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Particulate Matter Air Pollution and its Respiratory Effects in Asthmatic Children

Marianne Pelletier PhD student

Walden University

PH 8165-1

Instructor Dr. Joanne Flowers

Fall Quarter 2009

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Objectives

At the conclusion of this program, participants should be able to:

Define particulate matter (PM).

Know what PM particle size has to do with adverse effects on lung health.

Know what adverse effects PM has on the lungs in children with asthma and the role of oxidative stress.

Be familiar with the EPA regulatory programs addressing PM to decrease the burden on children with asthma.

State what interventions are still needed to address PM and its adverse events on the respiratory health in children with asthma.

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What is Particulate Matter (PM)?

Particulate Matter is small particles made up of many ingredients like organic chemicals, metals, nitrate and sulfate acids as well as soil and dust particles.

The EPA is concerned about health effects with particles 10 micrometers or smaller and divides them into 2 categories;

"Inhalable coarse particles, such as those found near roadways and dusty industries, are larger than 2.5 micrometers and smaller than 10 micrometers in diameter. “

"Fine particles, such as those found in smoke and haze, are 2.5 micrometers in diameter and smaller. These particles can be directly emitted from sources such as forest fires, or they can form when gases emitted from power plants, industries and automobiles react in the air. “

http//www.epa.gov/oar/particlepollution/

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What does size of PM have to do with the lungs?

Coarse PM (10-2.5 micrometers) can be inhaled past the nose and throat and get into the large airways like the bronchus.

Fine particulate matter (2.5 micrometers or smaller) can be inhaled and get into the small airways as well as the alveoli and pass through to the bloodstream.

2.5 micrometers is 30 times smaller than the circumference of one hair from your head!

http://www.epa.gov/oar/particlepollution/

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Air pollution causes oxidative stress in the lungs

Lungs are exposed to the air in the environment, therefore they are exposed to oxidants in air pollution and cigarette smoke.

Cigarette smoke is a mixture of over 5000 chemical compounds where oxidants are present in very high concentrations.

Oxidative stress causes direct injury to the lungs and signals cells to produce inflammation.

Particulate air pollution has been shown to generate oxidative stress in the lungs.

MacNee, W. (2005). Oxidants and COPD. Current Drug Targets-Inflammation and Allergy, 4, 627-41.

Liu, L., Poon, R., Chen, L., Frescura, A.M., Montuschi, P., Ciabattoni, G. et al. (2009). Acute effects of air pollution on pulmonary function, airway inflammation, and oxidative stress in asthmatic children. Environmental Health Perspectives, 117, 4, 668-74.

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Koenig and colleagues (1993) looked at 24 elementary schoolchildren with asthma during the winter months in Seattle.

Seattle is heavily polluted by PM air pollution from residential wood burning stoves in the winter.

PM from wood burning is associated with significant lung irritation in young asthmatic children.

Koenig, J.Q., Larson, T.V., Hanley, Q.S., Rebolledo, V., Dumler, K., Checkoway, H. (1993). Pulmonary function changes in children associated with fine particulate matter. Environmental Research, 63, 1, 26-38.

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As air particle pollution increases FEV1 decreases in children with asthma

Dales, R, Chen, L., Frescura, A.M., Liu, L., Villeneuve, P.J. (2009). Acute effects of outdoor air pollution on forced expiratory volume in 1s: a panel study of schoolchildren with asthma. European Respiratory Journal, 34, 2, 316-23

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Effects of PM on the Respiratory System in Children with Asthma.

Decrease in pulmonary function FEV1 (forced expiratory volume in 1 second).

Increase in airway inflammation

Increase in airway mucous

Increase in bronchoconstriction

www.healthline.com

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What are the symptoms in children of an asthma exacerbation due to inflammation in the lung?

Shortness of breath

Wheezing

Chest tightness

Cough

Use of accessory muscles for breathing

Abdominal breathing

Chest retractions

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Respiratory health of children declined in schools with poor air quality.

These schools were located next to busy roadways or near a refuse burning plant.

Cough and asthma were the most reported adverse events.

There was an increased asthma prevalence in these schools.

There was also an increased prevalence of bronchitis.

Ana, G.R., Shendell, D.G., Odeshi, T.A., Sridhar, M.K. (2009). Identification and initial characterization of prominent air pollution sources and respiratory health at secondary schools in Ibadan, Nigeria.

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Great Smoky Mountains National Park

http://www.epa.gov/visibility/

Clean Air Visibility Rule

Clean Air Day Hazy Air Day

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EPA Programs and Interventions on PM

Industrial Programs

Clean Air Interstate Rule www.epa.gov/cair/

Focused on reduction of air pollution crossing state boundaries

Clean Air Visibility Rule www.epa.gov/visibility/

Focus is to improve air quality in national parks and wilderness areas.

Acid Rain Program www.epa.gov/acidrain/

Focus on reducing acid rain to preserve natural habitats

NOx SIP Call program www.epa.gov/airtrends/

Focus on reducing air particles by reducing nitrogen oxide emissions

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EPA Programs for Mobile Sources of PM

Clean Air Non Road Diesel www.epa.gov/nonroad-diesel/2004fr.htm Focus on reduction of PM from future non road engines like farm equipment etc.

Heavy Duty Highway Diesel Program www.epa.gov/otaq/highway-diesel/index.htm Focus on cleaner emissions from

heavy duty trucks and buses.

There are also programs for passenger vehicles, motorcycles, generators, off-road all terrain vehicles and more.To find out more about other programs go to

www.epa.gov

AirNow Website www.airnow.gov

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Interventions for PM exposure for schoolchildren

When building new schools locate them away from busy highways and refuse burning plants.

Health care providers and school officials need to advocate for the health of our children to ensure this to be a top priority for regulatory policy decision making.

Treat asthma to a well controlled state.

Provide asthma education to asthmatic children as well as to their family friends and classmates.

Gilliland, F.D. (2009). Outdoor air pollution, genetic susceptibility, and asthma management: opportunities for intervention to reduce the burden of asthma. Pediatrics, 123, Suppl. 3, S168-73.

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Interventions for PM exposure for schoolchildren (cont)

Revisit school bus operations.

Have clean school air goals.

Monitor daily air quality data if available at www.airnow.gov and limit outdoor activities on highly polluted days.

Gilliland, F.D. (2009). Outdoor air pollution, genetic susceptibility, and asthma management: opportunities for intervention to reduce the burden of asthma. Pediatrics, 123, Suppl. 3, S168-73.

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Summary

Particulate Matter (PM)2.5-10 micrometers can cause injury to the lungs and a decline in lung function in asthmatic children.

PM can cause an increase in asthma prevalence in children.

PM causes oxidative stress damage to the lungs.

Asthma needs to be treated to a well controlled state by health care providers.

Asthmatic children and their parents need education about asthma treatment, exacerbations and treatment adherence.

The Environmental Protection Agency (EPA) has many regulatory programs addressing PM air pollution.

There are still many more interventions that need to be developed and implemented to address PM and its effects on the respiratory system and evidence of increased asthma prevalence.

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Recommended Reading

Ayres, J., Maynard, R.L. (1999). Air Pollution and Health. Academic Press: London

Donald, R.L. (2001). Air Pollution. Children’s Press: Canada

Jacobson, M.Z. (2007). Atmospheric Pollution. University Press: United Kingdom.

Valero, D. (2008). Fundamentals of Air Pollution. Elsevier: London

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Thank You !

Questions?

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References

Ana, G.R., Shendell, D.G., Odeshi, T.A., Sridhar, M.K. (2009). Identification and initial characterization of prominent air pollution sources and respiratory health at secondary schools in Ibadan, Nigeria.

Dales, R, Chen, L., Frescura, A.M., Liu, L., Villeneuve, P.J. (2009). Acute effects of outdoor air pollution on forced expiratory volume in 1s: a panel study of schoolchildren with asthma. European Respiratory Journal, 34, 2, 316-23

Environmental Protection Agency (2009a) Acid rain program. Retrieved on October 17, 2009 from www.epa.gov/acidrain/

Environmental Protection Agency (2009b) AirNow website. Retrieved on October 17,2009 from www.airnow.gov

Environmental Protection Agency. (2009c) Clean air interstate rule Retrieved on October 17 2009 from www.epa.gov/cair/

Environmental Protection Agency (2009d). Clean air non road diesel. Retrieved on October 17, 2009 from www.epa.gov/nonroad-diesel/2004fr.htm

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Environmental Protection Agency (2009e) Clean air visibility rule. Retrieved on October 17, 2009 from www.epa.gov/visibility/

Environmental Protection Agency (2009f).Heavy duty highway diesel program Retrieved on October 17,2009 from www.epa.gov/otaq/highway- diesel/index.htm

Environmental Protection Agency (2009g). NOx SIP call program. Retrieved on October 17,2009 from www.epa.gov/airtrends/

Gilliland, F.D. (2009). Outdoor air pollution, genetic susceptibility, and asthma management: opportunities for intervention to reduce the burden of asthma. Pediatrics, 123, Suppl. 3, S168-73.

Liu, L., Poon, R., Chen, L., Frescura, A.M., Montuschi, P., Ciabattoni, G. et al. (2009). Acute effects of air pollution on pulmonary function, airway inflammation, and oxidative stress in asthmatic children. Environmental Health Perspectives, 117, 4, 668-74.

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MacNee, W. (2005). Oxidants and COPD. Current Drug Targets-Inflammation and Allergy, 4, 627-41.