Feroza Daroowalla, MD, MPH

Division of Pulmonary Medicine

Stony Brook University
These slides were derived from the EPA website

What is ozone?
Ozone is a highly reactive gas molecule made

up of three oxygen atoms

Ozone occurs naturally in the stratosphere
(upper atmosphere)
In the lower atmosphere, ozone is formed
primarily from photochemical reactions of
man-made air pollutants
=Tropospheric ozone or "ambient" or "groundlevel" ozone

What is asthma?
Asthma is a chronic inflammatory

disease of the airways that causes

recurrent episodes of wheezing,
breathlessness, chest tightness, and
cough

Background Information
The prevalence of asthma has doubled in the

U.S. in the last 20 years

More than 20 million Americans report having
asthma
Rates are higher among children under 17,

minorities, and inner-city populations

10 million patient visits and more than

470,000 hospital admissions annually

Effects on human health

Breathing in ground level ozone damages the

respiratory tract
Respiratory symptoms
Decreases in lung function
Inflammation of airways

What are the symptoms of ozone

exposure
Coughing
Throat irritation
Pain, burning, or discomfort in the chest when

taking a deep breath

Chest tightness, wheezing, or shortness of
breath

What effects does ozone have

at the cellular level?
Ozone does not get scrubbed out in the upper

respiratory tract
Reaches the lower respiratory tract and dissolves
in the thin layer of fluid lining the airways of the
lung
Then ozone reacts rapidly with a number of
biomolecules
This results in free radicals and other oxidant

species
These react with epithelial cells, immune cells, and
with nerve receptors in the airway wall

How does ozone act in

the
Injurylung
and inflammatory response result in :
An increase in small airway obstruction
A decrease in the barrier function of the airway

epithelium
An increase in airway reactivity

After a period of weeks following a single

exposure, the airway appears to return to the

pre-exposure state

Does response vary among

individuals?
There is large variation in the response

among individuals
Some people may experience no symptoms or
lung function changes while the most
responsive individual may experience a 50%
drop in lung function and have severe
coughing, shortness of breath, or pain on
deep inspiration.

Which populations are

susceptible to ozone damage
One factor that explains variability is age,
young adults (teens to thirties) are more

responsive than older adults (fifties to eighties)

data do not suggest that children are more
responsive than young adults

Children may have more response if they are

more exposed (spend more time outside)

People with asthma are the most responsive

group

How does ozone affect people with

asthma?
Increased frequency of asthma attacks
Increased use of health care services
A worsening of underlying asthma status,
increasing the likelihood of an asthma attack or
requiring more treatment
Studies indicate a relationship between ambient
ozone concentration and medication use among
children and ER visits and hospital admissions for
asthma

How quickly do ozone-induced

respiratory symptoms resolve in
individuals
without asthma?

They should begin to improve immediately

upon cessation or reduction of exposure and
should have disappeared completely within 24
to 48 hours after the exposure ends

What are the effects of recurrent or

long-term exposure to ozone?
One of the major unanswered questions
whether repeated episodes of damage and repair
due to years of short-term ozone exposures result
in health effects
Some early evidence that long-term ozone

exposure may result in new asthma

suggest that young children may be especially

susceptible to effects of ozone on lung

development

Prudent to avoid repeated short-term exposures,

particularly in young children, until more is known

How much is too much

More potential for effect with longer time active

outdoors and with more strenuous activity

Human exposure studies indicate that:
levels above 0.12 ppm, heavy outdoor exertion for 1 to

3 hours can increase risk

levels between 0.08 and 0.12 ppm, moderate outdoor
exertion for 4 to 8 hours can increase risk

Moderate exertion = climbing stairs, tennis or

baseball, simple garden or construction work, and

light jogging, cycling
Heavy exertion = playing basketball or soccer,
chopping wood, heavy manual labor, and vigorous
running, cycling

What is the Air Quality

Index?
The Air Quality Index tells the public how clean
or polluted the air is
The AQI uses a scale from 0 to 500
The higher the AQI value, the greater the level
of pollution and the greater the health concern
AQI values below 100 are generally considered
to be satisfactory
The AQI is divided into six categories that
correspond to different levels of health concern.

When AQI values are above 100, air quality is

considered to be unhealthy, at first for
members of susceptible populations, then for
everyone as AQI values get higher

How can you reduce exposure

to ozone?
What is moderate exertion for one person

may be heavy exertion for another

Cutting back on the level and duration of
exertion when ozone levels are high will
help
The times of poorest air quality are
typically in the afternoon and early
evening for most locations

Information
Information about the health effects of ozone

may be found on the AIRNow Web site in the

Publications section
(http://airnow.gov/index.cfm?
action=static.publications) and the Your
Health section (http://airnow.gov/index.cfm?
action=static.health).
(http://www.epa.gov/ncepihom/)