Air pollution and chronic airway diseases: what should people know and do?

The health effects of air pollution remain a public health concern worldwide. Exposure to air pollution has many substantial adverse effects on human health. Globally, seven million deaths were attributable to the joint effects of household and ambient air pollution. Subjects with chronic respiratory diseases such as chronic obstructive pulmonary disease (COPD) and asthma are especially vulnerable to the detrimental effects of air pollutants. Air pollution can induce the acute exacerbation of COPD and onset of asthma, increase the respiratory morbidity and mortality. The health effects of air pollution depend on the components and sources of pollutants, which varied with countries, seasons, and times. Combustion of solid fuels is a major source of air pollutants in developing countries. To reduce the detrimental effects of air pollution, people especially those with COPD or asthma should be aware of the air quality and take extra measures such as reducing the time outdoor and wearing masks when necessary. For reducing the air pollutants indoor, people should use clean fuels and improve the stoves so as to burn fuel more efficiently and vent emissions to the outside. Air cleaners that can improve the air quality efficiently are recommended.     

Outdoor air pollution: counseling and exposure risk reduction

Air pollution is monitored on a daily basis in large population centers in the United States and reported to the general public through a variety of media outlets as the Air Quality Index. This index is based on current national air quality standards for criteria air pollutants established by the US Environmental Protection Agency. Patients at increased risk for adverse effects of inhaled air pollutants include those who have been diagnosed with chronic lung disease and cardiovascular disease, including asthma, chronic obstructive pulmonary disease, coronary artery disease, congestive heart failure, and peripheral vascular disease, although others may also be at risk during periods of unusually high pollutant levels. These patients should be educated regarding what symptoms may be related to poor air quality and how they can monitor the Air Quality Index to modify their activity to prevent symptoms and other adverse events. Heavy outdoor exertion should be avoided on days expected to have poor air quality, or performed earlier in the day on days when outdoor activity cannot be avoided. We recommend advising patients in clear, strong, personalized language that air pollution is harmful and that persons with cardiopulmonary disease are at elevated risk of experiencing a serious adverse health effect from exposure.     

What can individuals do to reduce personal health risks from air pollution?

In many areas of the world, concentrations of ambient air pollutants exceed levels associated with increased risk of acute and chronic health problems. While effective policies to reduce emissions at their sources are clearly preferable, some evidence supports the effectiveness of individual actions to reduce exposure and health risks. Personal exposure to ambient air pollution can be reduced on high air pollution days by staying indoors, reducing outdoor air infiltration to indoors, cleaning indoor air with air filters, and limiting physical exertion, especially outdoors and near air pollution sources. Limited evidence suggests that the use of respirators may be effective in some circumstances. Awareness of air pollution levels is facilitated by a growing number of public air quality alert systems. Avoiding exposure to air pollutants is especially important for susceptible individuals with chronic cardiovascular or pulmonary disease, children, and the elderly. Research on mechanisms underlying the adverse health effects of air pollution have suggested potential pharmaceutical or chemopreventive interventions, such as antioxidant or antithrombotic agents, but in the absence of data on health outcomes, no sound recommendations can be made for primary prevention. Health care providers and their patients should carefully consider individual circumstances related to outdoor and indoor air pollutant exposure levels and susceptibility to those air pollutants when deciding on a course of action to reduce personal exposure and health risks from ambient air pollutants. Careful consideration is especially warranted when interventions may have unintended negative consequences, such as when efforts to avoid exposure to air pollutants lead to reduced physical activity or when there is evidence that dietary supplements, such as antioxidants, have potential adverse health effects. These potential complications of partially effective personal interventions to reduce exposure or risk highlight the primary importance of reducing emissions of air pollutants at their sources.     

空气污染与心血管疾病专家共识

空气污染是全球性的严重公共卫生问题,也是对我国民众健康的严峻挑战。空气污染可增加心血管疾病发病及死亡风险,已成为一项重要且可干预的心血管疾病危险因素。空气污染导致的死亡主要为心血管疾病死亡。本共识汇总了国内外关于空气污染与心血管疾病的最新流行病学及临床研究证据,推荐室内使用清洁能源烹饪及采暖、在重污染天气佩戴符合国家标准的N95防护口罩等措施以降低个体对空气污染物的暴露水平。该共识为进一步加强医疗卫生人员对空气污染危害心血管健康的认识,帮助其开展健康宣教和确定未来科研方向,并为相关部门制定公共卫生政策提供参考。     

The public health relevance of air pollution abatement.

Assuming a causal relationship between current levels of air pollution and morbidity/mortality, it is crucial to estimate the public health relevance of the problem. The derivation of air pollution attributable cases faces inherent uncertainties and requires influential assumptions. Based on the results of the trinational impact assessment study of Austria, France, and Switzerland, where prudent estimates of the air pollution attributable cases (mortality, chronic bronchitis incidence, hospital admissions, acute bronchitis among children, restricted activity days, asthma attacks) have been made, influential uncertainties are quantified in this review. The public health impact of smoking, environmental tobacco smoke, and air pollution on the prevalence of chronic cough/phlegm are outlined. Despite all methodological caveats, impact assessment studies clearly suggest that public health largely benefits from better air quality. The studies are selective underestimates as they are strongly driven by mortality, but do not include full quantification of the impact on morbidity and their consequences on quality of life among the diseased and the caregivers. Air pollution abatement strategies are usually political in nature, targeting at polities, regulation and technology in mobile or stationary sources rather than at individuals. It is of note that key clean air strategies converge into abatement of climate change. In general, energy consumption is very closely related to both air pollution and greenhouse gases. The dominant causes of both problems are the excessive and inefficient combustion of fossil fuel. Thus, for many policy options, the benefit of air pollution abatement will go far beyond what prudent health-impact assessments may derive. From a climate change and air pollution perspective, improved energy efficiency and a strong and decisive departure from the "fossil fuel" combustion society is a science-based must. Health professionals must raise their voices in the political decision process to give strong support for clean air policies, both on a national and international level.     

How much will U.S. medicine change in the decade ahead?

During the past 12 years health care services have been increasingly used by low-income families, largely as a consequence of infusion of more funds into the health care system. The number of persons employed in health-care has gone up along with an expanded governmental role. Present governmental concerns are focused on cost and the relation of public attitudes to needs for, and costs of, a system of national health insurance. In the near future, medical services are not likely to be expanded, and various costly services may be contracted. The number of physicians will go up but the fraction in solo practice will decline. Patterns of physician maldistribution are not likely to be changed substantially. Costs will continue to go up, and government and other third-party payers will strive to control them. A comprehensive form of national health insurance will not come soon, and the public will become increasingly aware of the limits to which health care can improve their lives.     

Air pollution and allergic disease

Over the past several decades, there has been increased awareness of the health effects of air pollution and much debate regarding the role of global warming. The prevalence of asthma and allergic disease has risen in industrialized countries, and most epidemiologic studies focus on possible causalities between air pollution and these conditions. This review examines salient articles and summarizes findings important to the interaction between allergies and air pollution, specifically volatile organic compounds, global warming, particulate pollutants, atopic risk, indoor air pollution, and prenatal exposure. Further work is necessary to determine whether patients predisposed to developing allergic disease may be more susceptible to the health effects of air pollutants due to the direct interaction between IgE-mediated disease and air pollutants. Until we have more definitive answers, patient education about the importance of good indoor air quality in the home and workplace is essential. Health care providers and the general community should also support public policy designed to improve outdoor air quality by developing programs that provide incentives for industry to comply with controlling pollution emissions.     

The effects of outdoor air pollution on the respiratory health of Canadian children: A systematic review of epidemiological studies

BACKGROUND:

Outdoor air pollution is a global problem with serious effects on human health, and children are considered to be highly susceptible to the effects of air pollution.

OBJECTIVE:

To conduct a comprehensive and updated systematic review of the literature reporting the effects of outdoor air pollution on the respiratory health of children in Canada.

METHODS:

Searches of four electronic databases between January 2004 and November 2014 were conducted to identify epidemiological studies evaluating the effect of exposure to outdoor air pollutants on respiratory symptoms, lung function measurements and the use of health services due to respiratory conditions in Canadian children. The selection process and quality assessment, using the Newcastle-Ottawa Scale, were conducted independently by two reviewers.

RESULTS:

Twenty-seven studies that were heterogeneous with regard to study design, population, respiratory outcome and air pollution exposure were identified. Overall, the included studies reported adverse effects of outdoor air pollution at concentrations that were below Canadian and United States standards. Heterogeneous effects of air pollutants were reported according to city, sex, socioeconomic status and seasonality. The present review also describes trends in research related to the effect of air pollution on Canadian children over the past 25 years.

CONCLUSION:

The present study reconfirms the adverse effects of outdoor air pollution on the respiratory health of children in Canada. It will help researchers, clinicians and environmental health authorities identify the available evidence of the adverse effect of outdoor air pollution, research gaps and the limitations for further research.     

Policies for accelerating access to clean energy, improving health, advancing development, and mitigating climate change

The absence of reliable access to clean energy and the services it provides imposes a large disease burden on low-income populations and impedes prospects for development. Furthermore, current patterns of fossil-fuel use cause substantial ill-health from air pollution and occupational hazards. Impending climate change, mainly driven by energy use, now also threatens health. Policies to promote access to non-polluting and sustainable sources of energy have great potential both to improve public health and to mitigate (prevent) climate disruption. There are several technological options, policy levers, and economic instruments for sectors such as power generation, transport, agriculture, and the built environment. However, barriers to change include vested interests, political inertia, inability to take meaningful action, profound global inequalities, weak technology-transfer mechanisms, and knowledge gaps that must be addressed to transform global markets. The need for policies that prevent dangerous anthropogenic interference with the climate while addressing the energy needs of disadvantaged people is a central challenge of the current era. A comprehensive programme for clean energy should optimise mitigation and, simultaneously, adaption to climate change while maximising co-benefits for health--eg, through improved air, water, and food quality. Intersectoral research and concerted action, both nationally and internationally, will be required.     

Efficacy of an Outdoor Air Pollution Education Program in a Community at Risk for Asthma Morbidity

Background. Asthma management guidelines recommend avoiding exposure to indoor and outdoor air pollutants. A limitation of such recommendations is that they do not provide information about how the public should obtain and act on air quality information. Although the Air Quality Index (AQI) provides simplified outdoor air quality forecasts, communities with high rates of asthma morbidity tend to have low rates of internet access due to factors such as low socioeconomic status. Assessments of knowledge about air quality among low-income minority communities are lacking, as are community-based programs to educate the public about using the AQI. Methods. An air quality education program and system for disseminating air quality information were developed to promote pollutant avoidance during the reconstruction of a major highway in a low-income minority community on Chicago's South Side. The program, which centered on workshops run by community asthma educators, was evaluated using a pre-test, post-test, and 1-year follow-up questionnaire. Results. A total of 120 community workshop participants completed at least a portion of the evaluation process. At baseline, knowledge about air quality was limited. Following the workshops, substantial increases were noted in rates of correct answers to questions about health effects of air pollution, the availability of air quality information, and the color code for an AQI category. Approximately 1 year after the workshops were held, few participants could recall elements of the training. Few participants have internet access, and alternative means of distributing air quality information were suggested by study participants. Conclusions. Baseline knowledge of air quality information was limited in the community studied. Air quality education workshops conducted by community educators can increase knowledge about outdoor air quality and its impact on health over the short term. Refresher workshops or other efforts to sustain the knowledge increase may be useful. Given the known short-term and long-term effects of air quality on morbidity and mortality, air quality education efforts should be further developed, evaluated, and promoted for the general public, for people with underlying cardiopulmonary disease, and given the documented health disparities within the general population, for low-income and minority communities.     

Indian‐born patients attending a sexual health clinic in Australia have differing characteristics to their Australian‐born counterparts

We report a retrospective cross‐sectional study from Western Sydney that assessed the sexual health characteristics of Indian‐born patients attending sexual health services compared with Australian‐born controls. The sexual health needs of Indian‐born patients differed significantly from controls with those born in India reporting more sexual dysfunction and controls having more sexually transmitted infections (STI). These issues should be considered when delivering services to people from culturally and linguistically diverse backgrounds.     

Community-acquired pneumonia in older people: the need for a broader perspective

Community-acquired pneumonia (CAP) poses a substantial threat to the health of older adults. The incidence of this infection and mortality associated with it increase with age. Despite the considerable effect of CAP on older adults, little is known about the effect of socioeconomic and environmental factors on CAP in older people. This paper argues that broader determinants, including socioeconomic status (SES), nutrition, and factors in the physical environment such as exposure to tobacco smoke and air pollution need to be evaluated as potential risk factors for CAP in older adults. Data suggesting a relationship between low SES and risk of acquiring CAP exist; possible causal pathways include increased exposure through crowding or increased susceptibility to infection. Inadequate nutrition, exposure to tobacco smoke, air pollution, and not receiving immunization may predispose older people to lower respiratory tract infection. This study reviews current evidence for these potential risk factors and suggests priorities for research. A thorough understanding of these factors and their underlying biological mechanisms is needed to develop successful health-promotion strategies such as better immunization strategies and educational programs about nutrition. Determining the effect of air pollution on CAP in older adults is important in terms of reducing personal risk to older individuals and for healthcare agencies charged with formulating policy to protect the health of older adults.     

Indoor air pollution and airway disease.

Scientific interest in indoor pollution has been increasing since the second half of the 1980s. Growing scientific evidence has shown that because people generally spend the majority of their time indoors, indoor pollution plays a significant role in affecting health and is thus an important health issue. Indoor environments include dwellings, workplaces, schools and day care centres, bars, discotheques and vehicles. Common indoor pollutants are environmental tobacco smoke, particulate matter, nitrogen dioxide, carbon monoxide, volatile organic compounds and biological allergens. In developing countries, relevant sources of indoor pollution include biomass and coal burning for cooking and heating. Concentrations of these pollutants can be many times higher indoors than outdoors. Indoor air pollution may increase the risk of irritation phenomena, allergic sensitisation, acute and chronic respiratory disorders and lung function impairment. Recent conservative estimates have shown that 1.5-2 million deaths per year worldwide could be attributed to indoor air pollution. Approximately 1 million of these deaths occur in children aged under 5 years due to acute respiratory infections, and significant proportions of deaths occur due to chronic obstructive pulmonary disease and lung cancer in women. Today, indoor air pollution ranks tenth among preventable risk factors contributing to the global burden of disease. Further research is necessary to better evaluate the respiratory health effects of indoor pollution and to implement protective programmes for public health.     

China's heath care system and avian influenza preparedness

The severe acute respiratory syndrome crisis exposed serious deficiencies in China's public health system and willingness to report outbreaks of threats to public health. Consequently, China may be one of the weak links in global preparedness for avian influenza. China's rural health care system has been weakened by 20 years of privatization and fiscal decentralization. China plays a huge role in the global poultry industry, with a poultry population of 14 billion birds, 70%-80% of which are reared in backyard conditions. Although surveillance has been strengthened, obstacles to the timely reporting of disease outbreaks still exist. The weakened health care system prevents many sick people from seeking care at a health care facility, where reporting would originate. Inadequate compensation to farmers for culled birds leads to nonreporting, and local officials may be complicit if they suspect that reporting might lead to economic losses for their communities. At the local level, China's crisis-management ability and multisectoral coordination are weak. The poor quality of infection control in many rural facilities is a serious and well-documented problem. However, traditions of community political mobilization suggest that the potential for providing rural citizens with public health information is possible when mandated from the central government. Addressing these issues now and working on capacity issues, authority structures, accountability, and local reporting and control structures will benefit the control of a potential avian influenza outbreak, as well as inevitable outbreaks of other emerging infectious diseases in China's Pearl River Delta or in other densely populated locations of animal husbandry in China.     

Interventions to reduce individual exposure of elderly individuals and children to haze: a review

Given rapid economic developments and urbanization over the last few decades, China has experienced frequent haze episodes, which have adverse effects on public health. Children and elderly individuals are more susceptible than the general population to air pollution. In this study, we introduce interventions to reduce the exposure of elderly individuals and children to air pollution during hazy weather. These interventions include avoiding outdoor activities, wearing a dust mask, reducing burning biomass fuels, reducing frying and smoking at home, using an air filtration unit and taking supplemental antioxidants. However, the actual benefits of these measures remain unproven and are unlikely to be adequate. Sustained clean air policies remain the most important and efficient solution to reduce air pollution-related health effects.     

Targeting Household Air Pollution for Curbing the Cardiovascular Disease Burden: A Health Priority in Sub‐Saharan Africa

Household air pollution (HAP) is a major public health problem, particularly in sub‐Saharan Africa where most of the populations still rely on solid fuels for cooking, heating, and lighting. This narrative review highlights the direct and indirect evidence of the important role of HAP in cardiovascular disease, especially in sub‐Saharan African countries where highest rates of major cardiovascular disease and death are observed, and thus provides ample reason for promotion of preventive interventions to reduce HAP exposures in the region. There is an urgent need for efficient strategies to educate populations on the health issues associated with this health hazard, to provide affordable clean cooking energy for poor people and to promote improved household ventilation. High‐quality data on household energy practices and patterns of HAP and related health issues are still needed for efficient policy making in this region.     

Air pollution and chronic obstructive pulmonary disease

Limited data suggest that outdoor air pollution (such as ambient air pollution or traffic-related air pollution) and indoor air pollution (such as second-hand smoking and biomass fuel combustion exposure) are associated with the development of chronic obstructive pulmonary disease (COPD), but there is insufficient evidence to prove a causal relationship at this stage. It also appears that outdoor air pollution is a significant environmental trigger for acute exacerbation of COPD, leading to increasing symptoms, emergency department visits, hospital admissions and even mortality. Improving ambient air pollution and decreasing indoor biomass combustion exposure by improving home ventilation are effective measures that may substantially improve the health of the general public.     

Health effects and sources of indoor air pollution. Part I

Since the early 1970s, the health effects of indoor air pollution have been investigated with increasing intensity. Consequently, a large body of literature is now available on diverse aspects of indoor air pollution: sources, concentrations, health effects, engineering, and policy. This review begins with a review of the principal pollutants found in indoor environments and their sources. Subsequently, exposure to indoor air pollutants and health effects are considered, with an emphasis on those indoor air quality problems of greatest concern at present: passive exposure to tobacco smoke, nitrogen dioxide from gas-fueled cooking stoves, formaldehyde exposure, radon daughter exposure, and the diverse health problems encountered by workers in newer sealed office buildings. The review concludes by briefly addressing assessment of indoor air quality, control technology, research needs, and clinical implications.     

Australian women living with HIV/AIDS are more sceptical than men about antiretroviral treatment

A national survey of 925 people living with HIV/AIDS (PLWHA) in Australia conducted in the second half of 1997 showed that the proportion of HIV-positive women (61%) reporting they currently used antiretroviral treatment was significantly lower than that of men (79%). Women (37%) were also significantly less likely than men (59%) to report that they believe new treatments have brought hope and better prospects for PLWHA. Thirteen women and 63 men who completed the survey also participated in an in-depth interview which further explored the use of, and attitudes to, antiretroviral drugs for HIV/AIDS and their impact on personal relationships and work-related issues. Taken together, the survey and interview data suggest that male PLWHA have positive albeit qualified views about antiretrovirals and believe their health and future prospects have been improved by advances in treatments. In contrast, female PLWHA were sceptical about treatments and were unwilling to link their future prospects to the outcomes of antiretroviral therapy. Multivariate analysis of the correlates of attitudes to treatments revealed gender to be a significant independent predictor of more positive attitudes. These results are important considerations for health care workers in ensuring that HIV treatment services become more acceptable to HIV-positive women.