Epidemiologic studies on short-term effects of low levels of major ambient air pollution components

Since the development of the World Health Organization (WHO) Air Quality Guidelines for Europe, a large number of epidemiologic studies have been published documenting effects of major air pollutants on health at concentrations below existing guidelines and standards. In this review, recent studies are discussed that permit some evaluation of short-term health effects observed at exposure levels lower than the current WHO Guidelines or U.S. Environmental Protection Agency (U.S. EPA) standards. Some studies have been conducted at concentration levels that never exceeded existing guidelines or standards. Other studies have been conducted at exposure levels sometimes exceeding current guidelines or standards. The published analyses of several of these studies permit evaluation of low-level health effects either because analyses were restricted to levels not exceeding the guidelines or graphic analyses were reported suggesting effects at these low levels. For ambient ozone, effects on lung function of subjects exercising outdoors have now been documented at 1-hr maximum levels not exceeding 120 micrograms/m3, i.e., half the current U.S. EPA standard. One study even suggests that such effects occur at levels below 100 micrograms/m3. Several studies are now available documenting effects of particulate air pollution on health in the virtual absence of SO2. Effects on mortality and hospital admissions for asthma have been documented at levels not exceeding 100 micrograms/m3, expressed as 24-hr average inhalable particles PM10 concentration. Effects on lung function, acute respiratory symptoms, and medication use have been found at 24-hr average PM10 levels not exceeding 115 micrograms/m3. When the WHO Air Quality Guidelines and the U.S. EPA standard for PM10 were developed, there were no studies available on health effects of PM10. In this review, we include nine studies documenting health effects of measured PM10 at low levels of exposure, indicating that there is now an entirely new epidemiologic database that can be evaluated in the process of revising current guidelines and standards. The low levels of exposure at which effects on health were seen underscore the urgent need for such reevaluations.