HEALTH EFFECTS OF AMBIENT AIR POLLUTION

Transcription

1 HEALTH EFFECTS OF AMBIENT AIR POLLUTION

2 HEALTH EFFECTS OF AMBIENT AIR POLLUTION How safe is the air we breathe? Jane Q. Koenig University of Washington. U.S.A.... " Springer Science+Business Media, LLC

3 Library of Congress Cataloging-in-Publication Data Koenig, Jane a. Health effects of ambient air pollution : how safe is the air we breathe? / Jane Q. Koenig p. cm. Includes bibliographical references and index. ISBN ISBN (ebook) DOI / Air--Pollution--Health aspects. 2. Asthma--Environmental aspects. 1. Title. RA576.K '02--dc Copyright 2000 by Springer Science+Business Media New York Originally published by Kluwer Academic Publishers in 2000 Softcover reprint ofthe hardcover Ist edition 2000 AII rights reserved. No part of this publication may be reproduced, stored in a retrieval system or transmitted in any form or by any means, mechanical, photocopying, record ing, or otherwise, without the prior written permission of the publisher, Springer Science+Business Media, LLC. Printed on acid-free paper.

4 To Marci and Nathan

5 Contents Abbreviations List of figures List of tables Acknowledgements xiii xv XXI xxvii Chapter 1 Introduction: Scope of the book 1 Chapter 2 Structure of the respiratory system 5 Upper respiratory system 6 Lower respiratory system 8 Gas-exchange area 12 Cell types in the lung 13 Nervous innervation 13 Structural components 14 Conclusion 14 References 15 Chapter 3 Physiology of the respiratory system 17 Lung function 17 Nasal function 26 References 28 Chapter 4 Properties and sources of common ambient air pollutants 29 Sulfurous versus photochemical air pollutants 29 Criteria air pollutants 31 Carbon monoxide 33 Sulfur dioxide 34 Nitrogen dioxide 36 Particulate matter 37 Ozone 44 Hazardous air pollutants 45 Conclusions 47 References 48

6 viii Chapter 5 Exposure assessment 49 Biomarkers 56 References 59 Chapter 6 Inhalation exposure technologies 61 References 67 Chapter 7 Chapter 8 Chapter 9 Methods of assessment of pollutant-induced health effects 69 Animal toxicology and in vitro systems 70 Controlled human studies 71 Epidemiologic studies 73 Biomarkers 78 Polymorphisms 79 Conclusion 81 References 83 Asthma: A special case of susceptibility to air pollution 85 Definition and diagnoses 85 Natural history 87 Atopy 88 Morbidity and mortality rates 88 Biomarkers of inflammation: Cells 89 Biomarkers of inflammation: Mediators 91 Diet and asthma 93 Genetics of asthma 93 Economic burden 94 Fatal asthma 94 References 96 Health effects of sulfur oxides: Sulfur dioxide and sulfuric acid 99 Sulfur dioxide: controlled human exposure studies 99 Epidemiologic studies 106 Sulfuric acid: Controlled studies 107 Epidemiology 109 Conclusion 111 References 112

7 ix Chapter 10 Health effects of particulate matter 115 Deposition 115 Clearance 117 EPA NAAQS for PM 117 Health effects of PM 118 PM and cardiovascular disease 129 Chronic effects 130 Policy concerns and research needs 131 Conclusion 134 References 135 Chapter 11 Health effects of ozone 139 Upper airway effects 144 Lower airway effects 144 Epidemiological studies 155 Future research needs 158 References 159 Chapter 12 Health effects of nitrogen dioxide 165 Deposition/uptake 166 Controlled human studies 166 Upper airway effects 166 Lower airway effects 166 Pharmacologic/antioxidant interventions 168 Infectivity 169 Susceptible populations 171 Epidemiology 172 Conclusions 177 References 178 Chapter 13 Health effects of carbon monoxide 181 Exposure assessment 182 Health effects of CO 183 Controlled studies 183 Epidemiologic studies 184 Conclusion 185 References 187

8 x Chapter 14 Health effects of the hazardous air pollutants 189 Health effects of "air toxies" 189 Controlled human studies 190 Epidemiolog ical studies 191 References 193 Chapter 15 Health effects of indoor air pollution 195 Indoor air pollution sources 196 Exposure assessments: man-made 197 TEAM study 201 Indoor/outdoor ratios 202 Health effects of indoor pollutants: man-made 203 Natural indoor air pollutants 205 Control of natural indoor pollutants 209 Sick Building Syndrome 209 Conclusion 210 References 211 Chapter 16 Interactions between climate change and air pollution 213 Climate change and human health 215 Climate change, temperature, and air pollution 218 Other possible consequences of climate change 219 Conclusions 222 References 223 Chapter 17 Risk assessment for air pollutants 225 Basic definitions 226 Perception of risk 228 Examples of risk assessments for air pollutants 229 Risk management 231 Risk communication 232 Strengthening the foundation of risk assessment 233 References 235

9 xi Chapter 18 Standard setting for air pollutants 237 Definition of an adverse effect 237 Standard setting process of NAAQS 240 Limitations of process for NAAQS 240 NAAQS for PM: an example 241 Chapter 19 Conclusions and future directions 245 Index 247

10 ABBREVIATIONS AM BAL BHR CAA CFCs CO COHb COPD Em EPA ETS FEF 2S _ 7S FEV t FVC HAPs H+ H 2 S0 4 ICAM IgE IL INFy LDH NAAQS N0 2 PAF PFTs PM PM 10 PM cf PM 2.S Pb ppb ppm Raw Alveolar macrophage Bronchioalveolar lavage Bronchial hyperresponsiveness Clean Air Act Chlorofluorocarbons Carbon monoxide Carboxyhemoglobin Chronic obstructive pulmonary disease Exercise-induced bronchospasm Environmental Protection Agency Environmental tobacco smoke Forced expiratory flow in the mid portion of a FVC maneuver, from 25-75% Forced expiratory volume in one second Forced vital capacity Hazardous air pollutants Hydrogen ion Sulfuric acid Intercellular adhesion molecule-l Immunoglobulin E Interleukin; there are many forms -1 through -13 Interferon gamma Lactose dehydrogenase National Ambient Air Quality Standards Nitrogen dioxide Platelet activating factor Pulmonary function tests Particulate matter Particulate matter less than or equal to 10 micrometers Particulate matter between the sizes of 2.5 and 10 micrometers Particulate matter less than or equal to 2.6 micrometers Lead Parts per billion Parts per million Resistance of the airways

11 XIV Raw S02 TLV TNF-a TSP UV VOCs Ilg/m3 Specific resistance, Raw multiplied by the lung volume at the time of the measure Sulfur dioxide Total lung volume Tumor necrosis factor, alpha Total suspended particulate matter Ultraviolet light Volatile organic compounds Microgram per cubic meter

12 List of Figures Figure 2-1. The respiratory system Figure 2-2. Lateral wall of the nasal cavity. Figure 2-3, A schematic of the lobes of the right lung. Figure 2-4. A simplified schematic of the generations of the human airways. Figure 2-5. A diagram of an acinus showing the relationship between the terminal bronchioles, the respiratory bronchioles, and the alveoli. Figure 3-1. A schematic of the use of a spirometer showing the lung volumes that can be measured. Figure 3-2. A subject having his lung capacity measured in a pressurecompensated volume-displacement body plethysmograph. Figure 3-3 shows a young subject preparing to perform spirometry with considerable enthusiasm! Figure 3-4. Spirometric nomogram for calculating predicted values of FVC and FEV 1 in normal females over the age of 20 years. Figure 3-5. Spirometric nomogram for calculating predicted values of FVC and FEV 1 in normal males over the age of 25 years. Figure 3-6. A subject demonstrating the use of a scuba mask modified to measure the nasal work of breathing. Figure 3-7. Typical pressure-flow curves during measurement of nasal airflow resistance using posterior rhinometry. Figure 4-1 Comparison of trends in total national vehicle miles traveled and national highway CO emissions. Figure 4-2 Formation of H2S0 4 from S02 in the atmosphere.

13 xvi Figure 4-3. Summary of emissions between 1970 and 1995 (EPA, 1996). Figure 4-4a, An idealized size distribution of ambient PM showing fine and coarse modes and the portions collection in various samples. Figure 4-4b. A particulate matter size distribution collected in traffic showing mechanisms for nuclei, fine and coarse modes. Figure 4-5. Pie charts comparing the composition of PM in the eastern US (on the left) to that in the western US (on the right). Figure 4-6. Light scattering recording of fine particles associated with diesel bus emissions. Figure 5-1. A framework for exposure assessment. Figure 5-2. An exposure profile for N02 showing the effect of different activities.. Figure 5-3. Comparison of benzene emissions to benzene exposure in the US. Figure 6-1. A photograph of the University of Washington head dome. Figure 6-2. Schematic of a cell exposure system that maintains the cells at > 95% relative humidity and allows simultaneous exposure to a test atmosphere (S02' ozone, etc) and a clean air control. Figure 6-3. A schematic diagram of a gas-aerosol generation and delivery system for exposure of human subjects. Figure 8-1. Prevalence of asthma showing an increase from 1980 to Figure 8-2. Interactions among various cells and come consequent effects.

14 xvii Figure 9-1. An adolescent subject in a controlled laboratory setting walking on a treadmill while breathing S02. Figure 9-2. Changes in nasal power after air or S02 exposure comparing chlorpheniramine and placebo treatments. Figure 9-3. Comparison of S02levels and age-adjusted mortality due to asthma and chronic bronchitis in Yokkaichi, Japan. Figure 9-4. Effect of sulfuric acid exposure on average bronchial mucociliary clearance in 10 healthy subjects. Figure 9-5. Estimated adjusted mortality-rate ratios and pollution levels in the Harvard Six City study. Figure Deposition of particles of different sizes as a function of airway generation. Generation number begins with 0 indicating the trachea and increasing to number 21 which represents the periphery of the lung, the alveolar spaces. Figure Epithelial lining of the respiratory tract and the mucociliary escalator. The arrows indicate the upward direction in which the cilia move the overriding layer of mucus to which foreign particles are stuck. Figure Smoke concentrations, S02 concentrations and deaths in London in the winter of Figure Relative risk of death in Steubenville, Ohio by quartile of TSP. Figure Relative risk of asthma visits by quartile of PM IO concentration plotted against the mean PM IO concentration in the quartile. Figure a. Monthly mean PM IO and temperature for Utah Valley, 1985 through b. Monthly mean hospital admissions for bronchitis and asthma for all ages in three Utah cities.

15 xviii Figure Relative risk of development of new cases of definite symptoms of obstructive airway disease for differing average hours in excess of 40,50,60, SO, and 100 Jlg/m3 PM w. Figure 10-S. Inhibition ofrofa-induced IL-6 protein secretion by deferoxamine, a chelating agent. Dark bar = 2 hr exposure; light bar = 24 hr exposure. Similar results were seen for IL-S. Figure Potential mechanisms of ozone-induced injury in the lung. Figure Decreases in FEV 1 per hour exposure at air and three concentrations of ozone. Figure Predicted decrements in FEV l as a function of ozone concentration for three ages. Figure Changes in PEF after ozone and air exposure by antioxidant treatment versus. Figure Airway reactivity to methacholine aerosol after each exposure. Bars are means ± Standard Error. Figure N0 2 exposure to a woman while cooking. Figure Two-week integrated N0 2 concentrations in homes in Albuquerque. Figure Dose-response relation between the percentage change in the length of time to the threshold ischemic ST -segment change and the carboxyhemoglobin level after exercise. Figure Monthly average fine particle concentrations indoors associated with cigarette smoking. Figure A comparison of the sources of benzene emissions and the sites of benzene exposures for the US population.

16 xix Figure Simultaneous indoor and outdoor measurements of fine particles by nephelometry during one winter time week in Seattle. Figure Relative odds of respiratory illness of symptoms compared to maternal smoking frequency. Figure Number of hospitalizations in the past year compared with the presence or absence of allergy to agents. Figure 16-1 Per capita carbon dioxide emissions in Figure Estimated changes in global-mean temperature CC) (thin line) and CO 2 concentrations (thick dashed line) from 1860 to Figure Estimated percentage of various gases to global warming. Figure Geographical variation of melanoma mortality with latitude. Figure A scatter plot of maximum daily ozone concentrations versus maximum daily temperature in four US cities. Figure Elements of research, risk assessment, and risk management. Figure Spectrum of adverse effects

17 List of Tables Table 2-1. Components of the human respiratory system. Table 2-2. Common cell types in the lung. Table 3-1 Common parameters of lung capacity Table 3-2. Average minute ventilation rates for a variety of activities Table 3-3. Sources of variation in measurements of lung function. Table 3-4. Relationship of lung volumes to type of ventilatory impairment. Table 3-5. Spirometric guidelines for assessing degree of ventilatory impairment. Table 4-1. Comparison of general characteristics of sulfurous (London) and photochemical (Los Angeles) air pollution. Table 4.2 General sources of common wide spread air pollutants Table 4-3. US National Ambient Air Quality Standards. Table 4-4. Air quality units conversion table. Table 4-5. Washington State short-term standards for S02. Table 4-6. Sources of elemental species for PM2.5 and PM CF size fractions. Table 4-7. Chemical mass balance results for aggregated wintertime high PM 10 samples from San Jose, to Table 4-8. Chemical mass balance date for particulate matter air pollutants in Seattle, Washington.

18 xxii Table 4-9. Chemical mass balance data for particulate matter air pollutants in Spokane, Washington. Table Abbreviated list of classes of compounds in diesel exhaust. Table Formation of ozone, a secondary pollutant, from precursors Table Major industrial hazardous air pollutants Table List of priority HAPs (EPA) judged to be major and increasing threats to human health and the environment. Table Top 20 sources of toxic emissions for 37 toxic pollutants, 1990: Total annual emissions in tons/year. Table 5-1. Summary of passive sampling results for N0 2 in eight children. Table 5-2. Time activity and daily diary. Table 5-3. Estimated populations at risk residing in communities that have not attained one or more National Ambient Air Quality Standard - United States, 1991 Table 5-4. Advantages of biomarkers of exposure Table 6-1. Various inhalation exposure systems Table 6-2. Characteristics of gas-aerosol exposure systems. Table 7-1. Methods of Assessment of pollutant-induced effects. Table 7-2. Advantages and disadvantages of animal experiments Table 7-3. Advantages and disadvantages of controlled human experiments

19 xxiii Table 7-4. A typical symptom rating scale for use in controlled human studies of air pollutant effects. Table 7-5. Aspects of association necessary to establish causation. Brandon Hill Table 7-6. Advantages and disadvantages of human epidemiologic studies Table 7-7. Bi-variate correlation among exposure variables in Seattle (9/1/95 to 12/31/96) Table 7-8. Examples of the endpoints evaluated in typical acute and chronic epidemiologic air pollution studies. Table 7-9. A list of potential confounding variables in the field of air pollution epidemiology. Table Biomarkers of air pollutant-induced effects in human subjects Table Gradation of individual physiological responses to acute ozone exposure. Table 8-1. Risk factors for the development of asthma in childhood. Table 8-2. Potential risk factors for fatal asthma. Table 8-3. Pathological findings in cases of fatal asthma. Table 9-1. Percentage change in pulmonary function measurements after exposure to S02 or air in nine adolescent asthmatic subjects. Table 9-2. Percentage change in pulmonary function measurements after exposure to S02 or air in eight allergic non asthmatic adolescent subjects. Table 9-3. Interaction between cold, dry air and inhaled S02 on pulmonary function.

20 xxiv Table 9-4. Pharmacologic-S02 interactions Table 9-5. Washington State ambient air quality standards for sulfur dioxide. Table Various measures of PM air pollution. Table Combined effect estimates of daily mean particulate pollution Table Annual average PM 2.s values compared to the percentage of increasing risk of early death when compared with the cleanest city, Portage. Table Estimated increase in daily mortality, 95% CI, and t statistic by city and combined estimated associated with a 1 0 ~g/m3 increase in PM. Table Summary of studies of respiratory effects of exposure to wood smoke. Table Top ten topics for particulate matter research Table Current hypotheses of PM characteristics related to health effects. Table Common antioxidants present in the respiratory system. Table Comparison of estimated levels (~) of certain antioxidants in ELF from different mammals. Table Frequency of FEV l decrement in young adults after ozone exposure for 2 hours during intermittent exercise. Table Mean percent change in FEV l from baseline to post ozone exposure for black and white men. Table Average changes in various endpoints of inflammation after exposure to 0.4 ppm ozone.

21 xxv Table Mean CO concentrations (mglm3) in different situations. Table Relative risks of congestive heart failure admission among medicare patients as a function of ambient pollutant levels. Table Hazardous air pollutants that exceed the NOELs. Adapted from Woodruft et ai, Table Concentration of total neutrophils (x 10-4 ) seen in nasal lavage fluid after either air or VOC exposure. Table Characteristics of children by the proximity to industry of 74 elementary schools, Kanawha County West Virginia, Table Adjusted* cumulative incidence (%) of selected health outcomes by the proximity to industry of 74 elementary schools, Kanawha County West Virginia, Table Symptoms associated with indoor office environments termed "sick building syndrome" Table Common sources of indoor air pollution Table Concentrations (weighted means in fjg/m 3 ) in exhaled breath from subjects in New Jersey during Fall, Table Composition of the VOC mixture used in controlled studies Table Identified allergens in house dust in the United States. Table Percentage increase in UV with a 10% depletion of stratospheric ozone Table Three major forms of skin cancer and their characteristics. Table Major tropical diseases that are likely to spread with climate change.

22 xxvi Table Specific examples of adverse health effects related to climate change. Table Steps followed in a risk assessment protocol Table Uncertainty factors used in deriving reference doses and other standards Table Examples of risk-based priorities ranked into high-, medium, and low-risk. Table Groups most affected by air pollution. Table Issues to be considered in a statement of adverse effects Table Dimensions of concern to be addressed in a statement of adverse effects Table Comparison of risk assessment and risk management estimates from various agencies.

23 Acknowledgements Several of my colleagues read various chapters of this book and made invaluable comments. I thank Brook Madrone, Dan Jaffe, Therese Mar, Gary Norris, Dan Luchtel, and Paul V Williams for their careful reading of specific chapters. Therese Mar also helped me with many of the graphs. I thank Nathan Koenig for assistance with indexing. I also thank the students in my class on the health effects of air pollution, Spring quarter, 1999 who read the chapters for class and pointed out errors and areas to be clarified. Finally I express my deep gratitude to William E Pierson who taught me a lot about asthma and inspired our early studies into the health effects of air pollutants.