1. Respiratory Health Effects of Climate Change
Meredith C. McCormack, MD MHS
April 8, 2018

3. Projected Changes in Global Average Temperature
Source: USGCRP (2009)

4. Death toll exceeded 70,000 in Europe during the summer of 20031
Excess Mortality
Compared 2003 to
Highest death rates in France, Portugal, Italy, Spain, Luxenborg
No evidence of a harvesting effects in fall months that followed
June 1
Sept 30
Estimated excess of 70,000 deaths in summer 2003 compared to

5. People most affected by extreme temperature
Extremes of age- children and elderly
Those with underlying chronic disease
Living in a temperate climate
Lack of air conditioning
Mental illness, living alone
Studies in US regions- including NY, California, etc
They have shown that individuals, especially those with chronic disease are susceptible to the detrimental effects of heat
Braga et al. Environ Health Persp 2002; Basu Environ Mealth 2009
Kovats Annu Rev Public Health 2008; Semenza et al. Am J Prev Med 1999

6. 12.5 million Medicare beneficiaries
Respiratory hospitalizations increased 4.3% or every 10 ͦF increase in summer temperature
Risk was higher (1.4% higher) in areas with cooler average summer temperatures.
Effect was independent of pollution and strongest on same day
Anderson et al. AJRCCM 2013

7. Individual Exposure to Heat and Health Effects in COPD
McCormack MC et al. Annals of Am Thor Soc 2016

8. LONDON SMOG 1952
During this period and in the 2 weeks following, there was a sharp increase in deaths- with an 80% increase in mortality rates compared to December of the previous year.
It is estimated that there were an excess of 12,000 deaths These were primarily respiratory deaths – related to infection, including pneumonia, influenza, tuberculosis, exacerbations of asthma and obstructive lung disease- and there were also increases in cardiac deaths.
Martin AE. Mortality and morbidity statistics and air pollution. Proc R Soc Med 1964;57:

9. Particulate Matter
Current standards are 24 hour 35 and annual 12
Studies of severe episodes of air pollution
RESEARCH
Studies of air pollution in urban areas
Focus on susceptible populations
| | | | | | | | |
POLICY
Clean Air Act
1970
PM10 standard
1987
PM2.5 standard
PM2.5 standards tightened
2006, 2012

10. Clean Air Act: Top 6 Major Air Pollutants*
Particulate Matter
Ozone
Sulfur dioxide
Carbon Monoxide
Nitrogen dioxide
Lead
*Regulated based on health effects in sensitive populations
The clean air act identified criteria air pollutants that are regulated to protect human health. The standards are based evidence of health effects related to exposure in the general population and also in sensitive populations. Sensitive populations include children, the elderly, those with asthma and other chronic diseases

11. Epidemiologic evidence of association between PM and mortality
All cause mortality
Cardiopulmonary
Cardiovascular
cohort studies have established that exposure to pollution over time is associated with increased risk of mortality These estimates come from the Harvard 6 Cities Study, the American Cancer Survey and others. Findings reflect increases in average exposure over time that are associated with increases in mortality on the order of 5-15 percent per 10 ug/m3 increase in PM2.5
* Risk estimates per 10 µg/m3 increase in PM2.5 or PM10
Brook et al. Circulation 2010;121:

12. Air pollution during warm season and childhood asthma emergency visits
In addition to patients with underlying risk factors or history of heart and lung disease, children are a population that are sensitive to health effects of particulate pollution. Particulate pollution has been shown to exacerbate childhood asthma and has been linked to increases in symptoms, exacerbations and decreases in lung function. In a study of children evaluated in emergency departments in Atlanta hospitals, investigators- Stirckland and colleagues- demonstrated that increases in PM2.5 were associated with increased risk of emergency visits for asthma.
Children ages 5-17 years
Atlanta hospitals
Emergency visits for asthma or wheeze
Strickland et al AJRCCM; 182:

13. Health Effects of Air Pollution
Overall Mortality
Hospitalizations
Emergency Department Visits
Cardiac and Respiratory exacerbations
Myocardial Infarction
Heart Failure
COPD
Asthma
Respiratory Infections
Mention the fact that there is active investigation related the fact that pollution may be obesogenic

14. Sources

15. Reduction in air pollution has resulted in measurable health benefits
Samet JM, Burke TA, Goldstein BD. NEJM 2017

16. Take Home Message
The impact of climate change on air quality has significant respiratory health consequences
Scientific evidence has informed policy that has led to pollution reduction
Improved air quality has proven health benefits
Reduction of motor vehicle emissions and industrial emissions through regulation and adoption of low emission vehicles and clean power sources are needed to protect our air