Impact of Air Pollution on Health Rtn. Dr.H. Paramesh

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1 Bengaluru s Airpocalypse Air Pollution Problems and Solutions-18/03/2017 Impact of Air Pollution on Health Rtn. Dr.H. Paramesh MD, FAAP(USA), FIAP,FIAMS, FIAA, FCAAI, FPAI Pediatric, Pulmonologist, Environmentalist, Bengaluru Chairman - Lakeside Center for Health Promotion - Lakeside Education Trust drhparamesh@gmail.com

patent all the time 600 million alveoli Very thin membrane (0.

2 LUNGS: THE AMAZING ORGAN HP Children Suffer more from air pollution due to anatomic & physiological reasons million branching tubes Should remain patent all the time 600 million alveoli Very thin membrane (0.3 micron) 10,000 liters air every day 420 Lts of Oxygen 350 Lts of Carbon Dioxide 10,000 liters blood every day

Global Magnitude of the Asthma Asthma a global health epidemic > 1billion affected. Anticipate to 4 billion in 2050 WHO - 2015 Outdoor air pollution 3.7M deaths Indoor air pollution 4.3M deaths 5.

3 Global Magnitude of the Asthma Asthma a global health epidemic > 1billion affected. Anticipate to 4 billion in 2050 WHO Outdoor air pollution 3.7M deaths Indoor air pollution 4.3M deaths 5.3Trillion (US dollar) annual subsidies are given for fossil fuel industry, which is more than the total health budget of the world. Climate change will be the defining issue for health system in the 21 st century. HP

4 ESTIMATED MORBIDITY FOR NON COMMUNICABLE DISEASES BURDEN IN INDIA HP million (57.2 million) 2016 (45 million) million 28 million Asthma COPD million 1 million Cancer IHD Stroke Diabetes Chronic respiratory disease National Commission of Macroeconomics and Health GOI-2005

5 Trends of Asthma Prevalence in Bangalore 72.5 Persistent Asthma HP Series 1 Series 2 Series Asthma Persistent severe asthma H Paramesh IAP Text of Paediatrics 6 th Edition 2016

6 Source of Air Pollution HP Outdoor Air Pollution Automobile exhaust Power plant emission Open burning of solid waste Construction related activities dust Mining activities Pollen, fungi. Indoor Air Pollution Aero-biological Irritants

7 Data on Outdoor Air Pollution Children of heavy traffic schools suffer from more asthma and it further increases in lower socio economic children. H. Paramesh Indian Journal of Ped 2000,2006 Urban children suffer more asthma than rural H. Paramesh Indian Journal of Ped 2000,2006 Asthma is increased in summer season in 15 years 2% to 28.5% H. Paramesh. International journal of env. and health 2008, IAP text book of pediatrics 2016 Traffic police suffer more than non-traffic police H. Paramesh Karnataka State of Env and action plan. World bank 2003 Slow traffic 10 km/hr produce 6 times more CO than at 75 km/hr Central Institute of Road Transport Down to earth 2008 Asthma visits to ER increased by 100% during Diwali H. Paramesh Intl Conf. Env. Health Nelson Essentials of Pediatrics 2016

8 CONT.. Allergic Rhinitis increased 22.5% to 27.5% Between Middle ear and sinus problems increased proportionately Asriani M Chiu, H. Paramesh. Nelson Essentials of Pediatrics 2016 Chronic cough Under 18 is - 8% (1999) 20.78%(2016) H. Paramesh, sept 2016 SDB-27.35% Snoring 42.45% Mouth breathing 43.4% Bruxism 16.98% in Chronic cough children H. Paramesh, sept 2016 SDB in General Pediatrics is 8% and OSAS is 1.05% H. Paramesh et al updated ADEX module-2017

9 Sleep and the Cardiovascular System Blood pressure and heart rate are higher following sleep deprived nights (Voelker, 1999) Men who work 60+ hours a week are twice as likely to have a heart attack as men who work 40 hours or less (Heart Disease Weekly, 2002) Women who have less than 5 hours of sleep have a 30% increased risk of developing coronary heart disease. (Josefson, 2003) Chronic Sleep Deprivation increases insulin resistance -> Diabetes HP

10 INDOOR AIR POLLUTION HP Global billion people (42%) were affected in million death per year. - 58% are women and children. Indian million premature deaths per year. - 85% of Indian population are mainly women and children (1990). - Chulhas used solid cooking fuel, release smoke equivalent to 400 cigarettes per hour. A Down to earth Body Burden 2015,

11 Indoor Pollutants HP Aero-biologicals Dust mite % Cockroach % Fungi/ Pollens % Pets % Viruses/Bacteria % Irritants Cigarette smoke o % o % o % Mosquito Coil o % o % Other smokes Formaldehyde Volatile organic compounds H. Paramesh Ind. Jourl. of pediatrics 2002, 2006, H. Paramesh. International journal of env. and health 2008Asriani M Chiu, H. Paramesh. Nelson Essentials of Pediatrics 2016

12 Data on Indoor Air Pollution HP Use of Bio fuel in ill ventilated huts changed the sex ratio of asthma H. Paramesh Ind. Jourl of Ped 2002, 2006 Prevalence of asthma in well ventilated house is 8% (P<0.001), in ill ventilated house 42.7% (P<0.001) * Dirty cooking fuel has highest incidence of asthma* Cow dung 48.8 %, Electricity 1.2% (P < 0.001) Single parent smoking 22.8% (P<0.018) Non smoking 08.0% (P<0.004) * Mosquito coil produces nearly cigarettes equivalent carbon monoxide and particulate matter Single room dwelling with agricultural waste as cooking fuel has 10.5 fold increasing incidence of Pneumonia ** H Paramesh IAP textbook of Pediatrics. 6 th edition 2016

13 Air pollution and Health Pyramid Vannan Kandi Vijayan, Haralappa Paramesh1, Sundeep Santosh Salvi2, Alpa Anil Kumar Dalal3 Lung India

Oct-Dec 2016 WHO and governments at all levels invest in research, evolution and knowledge exchange, including indigenous and traditional knowledge, about the effectiveness of implementing

14 Oct-Dec 2016 WHO and governments at all levels invest in research, evolution and knowledge exchange, including indigenous and traditional knowledge, about the effectiveness of implementing multi-level, multi-action, and civil society-engaging health promotion strategies towards advancing the SDGs. Ref: PEI Health Promotion Declaration October2016 Charlottetown Canada :Alliance for Health Promotion. Geneva

15 Sustainable Development to control and prevent Airway Allergy Quality Education professionals, public, policy makers 2. Reduce Automobile Emission/find Alternate Affordable Energy 3. Action on climate change 4. Green Cover of Cities 5. Ocean Agriculture 6. Sustainable Cities and Communities 7. Traditional Dietary Habits 8. Affordable drugs to control inflammation and Airway remodelling 9. Giving emotional support to allergic children 10. Convince the policy makers as economic allocation for prevention 11. Legal activism 12. Population growth

16 :Sustainability to control of Asthma Impact of Education Hospital admission of Acute severe asthma E.R. visits of asthma % % % July 00 June 01 July 01 June 02 July 02 June 03 Paramesh.H., Cherian.E., Principles and Practice of Tropical Allergy and Asthma Ed Wiqar A Shaikh

17 2. Where is the car? 5 th Ave NY 1900

19 2. Caravan of disaster 5 th Ave NY 1913: Where is the horse?

20 2: Reduce Automobile Emission/ Reducing use of fossil fuels Reduce tail pipe emission - Increased speed of traffic - Maintain good roads - Decrease the personal vehicles - Increase the mass transport Reformulated petrol to reduce O 3 Oxygenated fuel in cold season to reduce CO

21 Times of India

22 The Autonomous (Self-Driving) Car Disruption Times of India, Tuesday, Jan 17, 2017

23 TOI July 17, 2016 Invites Tesla to set up manufacturing hub in India Offers to promote joint ventures between Tesla and other Indian auto companies Tesla senior executive admitted that their marketing hub has to be outside the US for markets in the rest of the world, and appreciated the Indian offer..will certainly be considered at the appropriate time in future

24 100% of energy could be renewable

25 3:Action on Climate Change Finding new energy source Utilization of Solar energy. Utilization of Atomic energy. 18 th May 1974

26 Solar heating The CO 2 Logistic We need 420 L of Oxygen/person/day We produce 360L of CO 2 /day/per person In a 30 * 40ft site house roof top one can install 5kw P.V system, Solar Power Plant which saves CO 2 emission equivalent to 325 trees. Ref. Solar system Co

27 4: Increase Green Cover Bangalore had 10 trees per person, now we have 1 tree for 10 persons. Giving free saplings of plants with tree guard and having the child s name over it is a very successful programme during World Environmental Day celebrations 1 grown tree provide oxygen for 4 people/year Recommended Indoor Plants H. Paramesh IAP textbook of Pediatrics 2016 Saalumaradha Thimmakka

28 5: Ocean Agriculture 1. Lot of nutrients for plant growth is existent below 200ft of ocean. 2. Technology in pumping that water to the surface will yield lot of growth of sea weeds and fish population. 3. Carbon sequestration occurs in these areas which reduces global warming and climate change. 4. Satellite can identify chlorophyll and fish population (Our Mars Satellite by Kiran Kumar ISRO Chief)

29 6:Sustainable Cities and Communities Limit the Rapid Urbanization depending on sustainability A city is judged as a good one based on how clean your drains and chimneys are, how good your footpaths and how safe it is for children and senior citizens. Bangalore city population: 2.92m m 2011 Traffic congestion 66,65,980 (Dec 2016) We add 1725 new vehicles/day (2016) It was 600 new vehicles/day (2010) We need 13,000Km of road to park bumper to bumper Speed is 9.6Km/hr No authorities can match the civic amenities needed Traffic congestion Drinking water (Shortage = 0021 MLD ERC 2012) Waste management Sanitary system

30 7: Traditional Dietary Habits Our Understanding of Asthma Continues to Increase Over Time HP Dietary Habits Phenotypes and Genetic United Airway Concept Inflammation and Remodeling Airway Hyperresponsiveness Bronchoconstirction 1.Kiley et al. Curr Opin Pulm Med. 2007;13: Tang EA et al. In: Adkinson NF Jr. Middleton s Allergy. Principles & Practice. 7th ed. Mosby Elsevier; 2009: Vignola AM et al. J Allergy Clin Immunol. 2000;105: Bousquet J et al. Allergy. 1992:47: Henderson J et al. Arch Dis Child. 2009;94(5): PostmaDS et al. Proc Am Thorac Soc. 2009;6: Dr H Paramesh etal Airway Disease Education And Expertise ADEX Indian Pediatrics volume 15-page February 15,2016

31 Reaction Oxygen Species (ROS) effect on the airways HP

32 Encourage Antioxidants Discourage HP Fruits Vegetables Butter Curds Fish Pickles (limited) Oils rich in Omega 3 fatty acids (Fish Oil) Wine (limited) Encourage traditional food habits Spicy Foods Carbonated drinks Fast Foods and take away food with High salt content National Jewish. Health. Emily Cloud - June 2010 Wickens K. et al. Allergy 2005, 60, Sultesz, M.M; Katona GG. Et al Int.J. Ped. Otolargngal 2010, 74,

33 Reduce oxidative stress 1. Decrease Outdoor Physical Activity Depending in air quality index New Delhi In the morning - Sooty cloudy haze from SPM U.S.A In the afternoon - Brownish haze from Ozone smog Immediate death 3,000 Nov 22, 2015 estimated death of 25,000 people Methyl isocyanate (MIC)

36 8: Airway Remodelling in Asthma and COPD Recent Concepts Airway Remodelling first documented 1922 Pulmonary vascular remodelling does occur and Increase PAP > 25mmHg adds up to complications Prevention: Inhaled steroids Antileukotrienes Not clearly Proved Anti IgE molecules Potential target of Therapy:* Prostaglandins E-2 to elevate cyclic AMP Anti IL-5 BCG Vaccination (Investigation) Drugs to enhance ciliary activity and Airway toileting. *S.K Jindal Editorial Lung India 2016, 1-2

37 H. Paramesh et al Indian Pediatrics Volume 53_February 15, 2016

9. Childhood pets linked to lower allergy risk HP All warm blooded animals potentially capable of sensitizing susceptible patients with allergy Source Mostly from saliva, urine, skin dander Allergy

38 9. Childhood pets linked to lower allergy risk HP All warm blooded animals potentially capable of sensitizing susceptible patients with allergy Source Mostly from saliva, urine, skin dander Allergy to dogs appears less than cats Avoidance most effective way to manage the animal sensitivity Family pets, in particular dogs, need not be removed to prevent allergies and in fact may protect against allergies. Note Often pets are stress busters & part of family Dr.H. Paramesh, IAP Text book of Pediatrics, 2016 Mclance Matheson etal Journal of Allergy and clinical immunology online July 13,2011

39 Behaviour problems of persistent asthma patient # 30 Argumentative 67% Labile mood 42% Attention seeking 67% Irritability 50% Destructiveness 33% Temper tantrums 50% Fearfulness 33% Nervousness 25% Dependency 33% Suicidal Tendency 3% H. Paramesh, Harsha WHO 2017

40 Economics on Health Care

41 10: Economic burden of diseases for the policy makers Global economics on Health 97% is for cure $ 7,452 billion (WHO: 2013) 03% is for prevention $ 272 billion (WHO: 2013) India spends over 52% of total budget on persistent asthma and antihistamines

11:Legal Activism Appointment of Retired Supreme Court Judge Bhurelal Committee to

H. Paramesh Study data 1979-2004) Recommending face mask to traffic police officers

Paramesh 1994-1998 Ministry of Environment and forest GOI) Banning tobacco smoke in

42 11:Legal Activism Appointment of Retired Supreme Court Judge Bhurelal Committee to reduce the air pollution in major cities and focus on school environment (Utilized Dr. H. Paramesh Study data ) Recommending face mask to traffic police officers after discussion in the parliament. (Utilized the study of Dr. H. Paramesh Ministry of Environment and forest GOI) Banning tobacco smoke in Public places in Karnataka before Supreme court judgement (Utilized Dr. H. Paramesh & E.Cherian 7½ years Study data-2001)

43 12: Population Growth Reduce the population growth

44 Take home message Allergic Airway Disease are the major socioeconomic, health care burden Air pollution is the major cause for the increasing prevalence of united airway disease Society determines the heath care management Sustainable development of health is the collective efforts of all the stake holders. It demands Think and act locally, propagate the results globally. Influence the policy makers in budgeting to look into research on CARE along with CURE. Link of education with Patients, Parents and Grand Parents for good compliance LINK for progress of Science depends on participation of Practitioners, Academicians, Researchers and Pharmaceutical Companies, while keeping our ethics

45 Conclusion The main objective of science is not to open the door to infinite wisdom but to roll back the boundaries of infinite error Bertold Brecht s Life of Galileo Nature has provided every one s need not for his greed Mahatma Gandhi

46 We can and will overcome Air Pollution and Global Warming A Healthy Breath will always bring Healthy life Each one Teach one and plant one tree

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