Presentation made by Dr Manas Ranjan Ray, Former Assistant Director and Officer-in-Charge (Research), Chittaranjan National Cancer Institute, Kolkata at a workshop in Pune focusing on review and critique of the draft National Clean Air Programme.

1. AIR POLLUTION AND ITS EFFECTS ON
HUMAN HEALTH
Dr. Manas Ranjan Ray
Former Assistant Director and Officer-in-Charge (Research)
Chittaranjan National Cancer Institute,
Kolkata

2. AIR POLLUTION
URBAN
Ambient
Vehicular Industrial
Thermal power Stations
Biomass Burning
RURAL
Indoor & ambient
NOx, SOx, CO,
PM, VOCs, PAHs,
trace metals
CO, SOx, NOx,
PM,
trace metals
NOx, SOx, CO, PM,
VOCs, PAHs
trace metals
Pesticides
OC, OP, C

3. Air pollution in Indian cities
•Mean annual concentrations of PM10 in most of the
Indian cities are far above the NAAQS
•Vehicular emission contribute 50-70% of urban
pollution; 10-20% by industrial emissions (e.g. TPS)
•PM2.5 are more potent for respiratory and
cardiovascular disease compared to PM10
•UFPs with diameters ≤ 0.1 µm are highly toxic due to
increased surface area and other characteristics

5. • Carbon dioxide andCarbon monoxide
• Oxides of sulfur (SO2)
• Oxides of nitrogen (NO2)
• Particulate matter- PM10, PM2.5, UFP
• Heavy metals- Pd, Cr, Cd, Fe, Cu, Hg, Mn
• Polyaromatic hydrocarbons [ PAHs, e.g. B(a)P]
• Volatile organic compounds [ VOCs, e.g. Benzene]
• Secondary pollutant Ozone (O3) [ VOC + NOx +
Sunlight]

6. • ‘Coarse’ particles (>2.5 m diameter)
• ‘Fine’ particles (<2.5 m diameter)
• ‘Ultrafine’ particles (<0.1 m diameter)
How do they differ?
Source /origin
Chemical composition
Respiratory tract deposition
Health effects

7. Naso-oropharangeal region
Large and water-soluble PMs
are removed
Tracheo-bronchial region
Smaller percentages of
PM10 and PM2.5 are
deposited
Alveolar region
PM10, PM2.5 and UFPs are
deposited; a fraction of UFPs
migrate to circulation
PM Deposition in Lungs and the Airways

8. Particulate Matter (PM): pollutant of prime
concern
PM10 : diameter < 10 microns
PM2.5 : diameter < 2.5 microns
Ultra fine particles (UFPs) : diameter < 0.1 microns
Smaller the size, greater the health risk

12. PFT of Children

14. 4 3.1
2.4
5.2
87.5
9.5
8.5
17.5
19.5
0
5
10
15
20
25
Sinusitis Running/Stuffy
nose
Sneezing Sore throat Common cold
& Fever
%ofindividuals
Upper Respiratory Symptoms
Control
Exposed

15. 5.8
10.4
1.5
4.9
7.6
16.5
19.9
5.8
22.4
15.9
0
5
10
15
20
25
Dry cough Cough with
phlegm
Wheeze Breathlessness Chest
discomfort
%ofindividuals
Lower Respiratory Symptoms
Control
Exposed

16. 18.7
25.7
39.8
43.5
0
5
10
15
20
25
30
35
40
45
50
Adult Children
%ofindividuals
Control
Exposed

18. 7.2 7
5.5
9.8
7.4
5.4
0
50
100
150
200
250
0
3
6
9
12
Winter Summer Monsoon
microgram/m3
%ofchildren
Dry cough
Cough with
phlegm
PM10
9.2
7.9
4.3
0
3
6
9
12
Low Medium High
%oftotal
Wet Cough
Inverse relation with SES
SES Dry cough Wet cough
High 1 1
Medium 2.31*
(1.96-2.73)
1.72*
(1.48-2.01)
Low 3.34*
(2.83-3.95)
2.20*
(1.89-2.57)

19. 0
10
20
30
40
50
60
70
80
90
Asthma Eye Irritation Headache

20. Air Pollution and Asthma
 Asthma is exacerbated by ozone and other
pollutants
 Significant associations of chronic pollution
exposure with asthma in children and adults
 Greater prevalence of asthma in the
polluted cities (3.8% vs. 2% in control)

22. Chronic air pollution exposure
Lung injury
Inflammation
Oxidative stress and Lung disease

23. COPD
 Chronic obstructive pulmonary disease (COPD) is a
progressive life-threatening disease
 It consists of two conditions- Chronic bronchitis and
emphysema
 Chronic air pollution exposure increases the risk of
COPD
 Three-fold increase in COPD in never-smoking
women of Kolkata and Delhi after adjusting for
possible confounders
 Women and people with low socioeconomic status are
more vulnerable

25. 1.6
4.9
0
4
8
%individuals
Control Exposed

27. Elastase
42
73
0
15
30
45
60
75
90
elastase+veAM(%)
Control Kolkata

28. Iron in AM

30. Elastase

32. Target cells and
poikilocytosis-
Anemia and liver
problem
Neutrophilia and Toxic
granulation-
Infection,
inflammation
Eosinophilia -Allergy
Hematological changes

33. CD4+ cells
CD8+ cells
CD19+ cells
CD16+56+
cells
0
200
400
600
800
1000
1200
0
200
400
600
800
0
200
400
600
800
0
200
400
600
800
cells/µlcells/µlcells/µl
Rural Urban
CD4 (FL2)
48%
CD8 (FL1)
53%

34. “It is not just the lungs and lower respiratory tract, the cardiovascular
system is also affected by air pollution”
Dr. Alfred Munzer
American Lung Association
Air Pollution Increases Heart Diseases

35. 4.7
1.4
6.7
3.5
10.1
5.3
23.7
14.5
0
5
10
15
20
25
Systolic
hypertension
Diastolic
hypertension
Systolic + Diastolic
hypertension
Tachycardia
Hypertension(%)
Control Exposed

36. 1.2 1.5 1.4
4.8
7.9
6.2
0
2
4
6
8
10
Boys Girls Total
%ofchildren
Rural Urban
8.6 9.8 9.3
31.8
26.4
29.4
0
7
14
21
28
35
Boys Girls Total
%ofchildren
Rural Urban
0
3
6
9
12
9-11 years 12-14 years 15-17 years
%ofchildren
Control
Delhi
Hypertension Pre-hypertension

37. 0
350
700
ng/l
sP-selectin (GMP 140)
0
5
10
15
%ofCD62P+Platelets
P-selectin (CD62P)
Control
Exposed
*
*

38. 47.4
160.9
0
85
170
OxLDL
PlasmaOxLDL(U/ml) Control
Exposed

39. 2.4
5.6
0
1
2
3
4
5
6
ImpairedLFT(%)
Control
Exposed
1.2
2.6
0
1
2
3
4
5
6
ImpairedKFT(%)
Control
Exposed

40. • Traffic related air pollution increases the risk of
type 2 diabetes in 50+ age group
• Women are more vulnerable
• People under insulin treatment are more at risk of
CVD during air pollution exposures
Kramer et al., Environ Health Perspect, May 2010
Rioux et al., 2011

41. Changes in menstrual cycle and
reproductive outcome
Hormonal changes like low serum estrogen and
progesterone, high serum prolactin and LH associated with
•Short, long or too irregular menstrual cycle
•Infertility
• Spontaneous Abortion
•Pre-term baby
• Stillbirth
• Underweight baby (< 2.5 kg)
• Congenital birth defects

42.  Inhaled UFPs translocate from lungs to blood,
adsorbed on RBCs, transported to all major
organs
 They can invade the blood-brain barrier
causing microvascular damage, blood clots
(brain stroke)
 Neuroinflammation, death of nerve cells
 Progressive neurodegeneration leading to:
 Alzheimer‘s and Parkinson's disease
Lung to Blood to Brain

43. 0
10
20
30
40
50
60
Depression (BDI-II score>=14)
Rural
Urban

44.  PM exposures decrease cognitive scores and memory in
school-age children
 NO2 and PM10 are associated with poor mental
performance
 Prenatal exposure to PAHs causes attention problems,
anxiety and depression in children
 Air pollution increases ADHD-related symptoms-
hyperactivity, inattention, aggression, conduct problems
Air Pollution, developing brain, and
children behavior

45. IARC Group I Human Carcinogens, 120 agents
•Arsenic Auramine production, Alcoholic beverages, Areca nut,
Asbestos , Inorganic Acid mists,
•Benzene. Benzidine dyes, Benzo[a]pyrene, Betel quid with or
without tobacco, 1,3-Butadiene, Beryllium
•Cadmium, Chromium (VI), Coal-tar pitches, Coal-tars, Coke
(fuel) production, household combustion of Coal
•Diesel engine exhaust
•Formaldehyde
•Haematite mining (underground) Iron and steel founding
•Mineral oils, Phenacetin
•Nickel, 4-(N-Nitrosomethylamino)-1-(3-pyridyl)-1-butanone (NNK)
•Silica dust as quartz2, 3,7,8-Tetrachlorodibenzo-para-dioxin, ortho-
Toludine,
•Vinyl chloride, Polychlorinated biphenyls (PCB)
•Ultraviolet Radiation, X-Radiation and Gamma radiation
•Wood dust, Welding fumes

46. Chromosomal and DNA
Damage

47. MN (A and B),
‘Broken egg’( C) ;
binucleation( D);
multinucleation
(E) ; pyknosis (F);
karyorrhexis (G)
and karyolysis
(H) in airway
epithelial cells of
biomass using
participants
A B
C D
E F
G H

48. 16.3
60
0
10
20
30
40
50
60
70
Lymphocytes(%)
Control
Exposed
Excess Comet formation suggests increase in DNA damage
DNA Damage

49. 8-Oxoguanine-expressing basal
and parabasal cells are more in
biomass users (A) compared to
that of LPG-users (B)
In contrast, OGG1 and APE1
expressing basal and parabasal
epithelial cells are less in
biomass users
A
B
C
E
D
F
Inadequate DNA Repair

50. Cellular abnormalities, risk of lung cancer

52. Response to air pollution
across population differs due to
• Extent & nature of exposure
• Co-exposure of different pollutant mixtures
• Population structure
• Nutritional & socio economic status
• Susceptibility factors

53.  PM2.5 effects are more in people with the lowest education.
Excess risk: 8.2, 7.2 and 5.5% per 10 μg/m3 for subjects with
low, medium and high education, respectively
 Dietary factors such as lower fruit and anti-oxidant intake,
lack of air conditioning, poorer housing conditions increase
the risk
 Women and children are more susceptible to air pollution
 PM2.5 effect is substantially higher among subjects with high
body mass index (BMI)
Susceptibility Factors

54. Overall mortality 0.5 - 1%
Cardiovascular mortality 1.4%
Respiratory mortality 3.4%
Hospitalization for respiratory diseases 0.8%
Hospitalization for asthma 1.9%
Source: Laden et al., 2000; Samet, 2000

55. • For every 50µg per cubic metre increase of
PM10 in breathing air, the cost for public
health in Mumbai is Rs. 452 crore/year
• For every 50µg of increase of NO2 in air, the
public health cost is Rs. 872 crore/yr
Patankar and Trivedi, Pub Health, Feb. 17, 2011.