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Routes to Clean Air 2015 - Dr Ian Mudway

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Dr Ian Mudway - King's College London - Health Effects of Air Pollution

Publié dans : Environnement

Routes to Clean Air 2015 - Dr Ian Mudway

  1. 1. Dr Ian Mudway Health Effects of Air Pollution ian.mudway@kcl.ac.uk
  2. 2. Additives Nitrogen dioxides (incl. NO2), ozone, particulate matter, volatile organic carbon compounds. PM associated chemicals Nitrogen dioxides (incl. NO2), ozone, particulate matter (PNC, PM2.5, PM10, coarse PM), organic carbon, elemental carbon, volatile organic carbon compounds, quinones. PAHs, metals (Fe, Cu, Cr, V, Ni, Sb, As, Cd, Al, etc), stable radicals, SOA, POA, sulphate, nitrate, NaCl.
  3. 3. Diesel What’s the consequence of this?
  4. 4. But this is what happened
  5. 5. Burden of disease from 20 leading causes in 2010 Lim et al. LANCET (2012) Ambient air pollution (PM2.5): Globally: - 3.1 million deaths - ~ 3.0% of all DALYs In Western, Central and Eastern Europe: - 430,000 premature deaths; - over 7 million years of healthy life lost Lim et al. LANCET (2012)
  6. 6. • 1000’s new health studies, reviews (2006-2015) • NPACT study (2013); ESCAPE (2013) • REVIHAAP (July 2013); HRAPIE (Dec 2013) • HEI Ultrafines report (2013) • WHO Black Carbon report (2012) • IARC Diesel exhaust reports (2013/2014) • WHO Burden of disease report (March 2014) What is already known
  7. 7. Conclusions of the HEI Traffic Report 2010 Health outcome Association with traffic air pollution exposure Mortality All-cause & CV Sufficient Asthma & Respiratory – children Asthma onset & prevalence Asthma is more common in children living in the street buffers with the highest concentration of traffic-related pollutants Exacerbation of asthma symptoms Children living in hot spots of traffic-related pollution experience more symptoms and exacerbations Sufficient Sufficient Asthma & Respiratory – Adults Adult onset of asthma (one study) Exacerbation of asthma symptoms (few studies) Hospitalisation rates Insufficient Suggestive but not sufficient Insufficient Lung function Living in proximity to high concentration of traffic air pollution may be associated with reduced lung function Suggestive but not sufficient
  8. 8. Meta-analysis of the association between long- term exposure to PM2.5 and all-cause mortality Hoek et al, EnvHealth 2013 These are all, by and large, associations derived from old cohorts exposed to historic levels of air pollution. What do they tell us about contemporary exposures?
  9. 9. Black Carbon – a better health indictor? Toxic component or source indicator? Estimated county- and season- specific relative risks (RR) of cardiovascular and respiratory hospitalization associated with PM2.5 components in 106 U.S. counties for the years 1999 through 2005 Janssen et al, Environ Health Perspect, 2011 Systematic review and meta-analysis of health effects of BC compared with PM mass based on data from time-series studies and cohort studies that measured both exposures
  10. 10. Controlled Diesel Exposures Exposure to DE: PM10 300µg/m3 and filtered air for 1 hour & 100µg/m3 and filtered air for 2 hours
  11. 11. Diesel induces inflammation in vivo Neutrophils after air Neutrophils after DE • Inflammation • Impaired lung function • Injury/remodelling • Impaired microbial defences • Carcinogenic constituents • Blood viscosity • Promotes atherosclerosis • Impaired vascular function • Ischaemia • Arrhythmias
  12. 12. How does air pollution impact o children’s development?
  13. 13. NO2 in Tower Hamlets & Hackney
  14. 14. Internal dose of black carbon
  15. 15. 16 Impaired lung growth Gauderman et al, 2004 (NEJM); southern California - 1,759 10-yr old children, 12 communities, 8-yr follow up - Lung function growth significantly reduced in areas with higher levels of traffic-related pollutants - NO2, PM2.5, elemental carbon (EC) associated with reduction in growth of FEV1 of between 79.7 and 101.4 mL - Clinically low FEV1 at age 18 positively correlated with level of exposure to NO2, PM10, PM2.5, EC
  16. 16. Gauderman et al, NEJM, 351: 1057-67, 2004 - 1.6% at lowest level of PM2.5 exposure - 7.9% at highest level of PM2.5 exposure (4.9x higher) Clinically low FEV1 at age 18 yrs
  17. 17. 18 Impaired lung growth Gauderman et al, 2004 (NEJM); southern California - 1,759 10-yr old children, 12 communities, 8-yr follow up - Lung function growth significantly reduced in areas with higher levels of traffic-related pollutants - NO2, PM2.5, elemental carbon (EC) associated with reduction in growth of FEV1 of between 79.7 and 101.4 mL - Clinically low FEV1 at age 18 positively correlated with level of exposure to NO2, PM10, PM2.5, EC Gauderman et al, 2007 (Lancet); southern California -Same study, local vs. regional pollutant levels -Living <500m from freeway associated with reduction in FEV1 growth of 81mL (vs. living >1500m away) -Significantly lower attained FEV1 by 18 yrs
  18. 18. Concerning news on the Horizon
  19. 19. 20 Causes for Optimism
  20. 20. PM2.5 air pollution & life expectancy in the US Pope et al, 2009 Reduction in PM2.5, 1980-2000 (μg/m3) Changeinlifeexpectancy,1980-2000(yr)
  21. 21. Improvements in PM10 (& PM2.5) reduces respiratory symptoms SAPALDIA Study, Schindler et al, 2009 New Cough Persistent Cough New Wheeze Persistent Wheeze
  22. 22. John Evelyn 1620 –1706 Cleaner Fuels Separate the vulnerable population from pollution sources Economic benefits Green infrastructure Moral imperative
  23. 23. Acknowledgements Centre for Primary Care and Public Health, QMUL: Chris Griffiths, Jonathan Grigg, Robert Walton, Isobel Dundas, Stephen Bremner, Nadine Marlin, Louise Cross, Neeru Garg, Alex Nanzer, Yasmeen Hanifa, Harpal Kalsi, Tom Round, Peter Bridge, Ratna Sohanpal, Adam Briggs, Grace Tuaf Toro, Niki Jakeways, Dev Gadhvi, Seif Shaheen, Rossa Brugha, Grainne Colligan, Chinedu Nwokoro, Anna Schwappach, David McLaughlin, Neetha Purushotham, Hannah Smithers. Environmental Research Group, KCL: Frank Kelly, Helen Wood, Jeenath Jamaludin, Andrew Grieve, Esme Purdie, Layla Aitlhadj, Eleanor Smith, Erik Van Nunen, Ben Barratt, Sean Beevers. Umea, Sweden: Anders Blomerg, Thomas Sandstrom, Annelie Behndig, Sundeep Salvi Imperial: Paul Elliot, Mireille Toledano, Liza Selley, Toby Athersuch

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