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 "ground-level"
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 lung
 Injury 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.publicatio
ns) and the Your Health section
(http://airnow.gov/index.cfm?action=static.health).
(http://www.epa.gov/ncepihom/)