Wood dust, Welding fumes
  35. 35. Chromosomal and DNA Damage
  36. 36. MN (A and B), ‘Broken egg’( C) ; binucleation( D); multinucleation (E) ; pyknosis (F); karyorrhexis (G) and karyolysis (H) in airway epithelial cells of biomass using participants A B C D E F G H
  37. 37. 16.3 60 0 10 20 30 40 50 60 70 Lymphocytes(%) Control Exposed Excess Comet formation suggests increase in DNA damage DNA Damage
  38. 38. 8-Oxoguanine-expressing basal and parabasal cells are more in biomass users (A) compared to that of LPG-users (B) In contrast, OGG1 and APE1 expressing basal and parabasal epithelial cells are less in biomass users A B C E D F Inadequate DNA Repair
  39. 39. Cellular abnormalities, risk of lung cancer
  40. 40. Response to air pollution across population differs due to • Extent & nature of exposure • Co-exposure of different pollutant mixtures • Population structure • Nutritional & socio economic status • Susceptibility factors
  41. 41.  PM2.5 effects are more in people with the lowest education. Excess risk: 8.2, 7.2 and 5.5% per 10 μg/m3 for subjects with low, medium and high education, respectively  Dietary factors such as lower fruit and anti-oxidant intake, lack of air conditioning, poorer housing conditions increase the risk  Women and children are more susceptible to air pollution  PM2.5 effect is substantially higher among subjects with high body mass index (BMI) Susceptibility Factors
  42. 42. Overall mortality 0.5 - 1% Cardiovascular mortality 1.4% Respiratory mortality 3.4% Hospitalization for respiratory diseases 0.8% Hospitalization for asthma 1.9% Source: Laden et al., 2000; Samet, 2000
  43. 43. • For every 50µg per cubic metre increase of PM10 in breathing air, the cost for public health in Mumbai is Rs. 452 crore/year • For every 50µg of increase of NO2 in air, the public health cost is Rs. 872 crore/yr Patankar and Trivedi, Pub Health, Feb. 17, 2011.

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