Air Pollution 101: Here’s Your Syllabus

Due to the incredible media exposure this week to our emergency pollution, I’ve been inundated with questions from both patients and international media about pollution. There’s still quite a lot of misinformation about pollution, so here are what I consider to be the most high yield, evidence-based and readable articles. I think reporters, scholars, parents — anyone concerned about air pollution — may find a few articles to be useful. So grab a comfy chair, smoke your favorite cigar, sit back and have a good read:

General Topics:

• Review of evidence on health aspects of air pollution – REVIHAAP — This is the World Health Organization’s 2013 uptate from their essential 2005 guidelines just below.
• World Health Organization Air Quality Guidelines – this is the essential report, from 2005. Their recommendations are the backbone for most countries’ policies.
• Meta-analysis of adverse health effects due to air pollution in Chinese populations — this is a new 2013 article with probably the most comprehensive review of the literature so far.
• The World Bank: Cost Of Pollution in China: economic estimates of physical damages – the very important 2007 report; a large PDF file to download. Read chapter 2, starting page 42, Health Impacts of Ambient Air Pollution
• Major pollution research articles, many co-authored by Dr C Arden Pope (read my conversation with him):
  •      Lung Cancer and Cardiovascular Disease Mortality Associated with Ambient Air Pollution and Cigarette Smoke: Shape of the Exposure–Response Relationships – a wonderfully interesting and provocative comparison of the effects of air pollution versus smoking.
  •      Epidemiology of Fine Particulate Air Pollution and Human Health: Biologic Mechanisms and Who’s at Risk? – an excellent review, although a bit dated.
  •      Pollution & Life Expectancy in the US – an excellent New England Journal article from January 2009, plus the editorial and a fascinating interactive map – Pollution & Life Expectancy in US Cities
  •      An association between air pollution and mortality in six U.S. cities. — this is part of the important Harvard Six Cities Study
  •      Lung cancer, cardiopulmonary mortality, and long-term exposure to fine particulate air pollution — analysis of the equally important American Cancer Society Cancer Prevention II study

Masks and Pollution:

• Reducing personal exposure to particulate air pollution improves cardiovascular health in patients with coronary heart disease – a collaboration of Centre for Cardiovascular Science, University of Edinburgh and some Beijing academics and hospitals. This is the best evidence I’ve seen so far that a proper N95 mask can help decrease risk! By the way, they used a 3M mask. Here also is the commentary
• Beneficial Cardiovascular Effects of Reducing exposure to Particulate Air Pollution With A Simple Facemask— from the same Beijing reseach team as above, this one also offers very practical evidence on the use of N95 masks.

Children and Pollution:

• Ambient Air Pollution: Health Hazards to Children – Pediatrics – This is an essential first read for any parents. It’s from the American Academy of Pediatrics Committee on Environmental Health. A bit dated, from 2004-5
• USC Children’s Health Study — here’s the collection of articles from what I consider the most comprehensive data set, following thousands of kids in smoggy LA. Includes this article:
• The Effect of Air pollution on Lung Development from 10 to 18 Years of Age – A prospective study showing decreased lung function in Los Angeles kids — at levels much, much lower than what we experience here every day
• Air Pollution Threatens The Health of Children in China – an excellent review from Pediatrics magazine, 2008

OK, that’s enough to keep everyone busy for a few days. I don’t expect us to work miracles here; I just hope to share the evidence and continue the discussion, and at the very least have us take proper precautions for our own families — and lead by example. Does anyone else have a favorite article? Please leave links in the comments below. (By the way, the cigar recommendation was sarcasm…a bit of dark humor in the midst of dark times…although “everything in moderation”, yes?)

Don’t leave home without one.

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