1. Long term effects of air pollution on health. Peter Burney. King’s College London

2. Breathlessness by night or day by annual mean PM10 (Sepaldia) Selected symptoms associated with measures of air pollution Some correlations work out better than others

3. Proportion of the non-smoking population with FVC < 70% by TSP (NHANES) Continuous increase in poor lung function as particulate levels rise. Adjusted for age, height, sex, race, obesity, occupation, temperature, income and region

4. The Meaning of Chronic Morbidity Repeated acute effects? Change in susceptibility? Irreversible changes?

8. Changes in lung function in different communities (Tashkin 1994) Relative decline in FEV1 (ml) TSP (mg/m3)MENWOMEN Lancaster 85 0 0 Long Beach101-18.4*-15.6** Glendora133-26.5**-16.2** Adjusted for age, height, initial FEV1, allergy and smoking *p<0.01; **p<0.001

9. Differences in lung function growth between ‘polluted’ and ‘unpolluted’ areas (from Jedrychowski, et al. 1999)

10. Factors predicting adult respiratory disease in the 1946 national birth cohort (Mann et al, 1992)

11. SMR from bronchitis related to area based infant mortality from LRTI Area SMR from bronchitis is associated with infant mortality from pneumonia 70years earlier.

15. Possible causes of inconsistency Various outcomes Various exposures Modifying factors Measurement errors Bronchitis COPD Allergy Asthma Cancer Early infection Premature birth

16. Possible causes of inconsistency Various outcomes Various exposures Modifying factors Measurement errors Particles SO2 NO2 Oxidants ‘Traffic’ Diesel

17. Lorry traffic affects infant lung disease in metropolitan but not urban or rural areas (Ciccone et al., 1998)

18. Effect of supplementing cyclists with antioxidants on the respiratory response to ozone (from Grievink et al. 1998)

19. Prospects The evidence is currently descriptive. The evidence is reported inconsistently. There is likely to be reporting bias. Much of the data refers to pollution patterns that are now largely historic.

20. ECRHS II A follow-up of subjects studied in ECRHS I A study of many different protocols linked to studying aetiology and prognosis Principal outcomes relate to atopy, asthma, lung function and bronchial hyper- responsiveness Some specific protocols on air pollution

21. ECRHS II centres

22. ECRHS II pollution protocols Historic review of air pollution data Measurement of PM2.5 in all centres Analysis of PM2.5 for metal content Measurement of dust mite allergen from beds Measurement of NO2 from kitchens, outside kitchen windows and at central monitor in selected centres

25. ECRHS II Analysis principally relates to the natural history (incidence, remission and modification of disease over time) of asthma, atopy, lung function, and airway responsiveness.

26. ECRHS II The major strengths of the study are its size, the diversity of the environments studied, the extent of the potential confounders being assessed.