Impact of Air Quality on Asthmatic Patients in the South Senge Ngalame

Concordia University

Epidemiology of Air Quality• Asthma affects 5-10% of the population or an estimated 23.4 million persons, including 7 million

children

• 7.6% of people in the south have asthma

• In the most recent listing of the 10 worst cities for Asthma, included the following southern cities and states, Richmond, VA( 1st), Chattanooga, TN (2nd ), Memphis, TN(3rd ), McAllen, TX(8th), Atlanta, GA(9th), and Knoxville, TN(10th)

• Average annual rate of physician office visits is 56.6 visits per 100 persons with asthma

• The visit rate of the emergency department is 8.7.

• The death rate is 1.5 and 1.6 per 10,000 persons with asthma.

All ages Children AdultsTotal Age <18 Age 18+

Total: 39,504 10,463 29,041 1,753 6,389 13,057 3,698 3,452 5,907 14,195 4,111    Male 18,103 5,821 12,282 923 3,697 6,624 1,900 1,928 2,795 5,456 1,403    Female 21,402 4,642 16,759 830 2,692 6,433 1,798 1,524 3,112 8,738 2,708

White Non-Hispanic: 24,845 4,993 19,852 711 2,942 7,972 2,094 2,101 3,777 10,029 3,190    Male 11,262 2,806 8,455 386 1,760 4,047 1,084 1,162 1,800 3,922 1,147    Female 13,583 2,186 11,397 326 1,182 3,926 1,010 938 1,977 6,107 2,043

Black Non-Hispanic: 6,123 2,119 4,003 408 1,303 2,228 722 574 932 1,732 452    Male 2,832 1,203 1,629 218 737 1,134 379 316 438 625 118    Female 3,291 917 2,374 190 566 1,094 343 258 493 1,108 333

Other Non-Hispanic: 2,755 900 1,855 172 568 906 274 262 371 893 215    Male 1,243 517 726 90 346 424 137 161 126 306 78    Female 1,511 383 1,129 82* 222 483 137 101 245 587 137

Hispanic: 5,782 2,452 3,330 461 1,576 1,951 607 516 828 1,540 254    Male 2,766 1,295 1,471 229 855 1,019 299 289 431 603 60*    Female 3,016 1,156 1,860 232 721 931 308 227 397 937 195

    Puerto

Rican:a 1,055 455 600 114 260 316 104 34* 178 298 67*        Male 449 190 260 41* 107 193 53* ** 115* 89* **        Female 605 265 340 73* 153 123 51* ** 63 209 47*

    Mexican/Mexican-American

:a 3,156 1,455 1,701 235 992 1,081 355 319 406 746 102        Male 1,657 796 861 125 553 596 167 177 251 371 **        Female 1,499 659 840 110 439 485 188 142* 155 375 90

Region:    Northeast 6,862 1,888 4,974 354 1,072 2,393 722 505 1,166 2,259 784    Midwest 8,530 2,190 6,340 323 1,369 2,990 840 793 1,357 2,968 880    South 14,544 4,088 10,456 750 2,447 4,433 1,286 1,180 1,967 5,452 1,461

 65+ 5 - 14  15 - 34  15 - 19Characteristic†

 0 - 4  20 - 24  25 - 34  35 - 64

Age (years)15-34

Table Lifetime Asthma Population Estimates -- in thousands by Age, United States: National Health Interview Survey, 2011

U.S. State InfoAdults with asthma in the US, 2009

Annual U.S. Prevalence Statistics for Chronic Diseases

Biomedical Basis• The air quality can give physiological, long

and short term effects on a person’s body.

• Air pollution is an immediate irritant that can aggravate sensitive areas such as the eyes, throat, nose and lungs

• Household combustion devices, motor vehicles, industrial facilities and forest fires are common sources of air pollution

• Air can be contaminated by a range of very different particles such as dust, pollen, soot, smoke, and liquid droplets

• Ozone (03), Nitrogen dioxide (NO2), Sulfur dioxide (SO2) and particulate matter are common factors in affecting air quality

Formation of Ozone

Environmental Factors • Nearly half (46 percent) of the U.S. population

live in counties that have unhealthful levels of either ozone or particle pollution

• An estimated 1-in-5 cases of asthma in the U.S. is linked to exposures to mold and dampness in homes; this costs the nation an estimated $3.5 billion in annual medical treatment costs.

• Asthma can aggravated by exposure to pollutant "triggers" such as certain components of vehicle exhaust and industrial emissions, tobacco smoke, pollen and allergens from animals and insects

• Urban environments have high levels of outdoor pollution and poor housing conditions, which frequently are associated with increased levels of indoor pollution

Social and Behavioral Factors • For adults, asthma is the fourth leading cause of

work absenteeism and “presenteeism,” resulting in nearly 15 million missed or lost ("less productive") workdays each year (this accounts for nearly $3 billion of the "indirect costs")

• Among children ages 5 to 17, asthma is the leading cause of school absences from a chronic illness

• It accounts for an annual loss of more than 14 million school days per year (approximately 8 days for each student with asthma) and more hospitalizations than any other childhood disease.

• It is estimated that children with asthma spend an nearly 8 million days per year restricted to bed

• The American Lung Association stated being in heavy traffic, or living near a road, may be even more dangerous than being in other places in a community

Biostatistics • The CDC stated that the south has 14,544 people who have asthma

• 10,456 of those people are adults 18 and up

• 4,088 represents children under 18

• In the southern region, 10-50 millions of tons of coal is being burned up by coal fired power plants

• A way to check the air quality to make sure it is safe is the Air Quality index

• The Air Quality Index (AQI) relates daily air pollution concentrations for ozone particle pollution, NO2, CO, and SO2 to health concerns for sensitive groups and for the general public

• Values below 100 are considered satisfactory. Values above 100 are considered unhealthy – first for certain sensitive groups of people, then for everyone as the AQI values increase

Biostatistics pt.2• In the southern region, between the years 2002-2007, the AQI values were considered

unhealthy for 10-20 days

• EPA strengthened the national standards for ground-level ozone, setting an 8-hour standard at 0.075 parts per million (ppm)”.

• The measure of ground level-ozone in the southern region was between 0.060-0.0075 ppm

• In certain areas of Alabama, Georgia, Tennessee, North Carolina, South Carolina, and Virginia, it was between 0.076-0.095 ppm.

Air Quality Index

Policy• The National Institutes of Health states: federal, state, and local health officials can track asthma

rates and the effectiveness of control measures so continuous improvements can be made in prevention efforts, promote influenza and pneumonia vaccination for people with asthma, and promote improvements in indoor air quality for people with asthma through measures such as smoke-free air laws and policies, healthy schools and workplaces, and improvements in outdoor air quality.

• The Clean Air Act, which was last amended in 1990, requires EPA to set National Ambient Air Quality Standards (NAAQS) for wide-spread pollutants from numerous and diverse sources considered harmful to public health and the environment.

• Two types of national air quality standards were established Primary standards set limits to protect public health, including the health of "sensitive"

populations such as asthmatics, children, and the elderly Secondary standards set limits to protect public welfare, including protection against visibility

impairment, damage to animals, crops, vegetation, and buildings

Policy pt.2• Requires periodic review of the science upon which the standards are based and the standards themselves

• The CDC established the National Asthma Control Program (NACP) Helps Americans to learn about asthma and how to manage it The NACP first incorporated interventions into its cooperative agreement structure in 2002 That year the program funded grantees to implement two scientifically-evaluated asthma interventions:

the Asthma and Allergy Foundation of America’s “Asthma Care Training for Kids” and the American Lung Association’s “Open Airways for Schools.”

Surveillance data show that these interventions decrease acute care visits and hospitalizations and increase compliance with asthma care plans.

By 2007, NACP funded all 36 grantees to develop and maintain a broad array of asthma interventions Including programs or campaigns for adult-specific asthma education and prevention, asthma

awareness, outreach, and communication, caregiver, school- and childcare center-based education and prevention, education and prevention targeted to underserved populations, trigger reduction and home visits, healthcare provider education and training, health plan coverage of asthma services, indoor air quality-based education and prevention, senior citizen-specific asthma education and prevention, state systems-based change, and tobacco use reduction.

References • American Lung Association. (2013). Disparities in the Impact of Air Pollution. Retrieved from:

http://www.stateoftheair.org/2013/health-risks/health-risks-disparities.html

• Asthma and Allergy Foundation of America. (2010). Asthma Facts and Figures. Retrieved from: http://www.aafa.org/display.cfm?id=9&sub=42#_ftn20

• Centers for Disease Control and Prevention. (2012).National Surveillance of Asthma: United States, 2001-2010 (DHHS Publication No. (PHS) 2013-1419). Hyattsville, Maryland: U.S. Government Printing Office.

• Centers for Disease Control and Prevention. (2013). 2011 National Health Interview Survey (NHIS) Data. Retrieved from: http://www.cdc.gov/asthma/nhis/2011/table1-1.htm

• Centers for Disease Control and Prevention. (2013). CDC’s National Asthma Control Program: An Investment in America’s Health. Retrieved from: http://www.cdc.gov/asthma /pdfs/investment_americas_health.pdf

• Chung, K., Cullinan, P., Han, I., Harrington, R., Jarup, L., Malliarou, E., McCreanor, J., Nieuwenhuijsen, M, Ohman-Strickland, P., Stewart-Evans, J., Svartengren, M., and Zhang, J. (2007). Respiratory Effects of Exposure to Diesel Traffic in Persons with Asthma. The New England Journal of Medicine, 357:2348-2358. DOI: 10.1056/NEJMoa071535

References• Council of State Governments. (2007). Preventing Asthma and Promoting Respiratory

Health. Retrieved from: www.healthystates.csg.org/NR/rdonlyres/BF03D8A7.../asthmaLPB.pdf

• Delfino, Ralph J. (2002) Epidemiologic evidence for asthma and exposure to air toxics: linkages between occupational, indoor, and community air pollution research [Abstract]. Environmental Health Perspectives, Volume 110(Supplement 4). Retrieved from:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1241205/

• Green Facts. (2013). Air Pollution Particulate Matter. Retrieved from: http://www.greenfacts.org/en/particulate-matter-pm/index.htm#2

• Medical News Today. (2007). Living with Asthma. Retrieved from: http://www.medicalnewstoday.com/info/asthma/living-with-asthma.php

References • Morris, Michael J. (2013) Asthma. Retrieved from:

http://emedicine.medscape.com/article/296301-overview#a0156\

• National Institutes of Health. (2011, May). Asthma in the U.S. growing every year. Retrieved from:http://www.niaid.nih.gov/topics/asthma/understanding/Pages/usAsthma.aspx#Whatcanbedone

• S, Jacob. (2010). Air Pollution Effects on the Human Body. LiveStrong.com: The Limitless Potential of You. Retrieved from: http://www.livestrong.com/article/148297-air-pollution-effects-on-the-human-body/

• Smith, Michael W. (2013) Slideshow: 10 Worst Cities for Asthma. Retrieved from http://www.webmd.com/asthma/ss/slideshow-10-worst-cities-for-asthma

• U.S. Environmental Protection Agency. (2012). Asthma, Air Quality, and Environmental Justice. Retrieved from: http://www.epa.gov/region4/air/naaqs/asthma.htm

References • U.S. Environmental Protection Agency Office of Air Quality Planning and Standards.

(2012). Our Nation’s Air Status and Trends Through 2010. Retrieved from: http://www.epa.gov/airtrends/2011/index.html

• U.S. Environmental Protection Agency. (2013). Asthma and Outdoor Air Pollution. Retrieved from: www.epa.gov/asthma

• The Weather Channel. (2012). Weather Glossary. Retrieved from: http://www.weather.com/glossary/a.html

• The World Health Organization. (2013). Health Topics: Air Pollution. Retrieved from: http://www.who.int/topics/air_pollution/en/index.html

• The World Health Organization. (2011). Air Quality and Health. Retrieved from: http://www.who.int/mediacentre/factsheets/fs313/en/index.html

• Wein H. (2011). Bad Air Day: Air Quality and Your Health. NIH News in Health. Retrieved from: http://newsinhealth.nih.gov/issue/Jul2011/feature1