Transcript Indoor Air Quality in Alaska

Air Quality in Alaska
Asthma Studies
Mary Ellen Gordian, MD, MPH
Institute for Circumpolar Health
Studies
Types of Air Pollution
Ambient (Outdoors)
• Dust from roadways
• Exhaust from
combustion engines
including diesel.
• Pollen
• Dust and fumes from
landfills and sewage
lagoons
Indoor Air
• Smoking
• Storage of chemicals
or gasoline
• Combustion heaters
(diesel?)
• People and animals
• Cooking
How Arctic Conditions Relate
to Air Pollution
• Low temperatures increase incomplete
combustion products.
• Temperature inversions prevent air mixing.
• Development increases traffic.
• Energy efficient homes trap pollutants.
Why are we concerned?
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90- 95% of our time is spent indoors.
Our homes are built air tight.
Indoor smoking causes fumes and particles.
Our gasoline contains 3-5% benzene.
Gasoline storage in house or in attached
garage causes fumes throughout the house.
• Furnaces in the garage can distribute air
pollutants throughout the house.
Respiratory Health of Children
1997 survey of Alaska Native children
grades 6-9 in YK Delta
• 24% have asthma or asthma symptoms
• 37% have chronic cough with sputum
• 39% have no respiratory symptoms
Anchorage indoor air benzene
study, 1996
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•
Arithmetic mean 16 ppb of benzene.
25% of homes about the mean.
Highest reading 344 ppb of benzene.
Alaskan children are exposed to benzene in
their homes, automobiles and ambient air
Indoor Pollutants
• Carbon monoxide- from unventilated
combustion.
• Particulates from indoor smoking and wood
stoves.
• Biologicals –dust mites, animal dander
germs
• Benzene- evaporates from stored gasoline
Carbon Monoxide (CO)
A deadly killer indoors
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Colorless, odorless.
Easily absorbed through the lungs
Forms carboxyhemoglobin in the blood
CO bonds with hemoglobin 240X stronger
than oxygen’s bond with hemoglobin
Normal Carboxyhemoglobin
levels in humans
• endogenous carboxyhemoglobin is 0.3-0.7%
• smoker’s carboxyhemoglobin 0.8 -8.0%
• after 8 hours continuous exposure to CO at
35ppm (workplace maximum),
carboxyhemoglobin = 5%
• the biological half-life of carboxyhemoglobin
in human blood is 2 to 5 hours depending on
respiratory rate.
Health Effects of CO at different
levels of Carboxyhemoglobin
• Below 5% COHb no symptoms in healthy people.
• If mother during pregnancy has COHb >0.7%
oxygen to the baby is reduced-increasing risk.
• Greater than 2.9% COHb increased angina with
exertion in patients with heart disease.
• Studies show hospitalization of elderly patients
with heart disease increases when ambient CO
increases.
Particulate Pollution
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Measured as PM10 or PM 2.5
Volcanic ash and freeze-dried soil (PM10)
Re-suspended from roadways by traffic.
Combustion sources (PM2.5)
– Diesel exhaust
– coal
– wood burning.
What is Asthma?
Asthma is a chronic respiratory disease
characterized by:
• eosinophilic inflammation of the airways;
• bronchial hyper-responsiveness to stimuli.
Different Types of Asthma
• Allergic asthma is associated with allergy as much
as 80% of childhood asthma is related to allergy.
• Intrinsic asthma is not associated with allergy.
• Post-infective asthma occurs after a lower
respiratory infection. Frequently clears by age 5.
Immune Responses
• Humoral
• T-helper 1 cells
• Immunoglobulin
response- IgM, IgG
• Cytokine responseIFN-gamma
• Cell-mediated
• T-helper 2 cells
• Immunoglobulin
response- IgE
• Cytokine responseIL4, IL5, IL 13
Tolerogenic Immune Response
To survive in an environment full of foreign
protein antigens, animals developed a method
of response that minimized the energy needed
to encounter non-infectious protein.
Recognition and minimal response- IgA,
Cytokine IL-10.
Known Risk Factors for Asthma
• Family history – genetic predisposition
• Environmental tobacco smoke
• Combination of family history and
environmental tobacco smoke exposure is
additive.
Allergens associated with Asthma
• Dust mite allergy has been associated with
asthma.
• Cockroach allergen are common in inner
city children, associated with asthma.
• Molds have been implicated.
• Animal allergens (cat is ubiquitous)
• Children with allergy have increased risk of
asthma.
World Wide Increase in Asthma
• Multi-center surveys show that asthma is
increasing worldwide.
• Greatest increases in “westernized”
English-speaking countries.
• Urban areas have more asthma cases than
rural areas.
• Increase in both children and adults.
Asthma Rates
Asthma Increasing
Australia
Costa Rica
New Zealand
Oman
Peru
Singapore
United Kingdom
United States
No Asthma Increase
Albania
Estonia
Indonesia
Latvia
Uzbekistan
What is Causing the Increase?
• Dietary Hypothesis
Changes in diet result in increased susceptibility to
allergic response.
• Hygiene Hypothesis
Increased cleanliness reduces level of endotoxin
which changes the immune system
• Adjuvant Hypothesis
Exposure to petroleum exhaust fumes changes the
immune system
Concerns for Dietary Hypothesis
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Reduction in locally grown food.
Increases in chemically treated food.
Salt intake is increased.
Omega 3 fatty acids reduce allergic
response in animals.
• Early intake of cow’s milk protein or soy
protein may increase risk of allergy.
Hygiene Hypothesis
Environmental exposure to endotoxin
has a crucial role in developing
tolerance to natural allergens
Hygiene Hypothesis
• Children living on farms have less risk of
allergy and asthma.
• Children in daycare have decreased risk.
• Children with older siblings less risk.
• Children with animal pets have less risk.
• Increased amount of endotoxin exposure in
farm homes, and homes with dogs
The Icon of Westernization
What is
westernization?
Individualization
Independence
Initiative
and your own car!
Adjuvant Theory
The exposure to traffic results in changes in
the immune system promoting cellmediated Th2 immunity characterized by
inflammation.
There is direct experimental evidence for this.
Evidence for Adjuvant Theory
• Children living near to freeways in Holland
have greater symptoms, reduced FEV1.
• Children hospitalized for asthma live near
high traffic areas as compared to children
hospitalized for GI problems in U.K.
• Children living near traffic have more
cough in Japan.
Laboratory Evidence
• People experimentally exposed to diesel
exhaust (DE) have 16 x greater response to
ragweed allergen than people not exposed.
• People exposed to DE make IgE to new
antigen exposure, while people not exposed
make IgA, IgG, but not IgE.
What are we doing in Alaska?
• Survey of Anchorage parents of children in
kindergarten and first grade in 13 schools
regarding asthma diagnoses, symptoms,
demographics, home environment and
family history.
• Over 1100 surveys received. Minorities well
represented. All socioeconomic classes
represented. Geographically distributed.
Study Design
• 13 schools representing a range of traffic
exposure and socioeconomic demographics
• All kindergarten and first-grade students
received surveys at registration, or in the
classroom. (50-85% response rate)
• Traffic data collected from state
• Traffic measured on roads with no data.
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Distribution
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2%
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6%
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Traffic Variables
• Nearest intersection to home is located on map.
• Two buffer zones 100 meters and 300 meters
around intersection is drawn and the length of
each road falling within buffer is measured.
• The length within the buffer is multiplied by the
average daily traffic on that road in that segment.
Some Unexpected Findings
• A great many children do not live in the
neighborhood school boundaries.
• Children diagnosed with asthma have an
increased number of respiratory illnesses.
• There is variation in asthma rates between
schools, highest 20%, lowest 6%.
Table 1 Unadjusted results of 100 meter exposure
OR (95% CI) *
Traffic Exposure
Low
Unadjusted (n=1043)
p-value †
0.210
Referent
Medium 1.03 (0.65, 1.63)
High
1.85 (0.96, 3.50)
*Maximum
likelihood estimates and Wald-based 95% Confidence
intervals for logistic regression models.
†p-values
are based on likelihood ratio tests for the inclusion of
the entire factor.
Table 2 Adjusted for Parental Asthma, Smoking, gender, income
100-meter Buffer
Adjusted (n=927)
OR (95% CI) * p-value †
Traffic Exposure
0.068
Low
Referent
Medium
1.06 (0.64, 1.77)
High
2.38 (1.19, 4.76)
*Maximum
300-meter Buffer
Adjusted (n=927)
OR (95% CI) * p-value †
0.024
Referent
1.37 (0.85,2.23)
2.74 (1.35, 5.56)
likelihood estimates and Wald-based
Confidence intervals for logistic regression models.
†p-values
95%
are based on likelihood ratio tests for the inclusion of
the entire factor.
100-meter Buffer
OR (95% CI) * p-value †
Gender
0.351
Male
Referent
Female
0.81 (0.53, 1.25)
Parental Asthma
<0.001
No
Referent
Yes
4.27 (2.74, 6.65)
Smoker in Home
0.203
No
Referent
Yes
1.34 (0.86, 2.10)
Income
0.183
<$20K
Referent
$20-49K
0.72 (0.43, 1.21)
$50-100K 0.49 (0.26, 0.93)
>$100K
0.81 (0.33, 1.94)
300-meter Buffer
OR (95% CI) * p-value
0.338
Referent
0.81 (0.52, 1.25)
<0.001
Referent
4.30 (2.75, 6.72)
0.177
Referent
1.37 (0.87, 2.15)
0.256
Referent
0.76 (0.45, 1.28)
0.52 (0.27, 1.01)
0.89 (0.37, 2.17)
Ty
so
n
F
a
Mo
i
un rvi ew
tai
nV
i
No e w
rth
W
sta
on
r
de
rP
ark
Mu
Go
l do
ve
on
rnm
en
Air
tH
po
i ll
rt H
eig
hts
Ch
i no
Ab
ok
bo
tt L
Ro
oo
ge
p
rs
Oc Park
ea
nv
Ba i ew
ys
ho
re
Asthma Rates in Schools
25.00%
20.00%
15.00%
10.00%
5.00%
0.00%
3.5
3
2.5
2
1.5
1
0.5
0
asthma rate
average income
Conclusions
• Exposure to traffic is a risk factor for
childhood asthma.
• The effect size of high traffic volume in a
100 meter radius of home is as great or
greater than having a smoker in the house.
• Residential housing and schools should be
buffered from high traffic areas.
Summary
• Outdoor air pollution from combustion and
traffic causes more problems in the Arctic
because of temperature inversions.
• Indoor air pollution is contributing to
respiratory disease in Arctic homes.
• Asthma may be affected by growing up
close to traffic.