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Components of Air pollution SMOG inc. Ozone Causes respiratory discomfort and inflames lungs. Formed in sunlight from VOC and NO 2. Sulphur dioxide Lung irritant formed from high sulphur fuels and smelting. - decreasing Carbon monoxide Asphyxiant formed by incomplete combustion in petrol engines. - decreasing Nitrogen dioxide Irritates lungs and increases asthma incidence. Particulate matter Complex mixture. Large particles formed by mechanical processes, small particles by combustion. Diesel exhaust carcinogenic. Vol. Organic compounds Carcinogenic. Evaporation and incomplete combustion of petroleum fuels. 2

Components of Vehicle pollution Carbon monoxide - now 70% less than 20 years ago, but still a problem. Lead - no longer an air pollution problem Nitrogen dioxide - produced in all motor engines and increasing as engines operate at higher temperatures. Fine particles - Produced in all diesel engines. Total mass decreasing but numbers increasing as particles produced become finer (and more harmful). Volatile organic matter - probably increasing. Includes known carcinogens such as benzene. Involved in smog formation with nitrogen dioxide and sunlight. 4

The NSW EPA records particles in two ways: PM10: the mass of particles less than 10µ (micrometers) in diameter in a cubic meter of air. National air quality goals (NEPM) state that PM10 levels should not exceed 50µg/m 3 averaged over 24 hours more than 5 times in a year. PM2.5: the mass of particles less than 2.5µ in diameter in a cubic meter of air. Both of these measures are dominated by larger, heavier particles and give little information about potential health impacts 7

IMPACT OF PARTICULATE POLLUTION Medical evidence* correlates increases in PM10 with widespread health impacts, with no safe threshold: 'A 10µg/m 3 increase in PM10 results in a 1% increase in hospital admissions’. BUT there was no marked increase in illness in Sydney as a result of the bush fires in 2003 when PM10 levels exceeded 200µg/m 3. It is the vehicle pollution contribution, including ‘smog’ and ultra-fine particles, which is the real problem in cities. *( '6 cities study' by Dockery, D.W. & Pope, C.A., in ) 8

Particles come in many sizes! PARTICLE size in micrometers 10µ2.5µ1.0µ0.1µ0.01µ PM10 PM2.5 Is the same size as Red blood cell Fungal spore BacteriaMumps Virus Compare withgrapefruitgolf ballcherrywheat seedsand grain Number for equal mass (1000) 10 6 ( ) 10 9 ( ) Surface area for equal mass ClassificationCoarseFineNano particle Sources From mechanical sources like dust. From combustion and vehicle exhaust 5

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SIZE MATTERS !! Particles do not have to be ‘toxic’ to cause harm. Titanium dioxide is not toxic. Inhaled titanium dioxide particles 0.2 µ in diameter cause little lung or other damage HOWEVER the same titanium dioxide, but in the form of 0.02 µ particles, causes severe inflammation in the lung. Most diesel particles are less than 0.2 µ in diameter. 9

How air pollution affects the body 9

Lung compromised by ultra-fine particles Healthy lung removing particles from airways Ultra-fine particles can penetrate lung cells.

Impact of ambient air pollution on birth weight in Sydney, Australia. T Mannes, B Jalaludin, G Morgan, D Lincoln, V Sheppeard, S Corbett (NSW Health) Occup Environ Med. 2005;62:524–530 Exposure of mothers to the common pollutants carbon monoxide, nitrogen dioxide and particulate matter were shown to have had a statistically significant adverse effect on birth weight, even though pollution levels were generally ‘low’. 13 Exposure to Traffic and the Onset of Myocardial Infarction Annette Peters, Ph.D., et al. New Engl J Med 351;17 October 21, 2004 Exposure to traffic leads to a 3 fold increase in the onset of myocardial infarctions within one hour afterward. The time the subjects spent in cars, on public transportation, or on motorcycles or bicycles was consistently linked with an increase in the risk of myocardial infarction.

Simplified diagram from ‘Triggering Myocardial Infarction’ by Peter Stone N Engl J Med 351:17 Oct

Inhalation of Fine Particulate Air Pollution and Ozone Causes Acute Arterial Vasoconstriction in Healthy Adults. Brook RD, et al. Circulation 2002;105:1534–6. Short-term inhalation (2 hrs) of fine particulate air pollution and ozone by healthy non-smoking adults (av age 35), at concentrations that occur in the urban environment, causes acute coronary artery vasoconstriction. The Effect of Air Pollution on Lung Development from 10 to 18 Years of Age W. James Gauderman, et al. N Engl J Med 2004;351: Current levels of air pollution have chronic, adverse effects on lung development in children from the age of 10 to 18 years, leading to clinically significant deficits in attained FEV 1 (forced expiratory volume) as children reach adulthood.

Recent medical research into pollution impacts Ozone was reduced by 28%, PM10 by 16% and NO 2 by 7%. Over the same period, childhood asthma requiring hospitalisation was reduced by 42%, but non-asthma hospitalisations were basically unchanged. Significant adverse health outcomes in 8 to 10 year old children, related to PM10 below NEPM goals. “These results provide evidence of health effects at lower than expected levels of outdoor air pollution in the Australian setting.”(Hunter valley) Impact of Changes in Transportation and Commuting Behaviors During the 1996 Summer Olympic Games in Atlanta on Air Quality and Childhood Asthma. Michael S. Friedman, MD et al. (JAMA 2001;285: ) Outdoor air pollution and children’s respiratory symptoms in the steel cities of New South Wales. Lewis,P.R.,Hensley,M.J. et al MJA.169: pp

Impacts of particle pollution on children: Increased rates asthma and chest infection. Significantly reduced lung development Children: breathe more per unit body weight than adults. have smaller airways and lungs. Have different rates of toxification and detoxification. Have immature host defence mechanisms. Have increased ventilation with play and exercise. 14

Air pollution is a preventable cause of disease, illness and death. Only the political will is required to fix the problem A concerted action to reduce pollution in Tokyo changed that city from being one of the most polluted in the world. In 1975, PM10 levels were higher than 100µg/ m 3 In 1998, PM10 levels were less than 45 µg/ m 3 The savings in health costs and lost wages are estimated to be more than $A 45.7 billion pa A.S. Voorhees - J. Risk Research Vol. 8, (June, 2005) 15

The motto of the Association is: When you can’t breathe- nothing else matters! 16 The American Lung Association web site has up to date information on the health impacts of air pollution