Contents. Background Sources Types Respiratory health effects Assessment methods In Kuwait Conclusion

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1 Air Pollution Saleh Alshehabi Occupational Health Physician MBBS Faculty of Medicine, Kuwait University MSc Occupational Health & Safety Uni of Surrey, United Kingdom PhD Occupational & Environmental Health Uni of Manchester, United Kingdom

2 Contents Background Sources Types Respiratory health effects Assessment methods In Kuwait Conclusion

3 Background Worldwide health problem 4 million die every year (80% CVD & 20% RD) 1 Low-middle income countries 1

4 Sources Industry Transport Power generation plants Waste (both domestic and agricultural) Other classification: points, lines and areas

5 Types Gaseous (CO, NO 2 /NO x, O 3 and SO 2 ) Particulate matter (nitrates, sulphates, other chemicals and dust; PM 10, PM 2.5 & PM 0.1 ) Organic compounds (e.g. benzene, 1,3-butadiene and polycyclic aromatic hydrocarbons [PAHs; benzo(a)pyrene; BaP]) Heavy metals (e.g. arsenic, cadmium, lead, nickel, chromium and mercury) Others (e.g. dust, pollen)

6 Summary of different types of air pollutants and examples of their sources Air Pollutant Examples of sources Gaseous: CO Incomplete combustion processes (e.g. engines emissions) NO 2 Combustion processes NO x Combustion processes O 3 Produced by the effect of sunlight upon other air pollutants (e.g. NO 2 ) SO 2 Combustion of sulphur-containing materials, such as fossil fuels Particulate Matter PM 2.5 Combustion of fossil and biomass fuels (PM): PM 10 Combustion of fossil and biomass fuels Volatile organic compounds benzene Combustion of fossil fuels and cigarette smoking (VOCs): 1,3-butadiene Transport emissions, cigarette smoking and combustion of wood, rubber and plastics PAHs (e.g. BaP) Incomplete combustion of organic materials, such as coal, oil, gas and wood Heavy metals: Arsenic Smelting of metals (e.g. lead and copper) Cadmium Burning coal, iron/steel production and cigarette smoking Lead Metals processing and waste incinerators Nickel Combustion of coal, oil, waste incinerations and steel production Chromium Chemical plants and incineration facilities Mercury Fuel combustion and waste incineration

7 The size of the PM2.5 and PM10 compared to the human hair2

8 Health effects Short-term and long-term health effects of air pollution 3 Short-term Air Pollution Exposure Long-term Air Pollution Exposure Daily mortality (any cause) Mortality due cardiac and respiratory diseases Respiratory and cardiovascular hospital admissions Chronic respiratory disease incidence and Respiratory and cardiovascular emergency departments visits prevalence (asthma, COPD and chronic pathological changes) Respiratory and cardiovascular primary care visits Chronic changes in physiological functions Increased use of respiratory and cardiovascular medications Lung cancer Days of restricted activity Chronic cardiovascular disease Work absenteeism Intrauterine growth restriction (low birth weight at School absenteeism Acute respiratory symptoms (cough, phlegm, infections) term, intrauterine growth retardation and small for gestational age) Physiological changes (e.g. decreased lung function)

9 Respiratory health effects Adverse health effects associated with certain air pollutants 4 Air Adverse Respiratory Effect Pollutant Acute Chronic CO Tachypnea and respiratory arrest NO 2 Cough and dyspnoea Decreased lung function, structural/functional changes in trachea/bronchi, increased respiratory mortality O 3 Increased respiratory symptoms, dyspnoea,, airway inflammation Decreased lung function increased airway responsiveness to nonspecific stimuli, respiratory depression and increased respiratory hospital admission SO 2 Irritation to nose and throat, increased respiratory symptoms, decreased lung function in asthmatics, corrosive damage to the airways and respiratory depression long-term breathing problems and increased respiratory morbidity and mortality PM 2.5 Exacerbation of asthma increased respiratory mortality in elderly people and increased risk of lung cancer PM Increased respiratory symptoms and illnesses and increased respiratory mortality in people with asthma or COPD Benzene Lead (Inorganic) Arsenic Cadmium Nickel Cough, tracheitis, laryngitis, bronchial irritation, pulmonary oedema and pulmonary haemorrhage Lung cancer Rhinitis, pharyngitis, laryngitis, trachiobronchitis, tracheal and bronchial haemorrhage, Cough, irritation of upper respiratory tract, dyspnoea, chest pain, pulmonary oedema, bronchitis, chemical pneumonitis and respiratory failure, Respiratory tract irritation, cough, dyspnoea, chest pain, pulmonary oedema, pneumonitis, rhinitis and sinusitis, Lung cancer Progressive pulmonary fibrosis, impaired lung function, bronchitis, COPD, interstitial fibrosis and lung cancer Anosmia, perforation of the nasal septum and lung cancer BaP Cough, respiratory irritation and chest pain Decreased lung function and lung cancer

10 Assessment methods Main assessment methods of air pollution exposure 3,5 Method of Assessment Example Data Inputs Advantage Disadvantage Qualitative Estimates Proximity to road Distance to main roads, traffic composition and flow Simple and easy to use Misclassification of exposure and controversial results Ambient concentrations at fixed site (measured) City-specific, or longitudinal estimates of exposure Average daily concentrations of air pollutants and meteorological data Measured data, reflect changes in ambient levels Neglect spatial variability of exposure Ambient concentrations (modelled) Spatially resolved estimates of exposure Incorporation of emission data, dispersion models and/or traffic patterns Spatial variability of exposure, probably more accurate Expensive, more difficult and not necessarily more accurate Indirect personal measurement Population, or individual estimates of exposure, or of longterm exposure Probabilistic models for variability of exposure, time-activity, location specific patterns incorporated with historical air pollution data More accurate, account for time spend in each place Limited for time-activity data availability, high cost when population size is large Direct personal measurement Individual estimates of exposure Continuous, or intermittent, measurement using personal monitoring Most accurate estimates of true personal exposure High cost when population size is large, very labour-intensive Biomarkers Individual measurement of biomarkers Blood lead levels, carboxyhaemoglobin Measure internal dose, high reliability High cost, limited biomarkers, difficult to differentiate between routes of exposure

11 In Kuwait..

12 6 Air Quality Monitoring Stations in Kuwait

13 Limit values in Kuwait compared to WHO and UK 6-8 Air Pollutant Limit Value (µg/m 3 ), annual mean WHO United Kingdom Kuwait NO PM PM

14 Air pollution (NO 2 and PM 10 ) levels in each air quality monitoring station in Kuwait in Air Quality Monitoring Station Air Pollutant (µg/m 3 ) NO 2 PM 10 Mansoria Al-Qurain Reqa Al-Jahra Ali Al-Salem Al-Mutla Rumeithiya Al-Fahaheel Shuaiba Saad Al-Abdullah Shuwaikh Al-Salaam

15 Annual mean air pollution (NO 2 and PM 10 ) levels for all air quality monitoring stations (combined) from Air Pollutant (μg/m³) PM NO

16 Conclusion Air pollution is a worldwide health problem Health effects of air pollution are associated with both short-term and long-term exposure; affecting mainly the CVS and RS The respiratory health effects from exposure to air pollution ranges from acute to chronic, including lung cancer The Air Quality Monitoring Stations (AQMSs) in Kuwait recorded high annual mean air pollution levels although the national limits are much higher than the international limits (WHO & UK) Adapting better air pollution assessment methods (e.g. modelled), along with increasing the number/distribution of the AQMSs, would probably give better estimations about the air pollution exposure levels in Kuwait

17 Thank You 1. World Health Organisation. Ambient (outdoor) air quality and health [Fact Sheet] Available from: 2. Agency USEP. How Big is Particle Pollution? [20/03/2016]. Available from: 3. World Health Organisation. Air Quality Guidelines - Global Update Available from: 4. Toxicology Data Network. Available from: 5. Zou B, Wilson JG, Zhan FB, Zeng Y. Air pollution exposure assessment methods utilized in epidemiological studies. Journal of Environmental Monitoring. 2009;11(3): Kuwait Central Statistical Bureau. Annual Statistical Bulletin of Environment. Available from: 7. Archives TN. The Air Quality Standards Regulations Available from: 8. World Health Organisation. Ambient (outdoor) air quality and health. Available from: [accessed on ]