The Negative Impact of Air pollutionon Respiratory Health
Dr Des Murphy
Consultant Respiratory Physician
CUH
The Lung
•In direct contact with the externalenvironment every time we breath.
•Uniquely susceptible to damage fromexternal airborne ‘assault’.
•Huge diversity of potential insults to theairway.
COPD :
•A disease state characterised byincompletely reversible, progressiveairflow obstruction that is associatedwith inflammation in the lungs caused byprolonged exposure to tobacco smoke andother noxious particles and gases.
•Chronic Bronchitis and Emphysema.
Genetic factors
COPDCOPD
Pathogenesis of COPD
•110,000 people diagnosed with COPD in Ireland and afurther 300,000 potentially undiagnosed.
-The Global Initiative for Chronic Obstructive Pulmonary Disease.
-Brennan N, et al. INHALE report 2007.
•In Ireland COPD accounts for 22% of total respiratorymortality.
•13,000 admissions with the primary diagnosis of COPDin Ireland each year.
-Brennan N, et al. INHALE report 2007.
Asthma
•Asthma is a chronic inflammatory disorder of the airwayswhich is associated with airway hyper-responsivenessleading to recurrent episodes of wheezing,breathlessness and coughing in response to an array ofstimuli.
•This variable obstruction within the airway is generallyreversible either spontaneously or with treatment.
Global Initiative for Asthma/
•Asthma is a serious global health problem.
-Approximately 300 million asthmatics worldwide.
Masoli M, et al. Allergy 2004;59(5):469-78.
•The prevalence of asthma is increasing.
-In the western world has increased by 50% every decade for thelast 40 years.
National Center for Health Statistics. Asthma prevalence, health care use and mortality:United States, 2003-2005. http://www.cdc.
•Ireland has the 4th highest prevalence ofasthma worldwide
-approx 470,000 people affected.
•Suboptimal asthma control is associated withsignificant limitation of activities of daily livingand is potentially fatal.
-approx 80 deaths per year from asthma in Ireland.
The Irish Asthma Society website. http://www.asthmasociety.ie/all-about-asthma/Asthma-Statistics.html.
•Clinical manifestations of asthma are generallywell controlled with appropriate therapy.
•With improved overall asthma control there is anobserved reduction in exacerbations in terms ofboth frequency and severity.
Pawankar R, et al. WAO Journal 2008; S4-S17.
Triggers
•Allergens.
•Solvents.
•Sinusitis/rhinitis.
•Sulphur Dioxide/ozone/nitrogen dioxide
•PM
•TRAP
•Occupation.
•Smoke.
•Pollution.
•Weather change.
•Exercise, hyperventilation
•Infection.
•Medications.
•GORD.
•Stress
General Measures
•Reducing exposure to some categories of riskfactors improves the control of asthma andreduces medications needs;
Reduce exposure to indoor allergens
Avoid tobacco smoke
Avoid vehicle emission
Identify irritants in the workplace
Reduce exposure to air pollution.
•29th March 2004 Irish Government introducedthe worlds 1st national ban on workplacesmoking.
•The Public Health (tobacco) act 2002 and thePublic Health (tobacco) (amendment) act 2004,prohibit smoking in indoor workplaces, includingbars and restaurants to reduce the risks toworkers health.
Workplace smoking ban (42 pubs) has:
1.Reduced particulate matter and benzene in pubs.
2.Reduced exhaled CO and salivary cotinine in barmen.
3.Improved health in non smoking bar staff.
4.Improved irritant symptoms in smoking bar staff.
5.Change in attitude of smokers-majority now favourban.
•Since Dublin smoky coal ban in 1990.
•Estimated 359 lives/year saved.
(116 respiratory and 243 cardiovascular).
•Real-time system of monitoring airquality/pollution.
•Allow patients with respiratory conditionsto tailor their activities.
•Resultant health and economic benefits-to individual and to society
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