Health effects of outdoor air pollution: Approach to counseling patients using the Air Quality Health Index

Alan Abelsohn; Dave M. Stieb

Article Figures & Data

Tables

Additional Files

View popup

Table 1

Health effects of air pollution

EXPOSURE	SYSTEM AFFECTED	HEALTH EFFECTS	STUDY
Short term	Cardiovascular	Increased rates of myocardial infarction and ischemia in those at risk	Bhaskaran et al,³ 2009 Pope et al,⁴ 2006 Szyszkowicz,⁵ 2009 Brook et al,⁶ 2010
		Exacerbation of cardiac failure	Brook,⁷ 2008 Goldberg et al,⁸ 2009 Medina-Ramón et al,⁹ 2008 Pope et al,¹⁰ 2008
		Increased incidence of arrhythmia	Pope et al,¹¹ 2004
		Increased incidence of deep vein thrombosis	Pope,¹² 2009 Baccarelli et al,¹³ 2009
		Increased incidence of stroke	Lokken et al,¹⁴ 2009
	Respiratory	Increased wheeze	Clark et al,¹⁵ 2010
		Exacerbation of asthma	Delfino et al,¹⁶ 2009 Holguin,¹⁷ 2008 O’Connor et al,¹⁸ 2008 McCreanor et al,¹⁹ 2007
		Exacerbation of chronic obstructive pulmonary disease	Halonen et al,²⁰ 2008 Sint et al,²¹ 2008 Zanobetti et al,²² 2008
		Bronchiolitis and other respiratory infections	Karr et al,²³ 2009 Ségala et al,²⁴ 2008
		Increased emergency department visits	Stieb et al,²⁵ 2009

Long term	General	Increased mortality	Krewski et al,²⁶ 2009 Pope et al,²⁷ 2009
	Cardiovascular	Increased myocardial infarction	Rosenlund et al,²⁸ 2009 Tonne et al,²⁹ 2009
		Accelerated development of atherosclerosis	Brook et al,⁶ 2010 HEI Panel on the Health Effects of Traffic-Related Air Pollution,³⁰ 2010
		Increased blood coagulability	Pope,¹² 2009 Liu et al,³¹ 2009
		Increase in systemic inflammatory markers	Simkhovich et al,³² 2008
	Respiratory	Increased incidence of pneumonia	Neupane et al,³³ 2010
		Increased incidence of lung cancer	Laden et al,³⁴ 2006
		Impaired lung development in children	Gauderman et al,³⁵ 2004
		Development of new asthma	Clark et al,¹⁵ 2010 Jerrett et al,³⁶ 2008 Künzli et al,³⁷ 2009 Lindgren et al,³⁸ 2009 Dell et al,³⁹ 2008
	Reproductive	Increased incidence of preterm birth	Wu et al,⁴⁰ 2009 Stillerman et al,⁴¹2008 Brauer et al,⁴² 2008
	Reproductive	Increased incidence of low birth weight	Salam,⁴³ 2008

View popup

Table 2

Sources of air pollution

POLLUTANT	SOURCE	CONDITIONS
Particulate matter	Traffic	Summer and winter
	Forest fires
	Wood smoke
	Infiltrates indoors
Ultrafine particulate matter (< 0.1 μm in diameter)	Diesel traffic	Close to busy roads
Ozone	Secondary to aerochemical reaction to nitrogen oxides and volatile organic compounds	Summer afternoons; heat and sunshine
Nitrogen dioxide	Traffic	Close to busy roads
Carbon monoxide	Traffic	Close to busy roads
Sulfur dioxide	Industrial plants—combustion and refining of coal, oil, and metal-containing ores	Close to industrial sources
Sulfur dioxide	Gasoline, although sulfur content has recently been reduced

View popup

Table 3

Groups vulnerable to the effects of air pollution

FACTOR	VULNERABLE GROUP
Age	Children, who spend more time outdoors, are more physically active, inhale more air per kilogram of body weight, and whose developing lungs are more vulnerable to damage
Age	Seniors
Pre-existing disease or condition	Patients with asthma, COPD, cardiovascular disease, ASHD, CCF, or diabetes⁴⁹
Pre-existing disease or condition	Patients who are pregnant
Increased exposure	People exercising outdoors
Increased exposure	Outdoor workers

ASHD—arteriosclerotic heart disease, CCF—congestive cardiac failure, COPD—chronic obstructive pulmonary disease.

View popup

Table 4

The AQHI categories and messages

HEALTH RISK	AQHI CATEGORY	HEALTH MESSAGES
HEALTH RISK	AQHI CATEGORY	AT-RISK POPULATION^*	GENERAL POPULATION
Low	1 to 3	Enjoy your usual outdoor activities	Ideal air quality for outdoor activities
Moderate	4 to 6	Consider reducing or rescheduling strenuous outdoor activities if you are experiencing symptoms	No need to modify your usual outdoor activities unless you experience symptoms of coughing and throat irritation
High	7 to 10	Reduce or reschedule strenuous outdoor activities. Children and the elderly should also take it easy	Consider reducing or rescheduling strenuous outdoor activities if you experience symptoms of coughing and throat irritation
Very high	Above 10	Avoid strenuous outdoor activities. Children and the elderly should avoid outdoor physical exertion	Reduce or reschedule strenuous outdoor activities, especially if you experience symptoms of coughing and throat irritation

AQHI—Air Quality Health Index.
↵* People with heart or breathing problems are at greater risk. Follow your doctor’s usual advice about exercising and managing your condition.
Data from Environment Canada.⁵¹ This table is adapted from an official work published by the Government of Canada; this adaptation has not been produced in affiliation with or with the endorsement of the Government of Canada.

Additional Files

Tables

CFPlus Additional Information

This data supplement contains Figures 1-3 demonstrating use of the Air Quality Health Index.

Files in this Data Supplement:

Adobe PDF - AQHI_Figs1-3.pdf