Appendices

Extra material has been made available on the website for Asthma and Air Pollution. This material does not appear in the printed brochure nor the PDF version.

Appendix 1. Air Quality Goals

Ambient air quality goals recommended by the National Health and Medical Research Council.
Interim national indoor air quality goals recommended by the National Health and Medical Research Council

Appendix 2. Air Pollutants

Exposure risks for selected air pollutants.

Appendix 3. Australian time series and panel studies

Time series studies of the effects of ambient air pollution on asthma conducted in Australia.
Asthmatic panel studies of the effects of ambient air pollution conducted in Australia.

Appendix 4. Exposure and respiratory outcomes

Australian studies on associations between exposure to NO2, ETS, formaldehyde and VOC and respiratory outcomes including asthma.

 

Appendix 1. Air Quality Goals

Ambient air quality goals recommended by the National Health and Medical Research Council

(adapted from http://www.nhmrc.gov.au/publications/pdfcover/aircover.htm)

Goals for Maximum Permissible Levels of Pollutants in Ambient Air*

Pollutant Measurement (µg/m3) Units (ppm) Measurement Criteria Notes NHMRC Session at which recommended
Carbon monoxide (CO) 10,000 9 Eight hour average not to be exceeded more than once a year This period of measurement is not to be confused with that for Threshold Limit Values. 98th (Oct 1984)
Lead

Nitrogen dioxide (NO2)		 1.5

320		 -

0.16		 Three month average
One hour level not to be exceeded more than once a month		 -

0.16 ppm replaces 0.17 ppm to conform with the method of measurement		 88th (Oct 1979)

92nd (Oct 1981)
Ozone, photochemical oxidants 210





170		 0.10





0.88		 Maximum hourly average not to be exceeded more than once a year
Four hour average		 A public warning to be given if ozone levels are expected to rise above 500 µg/m3 (0.25 ppm)


-		 119th (June 1995)




119th (June 1995)
Sulfates 15 - Annual mean - 104th (Nov 1987)
Sulfur dioxide (SO2) 700

570

60		 0.25

0.20

0.02		 Ten minutes average
One hour average
Annual mean		 “CAUTION: At these recommended levels, there still may be some people (for example, asthmatics and those suffering chronic lung disease) who will experience respiratory symptoms and may need further medical advice or medication”. 120th (Nov 1995)
120th (Nov 1995)
120th (Nov 1995)
Total Suspended Particulates (TSP) 90 - Annual mean TSP goal to be read in conjunction with annual SO2 goal. 92nd (Oct 1981)

* Expressed at 00C and 101.3 kPa. May 1996

Interim national indoor air quality goals recommended by the National Health and Medical Research Council

(adapted from http://www.nhmrc.gov.au/publications/pdfcover/aircover.htm)

Goals for Maximum Permissible Levels of Pollutants in Indoor Air*

Pollutant Measurement (µg/m3) Units (ppm) Measurement Criteria Notes NHMRC Session at which recommended
Carbon monoxide (CO) 10,000 9 Eight hour average not to be exceeded more than once a year This period of measurement is not to be confused with that for Threshold Limit Values. 98th (Oct 1984)
Formaldehyde #
Lead		 120

1.5		 0.1

-		 Not to be exceeded
Three month average		 Within domestic premises and schools
-		 93rd (June 1982)
88th (Oct 1979)
Ozone, photochemical oxidants 210





170		 0.10





0.08		 Maximum hourly average not to be exceeded more than once a year
Four hour average		 A public warning to be given if ozone levels are expected to rise above 500 µg/m3 (0.25 ppm)


-		 119th (June 1995)




119th (June 1995)
Radon # 200 becquerels per cubic metre (5.4 nCi/m3) - Annual mean Action level for simple remedial action in Australian homes. Where the concentration exceeds this level, householders should consult the appropriate State authority for advice. 109th (May 1990)
Sulfur dioxide (SO2) 700

570

60		 0.25

0.20

0.02		 Ten minute average
One hour average
Annual mean		 “CAUTION: At these recommended levels, there still may be some people (for example, asthmatics and those suffering chronic lung disease) who will experience respiratory symptoms and may need further medical advice or medication”. 120th (Nov 1995)
120th (Nov 1995)
106th (Nov 1988)
Total Suspended Particulates (TSP) 90 - Annual mean TSP goal to be read in conjunction with annual SO2 goal. 92nd (Oct 1981)
Total Volatile Organic Compounds 500 - Hourly average A single compound shall not contribute more than 50% of the total 115th (June 1993)

* Expressed at 00C and 101.3kPa.
May 1996 # Formaldehyde and Radon are final goals

 

Appendix 2. Air Pollutants

Exposure risks for selected air pollutants

Air Pollutant Lifetime cancer risks at 1 mg/m3
Acetaldehydea (1.5–9) x 10–7
Acrylonitrilea 2 x 10–5
Benzenea 4 x 10–6
Chloroforma 4 x 10–7
1,2-Dichloroethanea (0.5–2.8) x 10–6
1,1,2,2-Tetrachloroethanea (0.6–3.0) x 10–6
Trichloroethylenea 4.3 x 10–7
Vinylchloridea 1 x 10–6
Diesel exhaust (1.6-7.1) x 10–5
Environmental Tobacco Smoke 10–3

a Carcinogens

Air Pollutant - VOCs Guideline(mg/m3) Averaging time
Acrylic acid 54 1 year
2-Butoxyethanol 13,000 1 week
Carbon tetrachloride 6 1 year
Chlorobenzene 71 1 year
1,4-Dichlorobenzene 134 1 year
Dichloromethane 3000 24 hours
Ethylbenzene 22,000 1 year
Formaldehyde 100 30 minutes
Methyl methacrylate 200 1 year
Styrene 260 1 week
Styreneb 7 30 minutes
Tetrachloroethylene 250 24 hours
Toluene 260 1 week
1,3,5-Trichlorobenzene 36 1 year
1,2,4-Trichlorobenzene 8 1 year
Xylene isomers 870 1 year
Diesel exhaust 5.6 1 year
Manganese 0.15 1 year
Mercury (inorganic) 1 1 year
Vanadium 1 24 hours
Sulfur dioxide 500 10 minutes
  125 24 hours
  50 1 year
Nitrogen dioxide 200 1 hour
  40 1 year
Carbon monoxide 90ppm 15 minutes
  50ppm 30 minutes
  25ppm 1 hour
  10ppm 8 hours
Ozone 120 8 hours
Susp. Particulates risk est -
Lead 0.5 1 year

b Based on sensory effects or annoyance reactions.

 

Appendix 3. Australian time series and panel studies

Time series studies of the effects of ambient air pollution on asthma conducted in Australia

Authors City/Years Exposures Confounders Outcome Findings
Rennick & Jarman 19921 Melbourne
1989		 O3
Particles (nephelometry		 Not controlled Emergency presentations for asthma More asthma attendances by children on days with poor visibility
Goldsmith et al 19962 Melbourne
1989-91		 Particles (nephelometry)
SO2, NO2, O3		 Meteorological factors
Day of week		 Hospital admissions for asthma No relationship between air pollution and asthma admissions by children
Smith et al 19963 Sydney 1994 Particles (nephelometry)
PM10 250 μg/m3		 Meteorological factors Emergency present-ations for asthma Bushfire smoke not associated with asthma
Voigt et al 19984 Latrobe Valley 1988 Particles (nephelometry)
NO2, SO2, O3		 Season
UV radiation
Day of week		 Hospital admissions for asthma & COPD No relationship between air pollution and asthma admissions
Morgan et al 19985 Sydney
1990-94		 NO2 mean 1 hr max 29 ppb
O3 mean daily max 25 ppb
Particles (nephelometry)		 Temperature
Dew point temperature
Day of week		 Hospital admissions Increase in maximum NO2concentrations associated with 5.3(95%CI 1.1-5.7)% increase in childhood asthma admissions
Petroeschevsky et al 20016 Brisbane
1987-94		 Particles (nephelometry)
O3 8 hour mean 1.9 pphm
SO2, NO2		 Influenza
Day of week
Meteorological factors		 Hospital admissions 8 hour O3concentrations related to asthma admissions (RR 1.09, 95%CI 1.04-1.14)
Denison et al 20017 Melbourne
1994-97		 Particles (nephelometry)
O3, NO2, CO		 Day of week
School term
Influenza
Meteorological factors		 Hospital admissions Asthma admissions associated with particles, O3(warm season), NO2, and CO

Asthmatic panel studies of the effects of ambient air pollution conducted in Australia

Authors City/Years Subjects Exposures Confounders Outcome Findings
Henry et al 19919 Lake Munmorah & Nelson Bay 1987 99 children with a history of wheeze Annual average SO2LM 2, NB 0.3 μg/m3 Annual average NOx LM 2, NB 0.4 μg/m3   Symptom Diaries Air pollution not related to respiratory symptoms
Jalaludin et al 2000a10 Sydney 1994 32 children with a history of wheeze PM10 peak 210 μg/m3
O3, NO2
Pollen, Alternaria counts		 Temperature
Humidity
Hours spent outdoors
BHR to histamine		 Peak expiratory flow PEF only negatively associated with PM10 in children without BHR
Jalaludin et al 2000b11 Sydney 1994 125 children with wheeze± asthma O3, PM10, NO2 Pollen, Alternaria counts Temperature
Humidity

Peak expiratory flow

 Significant negative association between mean daytime O3 and daily PEF deviation

References

  1. Rennick GJ, Jarman FC. Are children with asthma affected by smog? Medical Journal of Australia. 1992;156(12):837-41.
  2. Goldsmith JR, Friger MD, Abramson M. Associations between health and air pollution in time-series analyses. Archives of Environmental Health. 1996;51(5):359-67.
  3. Smith MA, Jalaludin B, Byles JE, Lim L, Leeder SR. Asthma presentations to emergency departments in western Sydney during the January 1994 bushfires. International Journal of Epidemiology. 1996;25(6):1227-36.
  4. Voigt T, Bailey M, Abramson M. Air pollution in the Latrobe Valley and its impact upon respiratory morbidity. Australian & New Zealand Journal of Public Health. 1998;22(5):556-61.
  5. Morgan G, Corbett S, Wlodarczyk JH. Air pollution and hospital admissions in Sydney, Australia, 1990 to 1994. American Journal of Public Health 1998;88(12):1761-66.
  6. Petroeschevsky A, Simpson RW, Thalib L, Rutherford S. Associations between outdoor air pollution and hospital admissions in Brisbane, Australia. Archives of Environmental Health. 2001;56(1):37-52.
  7. Denison L, Simpson R, Petroeschevsky A, Thalib L, Williams G. Ambient air pollution and daily hospital admissions in Melbourne 1994-1997. 2001, Environment Protection Authority: Melbourne. pp. 84.
  8. Johnston FH, Kavanagh AM, Bowman DM, Scott RK. Exposure to bushfire smoke and asthma: An ecological study. Medical Journal of Australia. 2002;176(11):535-8.
  9. Henry RL, Bridgman HA, Wlodarczyk J, Abramson R, Adler JA, Hensley MJ. Asthma in the vicinity of power stations: II. Outdoor air quality and symptoms. Pediatric Pulmonology. 1991;11(2):134-40.
  10. Jalaludin B, Smith M, O'Toole B, Leeder S. Acute effects of bushfires on peak expiratory flow rates in children with wheeze: A time series analysis. Australian & New Zealand Journal of Public Health. 2000;24(2):174-7.
  11. Jalaludin BB, Chey T, O'Toole BI, Smith WT, Capon AG, Leeder SR. Acute effects of low levels of ambient ozone on peak expiratory flow rate in a cohort of Australian children. International Journal of Epidemiology. 2000;29(3):549-57.

 

Appendix 4. Exposure and respiratory outcomes                                

Australian studies on associations between exposure to NO2, ETS, formaldehyde and VOC and respiratory outcomes including asthma

Abbreviations & Glossary

FEV1 = Forced Expiratory Volume in 1 second
FVC = Forced Vital Capacity
NS = Not significant (p>0.05)
OR = Odds ratio

Authors City/ Years Study Exposures Confounders Outcome Findings
Garrett et al 19981 Latrobe Valley, Victoria
1989		 Longitudinal: 80 households with 148 children (53 asthmatics and 95 non-asthmatics); over a year Indoor NO2 levels Controlled: parental asthma, parental allergy,  child age, passive smoking and socio-economic status measured by house ownership Respiratory symptoms Nitrogen dioxide concentrations in the study houses were low, with a total of 10 samples exceeding 60 ppb (115 µg/m3). The overall median level was 11.6 micrograms/m3 (6.0 ppb), ranging from < 0.7 to 246 micrograms/m3 (128 ppb). Major indoor nitrogen dioxide sources were: gas stoves, vented gas heaters, and smoking. Some 67% of variation in indoor nitrogen dioxide levels could be explained by presence of major sources, house age, and outdoor levels. Gas stoves were the main contributors.

The presence of a gas stove significantly increased the likelihood of respiratory symptoms (odds ratio 2.2 [1.0-4.8]). However, neither of the other major nitrogen dioxide sources, gas heaters or smoking, were found to be significantly associated with respiratory symptoms. Nitrogen dioxide exposure was a marginal risk factor for respiratory symptoms. The interaction between atopy and gas stoves or NO2 exposure was NS.
Pilotto et al 19972 ACT Longitudinal: 388 children aged 6-11 years; conducted in winter Indoor NO2levels Controlled ??? Respiratory symptoms Exposure to NO2 at hourly peak levels of the order of > or = 80 ppb, compared with background levels of 20 ppb,  was associated with a significant increase in sore throat, colds and absences from school.
Smith et al 20003 Adelaide A longitudinal study over 6 weeks

Self-reported asthma (n=125)		 Participants wore lapel badges that measured NO2 daily Controlled for other exposures Respiratory symptoms A significant interaction between NO2 and age was observed. In adults, exposure to NO2 was associated with cough with a 1 day lag (OR: 1.15, 95% CI: 1.01-1.31). Daily personal exposures to NO2 are associated with asthmatic symptoms in children.
Volkmer et al 19954 South Australia Cross sectional study
14,124 families with a child aged 4 years 3 months to 5 years. (represents 73% of the targeted State preschool population.)		 parental smoking, type of fuel used for cooking and heating and method used for home cooling Controlled for other exposures, geographic location and SES Respiratory health Natural gas stove compared to an electric stove was significantly associated with increased prevalence rates for: (i) asthma (odds ratio [OR] 1.24); (ii) wheezing in the preceding 12 months (OR 1.16); excessive colds (OR 1.14); and hay fever (OR 1.13). The use of a unflued gas heater  compared to other forms of heating was significantly associated with increased prevalence rates for dry cough (OR 1.26), ever having wheezed
(OR 1.15) and wheezing in the preceding 12 months (OR 1.18). The use of a wood fire/heater compared to other forms of heating was significantly associated with a reduced prevalence rate for dry cough (OR 0.84) and ever having wheezed (OR 0.82).
Parental smoking was significantly associated with increased prevalence rates for bronchitis (OR 1.21) and ever having wheezed (OR 1.24).
Lewis et al 19985 Hunter and Illawarra regions of New South Wales A cross-sectional survey: 1993
3023 children aged 8 to 10 years.		 Out door pollutants, passive smoking at home, gas heaters. Controlled for other exposures Respiratory symptoms gas heating was associated with frequent wheeze.
Presence of an adult smoker in the home was associated with chest colds
Reese et al6 WA Cross sectional study: 468 children (48 with bronchioloitis) Cotinine
levels		 Controlled for confounders ??? Bronchioloits Cotinine levels were higher in the group with bronhiolitis compared to children with non respiratory illness. Cotinine levels were  correlated with parents’ current smoking
Habby et al 19947 from two rural regions of NSW Cross sectional study: 2765 children Parental smoking Controlled for confounders ??? Respiratory illness, lung function, BHR Passive smoking was associated with reduced FEV1, PEFR, and FEF25-75%.
Garrett et al 19981 Latrobe Valley, Victoria
1989		 Longitudinal: 80 households with 148 children (53 asthmatics and 95 non-asthmatics); over a year Form-aldehyde levels: in homes Controlled: parental asthma, parental allergy,
child age, passive smoking and socio-economic status measured by house ownership		 Atopy and Respiratory symptoms The median indoor formaldehyde level was 15.8 microg/ m3 (12.6ppb), with a maximum of 139 microg/m3 (111 ppb). Formaldehyde exposure was associated with atopy (OR=1.40 (0.98-2.00, 95% CI) with an increase in bedroom formaldehyde levels of 10 microg/m3).  Furthermore, more severe allergic sensitization was   demonstrated with increasing formaldehyde exposure. On the other hand, there was no significant increase in the adjusted risk of asthma or respiratory symptoms with formaldehyde exposure. However, among children suffering from respiratory symptoms, more frequent symptoms were  noted in those exposed to higher formaldehyde
Franklin et al 20008 Perth Cross sectional: 224 healthy children
6 to 13 yr of age		 Formaldehyde: in homes Controlled: atopy and other variables Lung function Exhaled NO There was no effect of formaldehyde levels on FVC or FEV1. There was, however, significantly higher levels of NO2 measured from children living in homes with average formaldehyde levels greater than 50 ppb (p = 0.02). Exhaled NO levels were 15.5 ppb
(10.5 to 22.9 ppb) for children from homes with formaldehyde concentrations  50 ppb and 8.7 ppb (7.9 to 9.6 ppb) for children from homes with formaldehyde concentrations < 50 ppb
Beach et al 19979 Melbourne Double blind cross over study; 17 asthmatics; VOC free paint Vs conventional paint VOC in paint Controlled for with in variation Respiratory symptoms, lung function airway responsiveness The new paint appears to be less likely to cause a worsening of respiratory symptoms than conventional acrylic paint, although this difference is not reflected in measurements of lung function or airway responsiveness.

References

  1. Garrett, M.H., et al., Respiratory Symptoms in Children and Indoor Exposure to Nitrogen Dioxide and Gas Stoves. Am. J. Respir. Crit. Care Med., 1998. 158(3): p. 891-895.
  2. Pilotto, L.S., et al., Respiratory effects associated with indoor nitrogen dioxide exposure in children. International Journal of Epidemiology., 1997. 26(4): p. 788-96.
  3. Smith, B.J., et al., Health effects of daily indoor nitrogen dioxide exposure in people with asthma. Eur Respir J. 2000. 16(5): p. 879-85.
  4. Volkmer, R.E., et al., The prevalence of respiratory symptoms in South Australian preschool children. II. Factors associated with indoor air quality. JPCH, 1995. 31(2): p. 116-20.
  5. Lewis, P.R., et al., Outdoor air pollution and children's respiratory symptoms in the steel cities of New South Wales. MJA, 1998. 169: p. 459-463.
  6. Reese, A.C., et al., Relationship between urinary cotinine level and diagnosis in children admitted to hospital. American Review of Respiratory Disease., 1992. 146(1): p. 66-70.
  7. Haby, M.M., J.K. Peat, and A.J. Woolcock, Effect of passive smoking, asthma, and respiratory infection on lung function in Australian children. Pediatric Pulmonology., 1994. 18(5): p. 323-9.
  8. Franklin, P., P. Dingle, and S. Stick, Raised Exhaled Nitric Oxide in Healthy Children Is Associated with Domestic Formaldehyde Levels. Am. J. Respir. Crit. Care Med., 2000. 161(5): p. 1757-1759.
  9. Beach, J.R., et al., The effects on asthmatics of exposure to a conventional water-based and a volatile organic compound-free paint.   Eur Respir J, 1997. 10(3): p. 563-6.