4 Sharifah Presentation

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INDOOR AIR POLLUTANTS EXPOSURE & THELEVEL OF TUMOR NECROSIS FACTOR-ALPHA

AMONG PRIMARY SCHOOLCHILDREN IN

KLANG VALLEY

Sharifah Nazariah SN1

Juliana Jalaludin1

Abdah MA2

1 Department of Community Health, Faculty of Medicine and Health Sciences, University PutraMalaysia,

2 Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, UPM, Malaysia


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Indoor air quality is a vital factor that influenced the health of occupants inbuildings as several indoor pollutants can be many times higher compared tooutdoors which significantly shown by studies (Fujii et al., 2001; Monn &Becker, 1999; Qian et al., 2004; Juliana et al., 2001 and Zailina et al., 1996).

Children are more susceptible thus, the school environment is probably themost important indoor environment as children spend as much as 80% of theirtimes either in school or at home.

Indoor environment in Malaysia is one of particular interest to study forvarious reasons especially for the prevalence of respiratory symptoms andillnesses as Malaysia has a humid type of weather.


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PARTICULATTE MATTERS (PM)

Fine particulate matter of diameters lessthan 2.5 microns (m) is a thoracic dust ableto penetrate deeply into the lungs

Fine particles result from fuel combustion(motor vehicles, power generation,industrial facilities), residential fireplaces

and wood stoves (EPA, 1997).

Course particulate consisting of particlessmaller than 10 microns is an inhalable dustable to deposited in the upper respiratorytract (nose and throat).

Generally emitted from vehicles traveling onunpaved roads, materials handling, and

crushing, grinding, and windblown dust(EPA, 1997)

PM2.5 PM10

Based on health considerations, PM10 and PM2.5 are usually selected as indicators of airpollution since those particles are small enough to enter the thoracic region (Wilson et al.,

2002) and cause morbidity (Castillejos et al., 2000; Romieu et al., 1998).


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Figure 2: PM deposited areaSource: ACGIH (1999)

Figure 3: Lung anatomy of childrenSource: CHW, 2012


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NO2

NO2 is major source (USEPA, 1996) and also indicator for mobile

vehicle exhaust (Grazuleviciene et al., 2004) In Malaysia contribute 70%75% of the total air pollution (DOE,

1996). Also Exposures to NO2 may impair breathing, damage airways and

tissue, and lead to chronic bronchitis and emphysema (Marathae,2004).


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Air pollution is approaching critical levels in a number of urbanareas of Malaysia such as Kuala Lumpur and Petaling Jaya(Zakaria, 2007).

People tend to spend approximately 90% of their time indoors

(USEPA, 2006), thus increase the frequency of exposure as well asacute and chronic respiratory problems especially among children andelderly (Ismail et al., 2010).

The pollutant levels in indoor school facilities are often 2 to 5 timeshigher compared to the outdoors and may trigger respiratory

symptoms & illness especially among children (USEPA, 2003; Gordon,2004).

Children are more sensitive than adults to air quality as their bodiesare still developing and the effect of environmental may interfere withthe growth of their lung function and immune systems (Smith et al.,

2000; Gordon, 2004).


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Cytokines are the hormones of the immune system which include TNF-

TNF-

Function : immune response to bacterial, and certain fungal, viral, parasitic invasions,and involve in the local inflammatory immune response (Goldsmith et al., 1998)

Known as proinflammatory mediators release when there are interaction of alveolarmacrophages (lung) with atmospheric particles (Goldsmith et al., 1998; Monn & Becker,1999 and Babu et al., 2004).

It is associated with chronic systemic inflammatory response (Weinberg and Buchholz,2006).

TNF-is soluble inflammation markers in sputum as macrophages (Out et al., 2001)


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Figure 5: Childrens lung developmentSource: Ritz and Wilhem, 2008


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Figure 6: PM deposited in the lungSource: Muayad, (2011)

Figure 7: mechanism of lung inflammation

Source: Pauly JL and Paszkiewicz (2011)

PM2.5


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SAMPLINGTECHNIQUE

* Stratifiedrandom sampling

STUDY LOCATIONNational primary school in Klang Valley

STUDY DESIGN* Cross sectional comparative

INCLUSIVE CRITERIA

Malaysian Standard 2 and 5 Healthy status Living 5 km within

the school

Urban Rural


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URBAN

PETALINGJAYA CHERAS

BERANANG RURAL


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SAMPLING PROCEDURES

EXPOSUREASSESSMENT

Portable Indoor Air

Monitor

Dust Trak AerosolMonitor (PM2.5 & PM10)

LaMotte Air SamplerTool (NO2)

QUESTIONNAIRE

Adapted fromAmerican ThoracicSociety ATS-DLC-78-CWHO (1994)

Focused on respiratorysymptoms, homeenvironmentexposures, lung diseasehistory and socio-

demographicinformation.

BIOMARKERSMEASUREMENT

Human TNF-ELISA Kit (Bender

Medsystems)


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Dust Trak AerosolMonitor

(PM2.5 & PM10)

LaMotte Air Sampler Tool(NO2)

Location: 1.5 m above floor level (Lee and Chang, 2000) atthe back of the classroom

EXPOSURE ASSESSMENT


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Sputum samples taken during school by inducing sputumusing dense aerosol of hypertonic (NaCl 4.5%) (Gibson, 1998)

for 5 to 20 minutes through ultrasonic nebulizer(Citizen Model Cun60).

Collected sputum was ultracentrifuge

The sample then used to measureTNF- using

ELISA

Analysis carriedout in Chemical

PathologicalLaboratory,

UPM.


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VariablesUrban (n=232)Number (%) Rural (n=198)Number (%) z Value p Value StandardMedian (IQR) Median (IQR)

PM2.5 (g/m3) 50.36 (17.43) 27.3 (6.17) -16.70


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Figure 8: Comparison of Respiratory Symptom among school children

0

5

10

15

20

25

30

35

Cough Phlegm Wheezing Chest Tightness

31.5

25.9

13.4

0

14.113.6

1 5

percentage

(%)

Respiratory Symptoms

Respiratory symptoms among schoolchildren

Urban

Rural


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VariableUrban

(n=232)Rural

(n=198) z Value p ValueMedian (IQR)

Median (IQR)

TNF (pg/ml) 4.21 (3.46) 2.35 (1.35) -10.78


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VariableUrban(n=232) Rural(n=198)

r value p value r value p valuePM10 0.115 0.08 -0.146 0.04*PM2.5 0.245 0.001** 0.187 0.008*NO2 0.174 0.008* 0.172 0.016*

Table 4: Correlation between concentration of Indoor air pollutants and TNF-alpha level


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The significantly higher exposure to PM2.5 and NO2 mayincrease the level of TNF-thus if continuously exposed willlead to acute or chronic respiratory illness

The significantly higher exposure of PM and NO2 havehigher probability to develop respiratory symptoms amongchildren live in urban compared to rural.

TNF-could be important in mediating the inflammatoryeffects in PM exposure studies through sputum induction asit promote safe, simple noninvasive approach


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THANK YOU


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Guidelines for IAQ Management in School

Environmental assessments of the school should be coordinated by school with thegovernmental agencies, state authorities and environmental & health department to planfor guideline used for school.

Maintenance and housekeeping

Good housekeeping practices might used in the routine maintenance and helps keep theschools protect the indoor quality and the health and well being of schoolchildren.Housekeeping should be done everyday (before and after end of class)

AwarenessEducate and make aware of the schoolchildren regarding IAQ issues. If the students areprovided with information about the sources and effects of pollutants, they can learn andact to reduce their personal exposure.

School Bus Exhaust.

Passing no-idling policies near the school building can reduce the indoor air pollution fromschool bus exhaust.


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