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Evidence Submitted to the Royal College of Physicians Working Party on the Lifelong Impact of Air Pollution

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Evidence Submitted to the Royal College of Physicians Working Party on the Lifelong Impact of Air Pollution Evidence submitted to the Royal College of Physicians working party on the lifelong impact of air pollution February 2016 Audit report title © Royal College of Physicians 2016 1 Overview – organisations that submitted evidence 1 Blizard Institute 2 British Heart Foundation 3 Cancer Research UK 4 Client Earth 5 Improvement Academy, Bradford 6 Global Action Plan (GAP) 7 Greater London Authority 8 Royal College of Obstetricians and Gynaecologists 9 Royal College of Physicians of Edinburgh 10 Sustrans 11 UK Health Forum 1 Blizard Institute Submitted evidence: • Changing personal exposure to air pollution within a city – PowerPoint • Changing personal exposure to air pollution within a city – abstract Changing Personal Exposure to Air Pollution Within a City Y. Ma, K. Miu, A. Whitehouse, N. Mushtaq, J. Grigg Centre for Genomics and Child Health, Blizard Institute, Barts and the London School of Medicine and Dentistry Black carbon There is currently no Results data on how much of Mean exposure to Black Carbon . Main constituent of inhalable a reduction in Each student did 11 walks over 60 days. Mean exposure to BC walking on a side road (N=11 trips) was 11974 ± fossil fuel-derived particulate Start personal exposure to 3741 ng per m3/min as compared to the main road of 38415 ± 35301 ng per m3/min. p=0.0226). matter (<10μm in aerodynamic carbon black can be diameter) (PM10) achieved by 4500 4500 . Taken up by airway choosing to regularly 4000 4000 macrophages (AMs) 3500 3500 move through cities . Inverse relationship between via routes with lower 3000 3000 Figure 1: Airway macrophages (AMs) imaged amount of AM black carbon and levels of locally 2500 2500 lung function1 and mortality2 under light microscopy. The black areas on the cytoplasm show uptake of black carbon by the generated pollutants. 2000 2000 AMs. Figure taken from Nwokoro, C., et al. 1500 1500 (2012). 1000 1000 Main 500 500 Black Carbon Methodology 0 0 Road 12:05:00 12:10:00 12:15:00 12:20:00 12:25:00 12:30:00 12:45:00 12:50:00 12:55:00 13:00:00 13:05:00 13:10:00 13:15:00 rd . Two 3 year medical students were selected to complete a pre-determined route in London Time Time Figure 6: Amount of Black Carbon exposure Figure 7: Amount of Black Carbon exposure Student Y: Main road (Figure 2) Student K: Side road (Figure 3) along the side road measured by the along the main road measured by the aetholometer on 13/08/14 aetholometer on 13/08/14 Macrophage black carbon Side Main road student: increased from 0.27 to 0.39 μm2 Side road student: decreased from 0.37 to 0.30 μm2 Conclusion Road We have shown that a simple intervention in changing your route can significantly affect personal pollution exposure and this is Figure 2: Main road route for Student Y with a total walking Figure 3: Side road route for Student K with a total walking reflected in the macrophage black carbon levels. distance of 2.98km and a total walking time of approximately distance of 3.06km and a total walking time of 44 minutes. Figure taken from Google Maps. approximately 46 minutes. Figure taken from Google Maps. We speculate that macrophage black carbon is a useful marker when assessing personalised Routes were completed by both students on the same day, within 2 hours of each other interventions to improve negative health effects Both routes have similar distance, time taken to complete and weather conditions of pollution levels and that interventions to Progress was tracked by using MapMyTracks application on a smartphone reduce peak PM exposure can be effective on an individual level. Monitoring short-term Black Carbon exposure Both subjects were given a pocket-sized portable aethalometer (Magee Scientific AE51) Figure 4: AE-51 Aethalometer – to monitor personal exposure to BC during the walks world’s first real time, portable Black Carbon aerosol monitor. The measurement accuracy is of +/- 0.1 Airway Macrophage Carbon count μg Eq.C/m3 at 150 ml/min. Figure References AM samples were collected using sputum induction, processed and placed on slides 1. Gauderman WJ, Avol E, Gilliland F, Vora H, Thomas D, Berhane K, et al. The effect of air pollution on lung development from 10 to 18 years of age. N Engl J Med. taken from Ecomesure (2015). 2 2004;351(11):1057-67. which were analysed for AM carbon by measuring the area of BC (μm ) within the AMs 2. Brunekreef B, Beelen R, Hoek G, Schouten L, Bausch-Goldbohm S, Fischer P, et al. Effects of long-term exposure to traffic-related air pollution on respiratory and cardiovascular mortality in the Netherlands: the NLCS-AIR study. Res Rep Health Eff Inst. 2009(139):5-71; discussion 3-89. Images Figure 1: Nwokoro C, Ewin C, Harrison C, Ibrahim M, Dundas I, Dickson I, et al. Cycling to work in London and inhaled dose of black carbon. Eur Respir J. 2012;40(5):1091-7. Figures 2 and 3: GoogleMaps. Google Maps: Google; [cited 2015 27/02]. Available from: https://www.google.co.uk/maps. Figure 4: Ecomesure. AE-51 Aethalometer http://www.ecomesure.com: Ecomesure; 2015 [cited 2015 27/02]. Available from: http://www.ecomesure.com/en/product/ae-51- aethalometer. End Changing personal exposure to air pollution within a city Kelvin Miu, Yunshu Ma, Abigail Whitehouse, Naseem Mushtaq, Jonathan Grigg Background: There is currently no data on how much of a reduction in personal exposure to carbon black can be achieved by choosing to regularly move through cities via routes with lower levels of locally generated pollutants. We sought to assess the effect of 2 regular routes to work (high and low) on airway macrophage black carbon – a marker of long term exposure to inhaled fossil-fuel derived particulate matter (PM). Methods: Two medical students were recruited living at the same address. One of the students walked on the route along the main road while the other walked on the route along the side road over a 12 week period. Personal exposure was assessed by repeated 24 h person black carbon. Internal black carbon was assessed by sputum induction and expressed as µm2. Results: Each student did 11 walks over 60 days. Mean exposure to BC walking on a side road (N=11 trips) was 11974 +/- 3741 ng per m3/min vs 38415 +/- 35301 ng per m3/min. p=0.0226). Macrophage black carbon increased from 0.27 to 0.39 μm2 in the student walking on the main road and decreased from 0.37 to 0.30 in the student walking on the side road. There was no associated change in lung function. There was no difference in the mean time taken to walk the routes (35.27 minutes vs 35 minutes) Particulate Matter Exposure * 150000 100000 50000 ng per m3/min 0 Side Road Main Road Route Conclusions: We have shown that a simple intervention in changing your route to and from work can impact on your pollution exposure and this is demonstrated in the macrophage black carbon levels. Personal monitoring is therefore an innovative way to create personalized interventions to improve the impact of pollution on health. 1. Nwokoro, C., et al., Cycling to work in London and inhaled dose of black carbon. Eur Respir J, 2012. 40(5): p. 1091-7. 2. Nwokoro, C., R. Brugha, and J. Grigg, Alveolar macrophages carbon load: a marker of exposure? Eur Respir J, 2013. 41(3): p. 763. 2 British Heart Foundation Submitted evidence: • RCP air pollution and health: response from the BHF • Articles highlighted by BHF-funded researchers Response from the British Heart Foundation December 2014 The British Heart Foundation (BHF) is the nation's leading heart charity. We are working to achieve our vision of a world in which people do not die prematurely or suffer from cardiovascular disease. In the fight for every heartbeat we fund ground breaking medical research, provide support and care to people living with cardiovascular disease and advocate for improvement in care and services. Research shows that air pollution can make existing heart conditions worse and cause cardiovascular events in vulnerable groups. Recent studies have linked air pollution to both increased incidence of heart attacks and an increased rate of hospitalisation of those living with heart failure. There are 2.3 million people in the UK living with coronary heart disease1 and 7 million living with cardiovascular disease.2 Given this large number and the likelihood of their exposure to air pollution, principally from diesel vehicles, therefore the BHF consider this to be a salient issue that must be improved to best support heart patients and the wider UK public. The BHF is therefore calling for the UK Government to reduce the UK‟s air pollution in as shortest time as possible, with the end goal of meeting the World Health Organization‟s lower thresholds for emissions. Since 2010 the BHF has provided £3.2 million for medical research that will help us better understand the link between air pollution and cardiovascular disease and joined the Healthy Air Campaign in the summer of 2013. Please find below the BHF‟s policy statement on air pollution which considers the evidence base regarding exposure to air pollution and cardiovascular disease, our advice to heart patients and our policy calls. 1 CHD GP Register, Quality and Outcomes Framework (4 nations, 2012/13) 2 BHF estimate based on latest UK Health Surveys containing CVD fieldwork (2011/12) Research shows that air pollution can make existing heart conditions worse and cause cardiovascular events in vulnerable groups.
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