1. Wood Smoke and Health August 23, 2007

2. Wood Smoke and Health Judy Bardin, ScD Wood Smoke Work Group August 23, 2007 Dept. of Ecology NW Regional Office

3. Composition of Wood Smoke Gases and fine particles suspended in air Visible and invisible components Inhalable particulate matter Carbon Monoxide Nitrogen oxides Volatile organic compounds benzo[a]pyrene, benzene, formaldehyde (Known or probable human carciongens)

4. Particulate Matter (PM) One of the biggest human health concerns from smoke, indoors or outdoors comes from PM The size of the particle is linked to their potential to cause health effects. The smaller the size the bigger the health risk. EPA, fact sheet, “Healthier Home Cleaner Environment, 2007

5. Fine PM (PM 2.5 ) Size less than 2.5 microns (called PM 2.5 ) Strongest association with health effects Adsorb and carry other toxic chemicals deep into the lung. Very small – stay airborne, travel indoors

6. What is PM2.5? The health risks from particulates are due in part to the small size. The smaller the size, the bigger health risk. PM 2.5 stays in the air much longer than PM 10, taking days to weeks to be blown away. British Columbia Ministry of the Environment

7. Respiratory and Cardiovascular Disease (CVD) CVD = heart disease and stroke A large body of research has shown: Both short term and long term exposure to PM is linked to increases in illness and death from respiratory and CVD diseases EPA, PM Criteria Document, 2004

8. PM and CVD Effects A number of potential harmful effects Heart rate (how fast heart beats) increased or decreased Abnormal heart rhythms Heart rate variability (how well heart reacts to stress) changes Blood pressure increases Blood coagulation and clot formation increases Inflammation Those with pre-existing medical conditions (especially heart and lung disease) may have the most serious health outcomes with these effects EPA, PM Criteria Document, 2004

9. Women’s Health Initiative Study Miller, et al., Joel Kaufman( Principle Investigator), Univ. Washington Women enrolled in the study at age 50-79 No previous CVD 36 US metropolitan areas From 1994-1998. Air Monitoring EPA AIRS pollution data base closest monitor (not > 30 miles) Long term annual average PM 2.5 exposure NEJM, 2/1/2007, 356:447-58

10. Women Health Initiative CVD Findings Each increase in 10 ug/m3 was linked to: 24% increased risk of a CVD event 76% increase in risk of death from CVD

11. Respiratory Effects of PM Increased lung injury and inflammation Decreased pulmonary function Increased airway reactivity Increased respiratory symptoms Exacerbation of Asthma Increased susceptibility to infection EPA, PM Criteria Document 11/04

12. Lung Cancer Several large cohort studies have shown associations between long term exposure to PM 2.5-10 or PM 2.5 and lung cancer The American Cancer Society cohort study found a 13% increased risk of lung cancer death per long term 10 ug/m 3 PM 2.5 exposure EPA, PM Criteria Document 11/04

13. Fine PM Level Rises Result In: More people with respiratory or cardiac symptoms Decreased activity, school absences, loss work days Increased health care provider visits Increased emergency department visits Increased hospitalizations Increased deaths (especially, heart, lung and stroke diseases) EPA, PM Criteria Document 11/04

14. Emergency Department (ED) Visits Slide courtesy of Dr. Jane Koenig

15. Loss of Life expectancy Life expectancy = how long people are expected to live Overall studies show that long term exposure to PM 2.5 results in a loss of life expectancy of ~ 1 year or more of life. EPA, PM Criteria Document 11/04

16. Summary of wood smoke effects in Seattle Increased symptoms in children with asthma (Yu et al,1999; Slaughter et al 2003) Increased visits to Emergency Depts. (Schwartz et al 1993; Norris et al 1999) Decrements in lung growth in children with asthma (McKown et al. 2006) Increased airway inflammation in children with asthma and adults with Respiratory disease (Koenig 2003, Jansen 2005 Slide Courtesy Dr Jane Koenig

17. Some People Are More Sensitive to Smoke Infants and young children Elderly (age 65 and older) Those with lung and cardiovascular disease (heart disease and stroke)

18. WA Young and Elderly (Percentage Statewide) Young (infants and young children) 8%, 5 years and younger 13%, 9 years and younger Elderly 11% age 65 and older

19. Children They breathe in more air in relation to body weight Lungs still developing Spend more time outdoors

20. Elderly Those 65 and older Pre-existing heart, lung, and other medical conditions Weaker immune systems Less able to take preventative measures

21. Lung & Cardiovascular Diseases May experience symptoms earlier and at lower levels Lung Disease Asthma, emphysema, bronchitis, chronic obstructive pulmonary disease (COPD) Cardiovascular Disease Previous heart attack, angina, coronary artery disease, stroke

22. WA State Asthma in Children 11 % of household with children report that they have at least on child with asthma 2006 Behavioral Risk Surveillance Survey (BRFSS) As reported by adult in household 12.9% of 10 th graders report that they have current asthma Report they used asthma medication or had an asthma attack in the last year 2006 Healthy Youth Survey

23. WA State Asthma in Adults 8.9 % report they have current asthma 14.3% report they ever had asthma

24. WA State Cardiovascular Disease (CVD) Report having CVD (2006 BRFSS) 7% of all adults 24% of adults age 65 and older

25. Overview One in ten people in WA report they have asthma One in four adults 65 and older report having CVD

26. Diabetes New evidence - diabetics at risk when PM levels rise Many diabetics have underlying CVD 7% of Washington residents report having diabetes

27. Overall Large segments of our population are at risk from breathing smoky air Reduction of exposure to smoke would help prevent illness and death in WA

28. References United States Environmental Protection Agency. (2004) Air Quality for Particulate Matter, volume II. Retrieved August 10, 2007, from http://cfpub2.epa.gov/ncea/cfm/recordisplay.cfm?deid=87903. http://cfpub2.epa.gov/ncea/cfm/recordisplay.cfm?deid=87903 Miller, K.A., Siscovick, S.S., Sheppard, L., Shepherd, K, Sullivan, J.H. Anderson, G.L., et al. (2007). Long-term exposure to air pollution and incidence of cardiovascular events in women. The New England Journal of Medicine, 356,447-458. Pope, C.A. III, Burnet, R.T., Thun, M.J., Calle, E.E., Krewski, D. et al. (2002). Lung cancer, cardiopulmonary mortality, and long-term exposure to fine particulate air pollution. The Journal of the American Medical Association, 287, 1132-1141. USEPA Healthier Homes Cleaner Environment. Retrieved August 10, 2007 from http://www.epa.gov/woodstoves/healthier.html Washington State Behavioral Risk Factor Surveillance System (BRFSS) Data: 2006 data weighted to reflect county over-sample, November 2006 & June 2007. Washington Healthy Youth Survey: Office of the Superintendent of Public Instruction, Washington State Departments of Health, Social and Health Services, and Community, and Trade and Economic Development, the Family Policy Council, and RMC Research, 2006. The burden of heart disease and stroke in Washington State, (2004), Washington State Department of Health, Community and Family Health. Washington State Population Counts: U.S. Census provided through Washington State Office of Financial Management (OFM)

29. References Slaughter JC, Lumley T, et al (2003). Effects of ambient air pollution on symptom severity and medication use in children with asthma. Ann Allergy Asthma Immunol 91(4): 346-53. Yu O, Sheppard L, Lumley T, Koenig JQ, Shaprio GG. 2000. Effects of ambient air pollution on symptoms of asthma in Seattle-area children enrolled in the CAMP study. Environ Health Perspect 108:1209-1214. Schwartz J, Slater D, Larson TV, Pierson WE, Koenig JQ. Particulate air pollution and hospital emergency room visits for asthma in Seattle. Am Rev Respir Dis. 1993 Apr;147(4):826–831. G Norris, S N YoungPong, J Q Koenig, T V Larson, L Sheppard, J W Stout. An association between fine particles and asthma emergency department visits for children in Seattle. Environ Health Perspect. 1999 June:107(6):489- 493. J.Q. Koenig, K. Jansen, T.F. Mar, T. Lumley J. Kaufman, C.A. Trenga, J. Sullivan,1 L.-J.S. Liu,1 G.G. Shapiro,3 and T.V. Larson. Measurement of offline exhaled nitric oxide in a study of community exposure to air pollution. Environ Health Pespect. 2003 October:111(13): 1625-1629. TF. Mar, K Jansen, K Shepherd, T Lumley, TV. Larson, JQ. Koenig. Exhaled nitric oxide in children with asthma and short-term PM2.5 exposure in Seattle. Environ Health Perspect. 2005 December:113(12):1791-1794.

30. Judy Bardin Epidemiologist Washington State Department of Health, Office of Environmental Health Assessments, 360- 236-3193 Judy.bardin@doh.wa.gov