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Environmental Pollution 151 (2008) 362e367

Human health effects of air pollution

Marilena Kampa, Elias Castanas*

Laboratory of Experimental Endocrinology, University of Crete,

School of Medicine, P.O. Box 2208, Heraklion, 71003, Greece

Received 4 June 2007; accepted 10 June 2007

The effect of air pollutants on human health and underlying

mechanisms of cellular action are discussed.

Abstract

Hazardous (Adj) chemicals (N) escape (Adv) to the environment (Adv) by (Adv) a
number (N) of natural (Adj) and/or anthropogenic activities (N) and may cause
(Adv) adverse (Adj) effects (N) on human (N) health (N) and the environment (N).
Increased (Adv) combustion (N) of fossil (N) fuels (N) in the last (Adv) century (N)
is responsible (Adj) for the progressive (Adj) change (N) in the at- mospheric
composition (N). Air ( N) pollutants (N), such as carbon monoxide (CO) (N), sulfur
dioxide (SO2) (N), nitrogen oxides (NOx) (N), volatile organic compounds (VOCs)
(N), ozone (O3) (N), heavy (Adj) metals (N), and respirable (Adj) particulate (N)
matter (N) (PM2.5 and PM10), differ in their chemical (N) composition (N),
reaction (N) proper (Adj), emission (N), time (N) of disintegration (N) and ability
 (N) to diffuse ( Adv) in long (Adj) or short (Adj) distances (N). Air (N) pollution (N)
has both (Adj) acute (Adj) and chronic (Adj) effects (N) on human (N) health (N),
affecting ( Adj ) a number (N)of different (Adj) systems (N) and organs (N). It
ranges (N) from minor (N) upper (N) respiratory (Adj) irritation (N) to chronic (Adj)
respiratory (Adj) and heart (N) disease (N) , lung (N) cancer (N), acute (Adj)
respiratory (N) infections (N) in children (N) and chronic (Adj) bronchitis (N) in
adults (N), aggravating (adj) pre-existing heart(N) and lung (N) disease (N), or
asthmatic (Adj) attacks (N). In addition (N), short (adj)- and long-term ( N)
exposures (N) have (N) also (Adv) been linked (Adv) with premature (adj) mortality
(N) and reduced (adv) life (N) expectancy (N). These effects (N) of air (N)
pollutants (N) on human (N) health (N) and their (P) mechanism (Adv) of action
(N) are briefly discussed (adv).
© 2007 Elsevier Ltd. All rights reserved.

Keywords: Air pollutant; Human health; Cellular actions; Detoxification

Terjemahan :

Bahan kimia berbahaya lepas ke lingkungan dengan sejumlah aktivitas alami dan / atau
antropogenik dan dapat menyebabkan efek buruk pada kesehatan manusia dan lingkungan.
Peningkatan pembakaran bahan bakar fosil pada abad terakhir bertanggung jawab atas
perubahan progresif dalam komposisi atasan. Polutan udara, seperti karbon monoksida (CO),
sulfur dioksida (SO2), nitrogen oksida (NOx), senyawa organik volatil (VOC), ozon (O3),
logam berat, dan partikel terserap (PM2.5 dan PM10) berbeda dalam komposisi kimianya,
reaksi yang tepat, emisi, waktu disintegrasi dan kemampuan untuk menyebar dalam jarak
yang jauh atau pendek. Polusi udara memiliki efek akut dan kronis pada kesehatan manusia,
yang mempengaruhi sejumlah sistem dan organ yang berbeda. Ini berkisar dari iritasi saluran
pernapasan bagian atas yang kecil hingga penyakit pernafasan dan jantung kronis, kanker
paru-paru, infeksi saluran pernafasan akut pada anak-anak dan bronkitis kronis pada orang
dewasa, yang memperparah penyakit jantung dan paru-paru yang sudah ada sebelumnya, atau
serangan asma. Selain itu, eksposur jangka pendek dan jangka panjang juga dikaitkan dengan
angka kematian dini dan penurunan harapan hidup. Efek polutan udara terhadap kesehatan
manusia dan mekanisme tindakannya dibahas secara singkat.
1. Introduction

Although a number (N) of physical (adj) activities (N) (volcanoes (N), fire (N), etc
(P). May (Adv) release (N) different (adj) pollutants (N) in the environment (N),
anthropogenic (N) activities (N) are the major (N) cause (N) of environmental (N) air
(N) pollution (N). Hazardous (adj) chemicals (N) can (N) escape (N) to(Adj) the
environment( N) by (adv) accident (N), but a number (N) of air (N) pollutants (N) are
released (N) from industrial (adj) facilities and other activities (N) and may (adv) cause
(N) ad- verse (adj) effects(N) on human (N) health (N)and the environment (N). By
definition (N), an air (N) pollutant (N) is any (adj) substance (N) which (adj) may (N)
harm(N) humans (N), animals (N), vegetation (N) or material (N). As (adv) far (adv) as
humans (N) are concerned (N) an air ( N) pollutant (N) may (adv) cause (N) or
contribute (adv) to an increase(N) in mortality (N) or serious (adj) illness (N) or
may(adv) pose (N) a present (N) or potential (adj) hazard(N) to human (N) health (N).
The determination (N) of whether (N) or not(adv) a substance (N) poses (N) a health
(N) risk (N) to humans (N) is based (adv) on (adj) clinical (N), epidemiological (N),
and/or animal (N) studies (N) which (adj) demonstrate(adv) that (adj) exposure (N) to
(adj) a substance (N) is associated (N) with health (N) effects (N). In the context (N) of
human (N) health (N),‘‘risk’(N)’ is the probability (N) (that a noxious (adj) health
(N)effects (N) may (adv) occur (adv)

* Corresponding author. Tel.: þ30 28 1039 4580; fax: þ30 28 1039 4581.
E-mail addresses: kampa@med.uoc.gr (M. Kampa), castanas@med.uoc.gr (E.
Castanas).

0269-7491/$ - see front matter © 2007 Elsevier Ltd. All rights reserved.
doi:10.1016/j.envpol.2007.06.012
TERJEMAHAN

Meskipun sejumlah aktivitas fisik (gunung berapi, api, dll.) Dapat melepaskan polutan yang
berbeda di lingkungan, aktivitas antropogenik adalah penyebab utama pencemaran udara
lingkungan. Bahan kimia berbahaya dapat terhindar dari lingkungan secara tidak sengaja,
namun sejumlah polutan udara dilepaskan dari fasilitas industri dan kegiatan lainnya dan
dapat menyebabkan dampak buruk pada kesehatan manusia dan lingkungan. Menurut
definisi, polutan udara adalah zat yang dapat membahayakan manusia, hewan, tumbuhan atau
bahan. Sejauh menyangkut manusia, polutan udara dapat menyebabkan atau berkontribusi
pada peningkatan angka kematian atau penyakit serius atau dapat menimbulkan bahaya saat
ini atau potensi bahaya bagi kesehatan manusia. Penentuan apakah suatu zat menimbulkan
risiko kesehatan bagi manusia atau tidak. Berdasarkan penelitian klinis, epidemiologis, dan /
atau hewan yang menunjukkan bahwa paparan zat dikaitkan dengan efek kesehatan. Dalam
konteks kesehatan manusia, '' risiko '' kesehatan berefek berbahaya kemungkinan dapat
terjadi.

2. Pollutant categories

The main(N) change (N) in the atmospheric (N) composition (N) is primar - ily
(adv) due to the combustion(N) of fossil (N) fuels (N), used (N) for the genera- tion
(N) of energy (N) and transportation (N). Variant (N) air pollutants (N) have (adv)
been reported (N), differing (adv) in their chemical (N) composition (N), reac- tion
properties (N), emission (N), persistence (N) in the environment ( Adv ), abil- ity
(N)to be transported (N) in long (N) or short (N) distances (N) and their (P)
eventual (N) impacts(N) on human (N)and/or animal health (N). However (Adv),
they (P) share some (N) similarities (N) and they (P) can be grouped (adv) to four
categories (N):
1. Gaseous pollutants (N) (e.g. SO2, NOx, CO, ozone, Volatile Organic Compounds).
(N)
2. Persistent organic pollutants (e.g. dioxins). (N)
3. Heavy (Adj) metals (e.g. lead, mercury). (N)
 4. Particulate Matter.(N)

Terjemahan
Perubahan utama komposisi atmosfir terutama terjadi pada pembakaran bahan bakar
fosil, yang digunakan untuk genera energi dan transportasi. Polutan udara beragam telah
dilaporkan, berbeda dalam komposisi kimianya, sifat reaktif, emisi, ketekunan di lingkungan,
kemampuan untuk diangkut dalam jarak yang jauh atau pendek dan dampak akhirnya
terhadap kesehatan manusia dan / atau hewan. Namun, mereka berbagi beberapa kesamaan
dan mereka dapat dikelompokkan menjadi empat kategori:
1. Polutan gas (misalnya SO2, NOx, CO, ozon, Volatile Organic Compounds).
2. Polutan organik yang persisten (misalnya dioksin)
3. Logam berat (misalnya timbal, merkuri).
4. Particulate Matter

Gaseous pollutants (N) contribute (adv) to a great (N) extent (N) in composi- tion
(N) variations (N) of the atmosphere (N) and are mainly (N) due to com- bustion (N)
of fossil (N) fuels (N) (Katsouyanni, (N) 2003 (adv). Nitrogen (N) oxides (N) are
emitted (adv) as (adv) NO which (adj) rapidly (adv) reacts (adv) with ozone (N) or
radicals (N) in the atmosphere (N) forming (adv) NO2 (N) The main (adj)
anthropogenic (N) sour- ces (N)are mobile (adj) and stationary (adj) combustion (N)
sources (N). Moreover (adv), ozone (N) in the lower (adv) atmospheric (N) layers (N)
is formed by (adv) a series (N) of reactions (N) involving (Adv) NO2 ( N) and
volatile organic (adj) compounds (N), a process (N) initiated (adv) by sun (N) light
(N). CO, (N) on the other(adj) hand (N), is a product (N) of incomplete (adj)
combustion (N). Its major (adj) source (N) is road (N) transport too (N). While (N)
the anthropogenic SO2 (N) results (N) from the combustion (N) of sulphur-containing
fossil (N) fuels (principally coal and heavy oils) (N) and the smelting of sulphur (N)
containing(Adv) ores(N), volcanoes (N) and oceans (N) are its major (adj) natural
(N) sources (N). The latter (N) contribute (adv) only ~2% (adv) of the total emissions
(N). Finally (adv) a major class (N) of compounds (N) that fuel combustion(N) and
espe- cially (Adv) combustion (N) processes (N) for energy (N) production (N)and
road transport (N) are the major (N) source (N) of emission (N) are the so called (N)
volatile organic (N) compounds (N) (VOCs). This is a class (N) of com- pounds,(N)
 which (Adj) includes (adv) chemical species (N) of organic (N) nature (N) such as
benzene (N). Even (adj) though (adj) the majority of gaseous (Adj) pollut- ants (N)
are inhaled (Adv) and mainly ( adj) affect (adv) the respiratory (adj) system (N) they
(P) can also induce (adv) haematological problems (CO, benzene) (N) and cancer
(N).

Terjemahan

Polutan gas berkontribusi besar dalam variasi komposisi atmosfer dan terutama
disebabkan oleh pembakaran bahan bakar fosil (Katsouyanni, 2003).Nitrogen oksida
dipancarkan sebagai yang tidak bereaksi cepat dengan ozon atau radikal di atmosfer yang
membentuk NO2. Sumber anthropogenik utama adalah sumber pembakaran bergerak dan
stasioner. Selain itu, ozon di lapisan atmosfer bawah dibentuk oleh serangkaian reaksi yang
melibatkan NO2 dan senyawa organik yang mudah menguap, sebuah proses yang dipicu oleh
sinar matahari. CO, di sisi lain, adalah produk dari pembakaran yang tidak sempurna. Sumber
utamanya adalah transportasi jalan juga. Sementara hasil SO2 antropogenik dari pembakaran
bahan bakar fosil yang mengandung belerang (terutama minyak batu bara dan berat) dan
peleburan bijih yang mengandung belerang, gunung berapi dan lautan adalah sumber alami
utamanya. Yang terakhir hanya menyumbang ~ 2% dari total emisi. Akhirnya kelas utama
senyawa yang membakar bahan bakar dan terutama proses pembakaran untuk produksi
energi dan transportasi jalan merupakan sumber utama emisi adalah senyawa organik volatil
yang disebut (VOC). Ini adalah kelas kombinasi, yang mencakup spesies kimia dari sifat
organik seperti benzena. Meskipun sebagian besar polutan gas terhirup dan terutama
mempengaruhi sistem pernapasan, mereka juga dapat menyebabkan masalah hematologis
(CO, benzene) dan kanker
 Persistent (Adj) organic (N) pollutants (N) form (N) a toxic (Adj) group of chemi- cals
(N). They (P) persist (adj) in the environment (adv) for long (Adj) periods of time
(adj) , and their effects (N) are magnified (Adj) as they (P) move up (N) through the
food (N) chain (bio-magnification) (N). They (P) include pesticides (N), as well as
dioxins (N), furans and PCBs (N). Generally(Adj), the generic term ‘‘dioxins ’’ (N) is used
(adv) to cover (Adv) polychlorinated dibenzo-dioxins (PCDDs) (N) and
polychlorinated dibenzo-furans (PCDFs) (N) while polychlorinated biphenyls (PCB)
(N) are called ‘‘dioxin like compounds’’ (N) and can (Adv) act (N) similarly (adv) in
terms (adv) of dioxin-type toxicity (N) (Schecter et al (N)., 2006 (adv). Dioxins (N) are
formed during (N) in- complete (adj) combustion (N) and whenever (adv) materials (N)
containing (adv) chlorine (N) (e.g. plastics) (N) are burned (adv). Emitted (adv) in the
atmosphere (adv), dioxins (N) tend to deposit (adv) on soil (N) and water(N) but, being
water (N)- insoluble (adj), they (P) do not contaminate (adv) ground water (N) sources
(N). Most (N) dioxins (N) in plants (adv) come from air (N) and dust (N) or pesticides
(N) and enter (Adv) the food (N) chain (N) where they (P) bio-accumulate (Adv) due to
their (P) ability (N) to be stably (N) bound (adv) to lipids (N).

Terjemahan
Polutan organik yang persisten membentuk kelompok kimia yang beracun. Mereka
bertahan di lingkungan untuk jangka waktu yang lama, dan efeknya diperbesar saat mereka
bergerak melalui rantai makanan (pembesaran bio). Mereka termasuk pestisida, juga dioksin,
furan dan PCB. Umumnya, istilah generik '' dioxin '' digunakan untuk menutupi
polychlorinated dibenzo-dioxins (PCDDs) dan polychlorin ated dibenzo-furans (PCDFs)
sementara polychlorinated biphenyls (PCB) disebut '' dioxin like compounds '' dan dapat
bertindak dengan cara yang sama. toksisitas dioksin (Schecter et al., 2006). Dioksin terbentuk
selama pembakaran sempurna dan kapan bahan yang mengandung klorin (misalnya plastik)
dibakar. Dipancarkan di atmosfer, dioksin cenderung menempel di tanah dan air tapi tidak
larut dalam air, mereka tidak mencemari sumber air tanah. Sebagian besar dioksin pada
tanaman berasal dari udara dan debu atau pestisida dan masuk ke rantai makanan dimana
mereka mengakumulasi bio karena kemampuan mereka terikat secara substansial dengan
lipid.

Heavy metals (N) include (adv) basic metal (N) elements such as lead (N), mercury
(N), cadmium silver nicke (N)l, vanadium (N), chromium (N) and manganese (N).
They (P) are natural (N) components (N) of the earth’s crust (N); they(P) cannot be
degraded (adv) or destroyed (adv), and can be transported (adv) by air (N), and enter
water (N) and human (N) food (N) supply (N). In addition, they (P) enter (adv) the
environment (N) ( through (N) a wide variety (N) of sources (N), including
combustion (N), waste water (N) discharges (N) and manufactur- ing (N) facilities. To
a small (adj) extent (N) they (P) enter human bodies (N) where (adv), as trace
elements (N), they (P) are essential (adj) to maintain the normal (adv) metabolic
(adv) reactions (N). However (adv), at higher (although rel- atively low) (adj)
concentrations (N) they (P) can become toxic (adj) (Jarup, 2003). Most (N) heavy
(adj) metals (N) are dangerous (adj) because they (P) tend to bio-accumulate (N) in
the human body (adv). Bioaccumulation (N) means an increase (N) in the
concentration (adv) of a chemical (N) in a bi- ological organism over time (adv),
compared to the chemical’( N)s concentration in the environment (adv). Compounds
(N) accumulate (adv) in organisms any time (adv) they (P) are taken (adv) in and
stored (adv) faster (adj) than they (P) are broken down (metabolized) (adv) or
excreted(adv).

Logam berat meliputi unsur logam dasar seperti timbal, merkuri, nikel perak kadmium,
vanadium, kromium dan mangan. Mereka adalah komponen alami dari kerak bumi;
mereka tidak bisa terdegradasi atau hancur, dan bisa diangkut melalui udara, dan masuk
ke air dan suplai makanan manusia. Selain itu, mereka memasuki lingkungan melalui
berbagai sumber, termasuk pembakaran, pembuangan air buangan dan fasilitas
manufaktur. Untuk sebagian kecil mereka memasuki tubuh manusia dimana, sebagai
elemen jejak, mereka sangat penting untuk mempertahankan reaksi metabolik normal.
Namun, pada konsentrasi yang lebih tinggi (walaupun relatif rendah) mereka bisa menjadi
racun (Jarup, 2003). Sebagian besar logam berat berbahaya karena cenderung
mengakumulasi bio di tubuh manusia. Bioakumulasi berarti peningkatan konsentrasi
bahan kimia dalam organisme biologis selama beberapa waktu, dibandingkan dengan
konsentrasi kimiawi di lingkungan. Senyawa menumpuk dalam organisme kapanpun
mereka dibawa masuk dan disimpan lebih cepat daripada dipecah (dimetabolisme) atau
diekskresikan.

Particulate matter (PM) (N) is the generic (adj) term (N) used for (N) a type (N)
of air (N) pollutants (N), consisting (adj) of complex (N) and varying (adv) mixtures
(N) of particles (N) suspended (N) in the breathing (adv) air (N), which (adj) vary
(adv) in size (N) and composition (N), and are produced (N) by a wide (adj) variety
(N) of natural (N) and anthropogenic (N) activities (N) (Poschl (N), 2005 (adv)).
Major (adj) sources (N) of particulate (N) pollution (N) are factories (N), power
plants (N), re- fuse (N) incinerators (N) , motor vehicles (N), construction activity
(N), fires (N), and natural windblown dust (N). The size (N) of the particles (N)
varies (PM2.5 and PM10 for aerodynamic diameter smaller (adj) than 2.5 mm (adv)
and 10 mm respectively (adv)) and different categories (adj) have (N) been defined:
Ultrafine particles (N) , smaller than 0.1 mm in aerodynamic diameter, Fine
particles, smaller (adj) than 1 mm, and Coarse (adj) particles (N), larger (adj) than 1
mm. The size (N) of the parti- cles (N) determines (adv) the site (N) in the
respiratory (adv) tract (N) that they (P) will (adj) deposit (N): PM10 particles (N)
deposit (N) mainly in the upper (adv) respiratory (N) tract (N) while (N) fine (N)
and ultra (adj) fine particles (N) are able (adj) to reach (N) lung alveoli (N). So far
(adv) , no (N) single (adj) component (N) has been (N) identified (adv) that could
explain (adv) most (N )of the PM effects (N). Among the parameters (N) that play
(adv) an important (adj) role (N) for eliciting (adv) health (N) effects (N) are the
size and surface of particles, their number and their composi- tion. The composition
of PM varies, as they can absorb and transfer a multitude of pollutants. However,
their major com- ponents are metals, organic compounds, material of biologic origin,
ions, reactive gases, and the particle carbon core. There is strong evidence to support
that ultra fine and fine particles are more hazardous than larger ones (coarse
particles), in terms of mortality and cardiovascular and respiratory effects. In
addition, the metal content, the presence of PAHs and other organic components
such as endotoxins, mainly contribute to PM toxicity.
Terjemahan
Particulate matter (PM) adalah istilah generik yang digunakan untuk jenis polutan udara,
yang terdiri dari campuran partikel kompleks yang bervariasi dan tergantung pada udara
pernapasan, yang bervariasi dalam ukuran dan komposisi, dan diproduksi oleh berbagai
aktivitas alami dan antropogenik. (Poschl, 2005). Sumber utama pencemaran partikulat
adalah pabrik, pembangkit listrik, sekering insinerator, kendaraan bermotor, aktivitas
konstruksi, kebakaran, dan debu angin alami. Ukuran partikel bervariasi (PM2.5 dan PM10
untuk diameter aerodinamis lebih kecil dari2,5 mm dan 10 mm masing-masing) dan kategori
yang berbeda telah ditentukan: Partikel Ultrafine, lebih kecil dari 0,1 mm pada diameter
aerodinamis, partikel halus, lebih kecil dari 1 mm, dan partikel kasar, lebih besar dari 1 mm.
Ukuran bagian menentukan lokasi di saluran pernapasan yang akan mereka deposit: deposit
partikel PM10 terutama di saluran pernapasan bagian atas sedangkan partikel halus dan ultra
halus dapat mencapai alveoli paru. Sejauh ini, tidak ada satu komponen pun yang dapat
diidentifikasi yang bisa menjelaskan sebagian besar efek PM. Di antara parameter yang
memainkan peran penting untuk memunculkan efek kesehatan adalah ukuran dan permukaan
partikel, jumlah dan komposisinya. Komposisi PM bervariasi, karena mereka dapat menyerap
dan mentransfer banyak polutan. Namun, komponen utama mereka adalah logam, senyawa
organik, bahan asal biologis, ion, gas reaktif, dan inti karbon partikel. Ada bukti kuat untuk
mendukung partikel halus dan halus itu lebih berbahaya daripada partikel yang lebih besar
(partikel kasar), dalam hal kematian dan efek kardiovaskular dan pernafasan. Selain itu,
kandungan logam, kehadiran PAH dan komponen organik lainnya seperti endotoksin,
terutama berkontribusi terhadap toksisitas PM
3. Routes of exposure

Humans (N) enter (adv) in contact (adv) with different air pollutants (N) pri-
marily via inhalation and ingestion, while dermal contact rep- resents a minor route
of exposure. Air pollution contributes, to a great extent, to the contamination of food
and water, which makes ingestion in several cases the major route of pollutant intake
(Thron, 1996). Via the gastrointestinal and respiratory tract, absorption of pollutants
may occur, while a number of toxic substances can be found in the general
circulation and deposit to different tissues. Elimination occurs to a certain degree by
excretion (Madden and Fowler, 2000).

Terjemahan

Manusia masuk dalam kontak dengan polutan udara yang berbeda secara langsung
melalui inhalasi dan konsumsi, sementara kontak kulit menghasilkan rute paparan minor.
Polusi udara berkontribusi, sebagian besar, terhadap kontaminasi makanan dan air, yang
membuat konsumsi beberapa kasus menjadi jalur utama asupan polutan (Thron, 1996).
Melalui saluran pencernaan dan saluran pernapasan, penyerapan polutan dapat terjadi,
sementara sejumlah zat beracun dapat ditemukan pada sirkulasi umum dan deposit ke
jaringan yang berbeda. Eliminasi terjadi sampai tingkat tertentu dengan ekskresi (Madden
dan Fowler, 2000).

4. Health effects

Sporadic air pollution events, like the historic London fog in 1952 and a number
of short and long term epidemiological studies investigated the effects of air quality
changes on hu- man health. A constant finding is that air pollutants contribute to
increased mortality and hospital admissions (Brunekreef and Holgate, 2002). The
different composition of air pollut- ants, the dose and time of exposure and the fact
that humans are usually exposed to pollutant mixtures than to single sub- stances,
can lead to diverse impacts on human health. Human health effects can range from
 nausea and difficulty in breath- ing or skin irritation, to cancer. They also include
birth defects, serious developmental delays in children, and reduced activity of the
immune system, leading to a number of diseases. More- over, there exist several
susceptibility factors such as age, nu- tritional status and predisposing conditions.
Health effects can be distinguished to acute, chronic not including cancer and
cancerous. Epidemiological and animal model data indicate that primarily affected
systems are the cardiovascular and the respiratory system. However, the function
of several other organs can be also influenced (Cohen et al., 2005; Huang and Ghio,
2006; Kunzli and Tager, 2005; Sharma and Agrawal, 2005).

Effects of air pollutants on different organs and systems

Respiratory system
Numerous studies describe that all types of air pollution, at high concentration, can
affect the airways. Nevertheless, sim- ilar effects are also observed with long-term
exposure to lower pollutant concentrations. Symptoms such as nose and throat ir-
ritation, followed by bronchoconstriction and dyspnoea, espe- cially in asthmatic
individuals, are usually experienced after exposure to increased levels of sulphur
dioxide (Balmes et al., 1987), nitrogen oxides (Kagawa, 1985), and certain heavy
metals such as arsenic, nickel or vanadium. In addition particulate matter that
penetrates the alveolar epithelium (Ghio and Huang, 2004) and ozone initiate lung
inflammation (Uysal and Schapira, 2003). In patients with lung lesions or lung dis-
eases, pollutant-initiated inflammation will worsen their con- dition. Moreover air
pollutants such as nitrogen oxides increase the susceptibility to respiratory infections
(Chauhan et al., 1998). Finally chronic exposure to ozone and certain heavy metals
reduces lung function (Rastogi et al., 1991; Tager et al., 2005), while the later are also
responsible for asthma, emphysema, and even lung cancer (Kuo et al., 2006; Nawrot et
al., 2006). Emphysema-like lesions have also been observed in mice exposed to
nitrogen dioxide (Wegmann et al., 2005).

Cardiovascular system
 Carbon monoxide binds to haemoglobin modifying its con- formation and reduces its
capacity to transfer oxygen (Badman and Jaffe, 1996). This reduced oxygen availability
can affect the function of different organs (and especially high oxygen- consuming
organs such as the brain and the heart), resulting in impaired concentration, slow
reflexes, and confusion. Apart from lung inflammation, systemic inflammatory changes
are in- duced by particulate matter, affecting equally blood coagulation (Riediker et al.,
2004). Air pollution that induces lung irritation and changes in blood clotting can
obstruct (cardiac) blood vessels, leading to angina or even to myocardial infraction
(Vermylen et al., 2005). Symptoms such as tachycardia, in- creased blood pressure and
anaemia due to an inhibitory effect on haematopoiesis have been observed as a
consequence of heavy metal pollution (specifically mercury, nickel and arsenic) (Huang
and Ghio, 2006). Finally, epidemiologic studies have linked dioxin exposure to
increased mortality caused by ische- mic heart disease, while in mice, it was shown that
heavy metals can also increase triglyceride levels (Dalton et al., 2001

Nervous system
The nervous system is mainly affected by heavy metals (lead, mercury and
arsenic) and dioxins. Neurotoxicity leading to neuropathies, with symptoms such as
memory disturbances, sleep disorders, anger, fatigue, hand tremors, blurred vision,
and slurred speech, have been observed after arsenic, lead and mercury exposure
(Ewan and Pamphlett, 1996; Ratnaike, 2003). Especially, lead exposure causes
injury to the dopamine system, glutamate system, and N-methyl-D-Aspartate
(NMDA) receptor complex, which play an important role in memory functions
(Lasley and Gilbert, 2000; Lasley et al., 2001). Mer- cury is also responsible for
certain cases of neurological can- cer. Dioxins decrease nerve conduction velocity
and impaired mental development of children (Thomke et al., 1999; Walkowiak et
al., 2001).

Urinary system
Heavy metals can induce kidney damage such as an initial tubular dysfunction
evidenced by an increased excretion of low molecular weight proteins, which
progresses to decreased glomerular filtration rate (GFR). In addition they increase
the risk of stone formation or nephrocalcinosis (Damek-Poprawa and Sawicka-
Kapusta, 2003; Jarup, 2003; Loghman-Adham, 1997) and renal cancer (Boffetta et
al., 1993; Vamvakas et al., 1993).

Digestive system
Dioxins induce liver cell damage (Kimbrough et al., 1977), as indicated by an
increase in levels of certain enzymes in the blood (see following discussion on the
underlying cellular mechanisms of action), as well as gastrointestinal and liver
cancer (Mandal, 2005).

4.2. Exposure during pregnancy

It is rather important to mention that air pollutants can also affect the developing
foetus (Schell et al., 2006). Maternal exposure to heavy metals and especially to
lead, increases the risks of spontaneous abortion and reduced fetal growth (pre- term
delivery, low birth weight). There are also evidences suggesting that parental lead
exposure is also responsible for congenital malformations (Bellinger, 2005), and
lesions of the developing nervous system, causing important impairment in
newborn’s motor and cognitive abilities (Garza et al., 2006). Similarly, dioxins were
found to be transferred from the mother to the fetus via the placenta. They act as
endocrine disruptors and affect growth and development of the central nervous
system of the foetus (Wang et al., 2004). In this respect, TCDD is considered as a
developmental toxin in all species examined.
 Organelle
dysfunction

Enzyme Acute or Chronic

Inhibition Toxic effects

Substitution of
ions
DNA/nucleoprotein
binding

Pollutants Carcinogenesis
Voltage-and ligand-gated ionic
Free radical channels Interference
generation

DNA damage Lipid

peroxidation Potein
oxidationr
Signal transduction interference

Fig. 1. Basic mechanisms of carcinogenesis

5. Conclusion

This brief review presents the adverse effects of a number of (air) pollutants in human

health. As shown, major impair- ments of different organs can be observed. The main

conclu- sion drawn is that, in view of increased exposure of humans in a diversity of

pollutants, dietary interventions, rich in plant-derived foods, may protect or decrease their

effects on different organs. This conclusion is supported by a number of epidemiological

studies on the beneficial effect of a Mediter- ranean-type diet on human health