1. Uncontrolled Air Pollution in India: Choked Lungs Anurag Agrawal MD PhD FCCP Head, Center of Excellence for Translational Research in Asthma & Lung disease

2. Crazy Bad Air Air Quality for Human Health https://earthdata.nasa.gov/featured-stories/featured-research/crazy-bad-airhttps://earthdata.nasa.gov/featured-stories/featured-research/crazy-bad-air (2010) http://sedac.ciesin.columbia.edu/data/collection/epi

3. What makes “Bad Air” Bad?  Respirable Suspended Particulate Matter  PM2.5 – cardiorespiratory effects clearly established, increased morbidity and mortality  PM5 – Less toxic but well established effects on both  PM10 – Ambiguous data on independent effects  Gases  Sulfur Oxides  Nitrogen Oxides  Ozone

4. Harvard Six City Study  Mortality ratios are shown for the six cities over two periods in relation to PM2.5  W atertown, MA  H arriman, TN  St. L ouis, MO  S teubenville, OH  T opeka, KS  P ortage, WI is reference Am J Respir Crit Care Med. 2006 March 15; 173(6): 667–672

5. Measuring Air Quality  Many Indices  AQI is used by the US (www.airnow.gov)  PM 2.5 major determinant, 12 ug/m3 corresponds to 50; 150 ug/m3 corresponds to 200  Most western countries set 50 ug/m3 as upper limt

6. Yesterday’s data in Delhi

7. RK Puram, 18 Feb, 6 PM, to 19 Feb, 3 PM, 2014

8. Lowest Lung Function in Indians 30-40% lower lung function after adjusting for age, gender, height, weight

9. Air Pollution and Lungs RURAL DWELLER LUNGSPOLLUTED CITY DWELLER LUNGS

11. Lithium and Strontium salts Calcium salts Incandescence of iron (with carbon), charcoal, or lampblack Sodium compounds Barium compounds Copper compounds Burning aluminum, titanium, or magnesium powder or flakes CHEMISTRY OF FIREWORKS COLORS FIREWORK FUEL Charcoal Sulphur

12. STUDY TOOLS MultiLog 2000 Gas Monitor (Quest Technologies, USA) Measures levels of 4 different gaseous pollutants (CO, NO, NO2 and SO2) at one time using electrochemical sensors. Can record levels at every 1 minute interval for up to 8 hours running time. Respiratory Health Questionnaire Symptoms of upper respiratory tract and lower respiratory tract Irritation in eyes and nose

13. MEAN CHANGES IN SO2 LEVELS (ppm) Before Diwali During Diwali After Diwali 0 1 2 3 4 5 6 SO2 levels ( in ppm ) Before DiwaliDuring DiwaliAfter Diwali Ambient SO2 levels reached values 200 times above the safety limits recommended by WHO

14. SymptomPre-existing Prevalence (%) New symptoms Prevalence (%) Total Prevalence (%) Cough 4.2  26.331.2 Breathlessness 2.5  10.813.3 Wheeze 1.8  4.36.1 PREVALENCE OF RESPIRATORY SYMPTOMS DURING THE DIWALI FESTIVAL n = 510

15. Is it better Indoors?  Many homes in India burn wood, leaves, cow- dung etc for heat.

16. Indoor PM2.5 levels in mcg/m3 109256 15-20 LPGBiomassUS homes p<0.0001 110256 15-20 INDOOR AIR POLLUTION DUE TO BIOMASS EXPOSURE Indoor PM2.5 levels: 287 homes 2 different seasons Measurement over 24 hrs

17. EXPOSURE TO BIOMASS SMOKE IS PERHAPS THE BIGGEST RISK FACTOR FOR COPD GLOBALLY 2 billion Kg of biomass burnt every day world-wide SmokersBMF-exposed 1.1 billion 3 billion 60,000 hours, 25 million lts of polluted air

18. Road Traffic: Outdoor Pollution  Rural areas are beginning to urbanize  The effects of being close to roads can be tested

19. Proximity to highway Biomass fuel: OR 1.46 (1.06 – 2.0) <500 mts >500 mts

20. Summary  Air pollution in India is at dangerous levels  Indoor pollution is a poorly recognized risk  The high rate of cardiac and respiratory problems in India may relate to air pollution  Efforts to highlight the problem and to improve air quality are needed

21. Thank you