Air Pollution and its Effects on Human Health

Presentation made by Dr Manas Ranjan Ray, Former Assistant Director and Officer-in-Charge (Research), Chittaranjan National Cancer Institute, Kolkata at a workshop in Pune focusing on review and critique of the draft National Clean Air Programme.

1. AIR POLLUTION AND ITS EFFECTS ON HUMAN HEALTH Dr. Manas Ranjan Ray Former Assistant Director and Officer-in-Charge (Research) Chittaranjan National Cancer Institute , Kolkata

2. AIR POLLUTION URBAN Ambient Vehicular Industrial Thermal power Stations Biomass Burning RURAL Indoor & ambient NOx , SOx , CO, PM, VOCs, PAHs, trace metals CO, SOx, NOx, PM, trace metals NOx , SOx , CO, PM, VOCs, PAHs trace metals Pesticides OC, OP, C

3. Air pollution in Indian cities Mean annual concentrations of PM 10 in most of the Indian cities are far above the NAAQS Vehicular emission contribute 50-70 % of urban pollution; 10-20% by industrial emissions (e.g. TPS) PM 2.5 are more potent for respiratory and cardiovascular disease compared to PM 10 UFPs with diameters ≤ 0.1 µm are highly toxic due to increased surface area and other characteristics

4. Constituents of vehicular pollution Carbon dioxide and Carbon monoxide Oxides of sulfur (SO2) Oxides of nitrogen (NO2) Particulate matter- PM10, PM2.5, UFP Heavy metals- Pd, Cr, Cd , Fe, Cu, Hg, Mn Polyaromatic hydrocarbons [ PAHs, e.g. B(a)P] Volatile organic compounds [ VOCs, e.g. Benzene] Secondary pollutant Ozone (O3) [ VOC + NOx + Sunlight]

5. Sizes of atmospheric particles ‘Coarse’ particles (> 2.5  m diameter) ‘Fine’ particles (< 2.5  m diameter) ‘Ultrafine’ particles (< 0.1  m diameter) How do they differ? Source /origin Chemical composition Respiratory tract deposition Health effects

6. Naso-oropharangeal region Large and water-soluble PMs are removed Tracheo-bronchial region Smaller percentages of PM 10 and PM 2.5 are deposited Alveolar region PM 10 , PM 2.5 and UFPs are deposited; a fraction of UFPs migrate to circulation PM Deposition in Lungs and the Airways

7. Particulate Matter (PM ): pollutant of prime concern PM 10 : diameter < 10 microns PM 2.5 : diameter < 2.5 microns Ultra fine particles (UFPs) : diameter < 0.1 microns Smaller the size, greater the health risk

8. Alveolar Macrophage - the sentinel of lung defence AM is the first line of defence in the lung & interact directly with toxic particles and gases Phagocytosis , migration & secretion of AM is pivotal in pathogenesis of lung diseases AM response varies with the level of pollutants Easily accessible by non- invaisve procedure

9. Carbon-laden AM

10. Alveolar macrophage response

11. PFT of Children

12. Air pollution adversely affects lung function

13. Reduced lung function

14. Lower respiratory symptoms Inverse relation with SES SES Dry cough Wet cough High 1 1 Medium 2.31* (1.96-2.73) 1.72* (1.48-2.01) Low 3.34* (2.83-3.95) 2.20* (1.89-2.57)

15. Air Pollution Increases Prevalence of Respiratory & related Symptoms

16. Air Pollution and Asthma Asthma is exacerbated by ozone and other pollutants Significant associations of chronic pollution exposure with asthma in children and adults Greater prevalence of asthma in the polluted cities (3.8% vs . 2 % in control)

17. Chronic air pollution exposure Lung injury Inflammation Oxidative stress and Lung disease

18. COPD Chronic obstructive pulmonary disease (COPD) is a progressive life-threatening disease It consists of two conditions- Chronic bronchitis and emphysema Chronic air pollution exposure increases the risk of COPD Three-fold increase in COPD in never-smoking women of Kolkata and Delhi after adjusting for possible confounders Women and people with low socioeconomic status are more vulnerable

19. Air pollution and COPD

20. Elastase

21. Iron in AM

22. NK BA TC Hematological changes

23. Elastase

24. Ciliocytophthoria , Viral infection

25. Target cells and poikilocytosis- Anemia and liver problem Neutrophilia and Toxic granulation- Infection, inflammation Eosinophilia - Allergy Hematological changes

26. CD4+ cells CD8+ cells CD19+ cells CD16+56+ cells cells/ µl cells/ µl cells/ µl cells/ µl CD4+ CD8+ Rural Urban Immune alterations CD4 (FL2) 48% CD8 (FL1) 53%

27. “It is not just the lungs and lower respiratory tract, the cardiovascular system is also affected by air pollution” Dr. Alfred Munzer American Lung Association Air Pollution Increases Heart Diseases : Lungs Heart 1 1 : :

28. Air Pollution increases prevalence of Hypertension

29. Prevalence of hypertension increased progressively with age Hypertension Pre-hypertension Hypertension in children

30. * * 1.8-fold rise in platelet number 4-fold rise in platelet P-selectin 9-fold rise in sP -selectin in plasma 2-fold rise in aggregation & ATP-release Platelet activation – Cardiovascular risk CNCI

31. Oxidized LDL in blood, increased risk of CVD

32. 2-fold rise in liver and kidney function impairments 4-fold rise in Type 2 diabetes Liver and kidney function

33. Air pollution and diabetes Traffic related air pollution increases the risk of type 2 diabetes in 50+ age group Women are more vulnerable People under insulin treatment are more at risk of CVD during air pollution exposures Kramer et al., Environ Health Perspect , May 2010 Rioux et al., 2011

34. Changes in menstrual cycle and reproductive outcome Hormonal changes like low serum estrogen and progesterone, high serum prolactin and LH associated with Short, long or too irregular menstrual cycle Infertility Spontaneous Abortion Pre-term baby Stillbirth Underweight baby (< 2.5 kg) Congenital birth defects

35. Inhaled UFPs translocate from lungs to blood, adsorbed on RBCs, transported to all major organs They can invade the blood-brain barrier causing microvascular damage, blood clots (brain stroke) Neuroinflammation , death of nerve cells Progressive neurodegeneration leading to: Alzheimer‘s and Parkinson's disease Lung to Blood to Brain

36. Depression

37. PM exposures decrease cognitive scores and memory in school-age children NO 2 and PM 10 are associated with poor mental performance Prenatal exposure to PAHs causes attention problems, anxiety and depression in children Air pollution increases ADHD-related symptoms-hyperactivity , inattention, aggression, conduct problems Air Pollution, developing brain, and children behavior

38. IARC Group I Human Carcinogens, 120 agents Arsenic   Auramine production, Alcoholic beverages , Areca nut , Asbestos , Inorganic Acid mists, Benzene. Benzidine dyes, Benzo [ a ] pyrene , Betel quid with or without tobacco, 1,3-Butadiene, Beryllium Cadmium, Chromium (VI), Coal-tar pitches, Coal-tars, Coke (fuel)  production, household combustion of Coal Diesel engine exhaust Formaldehyde Haematite mining (underground) Iron and steel founding Mineral oils, Phenacetin Nickel, 4-(N- Nitrosomethylamino )-1-(3-pyridyl)-1-butanone (NNK) Silica dust as quartz2, 3,7,8-Tetrachlorodibenzo- para -dioxin, orth o-Toludine , Vinyl chloride, Polychlorinated biphenyls (PCB) Ultraviolet Radiation, X-Radiation and Gamma radiation Wood dust, Welding fumes

39. Chromosomal and DNA Damage

40. MN (A and B), ‘Broken egg’( C) ; binucleation ( D); multinucleation (E) ; pyknosis (F); karyorrhexis (G) and karyolysis (H) in airway epithelial cells of biomass using participants A B C D E F G H

41. Excess Comet formation suggests increase in DNA damage DNA Damage

42. 8-Oxoguanine -expressing basal and parabasal cells are more in biomass users (A) compared to that of LPG-users (B ) In contrast, OGG1 and APE1 expressing basal and parabasal epithelial cells are less in biomass users A B C E D F Inadequate DNA Repair

43. Cellular abnormalities, risk of lung cancer

44. Metaplasia and dysplasia of airway cells a b c d e f

45. Response to air pollution across population differs due to Extent & nature of exposure Co-exposure of different pollutant mixtures Population structure Nutritional & socio economic status Susceptibility factors

46. PM 2.5 effects are more in people with the lowest education. Excess risk: 8.2, 7.2 and 5.5% per 10 μg /m 3 for subjects with low, medium and high education, respectively Dietary factors such as lower fruit and anti-oxidant intake, lack of air conditioning, poorer housing conditions increase the risk Women and children are more susceptible to air pollution PM 2.5 effect is substantially higher among subjects with high body mass index (BMI) Susceptibility Factors

47. Every 10µg increase in ambient PM 10 causes increase in Overall mortality 0.5 - 1% Cardiovascular mortality 1.4% Respiratory mortality 3.4% Hospitalization for respiratory diseases 0.8% Hospitalization for asthma 1.9% Source: Laden et al., 2000; Samet , 2000

48. Social Cost of Air Pollution For every 50µg per cubic metre increase of PM10 in breathing air, the cost for public health in Mumbai is Rs . 452 crore /year For every 50µg of increase of NO2 in air, the public health cost is Rs . 872 crore /yr Patankar and Trivedi , Pub Health, Feb. 17, 2011.

49. THANK YOU