Health and Air, for Health Studies

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1 Overview and Assessment of the Key Databases Health and Air, for Health Studies H.Paramesh MD,FAAP(USA),FIAP,FIAMS,FIAA,FICAAI CSE Conference, New Delhi Director and Pediatric Pulmonologist,Lakeside Hospital Bangalore - India. Chairman, Technical Advisory Committee,Karnataka State Pollution Control board. Permanent member Environment Monitoring Committee Metro Rail system in Bangalore Founder, Chairman Environment and Health group of Indian Academy of Pediatrics Chairman: Health Section. State of Environment action plan. World Bank Project, Karnataka

2 Air LIFETIME EXPOSURES OF POLLUTANTS Drinking Water Domestic Environments Soil : Dermal Soil : Ingestion Breast-feeding Intra-uterine Normal Food Occupational Exposure Birth 6mths 1yr 5yrs 16yrs 45yrs 65

3 Sinusitis frequency in Britain through the ages Bronze Age 0.5 Iron Age 0.5 Romano-British 3 Anglo-Saxon 7 Medieval % skulls showing sinusitis

LUNGS: THE ORGAN OF RESPIRATION Vulnerability of children to environmental exposures Children are especially vulnerable to the effects of pollutants Breathe more air relative to body weight Greater

4 LUNGS: THE ORGAN OF RESPIRATION Vulnerability of children to environmental exposures Children are especially vulnerable to the effects of pollutants Breathe more air relative to body weight Greater physical activity than adult (124 min Vs 21 min) During exercise there is 5 times more deposition of particles in the lungs (Chaiupa.D.C et al Env.Health Project.2004;112: ) Small airways favours deposition Rapid growth and development Different metabolism Developmental stage at exposure determines outcome

5 Environmental impacts on respiratory diseases ETS Intrauterine Smoking Decrease birth wt, small airways at birth (Nicotine, CO) ETS exposure associated with lower lung function throughout childhood Allergens (HDM) & irritants (Ozone) result in altered airway growth (Plopper et al) Decreased branching, thickened walls Strict allergen reduction (Woodcock et al) Greater lung function at 3y Increase O.M; Asthma.AR (Paramesh.H) Increase Sudden infant death syndrome Increase Sinusitis (Paramesh.H) Increase acute respiratory infection in ill ventilated huts in rural children under 5 years (Paramesh.H,Cherian.E) Indoor pollution altered gender prevalence (Paramesh.H,Cherian.E) Urban children suffer more allergy and rural children more of infection (Paramesh.H)

Bangalore Vehicles Total No. of vehicles as on 31 March 2005-25.

6 Bangalore Vehicles Total No. of vehicles as on 31 March Lakhs Two Wheelers 72% Autos 3% Cars 15% Buses 1% Trucks 4% others 6% Two Wheelers 72 % Three Wheelers (Autos) - 3 % Two Wheelers Cars Trucks Autos Buses others About 900 new vehicles are being registered in Bangalore everyday

7 Concentration in ug/m TSPM RSPM Nox SO2 YEAR Limits AMBIENT AIR QUALITY;AMCO BATTERIES

8 Indoor Pollutants / Asthma Triggers Aero-biologicals Irritants Dust mite /g Cockroach % Fungi Pollens % Cigarette smoke o % o % o % Mosquito Coil - 5.0% Pets % Other smokes Viruses/Bacteria % o RSV o Para influenza o Corono o Adeno o Legionella * Food % Formaldehyde Volatile organic compounds Asbestos Radon H. Paramesh Ind. Jourl. of pediatrics

9 Asthma Prevalence % 30% 25% 24.50% 29.50% 26.70% 20% 18.50% 15% 10% 9% 10.50% 5% 0% Indian J.Ped. Spi. Suppliment 2006 ; 73 : H.Paramesh

10 Prevalence of Persistent Asthma HP 80% 70% 80% 74.50% 63.40% 60% 50% % 40% 25.50% 30% 20% 20% 10% % Intermittent Asthma Persistent Asthma Paramesh Indian.J.Ped. Spl. Suppliment -2006; 73 :

11 Persistent Asthma grades and Prevalence 90.0% 80.0% 70.0% 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% 0.0% 77.1% 68.0% 64.0% 32.0% 27.8% 16.2% 6.5% 6.7% 4.0% Persistent Mild Persistent Moderate Persistent Severe Indian.J.Ped Suppliment 73: H.Paramesh

12 Seasonal Variation of Asthma Percentage of Children 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% % 75.8 % 55.8 % 24.3 % Monsoon Winter 19.9 % 2.8 % Summer Paramesh.H

13 Prevalence of asthma in school children 35.00% 30.00% 25.00% 20.00% 15.00% 10.00% 5.00% Age 6-15 years No (11.15%) No.3722 (19.34%) No.273 (31.14%) 0.00% Schools in low traffic regions Schools in heavy traffic regions P. Value I, II & III < H. Paramesh, Down to earth Schools in heavy traffic with low socio economic status

14 Symptoms related to air pollution / police Personnel Symptoms Asthma Traffic (1045) 26.12% Non Traffic (1160) 14.9% Cough Breathlessness Rhinitis Urticaria Feverishness Conjunctivitis 27 % 7.8 % 10.7 % 11 % 0.57 % 1.4 % 14.4 % 3.6 % 4 % 0.1 % 0.17 % 0.0 % Paramesh.H. Proceedings XI National Symposium on Environment June

15 Distribution of distance from the home to work place Traffic=1045(273) Non-traffic=1160(173) (69.2%) (58.9%) % (23.1%) 2 (2.2%) 18 (10.5%) 2 (0.8%) 13 (7.5%) Kms Kms Kms >31 Kms Traffic Low PEF Non-Traffic Low PEF Paramesh.H. Proceedings XI National Symposium on Environment June

16 Lead Poisoning Ingested, inhaled or absorbed thru skin Source - 86% of atmospheric lead auto exhaust, leaded petrol, water pipes, paint, battery storage, crystal glass, ceramic glaze, enamel jewelry etc. - Lead concentration in dust is directly proportional to the volume of traffic - Children absorb 50% and adults 10-20% of ingested lead. - Lead in tissue, cord blood correlate with air levels. Effect - GIT, peripheral nerve, central nervous system - Saudi Arabia study 5000 children 1989 using 0.8 G/L of lead in petrol showed no alarming lead poisoning - Bangalore study 863 children using 0.59 G/L of lead in petrol showed 4.6% of increased lead level over 10µg/dl* Trend - Use of unleaded petrol will reduce lead pollution. No cause for fear psychosis, however there should not be any complacence in preventive measures Avoid Mediagenic Disease * H Paramesh, Sameera Taipae, Taiwan

17 Tobacco smoking habit 41% of urban children yrs (3078) 21.8% of rural children yrs (2194) 36.0% of urban club going women 2.0% of rural farm worker women 30.6% of traffic police 34.0% of non traffic police 14.0% of Poultry farm workers 28.0% of Agriculture farm workers H. Paramesh, E. Cherian 2 nd International Conference on Environment and Health 2000

18 Asthma urban / rural children Age 6-15 years Year % Urban children % Rural Children H. Paramesh. Ind. J. of Ped

19 Gender/Asthma M:F = % Asthma / Indoor air pollution rural children Year 2001, No 119, Age yrs, Ratio M:F 1: % 8.00% 7.00% 6.00% 8.40% 5.00% 4.00% 5.80% 3.00% 2.00% 1.00% 0.00% 2.52% Total Boys Girls Source - H. Paramesh, E. Cherian. Ind. Joul of Pediatr 2002

20 Point prevalence of respiratory infection / indoor pollution no. 612 < 5 years. Rural study Cooking fuel - Agriwaste, dung cakes 70.00% 60.00% % Respiratory Infections 50.00% 40.00% 30.00% 20.00% 10.00% 67.40% 32.56% 0.00% Single room huts Double room huts Source - E.Cherian, H.Paramesh, Asian Ped Conf Bangkok

21 Women and children bear the brunt of air pollution;those living in slums are the worst affected Milligram-hour/cubic metre 10 - Female Male Female Male Female Male 0 - Slum Rural Urban,non-slum Mean exposure to respirable particulate matter Courtesy: Teri, Green India 2047; 2003

22 Burden of disease in India due to Asthma and Chronic Obstructive Pulmonary Disease (COPD) No of Cases in Lakhs Asthma-Chronic COPD-Chronic COPD- Acute Asthma-Acute Report: National Commission of Macroeconomics/Health Sept. 2005

23 16,000 13,525 12,000 10,312 10, Year 2825 Urban Rural Total Commission on Macroeconomics and Health Sept 2005

24 Environmental awareness of Prevention of respiratory diseases Long term urban, transport, traffic, monitoring planning Co-ordination of various municipal utility services Better technology, alternate fuel. Build mite retardant houses / good ventilation to suit our needs Sun dry the blankets, pillows and mattresses once a week Use indoor plants and exposure to sunlight once a week Control E.T.S, cockroach menance, over crowding Clean fuel for cooking Breast feed for at least 6 months Offer solid food after 6 months in atopic children Traditional foods.

25 Thank you

Flow of Talk. Need for ICON in Childhood Asthma. WISC : ICAAI Symposium Highlights of Airway Diseases 12/7/2012

Flow of Talk. Need for ICON in Childhood Asthma. WISC : ICAAI Symposium Highlights of Airway Diseases 12/7/2012 /7/ WISC :. ICAAI Symposium Highlights of Airway Diseases Pediatric Asthma in India Dr.H. Paramesh MD, FAAP(USA), FIAP,FIAMS, FIAA, FCAAI Director. Pulmonologist, Environmentalist, Lakeside Hospital, Bangalore