From: Subject: Health and Air Quality - Air Quality and Health Effects of Air Pollution Date: Mon, 20 Sep 2004 19:39:28 -0400 MIME-Version: 1.0 Content-Type: multipart/related; boundary="----=_NextPart_000_0000_01C49F49.8AD10680"; type="text/html" X-MimeOLE: Produced By Microsoft MimeOLE V6.00.2800.1165 This is a multi-part message in MIME format. ------=_NextPart_000_0000_01C49F49.8AD10680 Content-Type: text/html; charset="iso-8859-1" Content-Transfer-Encoding: quoted-printable Content-Location: http://www.hc-sc.gc.ca/hecs-sesc/air_quality/health_effects.htm Health and Air Quality - Air Quality and Health = Effects of Air Pollution

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HEALTH EFFECTS OF AIR POLLUTION

The human health effects of poor air quality are far reaching, = but=20 principally affect the body's respiratory system and the = cardiovascular=20 system. Individual reactions to air pollutants depend on the = type of=20 pollutant a person is exposed to, the degree of exposure, the = individual's=20 health status and genetics. People who exercise outdoors, = for=20 example, on hot, smoggy days increase their exposure to pollutants = in the=20 air.

The health effects caused by air pollutants may range from = subtle=20 biochemical and physiological changes to difficulty breathing, = wheezing,=20 coughing and aggravation of existing respiratory and cardiac=20 conditions. These effects can result in increased medication = use,=20 increased doctor or emergency room visits, more hospital = admissions and=20 even premature death.

Human=20 Respiratory System
Human=20 Cardiovascular System
Heart=20 and Lung Diseases
Pyramid=20 of Health Effects
Populations=20 at Risk
Leading=20 Causes of Hospitalization
Leading=20 Causes of Death
Estimating=20 Health Benefits

Human Respiratory System

The health of our lungs and entire respiratory system is = affected by=20 the quality of the air we breathe. In addition to oxygen, = this air=20 contains other substances such as pollutants, which can be = harmful. =20 Exposure to chemicals by inhalation can negatively affect our = lungs and=20 other organs in the body. The respiratory system is = particularly=20 sensitive to air pollutants because much of it is made up of = exposed=20 membrane. Lungs are anatomically structured to bring large=20 quantities of air (on average, 400 million litres in a lifetime) = into=20 intimate contact with the blood system, to facilitate the delivery = of=20 oxygen.

Lung tissue cells can be injured directly by air pollutants = such as=20 ozone, metals and free radicals. Ozone can damage the = alveoli -- the=20 individual air sacs in the lung where oxygen and carbon dioxide = are=20 exchanged. More specifically, airway tissues which are rich = in=20 bioactivation enzymes can transform organic pollutants into = reactive=20 metabolites and cause secondary lung injury. Lung tissue has = an=20 abundant blood supply that can carry toxic substances and their=20 metabolites to distant organs. In response to toxic insult, = lung=20 cells also release a variety of potent chemical mediators that may = critically affect the function of other organs such as those of = the=20 cardiovascular system. This response may also cause lung=20 inflammation and impair lung function.

Structure and Function

The human respiratory system is dominated by our lungs, which = bring=20 fresh oxygen (O₂) into our bodies while expelling = carbon=20 dioxide (CO₂). The oxygen travels from the lungs = through=20 the bloodstream to the cells in all parts of the body. The = cells use=20 the oxygen as fuel and give off carbon dioxide as a waste = gas. The=20 waste gas is carried by the bloodstream back to the lungs to be = exhaled.=20

The lungs accomplish this vital process - called gas exchange - = using=20 an automatic and quickly adjusting control system. This gas = exchange=20 process occurs in conjunction with the central nervous system = (CNS), the=20 circulatory system, and the musculature of the diaphragm and the = chest.=20

The human respiratory system can be divided into the upper = respiratory=20 tract and the lower respiratory tract. The upper respiratory = tract=20 includes the following rigid structures:

Nasal cavities: Filter the air we breathe and provide a = sense of=20 smell.

Pharynx: Acts in the respiratory and the digestive = system.

Larynx: Link between the pharynx and the trachea. =20 Generates the voice with the presence of vocal folds.

Trachea: The trachea is the bond with the lower = respiratory=20 tract. This is a flexible structure allowing the air to go = down to=20 the lungs.

In addition to gas exchange, the lungs and the other parts of = the=20 respiratory system have important jobs to do related to = breathing. =20 These include:

Bringing all air to the proper body temperature.=20
Moisturizing the inhaled air for necessary humidity.=20
Protecting the body from harmful substances by coughing, = sneezing,=20 filtering or swallowing them, or by alerting the body through = the sense=20 of smell.=20
Defending the lungs with cilia (tiny hair-like structure), = mucus and=20 macrophages, which act to remove harmful susbstances deposited = in the=20 respiratory system.

Diagram of Human Respiratory System

3D"Diagram

The respiratory system is sensitive to air pollution. The=20 cardiovascular system can be affected as well.

Human Cardiovascular System

The cardiovascular system has two major components: the heart = and a=20 network of blood vessels. The cardiovascular system supplies = the=20 tissues and cells of the body with nutrients, respiratory gases, = hormones,=20 and metabolites and removes the waste products of cellular = metabolism as=20 well as foreign matter. It is also responsible for = maintaining the=20 optimal internal homeostasis of the body and the critical = regulation of=20 body temperature and pH.

The inhalation of air pollutants eventually leads to their = absorption=20 into the bloodstream and transport to the heart. A wide = spectrum of=20 chemical and biological substances may interact directly with the=20 cardiovascular system to cause structural changes, such as = degenerative=20 necrosis and inflammatory reactions. Some pollutants may = also=20 directly cause functional alterations that affect the rhythmicity = and=20 contractility of the heart. If severe enough, functional = changes may=20 lead to lethal arrhythmias without major evidence of structural = damage to=20 the myocardium.

There also may be indirect actions secondary to changes in = other organ=20 systems, especially the central and autonomic nervous systems and=20 selective actions of the endocrine system. Some cytokins = released=20 from other inflammed organs may also produce adverse = cardiovascular=20 effects, such as reducing the mechanical performance and metabolic = efficiency of the heart and blood vessels.

Many chemical substances may cause the formation of reactive=20 oxygen. This oxidative metabolism is considered to be = critical to=20 the preservation of cardiovascular function. For example, = oxygen=20 free radicals oxidize low-density lipoproteins, and this reaction = is=20 thought to be involved in the formation of the atherosclerotic=20 plaques. Oxidized low-density lipoproteins can injure blood = vessel=20 cells and increase adherence and the migration of inflammatory = cells to=20 the injured area. The production of oxygen free radicals in = heart=20 tissues have been associated with arrhythmias, and heart cell = death.

Heart and Lung Diseases

Heart and lung illnesses and diseases are common in Canada, and = there=20 are many factors that can increase the chances of contracting them = such as=20 smoking and genetic predisposition. The role of air = pollution as the=20 underlying cause remains unclear but is the subject of = considerable=20 research. However, it is clear that air pollution, = infections and=20 allergies can exacerbate these conditions. An early = diagnosis can=20 lead to appropriate treatment and ensure a normal or close to = normal=20 quality of life. In many cases however, there is no cure and = those=20 affected may die prematurely. The following are the most = prevalent=20 diseases:

Minor Lung Illnesses - the common cold is the most = familiar of=20 these, with symptoms including sore throat, stuffy or runny nose, = coughing=20 and sometimes irritation of the eyes.

Lung Infections - croup, bronchitis, and pneumonia = are=20 caused by viruses or bacteria and are very common. Symptoms may = include=20 cough, fever, chills and shortness of breath.

Asthma - is an increasingly common chronic disease among = children and adults. It causes shortness of breath, coughing or = wheezing=20 or whistling in the chest. Asthma attacks can be triggered by a = variety of=20 factors including exercise, infection, pollen, allergies and = stress. =20 It can also be triggered by a sensitivity to non-allergic types of = pollutants present in the air such as smog.

Chronic Obstructive Pulmonary Disease (COPD) - is also = known as=20 chronic obstructive lung disease and encompasses two major = disorders:=20 emphysema and chronic bronchitis. Emphysema is a chronic = disorder in=20 which the walls and elasticity of the alveoli are damaged. = Chronic=20 bronchitis is characterized by inflammation of the cells lining = the inside=20 of bronchi, which increases the risk of infection and obstructs = airflow in=20 and out of the lung. Smoking is responsible for = approximately 80% of=20 COPD cases while other forms of air pollution may also influence = the=20 development of these diseases. Symptoms include cough, = production of=20 mucous and shortness of breath. It is important to note that = no cure=20 exists for people suffering from COPD although healthy lifestyle = and=20 appropriate medication can help.

Lung Cancer - is the most common cause of death due to = cancer in=20 women and men. Cigarette smoke contains various carcinogens and is = responsible for most cases of this often fatal disease. The = symptoms=20 of lung cancer begin silently and then progress to chronic cough, = wheezing=20 and chest pain. Air pollution has been linked somewhat = weakly to=20 lung cancer.

Coronary Artery Disease - refers to the narrowing or = blocking of=20
the arteries or blood vessels that supply blood to the = heart. =20 This disease includes angina and heart attack which share similar = symptoms=20 of pain or pressure in the chest. Unlike angina, the = symptoms caused=20 by heart attack do not subside with rest and may cause permanent = damage to=20 the heart. Smoking, lack of exercise, excess weight, high=20 cholesterol levels in the blood, family history and high blood = pressure=20 are some of the factors that may contribute to this disease.

Heart Failure - is a condition in which the heart is = unable to=20 cope with
its=20 work load of pumping blood to the lungs and the rest of the body. = The most=20 common cause is severe coronary artery disease. The main symptoms = are=20 shortness of breath and swelling of the ankles and feet.

Heart-Rythm Problems - are irregular or abnormal rythms = of the=20
heart beat. In some cases heart-rythm problems are caused by = coronery=20 artery disease. Symptoms of heart-rythm problems influttering in = the chest=20 (palpitation) and feeling light-headed. Some heart-rythm problems = are=20 life-threatening and need emergency treament.

Pyramid of Health Effects

=20

Air pollution can affect both the respiratory and cardiac=20 systems. The health effects of air pollution can be seen as = a=20 pyramid, with the mildest but not common effects at the bottom of = the=20 pyramid, and the least common but more severe at the top of the=20 pyramid. The pyramid demonstrates that as severity decreases = the=20 number of people affected increases.

Health Endpoints Associated with Increased Air Pollutants = Levels

Mortality: All non-accidental mortality causes

Hospital Admissions: Cardiovascular and Respiratory = Hospital=20 Admissions

Emergency Room Visits: Visit to an emergency = department

Asthma Symptom Days: Exacerbation of asthma symptoms in=20 individuals with diagnosed asthma

Restricted Activity Days: Days spent in bed, missed from = work,=20 and days when activities are partially restricted due to = illness

Acute Respiratory Symptoms: Respiratory-related symptoms = such as=20 chest discomfort, coughing and wheezing

Population at Risk

Although everyone is at risk from the health effects of air = pollution,=20 certain sub-populations are more susceptible. Individual = reactions=20 to air contaminants depend on several factors such as the type of=20 pollutant, the degree of exposure and how much of the pollutant is = present. Age and health are also important factors.

The elderly and people suffering from cardio-respiratory = problems such=20 as asthma appear to be the most susceptible groups.

Children and newborns are also sensitive to the health effects = of air=20 pollution since they take in more air than adults for their body = weight=20 and consequently, a higher level of pollutants. People = who=20 exercise outdoors on hot and smoggy days are also at greater risk = due to=20 their increased exposure to pollutants in the air.

Leading Causes of Hospitalization

3D"Leading

Respiratory and cardiovascular diseases are among the leading = causes of=20 hospitalization in Canada. In 1996-1997 there were 3.16 = million=20 hospital admissions in Canada of which cardiovascular and = respiratory=20 diseases accounted for 15% and 9%, respectively.

Air pollution exacerbates the condition of people with = respiratory and=20 cardiovascular diseases and causes measurable increases in the = rates of=20 hospitalization for these diseases. We do not yet understand = the=20 role of air pollution in causing these illnesses in the Canadian=20 population.

Leading Causes of Death

3D"Leading

Cardiovascular and respiratory diseases are among the leading = causes of=20 death in Canada. In 1997, 37% and 9% of over 200 000 deaths were = related=20 to cardiovascular and respiratory diseases respectively. =

Air pollution causes measurable increases in non-accidental=20 mortatlity.

Estimating Health Benefits

When examining a specific pollution-reduction option (such as = changing=20 gasoline composition) regulators may estimate the reduction in = health=20 effects that are expected, and the value to society of avoiding = those=20 health problems.

As a society, we pay for the health effects of air pollution in = many=20 ways. Additional health care costs for the treatment of = these=20 effects may come from any of the following: hospital admissions, = visits to=20 the emergency room or doctor's office, homecare service, = medication such=20 as inhalers for asthma. Other considerations include lost = productivity in=20 the workplace, lost wages due to sick time, out of pocket expenses = incurred while ill (e.g., additional child care costs), and, = finally lost=20 quality of life or life itself.

Steps in Estimating Health=20 Benefits
Baseline gasoline composition and changes to=20 composition	Changes in ambient air concentrations of = pollutants	Changes in health effects



Combustion of gasoline in vehicles and subsequent = changes=20 in exhaust emissions	Changes in human exposure	Value of health = benefits

A recent study examined the economic value of reducing the = health=20 effects of air pollution by introducing cleaner vehicles and fuels = in=20 Canada. This study found that the economic value of avoiding = these=20 health effects was $24 billion over a period of 24 years, = compared=20 to a cost of $6 billion to implement the program. This = methodology=20 has been used by Health Canada and Environment Canada in a number = of=20 initiatives to examine the benefits of control measures. To = see an=20 example of this process access the Sulphur in Gasoline Study at
http://www.ec.gc.ca/oged-dpge/level3e/finalsulphurReport/Toce.htm.=20


Last Modified 2003-12-11	Important N= otices=20

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