Health Effects of Haze (and How You Can Protect Yourself)

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Learn the health impact of haze and what you can do to protect you and your loved ones Haze is an atmospheric condition where particles, smoke, dust and moisture suspend in the air obscuring visibility. Sources of haze include emissions from power plants, industrial activities, traffic as well as farming practices. Forest fires in countries like the US, Australia and Europe during the hot and dry summer season are also a source of haze. In Southeast Asia, haze poses a serious and recurring problem every year, particularly between May to October, due to the burning of forests in some countries to clear land.

How Haze Can Affect Your Health

In the 1997 Southeast Asian haze which affected a number of countries in the region, an increase in air pollutants from 50 to 150 g/m3 is significantly associated with increases of 12% of upper respiratory tract illness, 19% asthma and 26% nasal inflammation (1). 1

Depending on how sensitive you are, the severity of the haze and the time of exposure, you may experience the following short-term adverse effects:

Irritated eyes, watering eyes, and/or conjunctivitis (a type of eye inflammation) Running nose, stuffy nose, sneezing, and/or post-nasal drip Throat irritation, dry throat, sore throat and/or coughing Headache, dizziness, fatigue and/or stress Decreased lung function, depressed respiratory immune defenses, chest pain, and/or bronchitis (lung inflammation)

These symptoms are usually mild and will subside when you stay indoor and limit your exposure to haze. However, in susceptible individuals and those suffering from chronic disease, especially respiratory and heart disease (e.g. coronary artery disease, asthma and chronic obstructive pulmonary disease), their condition may be worsened by haze. They are more likely to experience more severe haze-related effects than healthy people. Long-term effects As much as 94% of the particles in a haze are below 2.5 micrometers in diameter (1), that is, particles that are 30 times smaller than the width of a human hair. Due to their small size, these ultra small particles stay in the air longer and are easily carried over long distances, increasing their chances of being inhaled by animals and humans. Known as fine particles, particles emitted by forest fires are found to be toxic to the lungs, and are more toxic than particulate matter collected from ambient air from the same region. (2). Fine particles can also bypass normal body defence mechanisms and penetrate deep into the lungs due to their small size. When inhaled, they can enter the bloodstream and get absorbed by underlying tissue, potentially interacting with other compounds and substances in the body, for example bad cholesterol, to produce damaging effects such as inflammation. Below are some of the long-term risks associated with fine particles:

In a large prospective cohort study of adults without pre-existing cardiovascular disease, individuals with higher exposure to fine particles (measured by PM2.5 readings) experience a faster rate of thickening of the arteries compared to others living within the same city (3). This implies that higher long-term PM2.5 exposures could promote the development of vascular disease. Long-term exposure to fine particles increases the risk of death by cardiovascular disease and reduces life expectancy by several months to a few years (4).

Long-term exposure to PM2.5, that is, particles 2.5 micrometers or smaller, may contribute to the development of diabetes (5). Exposure to polluted air by expecting mothers has also been associated with spontaneous abortion, under-weight infants, birth defects and infant death (6). Considering the short-term effects fine particulate matter has on the respiratory system, it does not come as a surprise that a study said they can negatively impact respiratory health and impair pulmonary function (7). Other studies also linked increased chronic exposures to PM2.5 to population sinusitis in adults (8) and respiratory illness in infants (9).

How is Haze Monitored

Haze is measured by the Pollutants Standards Index (PSI). It is an index developed by the US Environmental Protection Agency (EPA) to present daily air pollution levels in an easy to understand format. In the US, PSI is also known as the Air Quality Index. PSI monitors air pollutants such as sulphur dioxide, nitrogen dioxide, ozone, carbon monoxide and particles that are 2.5 micrometers or smaller (PM2.5). With the latest PSI value, you can get a general idea of the current air quality and the health effects associated with it as indicated in the table below: Index Value Up to 50 51 to 100 PSI Descriptor Good Moderate General Health Effects Good Few or none for the general population Mild aggravation of symptoms among susceptible persons ie. those with underlying conditions such as chronic heart or lung ailments; transient symptoms of irritation eg. eye irritation, sneezing or coughing in some of the healthy population. Moderate aggravation of symptoms and decreased tolerance in persons with heart or lung disease ; more Health Advisory None for the general population None required Persons with existing heart or respiratory ailments should reduce physical exertion and outdoor activity. The general population should reduce vigorous outdoor activity. Appropriate public advisories regarding the use of respiratory masks and other health matters will be given. Elderly and persons with existing heart or lung disease should stay indoors and reduce physical exertion and outdoor activity. The

101 to 200

Unhealthy

201 to 300

Very Unhealthy

widespread symptoms of transient irritation in the healthy population. Early onset of certain diseases in addition to significant aggravation of symptoms in Hazardous susceptible persons; and decreased exercise tolerance in healthy persons.

general population should avoid vigorous outdoor activity. Appropriate public advisories on air cleaning devices for homes and offices will be given. Children, elderly and persons with existing diseases should stay indoors and avoid outdoor activity. The general population should avoid all unnecessary outdoor activity. Children, elderly and persons with existing diseases should stay indoors, keeping the windows and doors closed and avoiding physical exertion as far as possible. Outdoor activity should be avoided. The general population should keep physical exertion and outdoor activity to as low a level as possible.

301 to 400

Over 400

PSI levels above 400 may be life-threatening to ill and elderly persons. Healthy Hazardous people may experience adverse symptoms that affect normal activity.

Source: National Environment Agency, Singapore

How to Protect Yourself from Haze

The main pollutants in a haze that have greater health impact are the fine particles that are 10 micron and smaller in size. Their effects depend very much on the severity of the haze and how long one has been exposed to them. During a prolonged haze period when the air quality is poor, take the following precautions to protect yourself:

Pay attention to local air quality updates. Recommended precautions you should take will usually be given in the form of advisories based on the latest air condition. So it is recommended that you check your local health authoritys website regularly for the latest air quality update. Here are some websites to check for the following countries: o Singapore: National Environment Agency o Malaysia: Department of Environment o US: AIRNow

Avoid outdoor activities, especially outdoor sports. Children, pregnant women, the elderly, and those suffering from chronic illnesses, especially heart and respiratory disease, should remain indoor when the haze hits unhealthy levels. Healthy adults should avoid unnecessary outdoor activities. If you must exercise outdoor, avoid exercising in highly congested areas near busy roads and freeways, particularly during rush hours. Read more: Is Running in a Haze Bad for Health? Close all windows, doors and any openings that may allow haze to enter your home and office. Turn on the air conditioner if you have one. Note: If the weather is extremely hot, it can become dangerous if you stay indoor with all fresh air intake closed and has no air conditioner. In this case, seek alternative shelter. Use an air purifier to keep the particulate levels low. Choose an air purifier that is suitable for the size and type of your home. Avoid air cleaners that generate ozone as they will increase air pollution. Keep air conditioner in tip-top working condition with regular cleaning and servicing. Fine particles can enter an air-conditioned building through the fresh air intake and by infiltration through openings and gaps. If you are staying in a building with a central air conditioning system, install an air cleaning device. This helps to reduce the amount of air contaminants that may be circulating in your building. Take your medication regularly if you are suffering from an existing disease, especially heart disease and respiratory disease. If you feel breathless at any point in time, seek medical attention immediately. Drink more water and increase the intake of fresh fruits and vegetables. They help the body to flush out toxins absorbed through the skin and lungs, and improve the immune system. Cut down on alcohol and coffee as they promote fluid loss and leach nutrients from the body. Limit or avoid smoking indoor and the use of gas stove, wood fireplace, candles, incense and anything that burns and emits smoke. In an enclosed area, smoke, gases and pollutants emitted from burning sources are trapped indoor and could build up to hazardous level if they continue to burn for an extended period of time. Avoid driving if visibility is bad. When visibility is severely limited by the haze, avoid driving and use the public transport if you really need to get around. If you cannot avoid driving, do not speed and drive at a speed that suits the conditions. Roll up all the windows, turn on the headlight and avoid changing lanes, passing and crossing traffic. Increase your following distance and stay alert. Under severe haze condition, wear a respirator if you must go outside. Respirators work better than surgical masks as they seal better and restrict more polluted air from entering the nose and mouth. They also come with the right filter to remove fine particles found in a haze. If you stay indoor and yet still experience haze-related conditions, it may be necessary to use respirators indoor as well. Read more: How to Choose the Right Mask to Protect Yourself From Haze.

How to Choose the Right Mask to Protect Yourself From Haze

The sale of face masks has picked up significantly ever since Singapore was blanketed by smoke from Indonesia on Monday, 17 June 2013. Stocks for face masks have reportedly sold out in a number of stores and are yet to be replenished. But some common face masks available in stores may not provide sufficient protection against haze particles. Every face mask is constructed for a specific purpose, and choosing the wrong one will only give a false sense of security and little real life protection. Below we look at some common face masks and offer some suggestions on the right masks you should get:

Surgical Masks

Common surgical masks shown in the diagram are meant to catch the bacteria that may be present in your own bodily fluids, such as saliva and nasal discharge, and prevent infectious liquid droplets from spreading to others. Surgical masks are not designed to protect you from inhaling airborne bacteria, viruses and fine particles. Surgical masks typically have two straps, one on each side, that hook over the ears. Some may come with one strap that goes above the ears. A surgical mask should be worn if you are down with a cold, flu, or cough, and when you are working with patients. Surgical masks cannot provide adequate protection against fine particles present in smoke and haze. 6

Respirators
Respirators, also known as particulate respirators, are devices designed to protect the wearer from inhaling harmful dusts, fumes, vapors or gases. There are two main forms of respirators: disposable and reusable.

Disposable Respirators

Disposable respirators are masks that have the word NIOSH and either N95, N99, N100, R95, R99, R100, P95, P99 or P100 printed on them. NIOSH stands for the National Institute for Occupational Safety and Health. It is a U.S. federal agency that conducts research and make recommendations for the prevention of work-related injury and illness. A product that bears the word NIOSH means it meets certain standard recommended by the agency. The letter refers to the oil resistance of the respirator as indicated below: N: Not oil resistant R: Oil resistant P: Oil proof The number indicates the minimum amount of airborne particles (in percentage) that the respirator is able to filter. For instance, if a respirator is N95 certified, it means it can filter at least 95% of particles that do not contain oil. Disposable respirators, such as 3M N95 Particulate Respirator, should come with at least two straps that go around the head, one above the ears and one below. This ensures a tighter and closer fit to prevent particles from seeping through any loose gap. It is important to wear the mask snugly over your nose and under your chin. A mask that is worn loosely will not give adequate protection.

Disposable respirators are only meant for single use as their filters cannot be cleaned or replaced. They should be replaced regularly. Unused disposable respirators are valid for about three years from the date of manufacture, if they are not opened and stored properly. Some brands may last longer or shorter; be sure to check the expiry date before use. When used properly, a disposable respirator can protect you from smoke and haze.

Reusable Respirators

Examples of reusable respirators are those used by firefighters. They can be either full face or half face. Reusable respirators that come with air purifying feature, such as the half face particulate respirator shown in the picture, can be fitted with different types of filters to provide the level of protection that you need (for example, the pink filters used in the respirator shown is P100-certified). Other reusable respirators may come with their own air supply in the form of high-pressure gas tank to completely eliminate any chances of inhaling toxic particles. When used properly, reusable respirators offer the best protection against haze and smoke.

How Small Is One Micron and Why It Matters to Your Health

Dive into the world of airborne particles and learn how they can affect you despite their minute size. Every day we spend almost 90% of our time indoors, be it at home, at work or in school. But do you know that, according to the U.S. Environmental Protection Agency, the levels of air pollutants are two to five times higher indoors than outside, regardless of whether the buildings are located in rural or highly industrial areas? Even though the air in your home and office may smell and look clean, the fact is, unless you have bionic eyes, the many pollutants in the air cant just be detected with our naked eyes.

A close-up view of how pollen grains from common plants look like. Image source: Wikipedia

How Particles are Measured

Particles in the air are measured in micrometer (m), with one micrometer being onemillionth of a meter, or 1/25,400th of an inch. Sometimes, micrometre is also denoted by micron (). In this article, micron and micrometer are used interchangeably. To give you an idea of how small micrometer-sized particles are, a dust mite is about 3 micrometers in size, while a strand of hair is about 100 to 150 micrometers wide. So to a dust mite, your hair looks like a long stretch of wall! The smallest particles we can see with our eyes are those that are larger than 50 micrometers, such as the larger specks of dust collected on our furniture. Here are some particles and their typical sizes:

Pollen, mold, plant spores: 7 70 m Anthrax spore: 6 m Dust mites: 3 10 m Hairspray: 3 10 m Large bacteria: 1 20 m Auto emissions: 1 3 m Lead dust: 1 3 m Fungal spores: 0.50 7 m Cooking smoke/odors: 0.30 1 m Paint pigments: 0.30 1 m Dust: 0.20 8 m Pet dander: 0.15 8 m Small bacteria: 0.08 1 m Tobacco smoke: 0.008 0.6 m Viruses: 0.005 0.01 m Volatile organic compounds: Less than 0.001 m

Why Bother With Particle Size

Some airborne particles are known to trigger allergic reaction, and they are far too small for us to see with our eyes. For example, mold spores, dust mite droppings and pollen particles which are known to trigger hay fever are only about 3 to 70 micrometers in size. Fine particles, especially those with diameter 2.5 micrometers or less, are also believed to be the cause for a number of health problems from headaches and chronic fatigue to heart disease and cancer when one is regularly exposed to them. These include, but not limited to, particles from office equipment, volatile organic compounds, cigarette smoke, viruses and lead dust.

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Minute particles tend to stay suspended in the air longer than larger particles due to their small size, increasing the chances of being inhaled deep into our body. Once they are inhaled, they can pass through and deposit in our respiratory system, such as nose and lungs, and cause inflammation, itching, swelling, and/or mucus production. And because they are so small, they are also harder for the body to remove once they have lodged themselves deeply inside our soft tissues. Besides being potential irritants, fine particles may also introduce other smaller contaminants such as virus and bacteria that are hitching a free ride, triggering adverse reactions in those who are predisposed to certain disease, have pre-existing ailments, or have a weak immune system like the very young and old. When it comes to air quality, it is no longer out of sight, out of mind. What you cannot see can well be the cause of the health problems you are battling with today.

Is Running in a Haze Bad for Health?

In this post, we answer an avid runners question about exercising outdoor during a hazy weather condition. Q: Forest fires in neighboring countries have resulted in a haze over my country. Should I continue to run outdoor like I always do when my city is shrouded in a thick haze? Is haze harmful to my health? A: The short answer is, it depends. Haze is usually measured by the Pollutants Standards Index (PSI). With the PSI value, we can gauge the severity of air pollution in the last three to 24 hours, depending on how often readings are being taken. The higher the value, the more severe is the air pollution. Click here if you want to know the significance of the different PSI values and the health effects of haze.

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A Haze that Blanketed City-State Singapore in 2006. Image source: Flickr Generally, if the PSI value is below 100, it is safe to carry on normal activities outside as usual, provided you are not suffering from any respiratory or heart disease. If you do, it is advisable to refrain from unnecessary outdoor activities, including jogging and running, to limit your exposure to air pollutants. When we exercise, we tend to breathe harder than normal and increase our air intake. Therefore, if there are harmful particles in the air, as it will during a haze, we will inevitably breathe in more of these pollutants into our lungs. For those with an existing respiratory or heart condition, these minute particles can be dangerous as they could trigger an asthma or heart attack. As the PSI reading crosses above 100, there is an increased risk of getting eye irritation, sneezing or coughing. At this level and beyond, even those without any preexisting illnesses should limit their contact with air contaminants and cut down on outdoor activities whenever possible. If the PSI value continues to climbs above 200 or more, the haze may become potentially life-threatening for susceptible populations like heart and respiratory patients, the elderly

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and young children. People in this group should stay indoor and cut down on strenuous activities. The general population should also avoid vigorous outdoor activities. At home and in the office, you should close all windows and doors, turn on the air conditioner or air purifier if you have one, and avoid burning anything indoor to prevent the building up of indoor air pollutants. If you must go outside, it is advisable to put on a respirator, or at least a surgical mask. It may also be necessary to put on a mask indoor if the haze reaches a hazardous level. Click here for more safety measures you can take to reduce exposure to haze.

Keep Updated
It is important to keep an eye on the latest PSI value for your area before hitting the road for a run. Up-to-date health data is usually available on the websites of relevant government agencies. If you are located in Singapore, you can check the National Environment Agencys website at http://www.nea.gov.sg/psi for the latest PSI readings. If you have a choice between exercising indoor or outdoor during a haze, a smarter choice is almost always to exercise indoor, especially when the PSI climbs above 100. It is wise not to expose yourself to unnecessary air pollutants, especially fine particles, which can put your long-term health at risk.

Beware of Roadside Running

On a separate note, even when the weather is clear, you should also choose where you run carefully. If you have the habit of running along roads with heavy traffic, you are exposing yourself to diesel exhaust fumes which have been found in studies to promote cancerous growth, induce stress, increases the risk of heart disease and even affect the IQ of unborn babies. Be sure to read up on the potential serious damages traffic exhaust can do to your body before your next run! Are all these talks about haze and diesel fumes turning you off from running? Dont. Running is an excellent cardiovascular exercise that gives the lungs and heart a good workout. Just be sure to choose the right time and place to run. And there are no lack of good places to run. When there is a haze, head to your nearest gym and step on a treadmill or an elliptical trainer. If you do not wish to commit long-term to any particular gym, many of them do accept walk-in customers and you just need to pay per entry. After the haze has subsided and you prefer to stay off the road for your run, public parks and gardens are excellent choices. These green sanctuaries are free of dangerous traffic and filthy smoke, and they are also full of trees and plants that give off oxygen and aircleaning negative ions. Plus, you might even find like-minded people who share your love of running.

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7 Deadly Air Pollutants You Should Be Aware Of

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Microscopic air particles are all around us, and some of them can be deadly. Find out which are the ones you should beware of. Do you know that we breathe up to 40,000 times a day? That is almost 28 times per minute! But as nations become more and more industrialized and populated, the air that we depend on is also becoming more and more polluted. Rural areas which were once haven of fresh air are also increasingly tainted with air pollutants. Find out what are some of the common toxic pollutants that we come in contact with regularly and take steps to protect yourself today:

1. Radioactive Gas
Radon is a naturally occurring radioactive gas found in soils, rock, water, as well as homes, schools, and office buildings. It is a leading cause of lung cancer, second only to cigarette smoking. In the United States, some 20,000 lung cancer deaths are due to radon each year. EPA estimated that 1 in 15 homes in America has radon concentration that exceeds safety level.

2. Heavy Metal in the Air

When most people talk about lead contamination, they only associate it with the water we drink. However, lead can also exist in the air we breathe. Because dust picks up the heavy metal from peeling lead-based paint on toys, furniture and other household products. That is why lead dust is one of the common ways in which children get lead poisoned. Kids are also most susceptible to the brain damaging effects of lead due to their immature immune system.

3. Poisonous Combustion Byproduct

If you use a gas stove or kerosene heater, or live near to a power plant, the levels of nitrogen dioxide built up in your home is likely to be high. Nitrogen dioxide (NO2) is formed during most combustion and it is an eyes, nose, throat and lungs irritant. Longterm exposure to NO2 has been known to aggravate asthma and cause respiratory diseases such as chronic bronchitis.

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4. Colorless, Odorless and Tasteless Killer

Carbon monoxide (CO) is a highly toxic gas that can disrupt the ability of red blood cells in the body to carry oxygen, resulting in death even in relatively low levels. Sources of CO at homes include attached garages where cars are left running, roads during peak hours, malfunctioned fuel-burning appliances, as well as fireplaces.

5. Gases from Office Equipment

Do you know that common office equipments and stationery like copiers, printers, correction fluids, glues and adhesives emit volatile gases that may be harmful to your health? This is because chemicals which are used to make these handy stuff are released as organic gases that we eventually end up breathing. Possible health effects for prolonged exposure to organic volatile compounds include nausea, headaches and damages to the kidneys, liver and central nervous system.

6. Greenhouse Gas
When nitrogen oxides meet volatile organic compounds and sunlight, ozone is created. If you think more ozone is good because of our depleting atmospheric ozone layer, think again. This low-level ozone is different from the one that is 20 miles from earths surface. Ground-level ozone stings the eyes, inflames the airways and harms the lungs. A study found that people living in cities with higher ozone levels had a 30% higher risk of dying from lung disease.

7. Toxic Pesticide Fumes

Before reaching for a can of pesticide to terminate household pests, think of your life first. Pesticides dont just kill insects, they also end up poisoning all living things. One way is through microscopic droplets of pesticide which are small and light enough to float in the air. We eventually breathe these toxic chemicals into our lungs and kill ourselves slowly without ever knowing why.

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