Aug 2019
It turns out you don’t need to smoke for a lifetime to get emphysema. Just breathing polluted air can give it to you, according to a new study that is the largest and the longest of its kind. “We found that an increase of about three parts per billion [of ground-level ozone] outside your home was equivalent to smoking a pack of cigarettes a day for 29 years,” said Joel Kaufman, a physician and epidemiologist at the University of Washington who contributed to the study, as NPR reported.
The study, which was published in the Journal of the American Medical Association, or JAMA, found that long-term exposure to ground level ozone, the main component of smog, is like smoking a pack of cigarettes a day, as CNN reported. Just a slightly elevated level of air pollution can lead to lung damage, even for people who have never smoked.
The study tracked 7,071 adults aged 45 to 84 living in six U.S. cities: Chicago; Los Angeles; Baltimore; St. Paul, Minnesota; New York City and Winston-Salem, North Carolina for up to 18 years.
The researchers created an exposure assessment method that looked at air pollution levels outside participants’ homes and carried out CT scans and breathing tests, according to U.S. News and World Report. They assessed environments for levels of fine particulate matter, nitrogen oxide, black carbon and ozone.
All major air pollutants were linked to an increase of emphysema, a debilitating, chronic and irreversible lung disease that causes shortness of breath and shrinks the amount of oxygen that reaches the bloodstream. It’s almost always associated with smoking or long-term exposure to second hand smoke.
However, exposure to ground level ozone pollution showed the strongest link to an increased prevalence of emphysema. It was also the only pollutant to show an additional decrease in lung function, as CNN reported.
“Rates of chronic lung disease in this country are going up and increasingly it is recognized that this disease occurs in nonsmokers,” said Kaufman, as U.S. News and World Report reported. “We really need to understand what’s causing chronic lung disease, and it appears that air pollution exposures that are common and hard to avoid might be a major contributor.“
This is particularly troubling since the climate crisis is accelerating ground level ozone. While most air pollutants have declined thanks in large part to the Clean Air Act, ground level ozone has actually increased. Ozone is colorless and forms when pollutants from fossil fuels interact with sunlight. Pollution from cars, power plants, refineries and chemical plants all contribute to smog, and it is on track to get worse, as U.S. News and World Report reported.
“These findings matter since ground-level ozone levels are rising, and the amount of emphysema on CT scans predicts hospitalization from and deaths due to chronic lower respiratory disease,” said Dr. R. Graham Barr, a professor of medicine and epidemiology at Columbia University Irving Medical Center and a senior author of the paper, to CNN.
He added that smog “is accelerated by heatwaves, so ground-level ozone will likely continue to increase unless additional steps are taken to reduce fossil fuel emissions and curb climate change. But it’s not clear what level of ozone, if any, is safe for human health.”
“And so as climate change progresses, we expect that vulnerable populations and — even healthy populations — are going to see increased effects,” said Emily Brigham, a pulmonologist and assistant professor of medicine at Johns Hopkins University who was not involved in this study, to NPR.
U.S. #AirPollution Is ‘Completely Outrageous’ http://ow.ly/UXeE30lU6N2 @NRDC @GCAS2018U.S. Air Pollution Is ‘Completely Outrageous’The U.S. is one of the richest countries in the world and has the highest per capita spending on health care. But when it comes to air …ecowatch.com
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Original InvestigationAugust 13, 2019
Association Between Long-term Exposure to Ambient Air Pollution and Change in Quantitatively Assessed Emphysema and Lung Function
Meng Wang, PhD1,2,3; Carrie Pistenmaa Aaron, MD4; Jaime Madrigano, ScD5,6; et alEric A. Hoffman, PhD7; Elsa Angelini, PhD8; Jie Yang, PhD8; Andrew Laine, PhD8; Thomas M. Vetterli, MS8; Patrick L. Kinney, ScD9; Paul D. Sampson, PhD10; Lianne E. Sheppard, PhD1,11; Adam A. Szpiro, PhD11; Sara D. Adar, ScD12; Kipruto Kirwa, PhD1; Benjamin Smith, MD, MS4,13; David J. Lederer, MD, MS4,14; Ana V. Diez-Roux, MD, PhD15; Sverre Vedal, MD1; Joel D. Kaufman, MD, MPH1,16; R. Graham Barr, MD, DrPH4,14Author AffiliationsJAMA. 2019;322(6):546-556. doi:10.1001/jama.2019.10255 multimedia icon MultimediaVideo(4:20)Ambient Air Pollution and Change in Emphysema and Lung Function FullText Key Points
Question Is there an association between ambient air pollutants and progression of emphysema and changes in lung function in the general population?
Findings In this cohort study conducted between 2000 and 2018 that included 5780 participants in 6 US metropolitan regions followed up for a median of 10 years, there was a statistically significant association between baseline ambient concentrations of ambient ozone (O3), fine particulate matter (PM2.5), oxides of nitrogen (NOx), and black carbon with greater increases in emphysema assessed quantitatively using computed tomographic (CT) imaging. Concentrations of O3 and NOx, but not concentrations of PM2.5, over study follow-up were also associated with increases in emphysema. Baseline ambient O3 was significantly associated with a faster decline in forced expiratory volume in the first second (FEV1).
Meaning Long-term exposure to ambient air pollutants, especially O3, was significantly associated with increasing emphysema assessed quantitatively using CT imaging and with worsening lung function.Abstract
Importance While air pollutants at historical levels have been associated with cardiovascular and respiratory diseases, it is not known whether exposure to contemporary air pollutant concentrations is associated with progression of emphysema.
Objective To assess the longitudinal association of ambient ozone (O3), fine particulate matter (PM2.5), oxides of nitrogen (NOx), and black carbon exposure with change in percent emphysema assessed via computed tomographic (CT) imaging and lung function.
Design, Setting, and Participants This cohort study included participants from the Multi-Ethnic Study of Atherosclerosis (MESA) Air and Lung Studies conducted in 6 metropolitan regions of the United States, which included 6814 adults aged 45 to 84 years recruited between July 2000 and August 2002, and an additional 257 participants recruited from February 2005 to May 2007, with follow-up through November 2018.
Exposures Residence-specific air pollutant concentrations (O3, PM2.5, NOx, and black carbon) were estimated by validated spatiotemporal models incorporating cohort-specific monitoring, determined from 1999 through the end of follow-up.
Main Outcomes and Measures Percent emphysema, defined as the percent of lung pixels less than −950 Hounsfield units, was assessed up to 5 times per participant via cardiac CT scan (2000-2007) and equivalent regions on lung CT scans (2010-2018). Spirometry was performed up to 3 times per participant (2004-2018).
Results Among 7071 study participants (mean [range] age at recruitment, 60 [45-84] years; 3330 [47.1%] were men), 5780 were assigned outdoor residential air pollution concentrations in the year of their baseline examination and during the follow-up period and had at least 1 follow-up CT scan, and 2772 had at least 1 follow-up spirometric assessment, over a median of 10 years. Median percent emphysema was 3% at baseline and increased a mean of 0.58 percentage points per 10 years. Mean ambient concentrations of PM2.5 and NOx, but not O3, decreased substantially during follow-up. Ambient concentrations of O3, PM2.5, NOx, and black carbon at study baseline were significantly associated with greater increases in percent emphysema per 10 years (O3: 0.13 per 3 parts per billion [95% CI, 0.03-0.24]; PM2.5: 0.11 per 2 μg/m3 [95% CI, 0.03-0.19]; NOx: 0.06 per 10 parts per billion [95% CI, 0.01-0.12]; black carbon: 0.10 per 0.2 μg/m3 [95% CI, 0.01-0.18]). Ambient O3 and NOxconcentrations, but not PM2.5 concentrations, during follow-up were also significantly associated with greater increases in percent emphysema. Ambient O3 concentrations, but not other pollutants, at baseline and during follow-up were significantly associated with a greater decline in forced expiratory volume in 1 second per 10 years (baseline: 13.41 mL per 3 parts per billion [95% CI, 0.7-26.1]; follow-up: 18.15 mL per 3 parts per billion [95% CI, 1.59-34.71]).
Conclusions and Relevance In this cohort study conducted between 2000 and 2018 in 6 US metropolitan regions, long-term exposure to ambient air pollutants was significantly associated with increasing emphysema assessed quantitatively using CT imaging and lung function.
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ENVIRONMENTAL JUSTICE AND DENVER’S ‘ASTHMA ALLEY’, PART I: OVERVIEW
Lloyd Burton, PhD. Issue Team on Environmental Justice and Social Equity Conservation Steering Committee Peak & Prairie, August, 2019
The Colorado Chapter’s Executive Committee authorized the creation of our Issue Team on Environmental Justice and Social Equity (EJSE) just shy of two years ago now, in the autumn of 2017. Since that time, we’ve been working hard to fulfill the team’s double mandate: (1) ensuring that those who are suffering the greatest environmental health harms are getting the support they need to make their voices heard and their injustices righted; and (2) working with those being hit hardest by changes in land use and environmental policies to help have their rights and interests represented.
In pursuit of those goals, and in coordination with other Colorado Sierra Club (CSC) groups and teams, we’ve joined in actions such as protesting before the Colorado Oil and Gas Conservation Commission the permitting of a major O&G operation less than 1,000 feet from a middle school attended mostly by low-income minority students in Greeley. And EJSE team member Jamie Valdez has been leading an innovative effort to make common cause with utility company workers in the Pueblo area who may be negatively affected by decommissioning of Xcel’s older coal burning power plants.
However, most of our team’s Government Affairs and Advocacy efforts over the last two years have been focused on critical environmental injustice issues arising in northeast Denver’s industrial corridor along Interstate 70. Denver’s own public health studies show why it has become Denver’s “Asthma Alley”. In 2014, the Denver Department of Public Health and Environment published the results of a neighborhood health assessment study it had just completed in the low-income, majority-minority group neighborhoods of Globeville, Elyria, and Swansea (GES). They lie due east of the intersection of I-25 and I-70, and are actually bisected by I-70. What the study found was that these neighborhoods suffered a 40% higher rate of childhood asthma emergency room admissions than any other in the city, and nearly a 70% higher rate of congestive heart disease. As the study itself noted, both of these conditions are associated with the inhalation of high concentrations of highway traffic exhaust.
This research was one of the motivating factors behind the Sierra Club taking the lead— with other grassroots environmental justice allies—in filing a lawsuit in federal court against the Federal Highway Administration and Colorado Department of Transportation in 2017, seeking to prohibit the planned expansion of I-70 through GES. Though unsuccessful in achieving an immediate halt to the project, the settlement terms in this litigation was CDOT agreeing to contribute over a half million dollars toward an independently conducted, comprehensive study of all the sources of toxic and hazardous contaminants of the air, water, and soil in the Globeville, Elyria and Swansea neighborhoods. And there are indeed others.
Just north of (and upwind from) these neighborhoods lies the sprawling Suncor petroleum refinery, which processes the world’s dirtiest petroleum feedstocks: the Athabascan tar sands piped down from its mines in Canada. One of the byproducts of this process Suncor emits into the air is hydrogen cyanide: yes, the same gas the Third Reich used in the Holocaust. Additionally, these neighborhoods either abut or are within the 4.5-square-mile Vasquez Blvd./I-70 Superfund site, contaminated by a century’s worth of precious metal smelting. Over the next four years, an estimated 50,000 truckloads of partially contaminated soil will be excavated from the site for the subgrade section of the I-70 expansion project.
Our EJSE team is actively engaged in all three of these major environmental justice cases, as we have been for the last two years. On these issues, we work in partnership with other CSC committees (such as Legislative and Conservation) and we also work in alliance with other environmental justice advocacy groups. In upcoming articles in Peak and Prairie, we’ll be providing more detail on all three of these cases: what we’ve done up ‘til now, where things stand at present, what the future holds in store, and how you can help. EJSE team contact for more information about these cases is Lloyd Burton: lloyd.burton@ucdenver.edu.
