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OZONE

Health Impacts of. OZONE. POLLUTION. Volume Growth. The relationship between ozone pollution and pubic health. Dr. Tonya McDonald M.D. Pediatrician MyChildren’s Lancaster Kiest. Volume Growth. Overview. Describe how ozone is formed and where it is found

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OZONE

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  1. Health Impacts of OZONE POLLUTION

  2. Volume Growth The relationship between ozone pollution and pubic health Dr. Tonya McDonald M.D. Pediatrician MyChildren’s Lancaster Kiest

  3. Volume Growth Overview • Describe how ozone is formed and where it is found • Identify the effects that exposure to ozone has on the general population • Identify the effects that ozone has on asthma patients • Address typical patient questions and clinical scenarios relating to asthma

  4. Ozone • A gas composed of three atoms of oxygen • Can be good or bad • Ozone occurs in two layers of the atmosphere • Stratosphere- six to 30 miles above the earth • The “Ozone Layer” • “Good Ozone” • Troposphere- ground level to approximately six miles above earth • “Bad Ozone”

  5. Two Layers of Ozone O3 Good O3 Bad

  6. Ozone: Where Does Ozone Come From • Produced by chemical reactions between oxides of nitrogen (NOx) and volatile organic compounds (VOC) in the presence of sunlight • Acts as a respiratory irritant, is harmful to breathe, damages crops, trees and other vegetation http://www.epa.gov/air

  7. How Does Ozone Form? + UV O3 NOx + VOCs

  8. Ozone Concentrations Depend On… • Concentration and ratio of NOx and VOCs • Wind speed and direction • Terrain • Temperature • Stagnant conditions (depends on wind and temperature) • Time of year (“ozone season”)

  9. How Are People Exposed to Ozone • Ozone exposure occurs when people breathe ambient air containing ozone • The rate of exposure for a given individual is related to the concentration of ozone in the surrounding air and the amount of air the individual is breathing per minute • Dose = Concentration x Ventilation Rate x Time • Ozone concentrations are higher outdoors than indoors • Increased physical activity increases a person's rate of ozone exposure

  10. Ozone Reacts with the Respiratory Tract • The upper respiratory tract is not as effective in scrubbing ozone from inhaled air as it is for more water soluble pollutants • Consequently, the majority of inhaled ozone reaches the lower respiratory tract • Ozone reacts with chemical constituents of airway lining fluid throughout the respiratory tract, producing very reactive chemical intermediates

  11. Ozone Affects Health • Health Issues: Respiratory Problems • Coughing • Congestion • Chest Pain • Throat Irritation • Worsens respiratory diseases such as asthma, bronchitis and emphysema

  12. Volume Growth Human Lung • Air conducting • Trachea • Bronchi • Bronchioles • Gas exchange • Respiratory bronchioles • Alveoli

  13. Volume Growth Volume Growth Ozone Irritates Airways • Symptoms • Cough • Sore or scratchy throat • Pain with deep breath • Fatigue • Rapid onset • Similar symptoms - people with and without asthma

  14. Volume Growth Ozone Causes Inflammation • Ozone reacts completely in surface layer - forms reactive oxygen molecules • Influx of white blood cells • Damages cells that line the airways • Effect is greater 24 hours after exposure • Increases airway reactivity • Concern about repeated exposures

  15. “Pyramid of Effects” Volume Growth • Effects seen across a wide range of health outcomes • Sensitive groups include: • Asthmatic children and other people with lung disease • All children and older adults, especially people active outdoors • Outdoor workers Adversity of Effects Proportion of Population Affected http://www.epa.gov/air

  16. It’s a Public Health Concern • Estimated 60,000 children in Dallas County with Asthma • Prevalence of asthma in children is particularly high and because children are generally at higher risk due to time spent being active outdoors, • they may be disproportionately affected by ozone exposure • Ranked 8th for high ozone days out of 277 metropolitan areas • Dallas County is graded as an “F” for high ozone • Over 30 “Orange” Ozone Days a year • Poor Air Quality associated with increases in: • Hospital admissions • Doctor and emergency room visits • Medication use • Absences from work or school

  17. Ozone and People with Asthma • People with asthma are likely affected by ozone in two ways: • They might be more sensitive to ozone than other people and experience lung function changes • Exposure may worsen a person's  underlying asthma, increasing the probability of an asthma attack. • Respiratory symptoms and bronchodilator use are increased, and lung function is decreased, on days when ozone concentrations are high • Numbers of emergency room visits and hospital admissions for asthma are increased on days when ozone concentrations are high

  18. Asthma • Chronic inflammatory disorder of the airway • Infiltration of mast cells, eosinophils and lymphocytes • Recurrent episodes of wheezing, coughing and shortness of breath • Airway hyperesponsiveness • Reversible airflow obstruction, either spontaneously or with treatment.

  19. Asthma Exacerbation • Airway inflammation produces four forms of airflow limitation: • Acute bronchoconstriction • Inflammation of the airway wall • Increased mucus formation • Cell mediator proliferation * Airway wall remodeling

  20. Asthma is Different For Everyone • No two people have exactly the same asthma symptoms or outcomes Asthma’s two parts • The Quiet Part Inflammation • The Noisy Part Constriction

  21. Asthma Exacerbation Sequence

  22. Reduce Exposure to Reduce Risk • Reduce time spent outdoors when ozone levels are high (use AQI) • Pay attention to symptoms • People with asthma – follow asthma action plan • Coaches – rotate players frequently • People with heart disease • Check with your doctor • Don’t exercise near busy roads

  23. Children’s Asthma Management Text Messaging Program • The text messaging program provides educational asthma texts to program participants and caregivers phones. • The messages/reminders are educational and include: • Taking asthma medications • Following the child’s asthma action plan • Avoiding asthma triggers • Air Quality Alerts

  24. Community Collaboration • North Texas Asthma Consortium Program • Asthma-Friendly Flag Program • Multi-colored flag system reflecting outdoor air quality • Based on AQI used by EPA • Goals: • Inform school staff, students, parents and the community of the daily air quality • Provide alternative physical activities for poor ozone days • Reduce student exposure to harmful outdoor air pollutants • www.northtexasasthma.org

  25. Resources Environmental websites to check ozone alerts: • http://www.enviroflash.info provides email alerts • www.airnorthtexas.org • www.cleanair.org • www.tceq.state.tx.us • http://www.tceq.texas.gov/agency/data/aq-data.html • http://greendallas.net/air-quality/ • http://www.epa.gov/o3healthtraining/tools.html

  26. References • U.S. Environmental Protection Agency: Ozone and Your Patients' Health Training for Health Care Providers http://www.epa.gov/apti/ozonehealth/cme.html

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