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adults greater than 65 years (Ostro, Broadwin et al. 2006). Increased rates of myocardial
infarction, dysrhythmias, increased blood pressure, heart failure and hospitalisation for
cardiac events have been associated with higher air pollution levels (Pope, Verrier et al. 1999;
Peters, Liu et al. 2000; Linn and Gong 200I; Peters, Dockery et al. 2001; Pope, Burnett et al.
2W4\.
The 'Swiss Study on Air Pollution and Lung Diseases in Adults' involving over nine
thousand subjects showed positive conelations of levels of particulate matter, ozone and NOz
with chronic cough, chronic sputum production, and shortness of breath during the day,
during the night and on exertion, but not with other respiratory symptoms (Zemp, Elsasser et
al. 1999). This study also showed reduced lung function parameters for FVC, FEVr and
FEFzs-zs which negatively correlated with the same three pollutants (Ackermann-Liebrich,
Iruenberger et al. 1997, Schindler, 2001 #652). A major study in six cities in the USA
demonstrated a three fold increase in chronic cough with increased exposure to particulate
pollution @ockery and Pope 1994). Throughout Califomia from 1973 to 1987 site and season
specific particulates were monitored and showed correlations between the development of
symptoms of airway obstructive disease, increased severity of obstructive disease, chronic
productive cough and increased asthma (Abbey, Hwang et al. 1995). Stronger associations
were seen with those who were also occupationally exposed to dusts and fumes. Increased
symptoms of cough, bronchitis, asthma, and COPD were associated with increased air
pollution (Schwartz t993; Souza, Saldiva et al. 1998). Particulate matter was found to be
associated with respiratory diagnoses made by a physician and chronic bronchitis in a study
involving 53 urban areas throughout the United States with graduated levels of pollution
(Schwartz 1993).In Australia, ozone levels, particulate matter and the concentration of SOz
had strong associations with emergency department review of respiratory illnesses overall,
and for asthma exacerbations in twelve hospitals, though it proved difficult to detect out
differences between the pollutants (Atkinson, Anderson et al. 1999). Particulate matter levels
were also positively associated with hospital admissions for asthma and for COPD @rbas and
Hyndman 2005).
Histopathologic changes have been shown in lung tissue samples of individuals who died due
to violent causes depending on their pollutant exposure history. With the increased pollution,
there was increased presence of inflammatory reaction, wall thickening, ild secretory
hyperplasia. There were also increased carbon deposits along the regional lymphatic drainage
(Souza, Saldiva et al. 1998).
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