Buffalo HealthCast
The official health equity podcast of the University at Buffalo’s School of Public Health and Health Professions.
Buffalo HealthCast
The Hidden Dangers of Air Quality- Emphysema in a changing climate
Welcome to Buffalo HealthCast, the official podcast of the University at Buffalo's School of Public Health and Health Professions 🎙️
In this insightful episode of Buffalo HealthCast, we sit down with Dr. Meng Wang, an environmental health scientist, to explore the hidden dangers lurking in the air we breathe and their impact on lung health. Dr. Wang reveals how baseline levels of pollutants like PM 2.5, ozone, nitrous oxide, and black carbon contribute to the progression of emphysema. As climate change fuels air pollution especially from sources like wildfire smoke.
Dr. Wang emphasizes the critical need for targeted policies to protect vulnerable populations. He also discusses accessible solutions, including DIY air purifiers, and highlights the importance of public education and awareness about air quality in our changing climate. Don't miss this vital discussion on the intersection of air pollution, health, and climate.
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Welcome to another episode of buffalo healthcast. I'm vennela damarla Podcast Producer, and today we have Dr Meng Wang, a leading expert in environmental health research. In this episode, we will be discussing Dr Wong's research, which focuses on impact of air pollution, particularly ozone, on lung health and the progression of emphysema. Whether you are a healthcare professional or interested in learning more about air pollution, this episode of valuable insights. Dr Wong, thank you so much for joining us today. So before we get into your interesting research. Can you tell us a little bit about your background and what motivated you to pursue this research? Yeah,
Dr. Meng Wang:sure, so. My name is meng Wang. I am an environmental health scientist. Most of my research focuses on for assessment of air pollution and also trying to understand how air pollution could cause adverse effect of human health. Well, I did modeling work, and has been involved in several large collaborative studies focusing on mostly focusing on respiratory and cardiovascular health. The motivation of me to involved in this study actually has been for a long time. So my background actually originally from atmospheric science, not related to health at all. So at that time, I'm curious about like the chemistry of atmosphere, and then realizing some gluttons are really toxic, making me feel like how this chemicals could affect human health. So that moves me towards the health field. So it's a learning process for me for several years, and then I try to involved in some large cohort studies in there. I can collaborate with some physicians there, environment epidemiologist there, so I can leverage my experience in atmospheric science, but also find linkage to epidemiology. So that is why nowadays my I can my focus is on air pollution related epidemiology. It's
Vennela Damarla:wonderful. Dr Wang, so let us start with some questions. How do you see in the section of climate change and air quality evolving, and what implication does this have for respiratory health in the future?
Dr. Meng Wang:Yeah, so this is very big topic. I would say that climate change is general term, which means that it can be related to many extreme weathers like increased temperature, right? And then increased temperature can cause extreme heat and cold storms and etc. And this climate factors can actually impact air quality. So one typical example is wildfire, because now you can see that when the temperature goes up, the drought goes up, then it's possible that burning is getting more frequent, right, especially when we see lots of wildfires happen in the West Coast of the United States as well as in the Canadian country. So this is definitely indirect impact of climate change on air quality and the problem of wildfire smoke is that in the US and Canada, government has making a long term effort to reduce air pollution by many policies. Right. Clean Air Act is very successful, but because of climate change and that wildfire could offsite the effort of Clean Air Act and talking to the future. So you know, the IPCC has developed many climate models globally to try to pre project how temperature or climate factors as well as air pollution, could change in the next 50 or 100 years later. And what they find is that the pollution level can go high if there's no ending control on human activity. 80 or like human emissions, right? So, but they also simulate like, if people can control the greenhouse gasses, which is the leading cause of increased temperature. So, if they can control the greenhouse the emission of greenhouse gasses in different levels, then it's possible that temperature will go down in many years, and also the clean air. We can still see it's all about the like interactions between human efforts and the climate.
Vennela Damarla:Thankyou. Dr Wong, and I would completely agree with you regarding the wildfire, and this is the topic that you've been teaching us in the class too. So yeah, moving on to the next question. Could you briefly elaborate on how prolonged exposure to air pollutants such as ozone pm 2.5 and nitrous oxide affects lung health and function.
Dr. Meng Wang:Yeah. So usually, when we talk about air pollution, we say that air pollution have two effect. One is called a shorthand effect. Another one is called long term effect. The shorthand effect, in fact, it's like when air pollution goes high very rapidly, like wildfire event, then people may get disease immediately, right? And that is really because people already have some pre existing disease. So we call it like a harvest of human but for long term effect air pollution, just because everyone breathes air, right? So it's kind of explored to take life long. Many studies have already find that. So if people persist the exposed to air pollution for many years, it's possible that the pollution could increase their risk from the beginning for the Healthy People, and then gradually increase their biological pathways and clinical symptoms and eventually increase the Disease and come back to the respiratory disease. Actually, you can see that air pollution usually enters our bodies through respiratory system, right through respiratory tract. Respiratory disease definitely is most directly impacted by air pollution in terms of the pollutant. Though we know that particulate matter, and also our most important one. Particulate Matter is important because they are so tiny that they can easily enter into our respiratory tract. The train here area is more like the connection between the lung and our circulation system. So once this, if the particles are more enough, it can enter into our circulation system. And of course, cardiovascular disease, that means that particulate matter not holding a factor with BFP disease, but also increased risk of cardiovascular disease back to Otto. So Autumn is the gas pollutant. So autumn is usually enters into our affecting our lung. But OM is very active pollutant. It's easily interact with other pollutant. So there's once Otto enters into our respiratory tract. It can cause lots of chemistry happen in our lung. So this chemistry may release a new pollutant and then increase the risk of our lung disease. So this is a basic understanding for now in terms of how, PM, 2.9 organ may cause respiratory disease.
Vennela Damarla:Well, I really appreciate how you have detailed everything. Dr Wong, so which pollutant do you think have a stronger association with lung disease progression compared to other pollutants?
Dr. Meng Wang:So I would say that I cannot make a judgment so far. So you can see that different studies have different findings. Some studies, they find that PM, 2.5 may be the most important one. Some define also, or some study defined WC or other pretense. So that's really depending on the population, study area and also monitoring technology, Explorer assessment, I would say particulate matter, fine particulate matter, or maybe the most important risk factor for respiratory disease so far. Up because there's many studies have shown this consistently show this results. Okay,
Vennela Damarla:so you have mentioned about the long term effects as well as the short term effects of air pollution. So how do you think the long term effects of cumulative exposure to air pollutants differ from the short term impacts of acute exposure on respiratory health?
Dr. Meng Wang:Yeah, that's a great question. Usually, if we think about shorthand exposure, we compare. So if we think about shorthand exposure, we compare whether the exposure on the day that has a high level of pollution, as more people get disease, compared to the day another day, next to the day before and after this day Where the concentration is low, lower number of people get delays. So that is comparison of understand the shorthand effect of air pollution. I would say that shorthand effect happens because air pollution, important air pollution events happen. So some days when pollution happens, high pollution level in certain days and another days it goes up. So in that way, when the concentration immediately gets high. So people who has disease already respiratory disease, for example, so they will not tolerant to that high level of pollution, and then it's possible that they may get immediate disease sequence. So one several typical examples would be like people who had a COPD, they may have severe symptoms, getting more severe recipients during the high level pollution days, and then this may cause them to go to the hospital immediately, or go to the or more severely, may cause people die. So all this happened at very short time period, but it usually affects the people who already have pre existing disease, or had a like low immune system, right? Or have some Alexa sample population, but long term, back to the long term exposure to air pollution and health. This is maybe different to mechanism. So long term exposure, we don't consider like extreme air pollution event. It's more like a average exporter over long term period. So it's like people always we compare people living in high pollution area to the people who live in low exposure location area, and follow them up and say, better they develop these disease so, because it's follow so long period, and people can be from air pollution And gradually increase their for example, their like biological response, for example, like without it, can increase the risk of inflammation, passive stress, and this inflammation, if it's keep going on the inflation and lead to certain subclinical diseases. So for example, their lung function may go down, their blood pressure may go up, right? And these are the like pre clinical, subclinical symptoms. So for respiratory disease, one typical example is emphysema. Emphysema is a structure change of their lung, so once it happened, it's not reversible, right? And and also for cardiovascular disease, we have a term called as those sclerosis, meaning that the plug build up in cables vessels, and when it gets more serious, the plot cannot be removed, right? Unless you take us surgery. So this is how air pollution can gradually affecting the development of disease.
Vennela Damarla:So do you think short term exposure to air pollution with the pre existing conditions can cause irreversible lung damage?
Dr. Meng Wang:It's possible. I would say that, like I said, when short term air pollution event happens. It can worsen the lung disease or lung structure in that way. I say it's possible to cause some in reversible disease, but not like long train exposure, because the very support disease.
Vennela Damarla:what were the most surprising findings regarding the association between the air pollution and lung health in your study?
Dr. Meng Wang:Let me first introduce the study a little bit. So this is a multi side study in United States. So United States, we select 680s and then each city recruit 1000 people, starting from 2000 and follow them up all the way until 2020, so it's like a 20 years follow up period. And during this period, people will take CT scans apart about every four or five years and also take lung function test at the same time. So it's like a repeat measurement over time. The good thing of this study this size, like it's longitudinal follow up study with repeat measurement, so you can really track the progression of lung disease over time. So using CT scan, it can use physiological technology, quantify the area where the lung has abnormal change, have normal change, can be converted to this decide whether or severe the Emma sigma symptom is. So the larger area the abnormal area is, then the most Emma sigma is we expect. So in this case, we can see that the whole the emphysema progress over time and in the meantime. So the group I working with at University of Washington, we developed high resolution air pollution model. High Resolution means that it can predict air pollution bi weekly, and also at every single location of the participants. So each participant will assign unique Data Explorer value to them, so we can really track their air pollution data longitudinally for these participants as well. So both explorer and outcomes are longitudinal data, so we can link them together to see okay whether people living or exposed to high level of air pollution in this area also has faster progression of emphysema over these 20 years and yeah. So we focus on several key proteins. One is PM, 2.5 or five particulate matter. Second one is an o2, oxides of nitrogen, which is indicator of traffic emission. Third one is autumn, which is a secondary pollutant, very important to respiratory disease, and the last one is black carbon. So surprisingly, we actually find that all these pollutants at baseline are associated with faster progression of eczema over time. So baseline explorer means that the Explorer level assigned to the time as a time when people are recruited in 2000 so what it means is that at the time, if people exposed to high levels of game, 2.5 or ozone, for example, at the beginning, in early years, when they recruit this impact could be lifelong, already impacted their progression over time. So this is important, because you know that air pollution goes down right? So this means that people, like older people, may not really get benefit from really get benefit from clean air at the beginning, so at that time, the the bad air and already trigger their respiratory disease. Well,
Vennela Damarla:your study also tells that while concentration of particulate matter 2.5 and oxides of nitrogen decreased during the study, but ozone levels remain a concern. So what factors do you think that contribute to the increased level of ground level ozone?
Dr. Meng Wang:Yeah, so this, this is good question, and also complicated story. This is back. We'll be back to talk a little bit background about atmospheric chemistry. So you know, for fine particulate matter, I would just say at least a half of the particular PM, 2.5 man made sources like. Our vehicle emissions, our industry emissions, cooking, all generated particles. But autumn is different. Autumn is a secondary pollutant, which means that their product formation of autumn is not dependent on the lack of a man made emission. It's based on the chemistry. It's a product of primary pollutants like pm, 2.5 oxides of nitrogen, this pollutant. So if the Clean Air Act, basically the at the beginning is to control memory sources. But if you control memory sources, you control the emissions from pollutant generated from memory sources such as oxygenator such as oxides of nitrogen, but you cannot control OSM because ozone is not directly needed by the any of these manmade sources actually back to the chemistry. So autumn formation is very complicated, but in some circumstances, lower level of oxides of nitrogen and increase the level of autumn. So that's why control also. It's very challenging so far, even though in the US there's many policies to control autumn, but it's very difficult. You can imagine, like during the COVID pandemic, there's many industries. There are many people do not come out, so they do not drive and we have significant reduction of traffic emission, they will get better, much better air quality in terms of PMG on the fire size, nitrogen. On the other hand, we have a worsened ozone situation during this period. So it's complicated story back in in terms of chemistry and when link this flu trend to health effect, then that could be different mechanism as well. Yes,
Vennela Damarla:so despite the alarming findings, what gives you the hope for improving the lung health outcomes in the context of raising air pollution levels,
Dr. Meng Wang:I would say that overall air pollution, air quality is getting better overall, but we do see that it's unevenly distributed or anchored, disproportionately affecting different people, especially some like low income communities, they are historically exposed to close to industry or like those two traffic area, so their pollution level may not really receive the adequate benefit from the Clean Air Act. So in that way, their air pollution level may not really goes down that rapidly, and their health effect may be of concern now in the United States, and back to the what we can do to improve lung health. So I think there are two aspects we need to think about. One is the policy this level of policy makers, they may the policy should focus more on this, like vulnerable population, underserved community, this population, not focus on everyone, like previously in the act. It's like overall entire country, but now it should be more specifically focused on underserved community to reduce their level of solution. So we can see that many sponsors like the EPA and I actually invest the money to find to help communities to improve their resilience to air pollution. One thing they can do is that have education to people, because people in there, they may not well educated, knowing how to if air pollution event happens, what we should do, right? So like normally, if wildfire comes, then people will receive alert. They will have access to internet, watch TV, and then they know that, okay, next day, the model will have wildfires that we need to do something. But for low income communities, they may not know this they may not have access to know this knowledge. So in that way, the government should have some policies to help them increase their alert to this event, helping them, giving them resource to get access to this alert. On the other hand. I think the prevention could be at an individual level. Air pre fire has many studies have evidence that air pre fire can reduce air pollution, especially particulate matter, very effectively. But the problem is that this technology only be applied quite a lot of high income communities, but for low income communities, people may not afford this air purifier, but luckily, now there are some studies trying to build up like the DIY air pre fires. It's very simple. You just use the future air filter, built up a box and then attach a box fan. This could be a very simple air purifier, but more efficient than commercial one, and it cost like 1/3 or half price of the commercial air purifier. This is a very good example may be possibly used to increase people's health in terms of recipient days.
Vennela Damarla:Yeah, so DIY, air purifier, this is something new that I've learned today. Dr Wong, so the population such as, have low income communities and the population living near industries. How do you protect this population from air pollution? What can be done,
Dr. Meng Wang:like I said, this effort that should be done by both policy makers and individual like community residents. So now we have some studies find we have some connections with the buffalo African American community, and we know that they are living close to many of the communities are close to major road or too close to highway. So what we are hoping to do is that, first to increase their education level, like holding some event to the community, and to introduce, like, given a background about air pollution, what is so in that way, when air pollution event comes, they can know about this. And also, another way to do is like people. The problem for people is that they don't know their explorer level, what the exposure level is. So our pilot study is doing now is to give them the low sub cost sensor and monitor. The local sensor monitor is cheap, like a 30 to 50 bucks, but it can visualize the readings of levels of evolution as well as the color to indicate like green, yellow, red to indicate whether they should be concerning about their indoor air quality. So in that way, we hope that this will help the community people to get early alert of their indoor air quality problem, and we also try to use, like I mentioned, a DIY air purifier to see how effective it is to improve their health. And what's normal, I think now in this study, is that we notice that the sample population, for example, we typically focus on elderly participants. Elder participants, they they may have, like a decline memory, so they may not really know that. Okay, I should check the air sensor readings and when should I turn it on? When should I turn it off? There's really a lot of burden on them, so what we do is that we do it like a smart control system. We can use the air sensor to determine when we can switch on, switch off, their blog, and the plug will connect to the beautiful air purifier. So everything could be automatic, so we can set up a safety level to them. Once the level is above the safety level, then automatically turn on the air purifier. So in that way, we hope that this can help people, especially older people, or the self population, improving their health.
Vennela Damarla:Well, moving on to the next question, so how effective would be the Clean Air Act? You think the Clean Air Act would help people to protect from the air pollution with pre existing. Conditions, respiratory conditions, older individual and people from low socio economic status, yes,
Dr. Meng Wang:so I want to say that the original design of Clean Air Act is trying to reduce the overall emission of air pollution. That's including the traffic industry, everything this, because there's many policies behind it trying to reduce the manmade emission so the fusion level goes down rapidly, I would say over the past 30 years. Yeah, so like 30 years ago, the pm treatment level could be about over 50 microgram per cubic meter. Now it's below 10. So it's a remarkable achievement to the air pollution. So definitely I believe that because air pollution goes down so much, so much so there's a huge benefit on respiratory health. And actually some studies already evident your evidence. For example, one study conducted in California works on children's health. So recruited school children in elementary school and in seven sites, and then they follow them up for multiple years, and they check whether reduced air pollution is associated with better lung function, increase the lung function. And they did find a significant association, and that's very encouraging and clear evidence supporting that a clean air effect is very effective, but back to like the benefit applied to everyone, but not equally applied to everyone. So some places may have, for example, far away from the sources, may have less issue, but other resources, lots of communities near industry and that, so they also need to consider about the economics. So in that way, there's always fight between industry and the local community, the main the industry may not want to reduce their emission a lot, but community people concerned about it. So this about environmental justice issue remains, still remains in the United States, and that's also one of the most important topic. Now, okay,
Vennela Damarla:so what do you think are the biggest misconceptions about the effects of air pollution and health and how can we educate the public?
Dr. Meng Wang:But what I can say, one thing probably people may overlook or negligible is that? So in some areas where air pollution is low, people may feel that they are pretty safe. There's no problem. Air pollution has no effect on them at all, that they don't care about air pollution at all. I think on one hand, it's good that air pollution is air quality is good. They may have other environmental issue that they can they should be careful. But on another hand, current studies, they did not find, suggest that there's a safe threshold of air quality, of air pollution health. It means that even air pollution level is very low, there's a still adverse effect on human health. We cannot say that. Okay, air pollution below five microgram per kilometer, you don't need to care about it. There's no impact on you. Even it's lower, still have impact. It's like pathogenic compounds. You know that's constant. Genetic compound may cause cancer no matter how low the level is, and always cause cancer. Have agreed, can always increase the risk of cancer. Thing for air pollutant, we cannot say that, okay, areas are pretty air quality are pretty good, and then people don't need to care about it. So I think that's something we need to educate people that air pollution should always be care about, even though you are in a clean air location,
Vennela Damarla:yes. Doctor Wong noted, like you said, even the air pollution is lower, it can have an impact in a long run, yeah. So in your view, how significant is the role of ambient air pollution as a risk? Factor for chronic lung diseases compared to other known risk factors, such as smoking or occupational hazards.
Dr. Meng Wang:Yeah, so I would say that that's depending on what's the level of population you mentioned about. So if we talk about individual level, like for single people, maybe many other factors. Smoking may be very important risk factor for these people. And if people have poor dare to have it, they may there may be a big problem. But when we talk about population level, meaning that including all the people, putting all the people together, and put and then we reckon the risk based on differential risk factors, then air pollution would be top leading factors. So the long set general, you know loan set is like the top medical general, set general release, the top rank the risk factors that cause people dying every two or three years. And if you read the long set general, you will see that the ranking of air pollution, typically, PMG point goes up year by year. So like five years ago when I read the long set general five Part Two, the matter already ranked as number five of risk factor that may cause people time. The reason is that, or I would say that opposite is the risk factors are smoking, like blood high blood pressure, so all these traditional risk factors. The reason why air pollution because so many people die, but its level is actually low. The reason is really because all the people are exposed to air pollution compared to a few people mode. So because everyone are exposed to air pollution, potentially, the number of people get disease could be substantial. If you sum up these people who get disease as number could be really huge. And also then, if you look at the ranking in the most recent year, actually, image open the file is now top one or top two. So it's now the top of top of the top is the ranking of this risk factors. So the reason for it, in my understanding, is that many of the traditional risk factors has better control because people know how to do it, and it's very effective now, adding more effective now, and we have, like, a smoking control policy, and we have a better health care so in that way, traditional risk factors has been controlled, and the people get this disease because of the stresses factor. But now for air pollution, even though air pollution level goes down, also in many developed countries, I would say, not all the countries, but the population size going up, so it's offset the benefit of air pollution. So eventually the number of people die because of air pollution has been the ranking go up. Okay, so I hope I explained this clear.
Vennela Damarla:Yes, doctor Wong, you, you have explained it very clearly. You have mentioned that PM, 2.5 is the leading air pollutant right now. So are there any measures taken to control a PM, 2.5 air pollutant,
Dr. Meng Wang:yes, so PM, 2.5 is not like a new star. It's like an old friend for us for many years. So I would say that probably 1980s so there's the first study called the Harper six city study. That study, they identified that the five particulate matter is strongly associated with mortality in a cohort study. From there, people know that particulate matter is um. Important risk factor. And from then on, many studies prove this concept. And then EPA realized this problem. So for the Clean Air Act, controlling PM, 2.05 is one of the major task. So I would say that in the United States control. PM, 2.5 this effort keep going on for many years. There's lots of policies at like federal level, state level and country level, community level, individual level to control the pm 2.54
Vennela Damarla:it's really awful to know that pm 2.5 is increasing mortality rate. And it's also good to know that there have been a lot of measures and efforts by the government and then acts and policies to control this. So despite the challenges presented by the air pollution, what gives you hope for the future of lung health and public policy?
Dr. Meng Wang:Yeah, I would say that the current policies are still effective in reducing em 3.5 so now you know that the standard, the pm 2.5 standard, by EPA, become more rigorous every 10 years. So every 10 years, then EPA will re evaluate their policy, the standard, pm 2.5 standard, whether it's adequately protected human health. So very recently, I think this year, EPA updated uscpa updated the pm 2.5 standard, saying that the annual average level of pm 2.5 should be below nine micrograms per cubic meter. Previously the level is 12 microgram per cubic meter. So this is drop. And given that the level is already low, and they still want to reduce this level, so you can see that it's it's like reduce the pollution by 25% it's a very ambitious policy, and I think this policy will making sure that improving Air Quality will still be beneficial to our respiratory health, cardiovascular health, human health. Well, on the other hand, I think even though, in addition to the policy, the classic or traditional policy, like traditional source of air pollution, we may think more about controlling new source of pollution. Like I mentioned, how we can control climate change. We can slow down the climate global warming this step, just like I said, climate change have indirect impact on air quality. So for example, now government has some policies other than carbon neutralization. It's basically to reduce the carbon consumption, and in that way, the emission of greenhouse gasses will be controlled and the temperature, hopefully the temperature will be flattened out or go down in the future, and then in that way, solution level goes down, in the same case of the greenhouse gasses. So that's another angle I think should be care about myself, air pollution control and the beneficial to respiratory disease.
Vennela Damarla:Thank you, Doctor Wong for providing a great summary. So what final advice would you give to our listeners about protecting their families from air pollution?
Dr. Meng Wang:Yeah, so for families, I think I would suggest that everyone should know some basic about air quality. First, we should know that everyone are exposed to air pollution. So if there are many resources, actually, the researchers, government are making effort to provide many resources to community residents, helping them to understand what's the level it is. I can come up some resources, hopefully can be helpful. So one is that uscp have website. It showing the level of air pollution based on their air monitoring stations there, and when you train station will join visualize the level of pollution. For example, in New York State, the US, nysdc, they have a website, and they keep updating the level of air pollution hourly. So this could be a resource to look at, okay, whether your residential location is safe or not. Another resource is that, like the US, CDC and EPA, they develop some map for the environmental justice map or social vulnerability index map. So what this map is useful is that it gives you every single community some the information about what's the leading environmental risks are in this community, because not all the communities have the same environmental problem. Some community may have problem of noise. Explore. Some of them may have like air pollution. Some of them may have like the waste water, for example. So this map will giving you a sense about what's the problem in your environmental problem in your community. This will help people to understand this. And another one, I would suggest, is that if people identify that air pollution is a problem, or you're concerning about air pollution problem, the easiest way is to use air purifier. It's very effective to remove air pollution. And also, there's now several community organizations invest they are helping residents to solve the environmental problems. So there are many approaches hopefully can help the family to first know their risk of air pollution, Second, take actions to prevent air pollution. So
Vennela Damarla:are there any final concluding thoughts you would want to share with us? Dr Wong,
Dr. Meng Wang:well, I would say that air pollution is always a problem, but the problem of air pollution as angle has been shifting from traditional industrial control towards Eco community problem of air pollution, then not towards climate change, impact on air pollution and the human health. So it's like, keep going on story, and we are making effort to understand the problem, helping people to solve their problem and hopefully to improve their health.
Vennela Damarla:Thank you so much. Dr Wong, it's been really an insightful session. Stay tuned for another episode on buffalo healthcast. Thank you.