1. Air Quality and Your Health Susan Lyon Stone Clean Air Partners August 29, 2006 stone.susan@epa.gov

2. Human Lung Air conductingAir conducting –Trachea –Bronchi –Bronchioles Gas exchangeGas exchange –Respiratory bronchioles –Alveoli

3. Ozone Irritates Airways SymptomsSymptoms –Cough –Sore or scratchy throat –Pain with deep breath –Fatigue Rapid onsetRapid onset Similar symptoms - people with and without asthmaSimilar symptoms - people with and without asthma

4. Ozone Reduces Lung Function BASELINE 2HR4HR FEV1, % CHANGE -60 -40 -20 0 M-10

5. M-1c

6. Ozone Causes Inflammation Ozone reacts completely in surface layer - forms reactive oxygen molecules Influx of white blood cells Damages cells that line the airways Effect is greater 24 hours after exposure Increases airway reactivity Concern about repeated exposures – permanent structural changes

7. Respiratory Hospital Admissions by Daily Maximum Ozone Level, Lagged One Day 114 112 110 108 106 104 102 Ozone concentration (ppm) Respiratory Admissions.01.02.03.04.05.06.07.08.09.1 D-8a (Burnett et al, 1994)

8. California Children’s Health Study

9. CHS: School Absences 20 ppb increase in O 3 associated with an 83% increase in school absences for acute respiratory disease (Gilliland et al., 2001) Large economic impact of pollution-related school absences (Hall and Lurmann, 2003)

10. CHS: Ozone and New-onset Asthma McConnell at al., 2002

11. New Evidence from Current Review of Ozone Standard Physiological bases of increased sensitivity of people with asthma –Larger decreases lung function –Increased occurrence and duration nonspecific airway responsiveness –Increased airway responsiveness to allergens –Increased inflammatory responses

12. New Evidence from Current Review of Ozone Standard Hospital admissions Emergency room visits School absences Increased symptoms and medication use in asthmatic children

13. New Evidence from Current Review of Ozone Standard - Mortality Study done in Vancouver, BC with statistically significant results has 98 and 99 percentile values below 0.06 ppm O 3 US multi-city time-series studies provide strong evidence of association between short-term O 3 exposure and mortality Effects robust to confounding by copollutants

14. Sensitive Groups for Ozone People with lung disease Children Older adults People who are active outdoors

15. Air Pollution Disasters London buses are escorted by lantern at 10:30 in the morning Donora, PA at noon on Oct. 29, 1948

16. Particle pollution is a complex mixture derived from many sources Particle pollution is a complex mixture derived from many sources

17. Particle Deposition Larger particles (> PM 10 ) deposit in the upper respiratory tract Inhalable particles (< PM 10 ) penetrate into lungs Some particles (e.g., less than 0.1 um) may enter bloodstream Particles may react, accumulate, be cleared or absorbed

18. Association Between Long Term Exposure to PM and Mortality Harvard Six-Cities Adult Cohort Purpose was to study the association between pulmonary changes and long term exposure to sulfates and sulfur dioxide Enrollment 1974 – 1977 8,111 white men and women About 1,300 in each of six cities Age range 25 to 74 years Followed until 1991 (now 1999) 14 to 17 years of follow-up 111,076 person-years 1,430 death

19. Dockery et al., 1993

20. Particle Pollution Affects the Lungs You are exposed to particle pollution simply by breathing polluted air. Exposure increases when you exercise, because you breathe more vigorously and deeply than usual. Respiratory effects include: airway irritation cough phlegm decreased lung function airway inflammation asthma attacks bronchitis chronic bronchitis

21. And Particle Pollution Affects the Heart Particle pollution has been linked to changes that indicate your heart isn’t as healthy as it should be. Those include: Arrhythmias and changes in heart rate. Changes in the variability of your heart rate. Blood component changes C-reactive protein Fibrinogen Plasma viscosity Some studies indicate that particle exposure may cause heart attacks. And particles are linked with death from heart disease. Particle exposure has been linked to heart attacks.

22. It’s a Public Health Concern When particles aggravate heart and lung diseases that means increases in:  Hospital admissions  Doctor and emergency room visits  Medication use  Absences from work or school Particulate matter is linked to significant public health risks – including premature death from heart and lung disease.

23. Living Within 300 Meters of Local Roadways Affects FEV 1 Brunekreef et al., 1997

24. CHS: Low FEV 1 at Age 18 vs. Pollution Gauderman et al., 2004

25. Particles Trigger Heart Attacks Odds Ratios Hours before onset of MI 01 23 4 5 1.6 1.4 1.2 1.0 0.8 Days before onset of MI 01 23 4 5 1.6 1.4 1.2 1.0 0.8 Odds Ratios Peters et al., 2001 772 MI patients who survived 24 hours and completed interview

26. PM May Cause Effects in Healthy People * * * 2.9 47.2 107.8 206.7 0 50 100 150 PMNs (x10,000) Average CAPS Concentration (  /m 3 ) Devlin et al., 2003 Ghio et al., 2003

27. Mechanisms of PM effects on the cardiovascular system Ambient PM Clotting Factors Viscosity Pulmonary Inflammation Systemic Inflammation Endothelial Cell Dysfunction Platelet Activation Thrombosis Plaque Rupture Pulmonary Reflexes Autonomic Nervous System Cardiac Rhythm Cardiac Disruption Heart Rate Conduction/Repolarization Sudden Cardiac Death

28. Can We Link PM Effects with Specific Sources of Pollution? % Increase in Daily Deaths Residual Mn Salt Metals Fuel Oil Coal Mobile Crustal Laden et al., 2000 Speciation monitoring of airsheds of differing composition may enable identification of components, and sources of those components, that contribute to adverse health outcomes

29. The Utah Valley

30. Sensitive Groups for PM People with heart disease People with lung disease Older adults Children

31. Air Quality Index DescriptorsCautionary Statement Good 0 – 50 No message Moderate 51 – 100 Unusually sensitive individuals Unhealthy for Sensitive Groups 101 - 150 Identifiable groups at risk - different groups for different pollutants Unhealthy 151 - 200 General public at risk; sensitive groups at greater risk Very Unhealthy 201 - 300 General public at greater risk; sensitive groups at greatest risk

32. t Typical PM2.5 distribution Typical concentration- response relationship Typical risk distribution PM Risk Assessment Mortality risk; Schwartz, 1993

33. Use AQI to Reduce Risk Dose = Concentration x Ventilation Rate x Time Reduce these factors to reduce dose Pay attention to symptoms People with asthma – follow asthma action plan Coaches – rotate players frequently People with heart disease – check with your doctor

34. AIRNow - www.airnow.gov

35. Web Page for Health Care Providers www.airnow.gov/health-prof

36. Ozone Web Course for Health Care Providers

37. MedicalPoster

38. Asthma Factsheet

39. Particle Pollution and Your Health

40. Review Process for NAAQS Scientific studies on health and environmental effects EPA Criteria Document EPA Staff Paper Scientific peer review of published studies Reviews by CASAC and the public Public hearings and comments on proposals Proposed decision Final decision PM NAAQS Ozone NAAQS

41. Timeline for NAAQS Reviews Under a consent agreement for the PM and Ozone Reviews –PM Milestones Proposed decision - December 20, 2005 Final decision - September 27, 2006 –Ozone Milestones February 2006 – final Criteria Document October 2006 - final Staff Paper March 2007 – proposed decision for public comment December 2007 – final decision –Technology Transfer Network (TTN) for NAAQS review documents: http://www.epa.gov/ttn/naaqs/