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AIR POLLUTION AND HEALTHDr SUNDEEP SALVI MD, DNB, PhD, FCCP

Chest Research FoundationPune, INDIA

ssalvi@crfindia.com

LUNGS: THE AMAZING ORGAN

Oxygen – 420 LtsCarbon 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

The world is becoming more urbanized..And the Air is becoming more foul….

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

Remote sensing of air pollution from space

(Van Donkelaar et al. Environ Health Perspect 2010; 118(6): 847 DOI: 10.1289/ehp.0901623)

(Indian Inst. of Tropical Meterology)

(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

RUDOLF DIESEL

(1858-1913)

Pollutant Petrol Diesel

Carbon dioxide ++++ +Carbon monoxide +++ ++Benzene +++ ++

Nitrogen oxides + ++Hydrocarbons ++ +++Aldehydes ++ +++Sulphur dioxide + ++++PAHs + ++++Particulate matter* + ++++

Diesel vehicles produce 1500-times more particles than Petrol vehicles

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)

Residential Proximity to main roads during Pregnancy and Risk of Asthma

Japanese Birth Cohort Study, 756 pregnant mothers, Babies followed for 2 yrs after birth

<50 mts versus >200 mts

Doctor diagnosed asthma: 4.0 (1.4-11.2)

Doctor diagnosed eczema: 2.3 (1.1-4.6)

(Miyake Y et al, Pediatr Allergy Immunol 2010; 21: 22-28)

Maternal exposure to vehicular pollutants during pregnancy is strongly associated

with early childhood asthma

(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)

0

5

10

15

20

25

30

35

Low traffic Heavy traffic Heavy traffic + low

socioeconomic

%age

Traffic density around school and prevalence of Asthma amongst school children

11.5%

19.3%

31.1%

(Paramesh H. Indian J Paed 2002; 69(4): 309-312)

(n = 6550; Bangalore, India)

2-fold increase in prevalence

WHICH MODE OF TRANSPORT EXPOSES YOU TO MORE AIR POLLUTANTS?

Autorickshaw Bus Motor cycle

Pune Station to Kothrud

Deccan to Hadapsar

(Chest Research Foundation, 2007)

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

(in

pp

m)

Bus

Rickshaw

Bike AUC value for CO levles for 3 different transportation Mode

from Pune station - Kothrud

319.88

643.13663.50

0.00

100.00

200.00

300.00

400.00

500.00

600.00

700.00

Bus Rickshaw Bike

CO

le

ve

ls

CARBON MONOXIDE

(Chest Research Foundation, 2007)

WHO safety limit

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

SO

2 le

ve

ls (

in p

pm

)

Bus

Rickshaw

Bike

0.00

1.23

1.05

0.00

0.30

0.60

0.90

1.20

1.50

AU

C v

alu

es

Bus Rickshaw Bike

Difference in AUC values for SO2 for 3 different transportation

mode from Station - Kothrud

SULPHUR DIOXIDE

(Chest Research Foundation, 2007)

WHO safety limit

0

0.5

1

1.5

2

2.5

3

3.5

4

Smoking Physical

Inactivity

Diabetes Anger High

Cholesterol

Spending 1

hr in traffic

2.8 1.4 1.8 3.1 3.7 3.9

RELATIVE RISK OF SUDDEN HEART ATTACK

(Peters, New Engl J Med Oct 2004)

IMPACT OF AIR POLLUTION IN DIABETIC PATIENTS FROM PUNE CITY

Is there any association between ambient air pollution and serum inflammatory mediators in Type II diabetic patients from Pune city?

Blood C-Reactive Proteins Ambient Air Pollution LevelsMPCB data

Vs

1392 Type II Diabetic patients GPS Mapping of residence Correlations with SOX, NOX, PM10 studied

(Khafaie M et al, Diabetes Care 2013; 36: 625-630)

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

CharcoalSulphur

MEAN CHANGES IN SO2 LEVELS (ppm)

Before Diwali

During Diwali

After Diwali

-1

0

1

2

3

4

5

6

SO2

leve

ls (

in p

pm

)

Before Diwali During Diwali After Diwali

Ambient SO2 levels reached values 200 times above the safety limits recommended by WHO

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)

(Liu W, EHP 2003; 111: 1454-1460)

1 Mosquito coil = 100 cigarettes

(Dr Sahasrabuddhe T, ERS 2010)

Acute Laryngo-tracheo-bronchitis

INDOOR AIR POLLUTION AND RESPIRATORY IMPACT

MOSQUITO NETS

(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, Muscat2441 children 10 yrs

(Wang IJ et al, Eur Respir J 2011; 37(6): 1371-1377)

50 Pujaris in Pune

Spirometry:25% showed presence of Obstructive Airways Disease

OBSTRUCTIVE AIRWAYS DISEASE IN PUJARIS

The Telegraph2nd Sept. 2011

Indian Lungs are 30% weaker than

European/American Lungs

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THANK YOUDr SUNDEEP SALVI MD, DNB, PhD, FCCP

Chest Research FoundationPune, INDIA

ssalvi@crfindia.com