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Particle Pollution and Your Patients' Health

Review Questions

An answer key appears at the end of the review questions.

What is particle pollution?

1. Smaller particles (< 10 μm) are of more concern than larger particles (> 10 μm).

  • A. True
  • B. False

Particle Pollution Exposure

1. People with heart disease can let their symptoms be their guide as to when to reduce exposure to particle pollution.

  • A. True
  • B. False

Cardiovascular Effects

1.  Clinically important health effects of inhaled particle pollution include:

  • A. Acute coronary syndrome, including myocardial infarction and unstable angina
  • B. Arrhythmia
  • C. Exacerbation of chronic heart failure
  • D. Stroke
  • E. All of the above

2. The effects of chronic exposure to particle pollution were assessed in the Harvard Six Cities Study and the American Cancer Society’s Cancer Prevention II Study.

  • A. True
  • B. False

3.  Physiological and biochemical endpoints affected by inhaled particle pollution include all of the following except:

  • A.  Heart rate variability
  • B.  Blood pressure
  • C.  Glomerular filtration rate
  • D.  Vascular regulation
  • E.  Plasma viscosity and fibrinogen

Respiratory Effects

1. The adverse health effects of inhaled particle pollution depend on:

  • A. Inhaled dose
  • B. Individual susceptibility
  • C. Age
  • D. A and B
  • E. All of the above

2. Which people are more susceptible to particle pollution than healthy young adults?

  • A. People with asthma
  • B. People with COPD
  • C. Older adults
  • D. Children
  • E. A and B
  • F. All of the above

3. Particles 0.2 to1.0 μm in diameter show the highest fractional deposition for any respiratory system region.

  • A. True
  • B. False

4. Inhaled particles induce adverse health response through the following mechanisms:

  • A. Stimulation of lung receptors
  • B. Phagocytosis
  • C. Release of mediators
  • D. Mucociliary clearance
  • E. A and C
  • F. All of the above

5. Different people with pre-existing respiratory disease will respond to about the same extent when exposed to the same concentration of particle pollution.

  • A. True
  • B. False

6. Which of the following statements is false?

  • A. Adults with respiratory disease are more susceptible to adverse effects from exposure to particle pollution.
  • B. Apart from probable transient exacerbation of the disease, recurrent exposure of COPD patients to particle pollution will not accelerate the progression of the disease.
  • C. Airway inflammation is a typical response to particle pollution exposure.
  • D. There may be no immediate symptoms even at relatively high levels of particle pollution exposure.

Patient Exposure and the Air Quality Index

1. The AQI health and cautionary statements are pollutant-specific, and they suggest relatively simple measures people can take to reduce their risk from exposure to air pollution.

  • A. True
  • B. False

2. Particle pollution levels can be high

  • A. Any time of the year
  • B. Near busy roadways
  • C. During wildfires or dust storms
  • D. All of the above

3. The AQI is forecasted for many locations across the country.

  • A. True
  • B. False

4. When particle pollution levels are high, the groups that should reduce exposure to particle pollution are

  • A. People with heart disease
  • B. People with lung disease
  • C. Older adults
  • D. Children
  • E. All of the above

5. When particle pollution levels are high outdoors, they may also be high indoors.

  • A. True
  • B. False

6. When particle pollution levels are very high, people in sensitive groups should reduce exertion levels both outdoors and indoors.

  • A. True
  • B. False

Answer Key

What is particle pollution?

1. Smaller particles (< 10 μm) are of more concern than larger particles (> 10 μm).

  • A. True
  • B. False

True.  The EPA is concerned about particles that are 10 micrometers in diameter or smaller because these are the particles that generally pass through the throat and nose and enter the lungs and even the bloodstream. Larger particles (> 10 μm) are of less concern because they usually cannot enter the lungs, although they can still irritate the eyes, nose, and throat.

Particle Pollution Exposure

1. People with heart disease can let their symptoms be their guide as to when to reduce exposure to particle pollution.

  • A. True
  • B. False

The correct answer is B. False. Symptoms are not a reliable indicator of whether particle pollution levels are unhealthy. There may be no immediate symptoms even at relatively high levels of expsoure.  For people with heart diesase, the first symptom could be a heart attack. The most reliable way to know if particle pollution levels may be unhealthy is to check the current air quality at www.airnow.gov. 

Cardiovascular Effects

1.  Clinically important health effects of inhaled particle pollution include:

  • A. Acute coronary syndrome, including myocardial infarction and unstable angina
  • B. Arrhythmia
  • C. Exacerbation of chronic heart failure
  • D. Stroke
  • E. All of the above

E is the correct answer. All four clinical conditions are associated with exposure to inhaled particle pollution.

2. The effects of chronic exposure to particle pollution were assessed in the Harvard Six Cities Study and the American Cancer Society’s Cancer Prevention II Study.

  • A. True
  • B. False

The answer is A. True. The Harvard Six Cities Study and the American Cancer Society’s Cancer Prevention II Study provided the first cohort studies to shown clear evidence of an association between chronic exposure to particle pollution and mortality.

3.  Physiological and biochemical endpoints affected by inhaled particle pollution include all of the following except:

  • A.  Heart rate variability
  • B.  Blood pressure
  • C.  Glomerular filtration rate
  • D.  Vascular regulation
  • E.  Plasma viscosity and fibrinogen

The answer is C.  The preponderance of data indicates that particle pollution is associated with changes in heart rate variability, blood pressure, vascular regulation, and increases in acute phase reactants such as fibrinogen with associated changes in plasma viscosity. Changes in glomerular filtration rate have not been reported, but have not been examined in detail.

Respiratory Effects

1. The adverse health effects of inhaled particle pollution depend on:

  • A. Inhaled dose
  • B. Individual susceptibility
  • C. Age
  • D. A and B
  • E. All of the above

E is the correct answer. All of the above factors influence the inhaled amount of particle pollution and affect peripheral and central deposition of particle pollution, pathophysiologic responses, and ultimately health effects.

2. Which people are more susceptible to particle pollution than healthy young adults?

  • A. People with asthma
  • B. People with COPD
  • C. Older adults
  • D. Children
  • E. A and B
  • F. All of the above

F is the correct answer. Numerous epidemiological studies have reported increased susceptibility to particle pollution in children and the elderly and exacerbation of disease in patients with pre-existing respiratory disease.

3. Particles 0.2 to1.0 μm in diameter show the highest fractional deposition for any respiratory system region.

  • A. True
  • B. False

False. According to Figure 3., the fractional deposition of particles within this range is the lowest for any respiratory system region.

4. Inhaled particles induce adverse health response through the following mechanisms:

  • A. Stimulation of lung receptors
  • B. Phagocytosis
  • C. Release of mediators
  • D. Mucociliary clearance
  • E. A and C
  • F. All of the above

E is the correct answer. Phagocytosis and mucociliary clearance are defense mechanisms that are upregulated when particle pollution load is increased. However, they are not directly involved in inducing adverse physiologic response.

5. Different people with pre-existing respiratory disease will respond to about the same extent when exposed to the same concentration of particle pollution.

  • A. True
  • B. False

False. There is great variability in individual responsiveness to particle pollution among both healthy and at-risk people. Some individuals may show no response while others will have a measurable reaction.

6. Which of the following statements is false?

  • A. Adults with respiratory disease are more susceptible to adverse effects from exposure to particle pollution.
  • B. Apart from probable transient exacerbation of the disease, recurrent exposure of COPD patients to particle pollution will not accelerate the progression of the disease.
  • C. Airway inflammation is a typical response to particle pollution exposure.
  • D. There may be no immediate symptoms even at relatively high levels of particle pollution exposure.

B is the correct answer. Repeated exposures to particle pollution will accelerate the progression of COPD.

Patient Exposure and the Air Quality Index

1. The AQI health and cautionary statements are pollutant-specific, and they suggest relatively simple measures people can take to reduce their risk from exposure to air pollution.

  • A. True
  • B. False

The correct answer is A. True

2. Particle pollution levels can be high

  • A. Any time of the year
  • B. Near busy roadways
  • C. During wildfires or dust storms
  • D. All of the above

The correct answer is D. All of the above

3. The AQI is forecasted for many locations across the country.

  • A. True
  • B. False

The correct answer is A. True

4. When particle pollution levels are high, the groups that should reduce exposure to particle pollution are

  • A. People with heart disease
  • B. People with lung disease
  • C. Older adults
  • D. Children
  • E. All of the above

The correct answer is E. All of the above

5. When particle pollution levels are high outdoors, they may also be high indoors.

  • A. True
  • B. False

The correct answer is A. True

6. When particle pollution levels are very high, people in sensitive groups should reduce exertion levels both outdoors and indoors.

  • A. True
  • B. False

The correct answer is A. True

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