Air pollution can cause serious health consequences to more than 600 million people in South Asia

Posted on December 16, 2021 by Respro® UK Ltd

With another smoggy winter hanging over the vast and thickly populated Indo-Gangetic plains, there are fears of serious health consequences to more than 600 million people living in northern India and Nepal as well as in eastern Pakistan and Bangladesh.

Delhi, the biggest city in the region, showed an average air quality index (AQI) of 376 in November forcing the closure of schools that had just begun to reopen after COVID-19 restrictions.

Last year, the November AQI average for the region was 327 while for the same month in 2019 it was 312, indicating a rising trend that attracted the ire of the Supreme Court.

Delhi saw 11 ‘hazardous’ air quality days last month, the worst since the Central Pollution Control Board began the AQI measurement system in 2015. The hazardous category indicates an AQI of 301—500. The ‘good’ category is 0—50 which is followed by ‘moderate’ at 51—100 while anything in the 101—301 AQI range is considered unhealthy.

“We feel that nothing is happening… the pollution keeps increasing,” India’s chief justice N.V. Ramana said during a hearing on 2 December on deteriorating air quality in New Delhi and other north Indian cities. “If as many efforts as you (government) are claiming have been made, then why is pollution increasing?”

While wrangling goes on year after year over the source of the high levels of toxic pollutants in Delhi’s air and who is to be held responsible, there appears to be little public awareness of the consequences of inhaling particulate matter and other constituents of smoggy air.

“There is little awareness that most of the harm caused by air pollution is to the cardiovascular system — epidemiological studies have shown a strong association between air pollution and cardiovascular diseases including stroke.” Vipul Gupta, Chief of Neurointerventional Surgery Unit

Particulate matter that is smaller than 2.5 microns in size (PM 2.5) can increase risk of blockage of the carotid artery, the main blood vessel supplying the brain, says Gupta. “Even short-term exposure to PM 2.5 can lead to hospitalisation and death due to stroke.”

The WHO’s global air quality guidelines issued in September recommend tolerance levels for PM 2.5 at an annual average of five micrograms per cubic meter. Delhi’s average PM 2.5 levels in 2020 was 93 micrograms per cubic meter — 16.8 times the WHO limit — according to a paper released by the Council on Energy Environment and Water in June.

The Air Quality Life Index, released by the Energy Policy Institute, University of Chicago, in September, describes South Asia as “consistently the most polluted region with the people there seeing their lives shortened by an average of five years relative to what it would be if the region met the WHO guidelines”.

India alone has more than 510 million people living in the Indo-Gangetic plains who are on track to lose more than nine years of life expectancy if 2019 pollution levels persist, the report said.

For Bangladesh, residents may live 5.4 years longer if pollution levels meet the WHO guidelines, while residents of its capital city Dhaka could live 7.7 years longer. Those living in the polluted Terai region of Nepal stand to gain 6.7 years. In Lahore, Pakistan’s second-largest city, residents may live five years longer if the WHO guidelines are followed.

“While the exact source of smog over the Indo-Gangetic plains is still being investigated, it is evident that residents of the region, including Kathmandu, are severely affected by respiratory and cardio-vascular ailments during winter,” says Bhupendra Das, a pollution researcher at the Institute for Advanced Sustainability Studies, in Potsdam and at Tribhuvan University, Kathmandu.

“The winter months see ‘temperature inversion’ which traps particle pollutants and prevents the dispersion,” he adds. “If the pollutants come from burning plastic waste they are likely to release chlorides, including dioxins and furans which are among the most toxic substances known to man.”

The WHO says particulates cause health problems according to source, size and physical and chemical properties and that the wide variability makes research difficult. Additionally, airborne particulate matter is constantly on the move and undergoes chemical and physical changes in the atmosphere.

Some of the complexity of studying PM 2.5 is evident in research conducted by the Indian Institute of Technology – Madras and published January in Nature Research that showed how pollution over Delhi is different from that in other cities for its high chloride content that was responsible for the haze, lowered visibility and health impacts.

The authors suggest that local concentrations of hydrochloric acid, emitted from burning plastic, contributed significantly to reduced visibility. “Our work implies that identifying and regulating gaseous hydrochloric acid emissions could be critical to improving visibility and human health in India.”

In 2019, the Indian government declared a “war on pollution” and launched a National Clean Air Programme with a declared goal of reducing particulate pollution by 20—30/ per cent by 2024 from 2017 levels, although the situation has only worsened since.

In August the local state government in Delhi began installing smog towers at key areas of the city to vacuum up particulate matter and pollutants. However, these 24-meter high structures have not performed at the claimed 80 per cent efficiency with readings for late November and December showing efficiency rates of less than 40 per cent.

In fact, one tower showed the filtered air bearing 300 milligrams of particulate matter per cubic meter — a far cry from the safe limit of five micrograms per cubic meter prescribed by the WHO, making little difference to the number of years of life expectancy that Delhi residents stand to lose.

Air pollution can cause serious health consequences to more than 600 million people in South Asia
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The tightened recommendations for air quality by WHO pose new challenges even to Finland

Posted on December 15, 2021 by Respro® UK Ltd

Air pollution concentrations in Finland exceed most of the values of WHO’s new air quality guidelines. The situation is the worst with nitrogen dioxide from exhaust emissions of transport.

The World Health Organisation WHO has updated its air quality guidelines. The new guidelines were made to protect health. They are strict even for Finland, which is well known for its good air quality. For example, the concentrations of nitrogen dioxide in the largest Finnish cities can be even two or three times as high as the new WHO guideline values. In Finland, concentrations of fine particles, inhalable particles and ozone are also on a level which is harmful to human health.

To update the guidelines, WHO has analysed new research data on the health effects of air pollutants accumulated since 2005. The guidelines are meant for global use. WHO encourages highly polluted countries with a number of milestones.

Reaching the new guideline values is realistic in Finland

According to international comparisons, air quality in Finland is good, but air pollution can sometimes affect air quality even here.

“In Finland, the pursuit of these new, more stringent guideline values is still realistic. However, the concentrations of fine particles and ozone are heavily influenced by long range transport and reducing these concentrations can only be achieved through European and global emission control measures,” says Pia Anttila, Research Scientist at the Finnish Meteorological Institute.

On the other hand, road transport emissions such as nitrogen dioxide (i.e., exhaust gases) and inhalable particles (i.e., street dust), are a local problem. Their concentrations can be reduced by local measures. WHO guidelines are exceeded especially in busy urban environments. For example, the annual concentration values of nitrogen dioxide in the busiest streets of the Helsinki city centre are approximately three times higher than the guideline value.

“Emissions of exhaust gases are declining with new low-emission vehicles, but street dust will remain a problem also in the coming decades. Reducing particulate emissions from small-scale wood burning is also slow,” says Hanna Manninen, Head of Air Quality Unit at Helsinki Region Environmental Services HSY.

WHO also recommends measuring the quantitative concentrations of black carbon and particulate matter even though they have not yet been given guideline levels. In Finland, these have been measured for a long time at the background stations of the Finnish Meteorological Institute, at the research stations of the University of Helsinki, and in the Helsinki Metropolitan Area at the measurement stations of HSY. The concentrations of black carbon are increased especially by small-scale wood burning and emissions from old diesel cars.

More evidence of health effects of air quality at low concentration levels

As air quality has improved globally, it has been confirmed that air pollution affects health already at low concentrations.

“The updated WHO guidelines are based on strong evidence of the adverse health effects of long-term exposure when concentration guideline levels are exceeded. However, adverse health effects have also been observed at lower concentration levels than those in guidelines,” says Senior Researcher Otto Hänninen from the Finnish Institute for Health and Welfare.

The Finnish Meteorological Institute has compiled a report on the state of air quality in Finland in relation to the new WHO guidelines. The report is based on statutory monitoring results the quality of which has been assured. The monitoring is carried out by cities (partly in cooperation with industry) and the Finnish Meteorological Institute.

The tightened recommendations for air quality by WHO pose new challenges even to Finland – Finnish Meteorological Institute
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Reduced vehicle emissions have saved thousands of lives

Posted on December 14, 2021 by Respro® UK Ltd

Since 2008, the number of deaths caused by air pollution have been reduced by thousands in the United States as a result of decreasing vehicle emissions, according to a new study led by Harvard T.H. Chan School of Public Health. The improvements are the result of federal air pollution regulations and technological innovations by car manufacturers.

However, although emissions caused by large trucks have been significantly reduced, passenger light-duty vehicles such as pickup trucks or SUVs continue to contribute to air pollution in metropolitan areas.

“Recent reductions in vehicle emissions have yielded major health benefits, even though only small progress has been made on reducing their climate impact,” said study first author Ernani Choma, a research fellow in Harvard T.H. Chan School’s Department of Environmental Health. “Our results indicate that to achieve further public health and climate gains, even more stringent policies will be required.”

By using recent national emissions data, Choma and his colleagues modeled four scenarios for emissions in 2017: the actual emissions and three alternative scenarios in which the level of emissions was the same as in 2014, 2011, and 2008. 

The researchers found that deaths attributable to air pollution associated with vehicle emissions dropped from 27,700 in 2008 to 19,800 in 2017. If vehicles were still emitting at 2008 levels, they would have caused 48,200 deaths in 2017 (a 74 percent increase from 2008 to 2017).

Although there was a significant progress in reducing emissions from heavy-duty trucks, less progress was done with passenger light-duty vehicles such as cars, SUVs, or pickup trucks. According to the scientists, emissions from these vehicles caused two-thirds of public health burden from transportation-related air pollution in 2017.

“If the trends of increased population density with an aging population, and a shift to larger passenger vehicles continue, emissions, especially in urban areas, will continue to become more harmful and it will be harder to achieve further public health gains by small incremental improvements in new vehicles,” said study senior author John Spengler, a professor of Environmental Health and Human Habitation at Harvard.

“Our study findings strengthen the case for policies at the municipal level that encourage electric vehicles while discouraging conventional gasoline vehicles and for making our cities more accessible for non-motorized transportation such as biking or walking.”

The study is published in the journal Proceedings of the National Academy of Sciences.

Reduced vehicle emissions have saved thousands of lives • Earth.com
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Chronic exposure to air pollution may increase risks for ICU admission or death among COVID-19 patients, study finds

Posted on December 10, 2021 by Respro® UK Ltd

Hospitalized COVID-19 patients who had been chronically exposed in their neighborhoods to higher particulate matter — such as smoke, soot, and dirt — had increased risks for admission to the intensive care unit (ICU) and death compared to those without such exposure, Mount Sinai-led researchers reported in the American Journal of Respiratory and Critical Care Medicineon December 8.

The finding adds to our understanding about environmental factors that increase the risks of COVID-19. The researchers noted that chronic air pollution exposure can alter the pulmonary immune system, may increase systemic inflammation, and can be associated with increased risk for cardiovascular disease and metabolic syndrome. COVID-19 infections and deaths have also disproportionately occurred among Black, Latinx, and Indigenous populations, as well as among individuals with risk factors based on sex, age, and existing comorbid diseases such as diabetes and obesity.

“The COVID-19 pandemic has brought to the forefront the critical role of the environment on health disparities. These data suggest that long-term exposure to air pollution, even at concentrations below U.S. Environmental Protection Agency regulatory standards, is associated with higher COVID-19 morbidity and mortality amongst hospitalized patients,” said corresponding author Alison Lee, MD, MS, Assistant Professor of Medicine (Pulmonary, Critical Care and Sleep Medicine), and Pediatrics, at the Icahn School of Medicine at Mount Sinai. “Critically, air pollution is a modifiable risk factor. Policies to reduce air pollution must be considered a necessary public health measure, especially in communities that are disproportionately susceptible to air pollution’s deleterious effects.”

A team of researchers conducted a retrospective analysis of more than 6,500 COVID-19 patients admitted to seven New York City hospitals with ethnically diverse patient populations — including Mount Sinai Morningside, Mount Sinai Queens, NYC Health + Hospitals/Elmhurst, and NYC Health + Hospitals/Queens — amid the first peak of the pandemic from March to August 2020. The researchers estimated exposure levels to pollutants including particulate matter, nitrogen dioxide, and black carbon at the residential addresses of the patients at the time of admission. The team then assessed patient outcomes including mortality, ICU admission, and intubation. They found that chronic exposure to particulate matter, even at levels below current regulatory thresholds, was associated with an 11 percent higher risk of mortality and 13 percent higher risk of admission to the ICU. Exploratory analyses suggested that younger people of color may be particularly susceptible.

The study was developed through participation in the COVID-19 Unit for Research at Elmhurst (CURE-19) partnership, an initiative by Mount Sinai’s Arnhold Institute for Global Health and NYC Health + Hospitals/Elmhurst and Queens to research the global pandemic and root causes of health disparities in New York City.

“There is a lot we still don’t know about coronavirus, and that is why initiatives like the CURE-19 partnership are of utmost importance in the fight against this pandemic and our continued recovery,” said co-author Stanley Pierre, MD, MPA, NYC Health + Hospitals/Queens Patient Safety Coordinator and Director of the Clinical Centers of Excellence Development Program. “Being able to better understand what and how environmental factors play a role in New Yorkers’ health and COVID-19-associated risks not only allow us to better treat patients in the long-term, but also give us the opportunity to advocate for broader changes that can help prevent serious illness in the future.”

In addition to researchers from CURE-19, experts from Columbia University and the University of California, Berkeley contributed to the study. It was supported by grants from the National Institute on Minority Health and Health Disparities (R01MD013310), the National Institute of Environmental Health Sciences (P30ES023515, P30ES009089), the Eunice Kennedy Shriver National Institute of Child Health and Human Development (P2CHD058486), and the National Heart, Lung and Blood Institute (K23HL135349).

Chronic exposure to air pollution may increase risks for ICU admission or death among COVID-19 patients, study finds — ScienceDaily
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Does air pollution reduce the benefits of physical activity on the brain?

Posted on December 9, 2021 by Respro® UK Ltd

A new study shows that people who do vigorous physical activities, like jogging or playing competitive sports, in areas with higher air pollution may show less benefit from that exercise when it comes to certain markers of brain disease. The markers examined in the study included white matter hyperintensities, which indicate injury to the brain’s white matter, and gray matter volume. Larger gray matter volumes and smaller white matter hyperintensity volumes are markers of overall better brain health. The research is published in the December 8, 2021, online issue of Neurology®, the medical journal of the American Academy of Neurology.

“Vigorous exercise may increase exposure to air pollution and prior studies have shown adverse effects of air pollution on the brain,” said study author Melissa Furlong, PhD, of the University of Arizona in Tucson. “We did show that physical activity is associated with improved markers of brain health in areas with lower air pollution. However, some beneficial effects essentially disappeared for vigorous physical activity in areas with the highest levels of air pollution. That’s not to say people should avoid exercise. Overall, the effect of air pollution on brain health was modest — roughly equivalent to half the effect of one year of aging, while the effects of vigorous activity on brain health were much larger — approximately equivalent to being three years younger.”

The study looked at 8,600 people with an average age of 56 from the UK Biobank, a large biomedical database. People’s exposure to pollution, including nitrogen dioxide and particulate matter, which are particles of liquids or solids suspended in the air, was estimated with land use regression. A land use regression study models air pollution levels based on air monitors and land use characteristics like traffic, agriculture and industrial sources of air pollution.

Participants’ air pollution exposures were categorized into four equal groups, from lowest air pollution to highest.

Each person’s physical activity was measured for one week with a movement-detecting device they wore called an accelerometer. Then researchers characterized their physical activity patterns depending on how much vigorous physical activity they got, ranging from none to 30 minutes or more per week.

People who got the greatest amounts of vigorous physical activity each week, on average, had 800 cm3 gray matter volume, compared to an average of 790 cm3 gray matter volume in people who did not get any vigorous exercise. Researchers showed that air pollution exposures did not alter the effects of physical activity on gray matter volume. However, researchers did find air pollution exposures altered the effects of vigorous physical activity when looking at white matter hyperintensities. After adjusting for age, sex and other covariates, researchers found that vigorous physical activity reduced white matter hyperintensities in areas of low air pollution, but these benefits were not found among those in high air pollution areas.

“More research is needed, but if our findings are replicated, public policy could be used to address people’s exposure to air pollution during exercise,” Furlong said. “For example, since a significant amount of air pollution comes from traffic, promoting running or bicycling along paths far from heavy traffic may be more beneficial.”

A limitation of the study is that it used air pollution values from one year only, and levels may vary from year to year.

The study was supported by the National Institute on Aging, the National Institute of Environmental Health Sciences, the Arizona Department of Health Services, and the McKnight Brain Research Foundation. The study used data made available by the UK Biobank.

Does air pollution reduce the benefits of physical activity on the brain? — ScienceDaily
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EU urban population exposed to dangerous levels of air pollution

Posted on December 8, 2021 by Respro® UK Ltd

The majority of Europe’s population living in urban areas is exposed to dangerous levels of air pollution, said the European Environment Agency on Tuesday. Over 90 percent of urban population is exposed to high levels of fine particulate matter, nitrogen dioxide and ozone above those recommended by the World Health Organization (WHO). The European Commission has launched a revision of EU air quality standards to align them to WHO recommendations.

EU urban population exposed to dangerous levels of air pollution
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Long-term exposure to air pollution linked to metabolic-associated fatty liver disease

Posted on December 7, 2021 by Respro® UK Ltd

Metabolic-associated fatty liver disease (MAFLD) is a growing global health challenge and poses a substantial economic burden. A large-scale epidemiologic study in China has identified links between long-term exposure to ambient air pollution and MAFLD. These links are exacerbated by unhealthy lifestyles and the presence of central obesity, report scientists in the Journal of Hepatology, the official journal of the European Association for the Study of the Liver, published by Elsevier.

The incidence of MAFLD has increased steadily since the 1980s, currently affecting a quarter of the global population and a majority of patients with adult-onset diabetes and poses a substantial global burden. In Asia, MAFLD increased to 40% between 2012 and 2017. Formerly known as nonalcoholic fatty liver disease (NAFLD), it may progress to end-stage liver diseases such as cirrhosis and liver cancer, liver transplantation and liver-related death.

Accumulating animal studies have shown that breathing air pollutants may increase the risk of MAFLD. For instance, fine particulate matter exposure may trigger a nonalcoholic steatohepatitis (NASH)-like phenotype, impair hepatic glucose metabolism, and promote hepatic fibrogenesis.

“The MAFLD epidemic corresponds to environmental and lifestyle changes that have occurred alongside rapid industrialization worldwide, especially in many Asian countries. A growing number of studies have suggested that ambient air pollution, which is the biggest environmental problem caused by industrialization, may increase the risk of metabolic disorders such as insulin resistance and dyslipidemia, and related diseases such as type 2 diabetes mellitus and metabolic syndrome. However, epidemiologic evidence for the association was limited, so we conducted this research to improve our understanding of the effects of air pollution on human health and also to help reduce the burden of MAFLD.” – Xing Zhao, PhD, Lead Investigator, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China

Investigators conducted an epidemiologic study on the potential role of ambient air pollution in the risk of MAFLD in approximately 90,000 adults in China based on the baseline survey of the China Multi-Ethnic Cohort (CMEC), a prospective cohort that enrolled nearly 100,000 participants in southwest China from 2018 to 2019. The CMEC collected participant information including sociodemographics, lifestyle habits, and health-related history through verbal interviews performed by trained staff and subsequently assessed anthropometrics, biosamples (blood, urine, and saliva), and imaging data.

Researchers found that long-term exposure to ambient air pollution may increase the odds of MAFLD, especially in individuals who are male, smokers, and alcohol drinkers, and those who consume a high fat diet. Unhealthy lifestyle behaviors and an excess accumulation of fat in the abdominal area may exacerbate the harmful effects.

“Our findings add to the growing evidence of ambient pollution’s damaging effects on metabolic function and related organs,” commented Dr. Zhao and his co-investigators. “However, physical activity did not seem to modify the associations between air pollution and MAFLD. We suggest that future studies explore whether the timing, intensity, and form of physical activity can mitigate the harmful effects of air pollution.

The investigators propose that air pollution should be recognized as a modifiable risk factor for MAFLD. Populations at high risk should be aware of the air quality in the areas where they live and plan their activities to minimize their exposures to air pollution.

In an accompanying editorial, Massimo Colombo, MD, San Raffaele Hospital, Liver Center, Milan, Italy, and Robert Barouki, MD, PhD, University of Paris, Inserm Unit T3S, Paris, France, noted that the assessment of the major determinants of mortality worldwide by WHO showed that global pollution topped the list, ranking higher than smoking, alcohol consumption, and major infectious diseases, and that air pollution, the most critical component of global pollution, is likely to be responsible for millions of deaths per year worldwide.

“A better characterization of the liver exposome is expected to improve prevention and precautionary counseling,” commented Dr. Colombo and Dr. Barouki. “Indeed, whereas physical activity together with a healthy diet stand as a primary pillar in the fight against metabolic syndrome associated morbidities, including MAFLD, the findings that ambient pollution could exacerbate MAFLD risk might offer new clues to refining the counseling of these patients, for instance by restricting exposure of risk populations to open air settings at high level of pollution, as is recommended for patients suffering from severe asthma. It also constitutes an additional incentive for decision makers to speed up the efforts to conform with the WHO guidelines and limits on air pollution, as many cities in Europe and worldwide are still well above those limits.”

Long-term exposure to air pollution linked to metabolic-associated fatty liver disease
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Air pollution body to crack down on black carbon

Posted on December 6, 2021 by Respro® UK Ltd

The convention on air pollution is due to issue voluntary measures this week to curb black carbon emissions.

The convention on air pollution will be meeting from 6 to 8 December in Geneva, where it will adopt guidelines on how to reduce emissions from agricultural waste burning, including black carbon – a gas that is 680 times more heat trapping than CO2.

Since October 2019, 25 of the 51 pan-European parties to the air convention that have signed the amended Gothenburg Protocol– including Switzerland, the EU, the US and Canada – are legally required to reduce their fine particulate matter (PM2.5) emissions.

The measures, which are voluntary, are part of a growing shift of attention towards the need to bring down greenhouse gas emissions other than carbon dioxide in order to keep the world from warming up. Last week, the International Maritime Organization also agreed on non-binding measures to reduce black carbon emissions from the shipping industry in the Arctic.

What is black carbon and why does it need attention?

Black carbon, or soot, are tiny dark particles that rise from chimneys, wildfires and fossil fuel burning. As they go up in the atmosphere, they mix with water droplets and other elements, degrading air quality but also absorbing sunlight.

As a powerful heat trapping gas, studies suggest black carbon could also possibly be the second main driver of climate change right after CO2. Black carbon only stays a few weeks in the atmosphere, unlike CO2 which accumulates and remains in the air for decades, making the argument that slashing black carbon emissions would be a quick and easy fix to limit the rise in temperatures.

Agricultural waste burning and wildfires are the largest source of black carbon, making up roughly a third of emissions. However, practices such as open crop burning or forestry residue burning have long been viewed as a harmless and cheap way for farmers to clear land.

“In terms of CO2 emissions, agricultural residue burning was long considered essentially ‘carbon neutral’, because it was assumed the same amount of carbon lost to fire would be fixed by the subsequent year’s crop,” the report points out.

“As understanding of soil carbon cycles has grown, however, it has become clear to the vast majority of researchers that, due to loss of humus, soil structure and the soil itself, more carbon is lost from the soil annually than can be replaced by any subsequent crop.”

The deterioration of the soil can also have negative economic effects by causing nutrient loss and soil productivity, not to mention the impact on biodiversity, according to the document.

Among the issued guidelines, the air quality regulating body recommends that countries use fire-free alternatives, such as conservation agriculture, and chopping and spreading of the excess harvest residue or repurposing it off-field. These can in turn help build up climate resilience.

Air pollution body to crack down on black carbon – Geneva Solutions
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