Luiz Alberto Amador Pereira

The Impact of Sugar Cane–Burning Emissions on the Respiratory System of Children and the Elderly

We analyzed the influence of emissions from burning sugar cane on the respiratory system during almost 1 year in the city of Piracicaba in southeast Brazil. From April 1997 through March 1998, samples of inhalable particles were collected, separated into fine and coarse particulate mode, and analyzed for black carbon and tracer elements. At the same time, we examined daily records of children (< 13 years of age) and elderly people (> 64 years of age) admitted to the hospital because of respiratory diseases. Generalized linear models were adopted with natural cubic splines to control for season and linear terms to control for weather. Analyses were carried out for the entire period, as well as for burning and nonburning periods. Additional models were built using three factors obtained from factor analysis instead of particles or tracer elements. Increases of 10.2 μg/m3 in particles ≥ 2.5 μm/m3 aerodynamic diameter (PM2.5) and 42.9 μg/m3 in PM10 were associated with increases of 21.4% [95% confidence interval (CI), 4.3–38.5] and 31.03% (95% CI, 1.25–60.21) in child and elderly respiratory hospital admissions, respectively. When we compared periods, the effects during the burning period were much higher than the effects during nonburning period. Elements generated from sugar cane burning (factor 1) were those most associated with both child and elderly respiratory admissions. Our results show the adverse impact of sugar cane burning emissions on the health of the population, reinforcing the need for public efforts to reduce and eventually eliminate this source of air pollution.

Health effects of air pollution exposure on children and adolescents in São Paulo, Brazil

Children and adolescents have been considered more susceptible to the effects of air pollution than adults. In order to investigate the responses of children of different ages to air pollution exposure, daily records of hospital admissions for children in five age groups (equal or less than 2 years of age, 3–5, 6–13, 14–19, and all ages together, i.e., from 0–19 years of age) were obtained from January 1993 to November 1997 in São Paulo, Brazil, and were compared to daily records of PM10, O3, SO2, CO and NO2 concentrations in ambient air. For each age group a generalized additive Poisson regression was fitted controlling for smooth functions of time, temperature, humidity, and days of the week, with an additional indicator for holidays. Polynomial distributed lag models were used to estimate the 7‐day cumulative effect of each pollutant.

Air pollution from biomass burning and asthma hospital admissions in a sugar cane plantation area in Brazil

Objective: To evaluate the association between the total suspended particles (TSPs) generated from preharvest sugar cane burning and hospital admission due to asthma (asthma hospital admissions) in the city of Araraquara. Design: An ecological time-series study. Total daily records of asthma hospital admissions (ICD 10th J15) were obtained from one of the main hospitals in Araraquara, São Paulo State, Brazil, from 23 March 2003 to 27 July 2004. The daily concentration of TSP (μg/m3) was obtained using Handi-vol equipment (Energética, Brazil) placed in downtown Araraquara. The local airport provided the daily mean figures of temperature and humidity. The daily number of asthma hospital admissions was considered as the dependent variable in Poisson’s regression models and the daily concentration of TSP was considered the independent variable. The generalised linear model with natural cubic spline was adopted to control for long-time trend. Linear terms were used for weather variables. Results: TSP had an acute effect on asthma admissions, starting 1 day after TSP concentrations increased and remaining almost unchanged for the next four days. A 10 μg/m3 increase in the 5-day moving average (lag1–5) of TSP concentrations was associated with an increase of 11.6% (95% CI 5.4 to 17.7) in asthma hospital admissions. Conclusion: Increases in TSP concentrations were definitely associated with asthma hospital admissions in Araraquara and, despite using sugar cane alcohol to reduce air pollution from automotive sources in large Brazilian urban centres, the cities where sugar cane is harvested pay a high toll in terms of public health.

Influence of socioeconomic conditions on air pollution adverse health effects in elderly people: an analysis of six regions in São Paulo, Brazil

Study objective: To evaluate if the effects of particulate matter (PM10) on respiratory mortality of elderly people are affected by socioeconomic status. Design: Time series studies. The daily number of elderly respiratory deaths were modelled in generalised linear Poisson regression models controlling for long term trend, weather, and day of the week, from January 1997 to December 1999, in six different regions of São Paulo City, Brazil. The regions were defined according to the proximity of air pollution monitoring stations. Three socioeconomic indicators were used: college education, monthly income, and housing. Main results: For a 10 μg/m3 increase in PM10, the percentage increase in respiratory mortality varied from 1.4% (95% CI 5.9 to 8.7) to 14.2% (95% CI 0.4 to 28.0). The overall percentage increase in the six regions was 5.4% (95% CI 2.3 to 8.6). The effect of PM10 was negatively correlated with both percentage of people with college education and high family income, and it was positively associated with the percentage of people living in slums. Conclusions: These results suggest that socioeconomic deprivation represents an effect modifier of the association between air pollution and respiratory deaths.

Association between air pollution and ischemic cardiovascular emergency room visits

This study observed the relationship between air pollutants and ischemic cardiac diseases such as angina and acute myocardial infarction in a representative cardiovascular center emergency room in São Paulo, Brazil. Daily emergency room admissions to the Institute of the Heart of the University of São Paulo, as well as data concerning daily air pollutant levels and meteorological variables, were collected from January 1994 to August 1995. Generalized additive Poisson regressions were fitted to the logarithm of the expected values of total emergency room visits due to angina or acute myocardial infarction, controlling for smooth functions of season and weather and indicators for days of the week. All investigated pollutants were positively associated with ischemic cardiovascular disease emergency room visits, and the time lags were relatively short, but only CO presented an effect that was statistically significant. An interquartile range increase in CO was associated with an increase of 6.4% (95% CI: 0.7-12.1) in daily angina or acute myocardial infarction emergency room visits. This result did not change when estimates were done using linear models and natural cubic splines. This study showed that air pollution has a role in cardiovascular morbidity in São Paulo, reinforcing the necessity for air pollutant emission-controlling polices in urban areas.

Queima de biomassa e efeitos sobre a saúde

A primeira ideia que se forma na mente das pessoas e do pesquisador e associar a poluicao do ar aos grandes centros urbanos, com a imagem de poluentes sendo eliminados por veiculos automotores ou pela chamine de suas fabricas. Entretanto, uma parcela consideravel da populacao do planeta convive com uma outra fonte de poluicao, que atinge preferencialmente os paises em desenvolvimento: a queima de biomassa. Este artigo tem como objetivo chamar a atencao do pneumologista, da comunidade e das autoridades para os riscos a saude da populacao exposta a essa fonte geradora de poluentes, seja em ambientes internos, seja em ambientes abertos. O presente trabalho caracteriza as principais condicoes que levam a combustao de biomassa, como a literatura tem registrado os seus efeitos sobre a saude humana, discutindo os mecanismos fisiopatologicos envolvidos, e finaliza com a apresentacao de dois estudos recentes que enfatizam a importância da queima de um tipo especifico de biomassa, a palha da cana-de-acucar, pratica comum no interior do Brasil, e sua interferencia no perfil de morbidade respiratoria da populacao exposta.

Repercussões clínicas da exposição à poluição atmosférica

Atmospheric pollution is a topic of extensive discussion the world over. The clinical repercussions of exposure to the principal atmospheric pollutants are summarized herein. According to the American Environmental Protection Agency, air quality standards for these agents are set based on their primary and half-life values. The respiratory effects of the burning of fossil fuels and biomass are succinctly presented, with a special focus on alerting health care professionals of the increased morbidity related to environmental pollution.

A poluição do ar e o sistema respiratório

A poluicao atmosferica encontra-se presente nos mais diferentes cenarios ao longo dos ultimos 250 anos, desde que a Revolucao Industrial acelerou o processo de emissao de poluentes que, ate entao, estava limitado ao uso domestico de combustiveis vegetais e minerais e as emissoes vulcânicas intermitentes. Hoje, aproximadamente 50% da populacao do planeta vivem em cidades e aglomerados urbanos e estao expostas a niveis progressivamente maiores de poluentes do ar. Este estudo e uma revisao nao sistematica sobre os diferentes tipos e fontes de poluentes do ar e os efeitos respiratorios atribuidos a exposicao a esses contaminantes. Podem ser creditados aos poluentes particulados e gasosos, emitidos por diferentes fontes, aumentos nos sintomas de doencas, na procura por atendimentos em servicos de emergencia e no numero de internacoes e de obitos. Mais do que descompensar doencas pre-existentes, exposicoes cronicas tem ajudado a aumentar o numero de casos novos de asma, de DPOC e de câncer de pulmao, tanto em areas urbanas quanto em areas rurais, fazendo com que os poluentes atmosfericos rivalizem com a fumaca do tabaco pelo papel de principal fator de risco para estas doencas. Na rotina de clinicos e pneumologistas, esperamos contribuir para consolidar a importância da investigacao sobre a exposicao aos poluentes do ar e o reconhecimento de que esse fator de risco merece ser levado em conta na adocao da melhor terapeutica para o controle das descompensacoes agudas das doencas respiratorias e para a sua manutencao entre as crises.Over the past 250 years-since the Industrial Revolution accelerated the process of pollutant emission, which, until then, had been limited to the domestic use of fuels (mineral and vegetal) and intermittent volcanic emissions-air pollution has been present in various scenarios. Today, approximately 50% of the people in the world live in cities and urban areas and are exposed to progressively higher levels of air pollutants. This is a non-systematic review on the different types and sources of air pollutants, as well as on the respiratory effects attributed to exposure to such contaminants. Aggravation of the symptoms of disease, together with increases in the demand for emergency treatment, the number of hospitalizations, and the number of deaths, can be attributed to particulate and gaseous pollutants, emitted by various sources. Chronic exposure to air pollutants not only causes decompensation of pre-existing diseases but also increases the number of new cases of asthma, COPD, and lung cancer, even in rural areas. Air pollutants now rival tobacco smoke as the leading risk factor for these diseases. We hope that we can impress upon pulmonologists and clinicians the relevance of investigating exposure to air pollutants and of recognizing this as a risk factor that should be taken into account in the adoption of best practices for the control of the acute decompensation of respiratory diseases and for maintenance treatment between exacerbations.

Air pollution and pediatric respiratory hospital admissions in São Paulo, Brazil

In order to investigate the relation between air pollution and child morbidity in Sao Paulo, a time-series study was carried out. Daily records of hospital admissions for children under 13 years old were obtained at the Health State Secretary, covering 112 hospitals in the period from October 1992 to October 1993. Daily levels of PM10, ozone, SO2, CO and NO2 were obtained from the environmental state agency (CETESB), while both CETESB and the Institute of Astronomy and Geophysics (IAG) of the University of Sao Paulo provided daily measures of temperature and relative humidity. Daily counts of child respiratory admissions (RESP) were considered as the dependent variable of pollutants in regression models, controlled for months of the year, days of the week, weather factors, and the daily number of non respiratory admissions (NORESP). PM10 and ozone were the pollutants that exhibited the most robust association with RESP. The mean levels of PM10observed during the period of study (70 μg m−3) were associated with an increase of 12% in RESP. The association between air pollution and RESP was significant within a time lag between 1 to 7 days and was dose-dependent. This result indicates that air pollution represents a significant pediatric health problem in Sao Paulo. Copyright

Air pollution and neonatal deaths in São Paulo, Brazil

Air pollution has been associated with health effects on different age groups. The present study was designed to assess the impact of daily changes in air pollutants (NO2, SO2, CO, O3, and particle matter (PM10)) on total number of daily neonatal deaths (those that occur between the first and the 28th days of life) in São Paulo, from January 1998 to December 2000, since adverse outcomes such as neonatal deaths associated with air pollution in Brazil have not been evaluated before. Generalized additive Poisson regression models were used and nonparametric smooth functions (loess) were adopted to control long-term trend, temperature, humidity, and short-term trends. A linear term was used for holidays. The association between air pollutants and neonatal deaths showed a short time lag. Interquartile range increases in PM10 (23.3 microg/m(3)) and SO2 (9.2 microg/m(3)) were associated with increases of 4% (95% CI, 2-6) and 6% (95% CI, 4-8), respectively. Instead of adopting a two-pollutant model we created an index to represent PM10 and SO2 effects. For an interquartile range increase in the index an increase of 6.3% (95% CI, 6.1-6.5) in neonatal deaths was observed. These results agree with previous studies performed by our group showing the deleterious effects of air pollutants during the perinatal period. The method reported here represents an alternative approach to analyze the relationship between highly correlated pollutants and public health problems, reinforcing the idea of the synergic effects of air pollutants in public health.