Air Pollution impact on Acute &

Chronic Respiratory Diseases

dr. Efriadi Ismail, Sp.P, Subsp. P.K.L(K), FISR

Occupational and Environmental Lung Health Division Dept. Pulmonology & Respiratory Medicine - FKUI
National Respiratory Center, Persahabatan Hospital Jakarta
Perhimpunan Dokter Paru Indonesia (PDPI)
dr. Efriadi Ismail, Sp.P (K), FISR

EDUCATION :
● MD, Faculty of medicine Universitas Andalas, Padang : 2006

● Pulmonologist , Dept. Pulmonology and Respiratory Medicine, Faculty of

medicine of Universitas Indonesia, Jakarta 2016

● Pulmonologist Consultant : Occupational and Enviromental Lung Health,

Kolegium Pulmonologi dan kedokteran Respirasi Indonesia, 2021
● FISR (Fellowship of Indonesian Society of Respirology), 2022

CURRENT POSITION :
● Staff of Occupational & Lung Health Division, Department Pulmonology and
Respiratory Medicine, Faculty of Medicine of Universitas Indonesia, National
Respiratory Center, Persahabatan Hospital Jakarta
● Pengurus PP PDPI (Perhimpunan Dokter Paru Indonesia)
● Anggota Komite
● FC Napas Pendek – Right Fullback
Polutan tertentu (Selected Pollutans)

World Health Organization. Air pollution. Geneva: World Health Organization; cited in jan 2023
 Introduction
• Air pollution is one of the greatest environmental risk to
health.
• Air pollution kills an estimated seven million people
worldwide every year.
• WHO data shows that 9 out of 10 people breathe air
containing high levels of pollutants
• More than 80% of people living in urban areas that monitor
air pollution are exposed to air quality levels that exceed
WHO guideline limits
• In 2019, 99% of the world’s population was living in places
where the WHO air quality guidelines levels were not met.
• The combined effects of ambient air pollution and household
air pollution are associated with 6.7 million premature deaths
annually.
• Ambient (outdoor) air pollution is estimated to have caused
4.2 million premature deaths worldwide in 2019.
• Some 89% of those premature deaths occurred in low- and
middle-income countries, and the greatest number in the
WHO South-East Asia and Western Pacific Regions.
 Source of Air pollution
• Household
• Transport
• Industrial Practice
• Agriculture
• Waste management
• Natural source

https://www.who.int/health-topics/air-pollution#tab=tab_1
 Classification of air pollutants
(Bernstein et al., 2004)

A. Primary – secondary B. Indoor – outdoor C. Gaseous – particle

pollutants pollutants pollutants
• Primary: pollutants • Indoor pollutants • Gaseous: SO2, NOx,
emitted directly into the • Sources: cooking and ozone, CO, Specific
atmosphere combustion smoking, volatile organic
• Secondary: result of heating, biologic agents compounds
chemical reactions with • Particle:
other pollutants and • Outdoor pollutants • coarse PM (PM 10)
gases. • Sources: industrial, • Fine PM (PM2.5)
commercial, mobile, • Ultrafine PM (PM0.1)
urban, regional,
agricultural, natural
https://www.nps.gov/subjects/air/sources.htm
Fontan J. Air pollution [internet]. encyclopedie-environnement.org. [updated 2019 Mar 7, cited 2021 Dec 4]. Available from: https://www.encyclopedie-environnement.org/en/air-en/air-pollution/
 WHO Air Quality Guidelines 2021
• WHO Air quality guidelines" offer global guidance on thresholds and limits for
key air pollutants that pose health risks
Kadar polutan yang direkomendasikan oleh
WHO

Int. J. Environ. Res. Public Health 2020

http://www.who.int/mediacentre/factsheets/fs313/en/
AIR QUALITY INDEX
• The AQI is an index for reporting daily air quality.
• It tells you how clean or unhealthy your air is, and what associated
health effects might be a concern.
• The AQI is calculated for four major air pollutants:
• ground level ozone
• particle pollution
• carbon monoxide
• sulfur dioxide
Indonesia Air Quality Index
 https://waqi.info
Air quality scale
Descriptor Index Risk Message
Value
Good 0 - 50 Air quality is considered satisfactory, and air pollution poses little or
no risk
Moderate 51 - 100 Air quality is acceptable; however, for some pollutants there may be
a moderate health concern for a very small number of people who
are unusually sensitive to air pollution
Unhealthy for 101 - 150 Members of sensitive groups may experience health effects. The
Sensitive Groups general public is not likely to be affected.

Unhealthy 151 - 200 Everyone may begin to experience health effects; members of
sensitive groups may experience more serious health effects
Very Unhealthy 201 - 300 Health warnings of emergency conditions. The entire population is
more likely to be affected.
Hazardous 300 + Health alert: everyone may experience more serious health effects

The Air Quality Indexes are based on PM2.5, PM10, Ozone, NO2, SO2 and CO hourly measurements
Polutan Udara Ambien Masuk ke dalam Ruangan, dan
Mempengaruhi Kualitas Udara Ruang

66 µg/m3
61 µg/m3
60
60 µg/m3 60 µg/m3
49 µg/m3
50 µg/m3
45 40 µg/m3
41 µg/m3

30
“Healthy” zone
Resiko kesehatan
lebih rendah
15

0
Outdoor Indoor Outdoor Indoor Outdoor Indoor Outdoor Indoor

Klinik Medis di Pondok Indah, daerah Sekolah di Kelapa Gading Gedung Perkantoran Modern di Blok M Rumah di Bintaro (Daerah
elite di Jakarta Selatan (daerah pemukiman di Jakarta (Daerah Komersil di Jakarta Selatan) Perumahan di pinggir Jakarta)
Utara)

0-12 µg/m3 13-35 µg/m3 36-55 µg/m3 56-150 µg/m3 151-250 µg/m3
(Good) (Moderate) (Unhealthy for (Unhealthy) (Very
S.G.) Unhealthy)

C O N F I D E N T I A L 15
Source: Nafas Clean Air Zone 2022 data (collected during trial phase)
Gas Iritan : à IRITASI • Pada mata menyebabkan mata
Sox merah, berair.
Nox • Pada hidung menyebabkan hidung
Ozon berair, gatal dan hidung mampet
atau hidung tersumbat.
• Pada saluran napas atas
menyebabkan sakit
tenggorokan, gatal tenggorokan
Partikel : à IRITASI dan batuk-batuk
VOC • Pada saluran napas bawah dapat
PM menyebabkan sesak napas, batuk
Karsinogen
berdahak. à ISPA

Gas Asfiksian : Bila terhirup ke saluran napas dapat

CO menyebabkan asfiksia atau sesak
CO2 napas karena kurang oksigen
 1. Particulate matter
• Particulate matter adalah campuran
bahan organik dan anorganik kimia
termasuk karbon organik dan elemen
organik yang beragam sesuai daerah
dan musim.
• Partikel dalam ruangan terdiri dari PM
25 dan PM 10 dan UFP yang
menginfiltrasi dari luar ruangan ke
dalam ruangan.
• Sumber PM dalam ruangan: asap rokok,
memasak dengan kerosin atau bahan
bakar biogas, kayu bakar, lilin

Int. J. Environ. Res. Public Health 2020, 17, 8972

 PM Type and Penetratibility

Manisalidis I, Stavropoulou E, Stavropoulos A, Bezirtzoglou E. Environmental and Health Impacts of Air Pollution: A Review. Front Public Health. 2020;8(14):1-13.
Particullate Matter
For every 10 µg/m3 PM increase above the threshold:
• 7% increase in hospital visits with respiratory disease
• 3.5% increase in acute respiratory disease.1
• 3% increase in cardiovascular disease.1
• 2.5% increase in visits to the emergency room.2
• 1% increase in mortality in pneumonia.2
• 8% increased risk of death in lung cancer.3

Threshold PM 10 : 50 μg/m3 24-hour mean and PM 2.5 : 25 μg/m3 24-hour mean

1. Kaiser Permanente, South California
2. California Enviromental Protection Agency
3. Pope et al. Study of Cancer Prevention II
- AIR POLLUTION AND HEALTH EFFECT-

EMISSIONS
SOURCE

a quantitative CONCENTRATIONS
expression of the amount
of pollutant within a given
environmental medium.
amount of
pollution that
EXPOSURE DOSE actually crosses
one of the body
“the event when a person comes into boundaries.
contact
with a pollutant of a certain concentration
during a certain period of time”
HEALTH
EFFECTS
WHO AirQuality Guidelines
2005
 Pajanan PM dalam ruangan
• Pajanan terhadap PM berhubungan dengan penurunan fungsi paru dan
kardiovaskuler melalui proses inflamasi.
• Peningkatan risiko infeksi akut saluran napas bawah, berhubungan dengan
penyebab kematian pada anak-anak di negara berkembang
• Perburukan gejala respirasi dan eksaserbasi pasien PPOK
• Pajanan terhadap UFP menyebabkan stres oksidatif dan inflamasi paru.
• Konsentrasi PM yang lebih tinggi berkaitan dengan peningkatan gejala asma
(khususnya PM 25 terhadap kejadian mengi pada anak-anak)

Int. J. Environ. Res. Public Health 2020, 17, 8972

Efek terhadap kesehatan
Efek jangka Pendek (akut) Efek jangka Panjang (kronik)
• Iritasi mukosa • Penurunan fungsi paru/faal paru
à mata merah, hidung berair, bersin • Hiperreaktivitas bronkus
• Iritasi saluran napas atas, bawah • Reaksi alergi
à Peradangan, sakit tenggorokan, • Risiko asma
batuk, dahak • Risiko PPOK
• Peningkatan ISPA • Risiko penyakit jantung dan pembuluh
• Peningkatan serangan asma, PPOK darah
• Peningkatan serangan Jantung • Risiko kanker
• Peningkatan kunjungan IGD RS krn
respirasi atau jantung
• Risiko keracunan gas toksik
 Masalah kesehatan akibat polusi udara
kanker paru 29%
Infeksi saluran napas akut 17%
PPOK 43%
Eksaserbasi asma
Orang yang berisiko tinggi
terdampak polusi udara ruangan

• Anak dibawah 5 tahun dan orang tua

• Orang yang sedang sakit
• Wanita hamil
• Orang dengan gangguan respirasi dan jantung
• Perokok
• Pekerja pabrik

AQI, Purelogic Labs India diunduh pada Februari 2023 Susanto AD. Air pollution and human health. Med J. 2020;29(1):8–10.
 Data Indonesia Per 100.000
penduduk
2014 2019
Stroke 1 1 Stroke

Penyakit Jantung Iskemik 2 2 Penyakit Jantung Iskemik

Diabetes 3 3 Diabetes

Tuberkulosis 4 4 Sirosis

Sirosis 5 5 Tuberkulosis

10 Penyakit dengan PPOK 6 6 PPOK

Kasus Terbanyak di Diare 7 7 Diare

Indonesia, 4 Kelainan Neonatal 8 8 Hipertensi

diantaranya adalah Pneumonia 9 9 Kanker Paru

Penyakit Respirasi Hipertensi 10 10 Pneumonia

Kanker Paru 11 11 Penyakit Gagal Ginjal Kronik

Penyakit Gagal Ginjal Kronik 12 12 Kelainan Neonatal

Kecelakaan Lalu Lintas 13 13 Kecelakaan Lalu Lintas

Asma 15 16 Asma

Penyakit Respirasi
Sumber: Institute for Health Metrics and Keterangan:
Sumber: Pengelolaan data dari Evaluation (IHME), 2019 Penyakit Non Respirasi
berbagai riset
 Faktor Resiko Polusi
Udara Terhadap 5
Penyakit Respirasi
Terbesar di
Indonesia

Sumber: Pengelolaan data dari

berbagai riset
 Jumlah Kasus dan
Biaya 5 Penyakit
Terbesar di Bidang
Respirasi

Salah satu faktor resiko terbesar

dari 5 penyakit tersebut adalah
paparan polusi udara
https://www.gov.uk/government/publications/health-matters-air-pollution/health-matters-air-pollution
Airborne Disease Related Air Pollution

• Airborne diseases are caused by pathogenic

microbes small enough to be discharged from an
infected person via coughing, sneezing, laughing and
close personal contact or aerosolization of the microbe.
• The populations (also considering gender, age, and genetic
factors) that live in areas at high levels of pollutants are in a
chronic inflammatory state, which makes them more
susceptible to respiratory and cardiovascular diseases also
airborne disease.
 8 major categories of sources of
airborne bacteria, viruses, and fungi

The following eight major categories of sources of airborne bacteria,

viruses, and fungi in the built environment:
1. Humans
2. pets
3. plants
4. plumbing systems
5. heating, ventilation, and air-conditioning systems;
6. mold
7. dust resuspension
8. the outdoor environment.

https://microbiomejournal.biomedcentral.com/articles/10.1186/s40168-015-0144-z#citeas
 Sources of airborne pathogens indoors and
potential for environmental surface contamination

M.K. Ijaz et al. / American Journal of Infection Control 44 (2016) S109-S120

 Environmental factors associated with
survival of airborne infectious agents

M.K. Ijaz et al. / American Journal of Infection Control 44 (2016) S109-S120

 PM Has a Role in Bacterial and Viral Transmission

• Air is a vehicle through which microbial agents can move around the
environment.1
• Plants and cellular fragments, bacteria, fungi, viruses, parasites, and
spores can be components of the bioaerosol.1
• Two mechanisms have been demonstrated to be induced in lungs after
PM exposure, both in humans and experimental models : 2
1. Oxidative stress; exposure to these pollutants induces the production of free
radicals that induce damage the cells.
2. Inflammation; PM induces the activation of the immune response and thus the cell
enters in an inflammatory state.

1. Int. J. Environ. Res. Public Health 2020, 17, 4487

2. https://doi.org/10.1016/j.toxlet.2009.05.023
Fine Particullate Matter

• Mushtaq et al. found that FPMs could facilitate bacteria adherence to

lower airway cells and increase the vulnerability of cells.1
• Liu et al. proposed that exposure to FPMs promoted ROS generation in
lung epithelial cells and disrupted the epithelial barrier, leading to the
invasion of Pseudomonas aeruginosa (P. aeruginosa).2
• Shears et al. suggested that exposure to diesel exhaust particles would
retard the phagocytic function of alveolar macrophages and increase
pneumococcal infections in the lung.3

1. J. Allergy Clin. Immunol. 2011, 127, 1236−1242.e2.

2. J. Thorac. Dis. 2019, 11, 2617−2627.
3. J. Allergy Clin. Immunol. 2020, 145, 1272−1284.e6.
 Effects of Air Pollution to Human Lung
• PM are extremely irritant to the respiratory tract, induces
oxidative stress that can lead to pulmonary and systemic
inflammation. Some of it can be carcinogenic.
• Chronic exposures to oxidative stress can cause bronchial
remodelling and COPD.
• O3 can induces mucosal inflammation of respiratory tract and
airways obstruction in the presence of stimuli (ex: cold, exercise)

Arbex MA, Santos UP, Martims LC, Saldiva PH, Pereira LA, Braga AL. Air pollution and the respiratory system. J Bras Pneumol. Sep-Oct 2012;38(5):643-55.
 Effects of Air Pollution to Human Lung
• SO2, NO and NO2 are irritant and can increases bronchial reactivity
(lead to bronchoconstriction) and susceptibility to infections and
allergen
• CO can bind with hemoglobin and interfering with oxygen
transport. It can causes nausea, dizziness, and headache.

Arbex MA, Santos UP, Martims LC, Saldiva PH, Pereira LA, Braga AL. Air pollution and the respiratory system. J Bras Pneumol. Sep-Oct 2012;38(5):643-55.
 Air Pollution and Immune System
• Inhaled particulates and
gases interact with
epithelial cells lining the
airways and professional
immune cells within the
airways
• Stimulated cells act as
part of multicellular
immune responses and
perturbation of these
can cause disease

Glencross DA, Ho TR, Camina N, Hawrylowicz CM, Pfeffer PE. Air pollution and its effects on the immune system. Free Radical Biology and Medicine. 2020;151:56-8.
 Air Pollution and Respiratory Infection
Pathogen carried
in air pollution +
decreased immune
respiratory
defense à more
susceptible to
respiratory
infection, including
COVID-19

Bourdrel T, Annesi-Maesano I, Alahmad B, Maesano CN, Bind MA. The impact of outdoor air pollution on COVID-19: a review of evidence from in vitro, animal, and human studies. Eur Resp Review. 2021;30:200242.
 Air Pollution and Acute Respiratory Infection
• Air pollution enhances the severity of respiratory infections, particularly in
children
• Odo et al. (2022): A multi-country study of 573.950 children from 35
developing countries
• A 10 µg/m3 increase in PM2.5 was associated with greater odds of
having an ARI (OR: 1.06; 95% CI: 1.05–1.07)
• The association between PM2.5 and ARI was robust to adjustment for
NO2 and O3.
• Horne et al. (2018): From 146.397 children in Utah
• The odds of ALRI increased within 1 week of elevated PM2.5 and
peaked after 3 weeks with a cumulative 28-day odds ratio of 1.15 per
+10 μg/m3 (95% confidence interval, 1.12–1.19)

Odo DB, Yang IA, Dey S, Hammer MS, van Donkelaar A, Martin RV, et al. Ambient air pollution and acute respiratory infection in children aged under 5 years living in 35 developing countries. Environment International. 2022;159:107019.
Horne BD, Joy A, Hofmann MG, Gesteland PH, Cannon JB, Lefler JS, et al. Short-Term Elevation of Fine Particulate Matter Air Pollution and Acute Lower Respiratory Infection. Am J Respir Crit Care Med. 2018;198(6):759-66.
Efek kesehatan dari polusi udara

Kematian dini

Kunjungan Rumah Sakit

Kunjungan ke dokter/ UGD Beratnya
dampak
Aktivitas terhambat/ penurunan kesehatan
performans
Peningkatan penggunaan
obat-obatan yang mengurangi gejala
Perubahan fungsi paru, respons pd kardiovaskuler
kerusakan tingkat sel, respons sel imunitas
(subclinical)
Proporsi populasi yang terkena

American Thoracic Society 2000

 Mucociliary clearance

dust
particles

Gel layer
mucus
Soln layer
cilia

Bronchial wall epithelium

Goblet cell
Depend on:
-mucus layer produces byGablet
Mucous gland cells and Mucous gland)
-kinetics of the cilia
 Air Pollution and Respiratory Infection
• Putative
mechanism of air
pollution in risk
of respiratory
infection

Horne BD, Joy A, Hofmann MG, Gesteland PH, Cannon JB, Lefler JS, et al. Short-Term Elevation of Fine Particulate Matter Air Pollution and Acute Lower Respiratory Infection. Am J Respir Crit Care Med. 2018;198(6):759-66.
ISPA/PNEUMONIA
Hou dkk

hubungan PM 2.5 dengan terjadinya pneumonia

pada anak-anak yang terkena pajanan asap.

Mycoplasma pneumoniae

Qiu H

Hongkong pada periode Januari 2011 - Desember 2012 à

setiap konsentrasi 10 µg/m3 PM 2.5 terjadi peningkatan
angka masuk RS 3.3% dengan pneumonia.

Hou W, Xu X, Lei Y, Cao J, Zhang Y, Chen L, et al. The role of the PM 2.5-associated metals in
pathogenesis of child Mycoplasma pneumoniae infections: a systematic review. Environ Sci Pollut Res.
2016
 Air Pollution and Tuberculosis
• Poor air quality is highly likely to link aetiologically to the risk of TB
• Lin et al. (2019):
• The increment of the risk of TB occurred in a region with a higher level
of air pollution
• Highest population attributable fraction (PAF): CO > NOX & NO2
• Liu et al. (2021): from 83.555 new TB cases in China
• Short and long-term exposures to outdoor ait pollutants (SO2, NO2, CO,
O3, and PM2.5 were significantly associated with new infection TB,
recurrent TB risk, and mortality
• SO2 and PM2.5 exhibited more consistent & strong associations

Lin YJ, Lin HC, Yang YF, Chen CY, Ling MP, Chen SC, et al. Association Between Ambient Air Pollution and Elevated Risk of Tuberculosis Development. Infect Drug Resist. 2019;12:3835-47.
Liu Y, Zhao S, Li Y, Song W, Yu C, Gao L, Ran J, et al. Effect of ambient air pollution on tuberculosis risks and mortality in Shandong, China: a multi-city modeling study of the short- and long-term effects of pollutants. Environ Sci Pollut Res Int. 2021;28(22):27757-68.
 Air Pollution and Tuberculosis
• Liu et al. (2018): A time-
series study in Jinan,
China:
• A positive association
between ambient
PM2.5 & CO
exposures and the
risk of newly
diagnosed
pulmonary TB in
China

Liu Y, LiangLiang C, Hou L, Yu CB, Tao NN, Liu JY, et al. Ambient Air Pollution Exposures and Newly Diagnosed Pulmonary Tuberculosis in Jinan, China: A Time Series Study. Scientific Reports. 2018;8:17411.
 Air Pollution and COVID-19
• Air pollution can increase COVID-19
transmission, severity of the disease,
and mortality
• Frontera et al. (2020):
• The highest number of COVID-19
cases in Italia was recorded in the
most polluted regions with
patients presenting with more
severe forms of the disease
requiring ICU admission
• Mortality was two-fold higher in
the polluted regions
• Chronic exposure to air pollution
causes alveolar ACE-2
overexpression à increase viral
load à depleting ACE-2 receptors
and impairing host defences

Wang B, Chen H, Chan YL, Oliver BG. Is there an association between the level of ambient air pollution and COVID-19? Am J Physiol. 2020;319:l416-21.
Frontera A, Cianfanelli L, Vlachos K, Landoni G, Cremona G. Severe air pollution links to higher mortality in COVID-19 patients: The “double-hit hypothesis. Journal of Infection. 2020;255-9.
Health-problem conditions related to long exposure
of air pollution prior COVID19 infection

• Poor air quality can put recovered COVID-19 patients at risk of getting
long COVID
• Deteriorating air quality can worsen respiratory health
- Air pollution can worsen other pre-existing conditions,
increasing the risks of hospitalization.
- Those who have recovered from severe COVID infections
continue to remain at risk of developing lung injuries due to the
rising pollution levels.
• Poor air quality may slow down recovery of the lungs after COVID
infection
• People suffering from asthma, COPD, and other repiration problems
need to be extra careful in advance to negative impact of air pollution.
Arbex MA, Santos UP, Martims LC, Saldiva PH, Pereira LA, Braga AL. Air pollution and the respiratory system. J Bras Pneumol. Sep-Oct 2012;38(5):643-55.
Polusi Udara dan respons inflamasi alergik

• Polutan terutama dari gas pollutant

buang diesel (DEP)/PM10
dapat meningkatkan
timbulnya inflamasi alergik
pada paru

à Direct/respons akut :
Allergen LPS
à induksi bronkokonstriksi Particle
/penyempitan
Host (gene)- Host (gene)- Host (gene)-LPS
saluran napas allergen interaction particle interaction interaction
/hiperesponsif saluran napas
Tingkat beratnya
respons alergik
Efek kronik atau Jangka Panjang

• Penurunan fungsi paru/faal paru

• Hiperreaktivitas bronkus
• Reaksi alergi
• Risiko asma
• Risiko PPOK
• Risiko penyakit jantung dan pembuluh darah
• Risiko kanker
 Penurunan fungsi paru
• Polisi lalu lintas (2012)
1. Jakarta selatan ( abnormal 5% ; Obstruksi 2,8%- Restriksi
Southern California Children’s Health Study → 2,2%)
2. Jakarta pusat (abnormal 19,8%; Obstruksi 8,2%- Restriksi
11,6%)
•pajanan PM 2.5 jangka panjang akibat polusi 3. Jakarta Timur (abnormal 15,3%; Obstruction 5,3%-
Restriksi 10%)
udara dapat menyebabkan penurunan
pertumbuhan fungsi paru pada anak-anak. • Penyapu jalan
1. Dewi, Pekanbaru ( PEFR abnormal 52,9%) à 2013
2. Meita, Semarang ( abnormal 90%; Mixed 6,7%) à 2015
• Pada anak usia 10-18 tahun ditemukan 3. Bagus, Surabaya ( 6/10 or 60% mild restriksi) à 2016
penurunan nilai fungsi paru VEP1.
• Penjual koran di lampu merah
1. Handayani, Pekanbaru ( PEFR abnormal 52%) à 2011

Global Initiative for Chronic Obstructive Lung Disease (GOLD). Global strategy for the diagnosis, management and prevention of chronic obstructive
pulmonary disease update 2015;2014.p.6-21
Pope CA, Dockery DW. Health Effects of Fine Particulate Air Pollution: Lines that Connect. J. Air and Waste Manage. Assoc. 2012
 ASMA
Delfino dkk

53 anak penderita asma dengan usia sekitar 9-18

tahun di California didapatkan hubungan pajanan
PM 2.5 à penurunan fungsi paru pada pasien asma

Hua J dkk

Negara China à hubungan pajanan PM2.5 dari

karbon hitam à asma pada anak-anak dengan risk
ratio adalah 1.06 kali untuk PM 2.5.

Wendt JK, Symanski E, Stock TH, Chan W, Du XL. Association of short-term increases in ambient air pollution and timing of initial
asthma diagnosis among medicaid-enrolled children in a metropolitan area. Environmental Research. 2014;131:50–8.
 ASMA

Polusi

Huang SK, Zhang Q, Qiu Z, Chung KF. Mechanistic Impact of Outdoor Air
Pollution on Asthma and Allergic Disease. J Thorac Dis. 2015;(1):22-33.
 Asma
• Prevalens asma pada penyapu
jalan, yang terkena polusi udara :

1. India ( 1,8%)
2. Denmark (2,3%)
3. Jakarta-Indonesia ( 3,1%)
(Mirza, Agus DS, Budhi A. Dept Pulmo
FKUI 2016)
 COPD

• Prevalens PPOK pada populasi yang

terekspose polusi udara

1. Jerman (4,5%) à populasi yg

terexpose,
perempuan
2. Denmark ( 2,5%) à penyapu jalan
3. Jakarta-Indonesia (6,58%) à penyapu
jalan
(Wahju A, Faisal Y, Agus DS. Dept Pulmo FKUI
2016)

Guide P, Copd TO. Pocket Guide To Copd 2020 Report. 2020; Available from: https://goldcopd.org/wp-content/uploads/2020/03/GOLD-2020-POCKET-GUIDE-ver1.0_FINAL-WMV.pdf
 COPD & Air pollution
• Acute exposure og PM2,5 induced
inflammatory cells infiltration and
hyperemia in the lung tissue à
stimulation of inflammatory factors à
vicious cycle that damages lung
endothelial cells and further
aggravates lung injury
• PM has the ability to generate oxygen
free radicals à stimulate cells to
ptoduce large number of ROS à
damage lung cells
• ROS production induced by oxidative
stress can lead to DNA damage and
change in gene expression
Duan RR, Hao K, Yang T. Air pollution and chronic obstructive pulmonary disease. Chronic Dis Transl Med [Internet]. 2020;6(4):260–9. Available from: https://doi.org/10.1016/j.cdtm.2020.05.00
 Caused of acute exacerbations of chronic obstructive
pulmonary diseases
● Non-infectious (20-40% of all
• Infections (60-80% of all exacerbations) exacerbations)
• Haemophilus influenzae
○ Heart Failure
• Streptococcus pneumoniae
• Moraxella catarrhalis ○ Pulmonary embolism
• Viruses
○ Non- pulmonary infections

• Infrequent (15-30% of all infectious ○ Pneumothorax

exacerbations)
• Pseudomona aeruginosa
● Precipitating of environmental factors
• Oppostaphylococc us aureus
• Oportunistic gram- negative species ○ cold air

○ air pollutions

○ allergen

Decramer M, Janssens W, Miravitlles M. Chronic obstructive pulmonary disease. Lancet [Internet]. 2012;379(9823):1341–51. Available from: http://dx.doi.org/10.1016/S0140-6736(11)60968-9
 Lung Cancer
• Main risk factor of lung cancer is
active smoking. But, exposure to
environmental occupational
carcinogens is also recognized as risk
factors.
• Meta-analysis from Hamra, et all
shows that: meta relative risk was
1.09 for lung cancer relared to PM 2,5
and PM 10 respectively.
• For each 10 ug/m3 increased in
ambient PM2,5, incidence of lung
cancer increased.
• Tudorache E, Oancea C. Air pollution
exposure — the ( in ) visible risk
factor for respiratory diseases.
2021;19615–28.

Tudorache E, Oancea C. Air pollution exposure — the ( in ) visible risk factor for respiratory diseases. 2021;19615–28.
 Upregulated or
downregulated
DNA function
due to air
pollution à
Lung Cancer

Shahadin MS, Mutalib NS Ab, Latif MT, Catherine Greene M, Tidi H.Challenges and Future Direction of Molecular Research in Air Pollution-Related Lung Cancers. Lung Cancer. 2018;5002(18):30230-7.
 Kanker paru
The International Agency for Research on Cancer
(IARC) à PM bersifat karsinogenik (penyebab
kanker)
(class I carcinogen)

Global Burden of Disease Project àpada tahun

2010, ditemukan 3,2 juta kematian di seluruh
dunia à polusi udara
223.000 kasus
akibat kanker
paru

Tecer LH, Alagha O, Karaca F, Tuncel G, Eldes N. Particulate matter (PM(2.5), PM (10-2.5), and PM (10)) nd children’s
hospital admissions for asmth and respiratory disease: a bidirectional case-crossover study. J Toxicol Environ Health A. 2008
 How to Prevent and Reduce Air
Pollution
Collaboration between professional, governmental, and non-
governmental organization is needed to control and reduce the air
pollution
• Regulations limiting vehicle and factory emission
• Emission monitoring
• Enforcement for industrial emission
• Project on mass rapid transportation in some big cities
• No-smoking areas
• Shifting to renewable energy sources
Susanto AD. Air pollution and human health. Med J. 2020;29(1):8–10.
 Gedung ramah lingkungan
• Desain Gedung yang
menghasilkan sedikit polusi
dan penggunaan sumber daya
yang lebih baik
• Desain, konstruksi dan
perawatan Gedung
meminimalisir polutan dalam
ruangan
• Memastikan udara segar yang
cukup dan tersirkulasi dan
menjaga kelembaban untuk
menghindari lembar yang
berkaitan dengan masalah
jamur.
 Mengontrol Polusi udara dalam ruangan
• Dilusi adalah prinsip mengontrol kualitas udara dalam ruangan
• Udara segar dari luar bercampur melalui sistem ventilasi-ac dan jendela yang dapat
dibuka
• Sistem pembersihan udara yang dapat mengurangi potensi polusi seperti partikel,
vapor dan gas
• Dapat dipasang dengan pemanas, ventilasi dan sistem Ac atau dapat dipasang
terpisah
• Edukasi untuk tidak memasang alat dengan ventilasi buruk
• Edukasi agar memakai produk yang aman
• Edukasi pentingnya pengetahuan pajanan bahan berbahaya dan cara menghindarinya.
• Di wilayah perkotaan risiko penyakit lebih tinggi karena lebih banyak melakukan
aktifitas dalam ruang tertutup seperti: rumah, transportasi umum, kantor, ruang kelas,
restoran dan bioskop.
• Kontaminan yang berhubungan dengan ventilasi udara yang buruk adalah radon, asap
rokok, emisi dari VOC
Conclusion
• Air pollution is one of main environmental problem in the world
and causes many illnesses and deaths from respiratory diseases
• Air pollution can causes irritation of respiratory tract, mucosal
inflammation (acute and chronic), induce oxidative stress, and
trigger allergic reaction that can lead to various lung diseases such
COPD, asthma, infection and lung cancer
• Reduction and prevention of air pollution need collaboration of
professional, governmental, and non-governmental organization
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