Air Quality and its Respiratory Outcomes

Background and Introduction:

Air pollution releases pollutants which is a mixture of gases and solid particles in the air that are detrimental to human’s overall health. These particles are usually caused by human activities and ambient air pollution which are environmental issues that affect human health overall (Saxon et al. 2005). According to the NIH, when the National Ambient Air Quality Standards were established in 1970, air pollution was regarded primarily as a threat to respiratory health. This pollution is characterized by its chemical composition, source, size, and place of emission.  Primary pollutants are released from sources and they include sulfur dioxide (SO₂), carbon monoxide (CO), and particulate matter (PM). Secondary pollutants come from chemical reactions which include ozone (O₃), and nitrogen dioxide (NO₂) and these are based (Susanto, 2020). The detrimental effects of primary and secondary pollutants include:

• Ozone: Ground-level Ozone isn’t emitted directly; it’s formed in the atmosphere from other primary pollutants when the sun is out. Ozone exposure has been linked to breathing problems, asthma, reduced lung function & respiratory diseases. It is surprising that ozone levels over cities are low in contrast to the increased amounts occurring in urban areas, which could become harmful for cultures, forests, and vegetation.
• Carbon Monoxide: The main sources of Carbon Monoxide include the toxic fumes emitted by our vehicles and industrial activity which relies on fossil fuels (e.g., coal, oil, natural gas). At high levels, CO exposure can impact the level of oxygen transported in the bloodstream to critical organs. Carbon monoxide affects the greenhouses gases that are tightly connected to global warming and climate. This should lead to an increase in soil and water temperatures, and extreme weather conditions or storms may occur.
• Particulate Matter 2.5 & 10: Particulate Matter is a broad family of inhalable and respirable particles, categorized by their size. Sources of PM can be natural or man-made, like dust, fire smoke, sea-salt, soot or they may come from industrial activities.
  • PM10 is inhalable, meaning it can get into the lungs and cause inflammation in the respiratory system and heart. PM2.5 gets even further into our bodies, passing into the bloodstream where it can get transported to multiple organs.
• Nitrogen Dioxide: NO2 plays a role in the creation of Ozone and Particulate Matter and like SO2, mainly gets emitted by industrial and traffic sources. NO2 increases symptoms of bronchitis, asthma & contributes to reduced lung function as well as growth
• Sulfur Dioxide: Sulfur Dioxide is produced from the burning of certain fossil fuels and from certain methods of metal extraction. SO2 can also contribute to the phenomena of acid rain. SO2 exposure has been found to harm the respiratory system and cause eye irritation. According to the World Health Organization, it can increase the risk of infection.

Extreme natural events or disasters also lead to air pollution such as forest fires, volcanic activity, desert winds, storms, etc. Anthropogenic air pollutants come from factories, emission from road and air transport vehicles, power plants while indoor pollution is seen from homes while cooking and using heat in the house with charcoal, open fire/ traditional stoves, and wood. Majority of indoor pollutants come from volatile organic compounds (VOC) which vaporize at or near room temperature. They are called organic because they contain carbon. VOCs are given off by paints, cleaning supplies, pesticides, some furnishings, and even craft materials like glue. Gasoline and natural gas are major sources of VOCs, which are released during combustion.

According to the World Health Organization (WHO), currently 92% of the world’s population breathe poor quality. Almost 160 million persons live in areas of the United States that exceed federal health-based air pollution standards (Laumbach, 2010)

The nature of air pollution whether or not it being indoor or outdoor pollutants, release allergic or irritant material that leads to asthma and respiratory discomfort. Asthma and allergic diseases are on the rise and they are related to environmental pollution, environmental microbes and infections. Pollution and its interaction with allergens can change or alter the immune system whereby the pollutants upregulate costimulatory molecules on macrophages (Saxon et al. 2005).  These costimulatory molecules are expressed on the surface of various cells and play an important role in initiating and sustaining immunity. Exploitation through air pollutants affect the costimulation pathways and provides incentive to the pathogens and thereby abates the functioning of the immune system (Khan et al. 2012).

Airway inflammation occurs when gaseous pollutants affect both airways and increase the immune system services provided by neutrophils, B cells, and macrophages. These lead to altered lung function and increase airway resistance especially after being exposed to ozone.

Asthma and allergies are induced by air pollutants are guided by the duration of exposure, type and size of dust, and concentration. The deposition of inhaled particles and gases are influenced by the physical and chemical properties of the inhaled agent, and also by various host factors (Al Saadi, 2010).  The particle size shows how the body responds, particles between 3-10µm in diameter are deposited in the tracheobronchial tree and initiate constriction and coughing while particles that are smaller than 0.1µm are exhaled (Al Saadi, 2010).

To determine some limitations that can occur in my research project I found a study that was done in an Amish community and according to the authors the exposure to microbes during childhood from breastfeeding influences the immune system that doesn’t develop to asthma. A similar study was done in Russia and Finland, the individuals exposed to bacterial load such as dust and water had a higher prevalence of asthma. This could be a limiting factor in figuring out if genetic influence has an effect on asthma and certain allergies regardless of environmental pollution. However, some studies show that breastfeeding is not protective against allergy and asthma development.

A limiting factor that can occur is when looking at areas/locations where asthma and allergy is prevalent in non-polluted areas and the area location. A study was done from different parts of Norway that have a low population and high populations in order to compare the prevalence, there we see a correlation with the population factor decreasing as the altitude of area of residence increases. It is also known that the Baltic region is where environmental exposures are low, and studies have shown that individuals in these high-altitude areas and dry climate have improved lung function. In higher altitude regions where the climate is good and has a low allergen load, the only cause of asthma seen was due to being allergic to animals while some where due to atopy i.e., the genetic tendency to develop allergic diseases and the other factor was indoor smoking.

It is important to know about the air pollutants and recognize why the air quality is very crucial to human health, not only does it damage human health and lead to respiratory issues, heart problems, etc. but it also damages the environment. The air is important for living things to survive and breathe on. Exposure to air pollution may depend on one’s location or weather but our daily activities contribute to harmful pollution.

The purpose and objective of my study is to evaluate the relationship between air quality and respiratory outcomes such as asthma, allergies, sinus infections, etc. due to air pollution and one’s lifestyle as factors. Air quality and air pollution has major impacts on human health and my goal is to better develop a way to understand what triggers these adverse effects and how our environment and play a role to it. For my project, I would like to measure the air quality and survey individuals in Bloomington/Indiana area to determine how there is a correlation between air quality in various environments and how lifestyle has impact to health.

 

Research Methodology/ Study Design:

In order to find a correlation between these two I have come up with a method that was inspired by previous studies for this study.  In order to measure the air quality, I will make use of an air quality detector and go to various urbanicities and regional variations like the city, rural areas (countryside, farms), and towns in Bloomington/Indiana area to measure the air quality and determine if there are any differences between them and also make use of the data from the U.S Environmental Protection Agency [EPA] to capture region characteristics. The EPA’s website shows more than 1,000 monitoring stations across the United States that measure ambient concentrations of criteria air pollutants and the locations that fail to meet one or more standards are designated “nonattainment” areas (Laumbach, 2010).

The results and data presented by the air quality detector and monitoring sites will be shown using a scatterplot of the concentrations of particulates in the span of three weeks in the region variation. This part of my research in this experiment is similar to a study that was done across the Detroit area by creating contour maps to depict the distribution of measured components in the air like NO₂, PM_2.5 and PM_10.  Their aim of monitoring resolution was emphasized by findings that urban NO₂ concentrations measured 50 m apart can vary by as much as 300% and they also had to take into account traffic-related pollutants and intra-urban exposure to airborne pollutants which may be associated with larger health effects than inter-urban variability.

According to the U.S. Environmental Protection Agency [EPA], population density has an effect to air particulate and that population is concentrated in urban neighborhoods that have lower air quality compared to suburban areas. For example, in overpopulated cities like New York and Los Angeles they are ranked as the worst regions for particulate pollution and have 0.5 million more asthmatics, and 1.6 million more people with cardiovascular disease are exposed to these pollutants. In another study they examined whether neighborhood-level population exposures to ozone and fine particulate matter were higher in more compact metropolitan regions than in sprawled regions. They used data from the EPA and did a regression analysis to see exposure of poor air quality in neighborhoods with region compactness. In order to find this correlation of air quality, exposure to air pollutants, and urbanicity.

Another aspect I will incorporate into my methodology is the use of an anonymous survey which will be created using Google Forms and it will have the following questions which factor into how I can correlate one’s lifestyle, air quality and population of one’s urbanicity, and respiratory outcomes.

• Sex (Female or Male),
• Age Group (18-30; 60-above)
• BMI Classification (Normal, Overweight, Obese)
• Smoking Status (Current, Former, Never)
• Urbanicity (rural or countryside, large central metro or city, towns, etc.)
• Race/ Ethnic group
• Respiratory health outcomes (asthma, sinus infections, allergies, bronchitis, none of the above)
  • If any allergies seen, what are you allergic to?

Including factors like race, sex, and age is important, studies have shown that asthma has been shown to be distributed disproportionately across race/ethnic groups and sex. According to the National Hospital Discharge Survey and National Vital Statistics System has indicated that disparities in asthma-related hospitalization and mortality may be increasing over time. BMI is categorized as BMI < 25 representing normal or underweight, 25 ≤ BMI < 30 representing overweight, and BMI ≥ 30 representing obese. Taking into account one’s BMI is important, obesity is a risk factor for development of certain respiratory diseases it leads to changes in pattern of breathing, airway resistance and gas exchange. These changes are due to the increased elastic load posed by excess weight on the thorax and abdomen, and ventilation–perfusion mismatch. There has evidence that shows that outdoor pollution has effects on patients with COPD or history of smoking, this led to me asking for smoking status in the survey.

The Center for Disease Control and Prevention (CDC) state that the prevalence of asthma has increased in the U.S. and studies have proved that minority groups usually bear the burden of asthma, while some studies have shown an association between socioeconomic status (SES), area of residence and race that explain asthma prevalence across these groups. A study was done in Boston- area to investigate one’s area of residence and SES and its association between race and asthma. They did a screening questionnaire with participants that were diagnosed with allergies, they asked specific questions like if one was allergic to house dust, pollen, or if either or their parents were. The results showed that race was related to socioeconomic factors and the area of residence. Most of the Whites and Asians came from homes with more highly educated parents and higher total family incomes, and from areas of residence with low poverty rates. African Americans and Hispanics had the most account of asthma amongst their communities. Identifying one’s area of residence or urbanicity may help in approximately determining the socioeconomic status of the individual which plays in the prevalence of asthma and that is why it is excluded from the questions I will ask on the survey. There has been interests of life expectancy shortening due to air pollution and the effect on shortening life expectancy has been estimated at 1–2 years for realistic exposure which is higher compared with the effects of other lifestyle or environmental risk factors related to mortality. Case-control studies also continue to provide evidence of a link between air pollution especially from traffic and lung cancer Recent work has suggested that effects on life expectancy are not uniformly distributed but depend on factors such as education which implies that life expectancy could be reduced more in disadvantaged population groups that do not have the opportunity to be educated on these harmful pollutants (Brunekreef, 2002).

In developing countries, air pollution is more serious due to overpopulation and uncontrolled urbanization along with the development of industrialization. This leads to poor air quality, especially in countries with social disparities and a lack of information on sustainable management of the environment (Manisalidis, 2020).

Some limitations can occur in this study especially in regard to the genetic/biologic influence on asthma regardless of one’s exposure poor/good air quality or race. However, the study mentions how they took into account by looking at a multiethnic population of children in Michigan that were in a socioeconomic homogenous area and still found that the prevalence of asthma was still prevalent among African American and Hispanics children compared to White children.

 

Results:

For the first part of my results and this was obtained from the google forms.

A total of 33 responses from the survey:

• 29 females and 4 males
• All participants between the ages of 18-30 years old
• 26 White, 4 Black/African American, 3 Asian/Pacific Islander
• 18 reside in towns, 9 reside in city/large central metro, 4 in countryside/ rural areas.
• 22 Normal weight, 8 overweight, 3 obese
• 27 Never smoked, 2 Former, 1 Rarely, 3 Social/Weed
• 23 No respiratory outcome, 5 Allergies, 1 Asthma, 2 (asthma, allergies, sinus infections)

 

For the second part of my study, I went to three locations around Bloomington area and the outskirts. I went downtown Bloomington for my city or large metro location, I then went to a neighborhood town in Bloomington and for my rural or countryside location I went to Brown County state park. The results of the primary and secondary pollutants at this location are seen in the figures below.

 

Countryside / Rural:

City/ Downtown:

Town/Neighborhood:

Discussion:

My initial hypotheses were that the urbanicities that had a higher population specifically the cities) will have a higher respiratory outcome. As expected, the 4 individuals that lived in higher population density areas such as cities and large central metro had asthma, sinus, or allergies. Two which were Black/African American while two are White. Two individuals (Asian and White) that reside in towns have allergies Those that were former or social smokers had no respiratory outcomes which seemed surprising but the two individuals that were overweight have respiratory outcomes. I also found a surprising find which agreed with my results which says that ozone levels are lower in cities compared to urban/rural areas which are in turn harmful to forests and vegetation. Another interesting find during my study was recognizing why the countryside/rural area had a higher number for PM2.5 which is a main pollutant compared to the city. This could be due to the high rate of tourists and traveling from cars which release exhausts. There are also studies that address the impact of AQ on tourism but at the macro level. That is, not analyzing the individual decisions of the tourist, but looking at the tourism industry of a country or region or a specific tourism attraction (such as a natural park). Carbon dioxide has no significant impact on tourism which we see from the results from my study while comparing it to the other urbanicities while PM 2.5 has a significant negative impact. The reason for this result may be that the effect of PM 2.5 on air is that its more perceptible compared to CO2 (colorless and odorless). It was concluded that SO2 has the largest impact on tourism demand, followed by PM 2.5, NO2 and PM 10, while CO (carbon monoxide) and O3 seem to have little influence (Eusébio et al. 2020). The NIH explains this to be mainly known as Traffic-Related Air Pollution (TRAP) from motor vehicle emissions, which may be the most recognizable form of air pollution. It contains most of the elements of human-made air pollution: ground-level ozone, various forms of carbon, nitrogen oxides, sulfur oxides, volatile organic compounds, polycyclic aromatic hydrocarbons, and fine particulate matter.

This study finds a correlation between the air quality of various areas and its respiratory outcomes, but how can we prevent harmful air quality and air pollution in these areas where it is prevalent. For long term solutions, primary prevention should be advised which can be done by reducing car use by using public transportation; walking or bicycling when smog levels are not high; keeping cars well-tuned, checking the emission control system, avoiding idling for long periods and turning off the engine while waiting; buying a fuel-efficient vehicle, driving at moderate speeds and avoiding use of gasoline empowered vehicles and machines (e.g., motorbikes, motorboats and gas lawnmowers); considering energy efficiency at home; choosing alternatives to household cleaners and oil-based paints that emit volatile organic compounds; and disposing of toxic household waste appropriately (Abelsohn, 2002). There should also be changes seen by creating societal actions at the government level. This can be done by creating or implementing standards on urban planning and public transportation, motor vehicle emission standards, etc. For patient education for those affected by respiratory outcomes should consider elements such as reducing outdoor activities when the air quality index is in the unhealthy range and this can be done by checking apps such as the weather app on phones (Gilliland, 2009).

 

Conclusions:
This study has shown important information regarding air quality of different locations and its respiratory outcomes and although the participation number was not as many to give accurate results and a definite answer, we do see a correlation between both factors. It is also important to pay attention to ways to reduce air pollution and improve air quality measurement. Given the high cost of further measures to reduce air pollution, and the many new findings which suggest that health effects can be seen at even at lower concentrations of pollutants, the health effects of air pollution need to receive much scientific and regulatory interest as many continue to research this environmental issue.

 

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