INDOOR AIR POLLUTANTS EXPOSURE & THE LEVEL 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 Putra Malaysia, 2 Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, UPM, Malaysia

Indoor air quality is a vital factor that influenced the health of occupants in buildings as several indoor pollutants can be many times higher compared to outdoors 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 the most important indoor environment as children spend as much as 80% of their times either in school or at home.

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

PARTICULATTE MATTERS (PM)

PM2.5
Fine particulate matter of diameters less than 2.5 microns (m) is a thoracic dust able to penetrate deeply into the lungs Fine particles result from fuel combustion (motor vehicles, power generation, industrial facilities), residential fireplaces and wood stoves (EPA, 1997).

PM10
Course particulate consisting of particles smaller than 10 microns is an inhalable dust able to deposited in the upper respiratory tract (nose and throat). Generally emitted from vehicles traveling on unpaved roads, materials handling, and crushing, grinding, and windblown dust (EPA, 1997)

Based on health considerations, PM10 and PM2.5 are usually selected as indicators of air pollution 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).

Figure 2: PM deposited area Source: ACGIH (1999)

Figure 3: Lung anatomy of children Source: CHW, 2012

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).

Air pollution is approaching critical levels in a number of urban areas 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 as acute and chronic respiratory problems especially among children and elderly (Ismail et al., 2010). The pollutant levels in indoor school facilities are often 2 to 5 times higher 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 bodies are still developing and the effect of environmental may interfere with the growth of their lung function and immune systems (Smith et al., 2000; Gordon, 2004).

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 alveolar macrophages (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)

Figure 5: Childrens lung development Source: Ritz and Wilhem, 2008

PM2.5

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

Figure 7: mechanism of lung inflammation Source: Pauly JL and Paszkiewicz (2011)

STUDY LOCATION National primary school in Klang Valley

STUDY DESIGN * Cross sectional comparative

SAMPLING TECHNIQUE * Stratified random sampling

Urban

INCLUSIVE CRITERIA Malaysian Standard 2 and 5 Healthy status Living 5 km within the school

Rural

URBAN

PETALING JAYA

CHERAS

BERANANG

RURAL

SAMPLING PROCEDURES
QUESTIONNAIRE
Adapted from American Thoracic Society ATS-DLC-78-C WHO (1994) Focused on respiratory symptoms, home environment exposures, lung disease history and sociodemographic information.

EXPOSURE ASSESSMENT
Portable Indoor Air Monitor Dust Trak Aerosol Monitor (PM2.5 & PM10) LaMotte Air Tool (NO2) Sampler

BIOMARKERS MEASUREMENT
Human TNF- ELISA Kit (Bender Medsystems)

EXPOSURE ASSESSMENT

Dust Trak Aerosol Monitor (PM2.5 & PM10)

LaMotte Air Sampler Tool (NO2)

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

Sputum samples taken during school by inducing sputum using 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 measure TNF- using ELISA

Analysis carried out in Chemical Pathological Laboratory, UPM.

Table 2: Comparison of Indoor Air Pollutants inside Classroom between Urban and Rural Urban (n=232) Number (%) Median (IQR) PM2.5 (g/m3) 50.36 (17.43) Rural (n=198) Number (%) Median (IQR) 27.3 (6.17) -16.70 <0.001

Variables

z Value

p Value

Standard

35 g/m3
(EPA, 1997)

PM10 (g/m3) NO2 (ppm)

94.86 (29.86) 0.122 (0.07)

58.10 (7.76) 0.03 (0.009)

-16.05 -17.89

<0.001 <0.001

150 g/m3
(DOSH, 2005)

0.2 ppm
(DOSH, 2005)

Respiratory symptoms among schoolchildren

35 30 25 20

31.5

percentage (%)

25.9

Urban
15

14.1
10 5 0

13.6

13.4

Rural

Cough

Phlegm

Wheezing

Chest Tightness

Respiratory Symptoms Figure 8: Comparison of Respiratory Symptom among school children

Table 3: Comparison of TNF- between schoolchildren in urban and rural area

Variable

Urban (n=232)
Median (IQR)

Rural (n=198)
Median (IQR)
2.35 (1.35)

z Value

p Value

TNF (pg/ml)

4.21 (3.46)

-10.78

<0.001**

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

Variable
r value PM10 PM2.5
0.115 0.245

Urban (n=232) p value

0.08 0.001**

Rural (n=198) r value

-0.146 0.187

p value
0.04* 0.008*

NO2

0.174

0.008*

0.172

0.016*

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

The significantly higher exposure of PM and NO2 have higher probability to develop respiratory symptoms among children live in urban compared to rural.

TNF- could be important in mediating the inflammatory effects in PM exposure studies through sputum induction as it promote safe, simple noninvasive approach

THANK YOU

Guidelines for IAQ Management in School Environmental assessments of the school should be coordinated by school with the governmental agencies, state authorities and environmental & health department to plan for guideline used for school. Maintenance and housekeeping Good housekeeping practices might used in the routine maintenance and helps keep the schools protect the indoor quality and the health and well being of schoolchildren. Housekeeping should be done everyday (before and after end of class)

Awareness Educate and make aware of the schoolchildren regarding IAQ issues. If the students are provided with information about the sources and effects of pollutants, they can learn and act to reduce their personal exposure.

School Bus Exhaust.

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

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