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Health Effects of Air Pollution in Canada: Expert Panel Findings for the Canadian Smog Advisory Program

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Health Effects of Air Pollution in Canada: Expert Panel Findings for the Canadian Smog Advisory Program REVIEW Health effects of air pollution in Canada: Expert panel findings for The Canadian Smog Advisory Program DAVID M STIEB*t MD MSc CCFP FRCPC, L DAVID PENGELLYt+ PhD, N INA ARRON* BScPHN MHA, S MARTIN T AYLORt§ PhD, MARK E RAIZENNE* BSc *A ir Quality Health Effects Research Section, Health Canada, Ottawa, tJnstitute of Environment and Health. McMaster University and University of Toronto, +Departments of Medicine and Engineering Physics, McMaster University, Hamilton, §Department of Geography, McMaster University, Hamilton. Ontario OM STIEU, LO PE GE LLY, N ARRON , SM TAYLOR, ME its among indi viduals with heart or lung disease. rcducL'ci R AIZF.N E. Health effects of air pollution in Canada: exercise capaL·ity, increased hospital admissions and possi­ Expert panel findings for The Canadian Smog Advisory ble increased mortality. Similar effects were felt to occur in Program. Can Respir J 1995;2(3): 155-1 60. association with airborne particlL·s. with the l'xccption of inflammatory changes, and with the addition or increaseJ O n.J ECTIVE: To revit:w the evidrnce on health effects of air school absenteeism. Poor data 011 individual exposure were pollution for the Canadian Smog Advisory Program. identified as a limitation of studi..:s on hospital admi.,.,ions METHODS : Evide nce w;1s reviewed by two expert pane ls. and mortality. who were asked to define the health effects expected at RECOMMENDATIONS: The panels identified the need to levels o f exposure given by the National Ambient Air Qual­ reflect the evidence accurately without unduly r;1i .,i11g pub­ ity Objectives. to examine a variety or issue., re lated to lic concern and r..:commended that advisory health mes­ communicating with the public about environmental health sages identify expected health elkcts. while health care risks. and to draft health messages for the advisory program. providers could more appropriately recommend protective R ESU LTS : The panels concluded that health effects or actions to individuals. Supple mentary educational strat..:­ ground-level 01011..: at k'vcls that occur in Canada include gies and evaluation of the advi.,ory program were also pulmonary inflammation. pu lmon;iry fu11c1 ion decrements. recommended. (Po11r I<' rc;_1-u,11 c. rnir 11ag<' [56) airway hypcrreactivity. rc.,piratory .,y mptoms, pos.,iblc in­ neas..:d medication u.,c and physician/cmngency room vi.,- Key Words: i\cfrisorics. ;\ir 1>01!111io11. ( !:one. S111og CorrnJJ011dc11ff 111/d n·11ri111s: /),- /)m·i,I M S1ieh. Air Q1w/11y I /ni/1/1 E/fi'ct., Nc.11 ·an"/1 Scctio11. Hcalrh Cu11ad11. 1111.,10/ lorn/or ()8()3 (', 0 {111111('_1' .I' Pasture. 01tmra. c)111urio KI i\ IIL2 _ lc!t·11//om' 6/ 3-957-3 132. Fax r,J .i-9-1 I -45-16. c-11wil duff .,ricf,_ut _11 c1112()2@ isdrc1i3./1\\'C.cu '/'he rini-s e.,prcsscd i111/1is f'UJll-r arc rho.,c o(rhc 11wl1ors llllli dn 11nt necessarily rcprcscnr w1 o/jici11/ 11osiriu11 ,,(/lca/t/i Ca11w/11 C. 111nt Pw1cl ji1r rlic Cauwlian S///og Adri.wrr Program. Chuir: L 0(/\·id Pcngclly Plin. Ocpar1111rnts of J\.frdici11,· 11 11d D1gi11ari11g Phrsics. McMastcr Uni,·cr.,itr. l'a11c/ 111l'lllil/'rs: /Jarid V Butes lWD FRCP FRCPC FA CP FR.SC. Ol'f>urt1111·11r o( //ca/t// Cure u11rl £1iidc111io /o gr. Unirl'l'sitr 0(/Jriris/1 c,,J,1111/,iu; Afork Fra1111i1011 MD. D1part111c11t., of Medicine u11d Lm·ir,111111c11t,il Ml'dici11c. l/11i\'!'r.1i1_1· of Roc/1csrer: Teresa M MtGrurl, MO. ( >111urio Mi11istn· o)Lahow: Andre1v D O.r111a11 MD MSc FRCl'C. De11ar1mc11r., of'Cli11irnl [11ide111io/ogr and Biostati.l'tic.l' and 1-'wnilr Mcdici11e. McMastcr U11i\'nsity : Mar/.: E Rai:c1111c /!Sc. /1.ir Quality /Im/ti, Ejfcct.l' R,·.1,·un/1 Section . Hcaltlr Cwwda: Lo11 S!in1/i·ld M,-\ PCng. Tl,c Mf:'P Co111pa11_r: Frances Sih·ernw11 fir!). 0 ,•11urtmc11t o(Medicinc. U11i1 'ffsit_r of Torn11tn: Peter W S11111111r.:r.1 !'Iii). ;\ir Qualirr Rc.1('(/rc/i /Jra11cli. Enrim111111·111 Ca11ada: S Murrin Tur/or P/1/). nc1ium11m1 of(;,,ogm11l1_1'­ McM11stcr l/11ircr.,i1r: Sl'r'IT(' Vn lul MU MS,·. Oc/)(Jr//11e 11t of'Medicinc. U11i1·c rsit_1· o/'Britisli Co/1111i/1iu Can Resp1r J Vol 2 No 3 Fall 1995 155 STIEB ET AL Effets sur la sante de la pollution atmospheri­ de !'utilisati on des medic ament s ct des consultations ti l'urgence nu chcz le medecin parmi !cs individus soufl'rant d'une affection que au Canada : Resultats rapportes par un pulmonairc ou cardiaquc. unc tolerance rcduitc a r·cxcrcicc. unc groupe d'experts pour le Programme ca­ augrnenlation des hospitalisations ct augmentation possible de la mortalitc. On pense quc des clTcts sirn ilaircs sc produisent en nadien d'avertissement de smog association avec !cs particulcs aerogcncs. f1 l'exl'cption des changemcnts inllammatoircs, ct en y ajoutanl une augmcntation de 0BJECTIF : Passer en revue !es prcu ves des eflets sur la sante de l'abscnrcismc scolaire. Des donnccs in suflisantcs sur !'exposition la pollution atmospheriqm· puur le Programme canadien d\1verti,;­ individue ll e ant etc iclcnti fiecs comme unc limita tion des etudcs sement de smog. sur lcs hospitalisations et la mortalitc. METHODES : Les preuvcs ont etc examinees par dcux groupcs RF.COMMANOATIONS : Les experts ont idcntilil' le bcsoin de d'experts a qui !'on a demandc de dctennincr Ies cffcts attendus rclleter correctcmcnt lcs preuvcs sans trop sou lever d'inquietudes sur la santc [1 des nive;iux d'exposition fournis par !es objectifs dans la population et ont recommandc quc !cs mcssagcs-sante nationaux afferents f1 la qualite de ['air ambianr, d'cxamincr unc icl entifient lcs e !Tcts attcndus sur la santc. pendant quc !cs varietc de questions ayant trait al 'ini"ormation de la population sur pourvoycurs des soins de santc pourraicnt plus adcqualcmcnt !cs risques environncmentaux pour la sante, et d'cbaucher des recommancler des comportemcnts protcctcurs aux indiviclus. messages sanitai res pour le Programme cl 'averti ssement. Des strategies cducatives supplcmcntaircs ct unc evaluation du RESULTATS : Les groupes d 'experts ant conclu que lcs effets Programme d'avcrtisscmcnt ont aussi cte rccommandccs. sur la sante de !'ozone au ras du sol 11 des niveaux detcctes au Canada comprennent notammcnt l'int1ammation pulmonaire, la deterioration de la fonction pulmonairc, l'hyperreactivite bron­ Po11r nhtcnir la rcr.1·ion.fi·an(·aise i1111igra!e cl<' <"<'I article. nm111111- chiqlll·. de,, .,yrnptflmes respiratoircs. une augmentation possible 11i<111 ec m •ec f" all/Cur {/ f" adreSSC i11tfi</II ('(' . HE TERM "SMOG" IIAS BEEN US ED IN NORT H AMERICA served ground-level ozone concentrations in a number or T to describe a characteris tic form or air pollution that regions, its impacr is particularly apparent in Atlantic Can­ generally occurs from late spring to early fall. Smog was ada. where peak concentrations may occur at night. In most recogni zed as a Canadian pollution issue in the federal other areas, peaks occur during the late afternoon and early 'Green Plan' in 1990, and in 1993 Environment Canada evening in the summer months. In Canada, the current Na­ introduced the Canadian Smog Advisory Program. This re­ tional Ambient Air Quality Objective for ground-level ozone port presents background infonnation on air pollution in (I h maximum of 82 parts per bil lion ippbl - maximum Canada and summarizes the findings of an expert panel acceptable concentration) is exceeded most often in southern process undertaken in support of the Canadian Smog Advi­ Ontario. southern Quebec, Vancouver and southern New sory Program. It is a condensed and modified version of the Brunswick (5) (Figure I). original report on the panel process (I). Its purpose is to Airborne particles are very smal l pieces of solid or liquid provide clinicians and public health workers with the infor­ matter, which vary in si ze, chemical composition and sou1n·. mation needed to respond appropriately to questions or con­ Smaller particles. which have the greatest health signifi­ cerns of patients and members of the public that may he cance, tend to arise from man-made sources, particularly fuel triggered by snro.!! advisories. combustion, and include acid aerosols such as sulphates and nitrates, as well as metal oxides (6). Larger particles consist BACKGROUND mainly of naturally occurri ng substances. particularly soil Although air 4uality in Canada has generally improved (6). Particles less than IO ~1111 in diameter (PM 10) are consid­ over the past 15 years, smog episodes still Ol'cur. These ered 'inhalable' (7). The current National Ambient Air Qual­ episodes. which are primarily a summer phenomenon. con­ ity Objective for total suspended particles (TSP - airborne sist principally of elevated concentrations of ground-level particles of all sizes) is 120 µg/111 3 for 24 h concentration. ozone. although al'icl aerosols (a type of airborne particle) which is still exceeded at least I 0% of the time in some cities may also be present (2). A different form or smog, 'winter across Canada (5). The current US standard fo r PM 10 is 150 smog ' , may also lll'l'ur, whose principal constituents are µg/rn 3 for 24 h concentration. Recent data reveal 24 h con­ sulphur dioxide and airborne particles (inl'luding acid aero­ centrations that exceed I 00 µg/m3 in a number of Canadian sols) (2). G round-lewl owne and airbornL· particles were the cities (8). Health Canada is currently developing a Canadian focus of the panel process. PM 10 objective. Ground-lcwl ('tropospheric') ozone. which should be dis­ The Smog Advisory Program was introduced in the sum­ tinguished from stratosphcriL· o;:one ('the ozone layer').
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