Ewa Krakowiak, Jolanta Cembrzyńska
Contemporary possibilities of reducing health damage caused by particulate matter air pollution
Współczesne możliwości redukcji szkód zdrowotnych wywołanych pyłowymi zanieczyszczeniami powietrza atmosferycznego
Zakład Szkodliwości Biologicznych i Immunoalergologii, Instytut Medycyny Pracy i Zdrowia Środowiskowego, Sosnowiec
Pyłowe zanieczyszczenia powietrza atmosferycznego należą do globalnych zagrożeń środowiska i są uznawane przez Światową Organizację Zdrowia (WHO) za bezpośrednią przyczynę pogorszenia zdrowia i warunków życia ludzi. W Polsce zanieczyszczenie powietrza atmosferycznego wielokrotnie w ciągu roku przekracza poziomy związane z ryzykiem wystąpienia ostrych i przewlekłych problemów zdrowotnych. W celu ochrony zdrowia społeczeństwa niezbędna jest poprawa jakości powietrza poprzez wyeliminowanie lub ograniczenie emisji substancji zanieczyszczających do poziomów dopuszczalnych. Indywidualne narażenie na pyłowe zanieczyszczenia powietrza atmosferycznego, zwłaszcza w okresach epizodów wysokich stężeń, można ograniczać podejmując odpowiednie działania, do których należą: pozostawanie w pomieszczeniach zamkniętych, zmniejszenie przenikania powietrza atmosferycznego do pomieszczeń, ograniczanie wysiłku fizycznego na zewnątrz, szczególnie w pobliżu źródeł emisji zanieczyszczeń. Rosnąca liczba publicznych systemów ostrzegania o jakości powietrza ułatwia zwiększenie świadomości o zagrożeniu. Unikanie ekspozycji na zanieczyszczenia powietrza atmosferycznego jest szczególnie ważne w przypadku populacji wrażliwej. Należy kontynuować badania mechanizmów leżących u podstaw redukcji negatywnego wpływu zanieczyszczenia powietrza na zdrowie poprzez suplementowanie witamin, antyoksydantów czy odpowiednio skomponowaną dietę, a także stosowanie środków ochrony indywidualnej (półmaski filtrujące) w celu opracowania odpowiednich zaleceń dla populacji wrażliwej i generalnej. Istotne jest wypracowanie właściwych strategii dostosowanych indywidualnie i mających wpływ na redukcję szkód związanych z pyłowym zanieczyszczeniem powietrza atmosferycznego jednocześnie bez zaniechania zdrowej aktywności fizycznej. Działania podejmowane indywidualnie przez każdego człowieka muszą być dla niego bezpieczne i przynosić odpowiednie korzyści zdrowotne.
Particulate matter air pollution is one of global environmental threats and is considered by the World Health Organisation (WHO) to be a direct cause of deteriorated health and living conditions. In Poland, air pollution exceeds the levels associated with the risk of acute and chronic health conditions many times a year. In order to protect public health, it is necessary to improve air quality by eliminating or reducing the emission of pollutants to acceptable levels. Individual exposure to particulate air pollution, especially during the periods of high concentrations, may be limited by taking appropriate measures such as staying indoors with windows closed, reducing the inflow of outdoor air, limiting outdoor exercise, especially near the sources of emissions. The growing number of public air quality alert systems helps raise awareness of the risk. Avoiding exposure to air pollution is particularly important for sensitive populations. Studies should be continued to investigate the mechanisms underlying the reduction of negative effects of air pollution on health by vitamin/antioxidant supplementation or balanced diet, as well as by using personal protective equipment (filter half masks) to develop appropriate guidelines for both the sensitive and general population. It is important to develop appropriate, individually tailored strategies for reducing harm related to particulate matter air pollution without abandoning healthy physical activity. Action taken individually by each person must be safe and bring appropriate health benefits.
Particulate matter (PM) air pollution is a result of introducing solid, liquid or gaseous substances, which may remain in the atmosphere for a certain period of time, into the air. The chemical composition of particulate matter depends on its source. Natural (e.g. volcanoes, deserts, forest fires, soil and rock erosion, cosmic dust), and anthropogenic (resulting from human activity) sources may be distinguished. These may be pollutants introduced from energy and technological sources in an organised manner through an emitter (a chimney with a height of more than 40 m), being a point source of emissions, as well as from mobile sources associated with transportation and communication routes – motor vehicle emission (1).
The characteristics of particulate matter air pollution in Poland
In Poland, air quality is significantly affected by surface emission related to heating in the communal and living sector (single- and multi-family buildings, public buildings, service and trade buildings), which accounts for the so-called low emission, responsible for smog formation. The term low emission is also understood as communication and transportation-related, as well as unorganised emissions, i.e. generated by fires, field work, and dust from landfills or industrial accidents. Smog is an unnatural atmospheric phenomenon caused by anthropogenic air pollution in the presence of natural atmospheric phenomena, such as temperature inversion during windless weather, particularly in low lying areas. Air pollution is characterised by seasonal differences in its levels and composition. The smog observed in the heating season (from October to March) is typical of low emission, whereas the summer-time photochemical smog is mainly due to communication and transportation pollution. The levels and composition of air pollutants also change during the day. These changes occur as a result of, e.g. hours of heavy traffic, sunlight-dependent photochemical fluctuations, atmospheric conditions or hours of more intense heating of buildings (2, 3).
Emission of pollutants formed during incomplete combustion of fuel, often of poor quality, in old-type household furnaces is a serious problem in Poland. It causes a release of harmful substances, such as benzo(a)pyrene and other polycyclic aromatic hydrocarbons (PAHs), dioxins and furans (PCDD/Fs), as well as heavy metals (4, 5).
A classification according to aerodynamic diameter of particles is used for health risk assessment for particulate matter. The classification distinguishes two main particle fractions: PM10 (coarse particles) with aerodynamic diameter of less than 10 μm and PM2.5 (fine particles) with aerodynamic diameter of less than 2.5 μm (2). Fine particles include carcinogenic, mutagenic and cytotoxic compounds. In 2013, the International Agency for Research on Cancer (IARC) classified outdoor air pollution, including the particulate matter (PM), as carcinogenic to humans (Group 1) (6, 7).
Air quality is improving in most European countries. However, about 80% of the population lives in environments where the PM levels recommended in the WHO guidelines on particulate matter (Air Quality Guidelines – AQG), which are more strict than the limit and target levels set out in the EU law, are exceeded (8). According to latest research in 28 EU countries, about 53 and 82% of residents are exposed to increased PM10 and PM2.5, respectively, with the worst results recorded, among others, in Poland (9).
The effects of particulate matter air pollution on health
Epidemiological and clinical studies clearly demonstrate that there is a relationship between environmental exposure (short- or long-term) to particulate matter and the risk of adverse health consequences. These are due to human exposure to air pollution in different periods of life, from the prenatal period, through childhood to adult life. Air pollution is responsible for, among other things, the risk of premature death, especially due to cardiovascular diseases (e.g. myocardial infarction, ischaemic stroke or sudden cardiac arrest), as well as acute respiratory infections and lung cancer. Particulate matter affects fertility, pregnancy, as well as the development of newborns and children. Children of mothers exposed to increased levels of particulate matter air pollution present with lower birth weight and respiratory symptoms. There is a negative impact of air pollution on the development of neurons and cognitive abilities of a child, which in the future may lead to intelligence deficits, learning problems and, as a result, lower productivity and quality of life in adulthood. Scientific studies have linked the exposure to air pollution to type 2 diabetes mellitus in adults, as well as obesity, Alzheimer’s disease, dementia, premature ageing and depression. There is a significant increase in the number of patients reporting to healthcare institutions due to asthma exacerbation, allergies, chronic obstructive pulmonary disease (COPD) or atrial fibrillation (2, 10, 11).
The so-called sensitive population, which includes children and adolescents, pregnant women, the elderly and patients with respiratory or cardiovascular diseases (e.g. asthma, atherosclerosis, congestive heart failure) is at particular risk of adverse health consequences associated with air pollution. The inclusion of children in the sensitive population is based on the possible inhalation of higher doses of particulate matter per body mass, immature detoxification mechanisms, as well as still-developing internal organs. For other members of this risk group, the increased susceptibility to air pollution is due to chronic diseases, age or other factors contributing to reduced immunity (2, 10).
Globally, air pollution is the sixth leading risk factor for premature death and disability. It was shown in 2015 that air pollution contributed to more than 4 million total deaths, and 103 million lost years of healthy life (12). In Poland in 2016, more than 24,000 people died due to environmental exposure to air pollution. The main causes of death included cardiovascular diseases (death rate/100,000 inhabitants: 48.18), cancer (death rate/100,000 inhabitants: 8.79), and respiratory diseases (death rate/100,000 inhabitants: 5.71). Cardiovascular and respiratory symptoms were the main contributors to reduced quality of life due to short- or long-term disability (13).
Methods for the reduction of health-related harm due to particulate matter air pollution
Various strategic, legislative, information, technical, control and financial activities at national, regional and local levels are currently taking place in Europe, aiming to reduce human exposure to air pollution. In Poland, the most important action in the context of air and health protection is to reduce emissions of air pollutants in a manner allowing for effective improvement of air quality and compliance with the standards set by the law. Nevertheless, each person exposed to increased concentrations of particulate matter should themselves take measures to reduce the risk of potentially negative health effects. The development of appropriate strategies and recommendations for a society exposed to particulate matter air pollution is a very difficult and complex task due to the different levels of individual sensitivity and the heterogeneous chemical composition of particulates and their impact on human health. The knowledge on the levels of air pollution is the key to taking effective individual preventive actions. The basic strategy of harm reduction is to develop a habit of checking air quality using tools adapted for this purpose and, depending on the findings, to take appropriate preventive measures.
Air quality diagnostic tools
Tools for rapid air quality diagnosis that allow for linking the results with the level of public health risk are one of the elements in the process of reducing negative health outcomes due to human exposure to air pollution. In Poland, such actions result from the transposition of the decisions of the Directive of the European Parliament and of the Council on ambient air quality and cleaner air for Europe, the provisions of which require that such information on ambient air quality is made available to the public (14). In 2008, the European Environment Agency (EEA) in cooperation with the European Commission implemented the Air Quality Index to compare air quality in different European cities and regions. The possibility to quickly assess the level of public health risk due to daily concentration of air pollutants was one of the main reasons for the development of such tools (15). The assessment of ambient air quality allows for immediate action to be taken in response to the risk of exceeding information threshold or alert threshold, even a short-term increase of which may pose a risk to human health (16).
Considering the local specificity of environmental conditions and the persistent high concentrations of particulate matter and gaseous pollutants, the Polish Air Quality Index, which is a modification of the version recommended by the EEA, is used in Poland for the assessment of air quality. In addition to particulate matter (PM10 and PM2.5), the algorithm for determining the index categories also takes into account the concentrations of the main gaseous pollutants, such as sulphur dioxide, ozone, nitrogen oxide, carbon monoxide and benzene, with the index category being determined based on the concentration of the dominant pollutant in a given area. Air quality is classified based on six indices that correlate with the level of health risk and physical activity recommended for the general and sensitive population (tab. 1). These health risk levels are only general guidelines to make people aware of how to plan physical activity to limit the negative effects of air pollution on health. The index classes defined as ‘very good’ and ’good’ correspond to predefined acceptable levels for pollutants and good air quality with no potential to affect health. Moderate AQI means air quality that may initiate adverse health effects in the sensitive population. Increased levels of particulate and gaseous pollutants significantly reduce air quality (indices: rather poor, poor, very poor), which may increase negative health effects even in the case of short-term exposure (17).
Tab. 1. Polish Air Quality Index – health risk levels and recommended actions (17)
|Air Quality Index||Air Quality||Health risk level|
|General population||Sensitive population*|
|Very good||Very good||excellent conditions for all kinds of outdoor activities;|
the level of air pollution poses no health threat
|Good||Satisfactory||you can stay outdoors and do your usual physical activity without limitations;|
no or very low health risk
|Moderate||Acceptable||moderate conditions for outdoor physical activity|
| ||health risk|
|Rather poor||Rather poor||consider reducing or rescheduling activities outdoors, particularly long or strenuous ones|
| ||health risk|
|Poor||Poor||reduce to a minimum any outdoor activity, particularly long or strenuous ones||avoid staying outdoors; health risk|
|Very poor||Very poor.||reduce to a necessary minimum any outdoor activity, particularly long or strenuous ones||avoid staying outdoors; health risk|
*Groups sensitive to particulate matter air pollution include, among others, children and adolescents, patients with asthma and other respiratory diseases (e.g. chronic obstructive pulmonary disease), heart failure, and elderly people (over 65 years of age)
Powyżej zamieściliśmy fragment artykułu, do którego możesz uzyskać pełny dostęp.
Płatny dostęp tylko do jednego, POWYŻSZEGO artykułu w Czytelni Medycznej
(uzyskany kod musi być wprowadzony na stronie artykułu, do którego został wykupiony)
Płatny dostęp do wszystkich zasobów Czytelni Medycznej