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COMMITTEE ON THE MEDICAL EFFECTS OF AIR POLLUTANTS
Present Chairman: Professor J G Ayres Members: Prof. D Laxen Secretariat:
Dr R Maynard Observers: Prof. R
Anderson (St George's, University of London)
1. Apologies for absence were received from Prof. V Stone, Prof. K Donaldson, Prof. S Holgate, Prof. Poole-Wilson, Mr Fintan Hurley, Mr R Alexander (Welsh Assembly), Mr N McMahon (NI), Miss I Mills (HPA). 2. The Chairman welcomed Dr Elena Pasquali who was attending the meeting as part of the "Women in Science" initiative: Dr Janet Dixon (Defra) who was attending for item 5: Dr Roy Hamlet (HPA) who was undertaking a five year review of COMEAP. 3. Members were informed that Mrs Janice Cleverly had left the Secretariat. The Chairman asked for his thanks, and those of members, to be passed to Mrs Cleverly. 4. The Chairman reminded Members that they should declare any financial interests in items on the agenda. 5. The Chairman reminded Members to submit their expense claim forms. ITEM 2. MINUTES OF THE LAST MEETING HELD ON 23RD FEBRUARY 2007 6. A number of amendments were noted by the Secretariat.
It was agreed that the Secretariat should provide a new and edited copy of the
minutes before they were placed on the website. Annual Air Pollution meeting held at Cranfield 7. The Chairman asked for comments on the meeting. Members noted that Cranfield had provided excellent accommodation and that the meeting had been both well organised and interesting. Members pointed out that it had been helpful having experts from overseas present and suggested that these might undertake a more formal role at future meetings. It was agreed the Secretariat would pursue this. Chairman asked Members to contribute any ideas they may have regarding the content or organisation of the meeting to the Secretariat. ACTION: SECRETARIAT AND MEMBERS Gauderman Paper 8. The Chairman noted that the Secretariat would be preparing a note of Members' discussions for the Department of Health. A number of detailed points regarding the paper were raised. Professor Laxen questioned whether those living more than 500 metres from a road would be exposed to levels of air pollution greater than background due to the presence of the road. It was also noted that most studies of the effect of proximity to road and asthma tended to look at much shorter distances: 30-70 metres perhaps. Members noted that one of the areas studied (Lake Arrowhead), lay in the mountains and would therefore be rather different as regards air pollution climate than from those in urban areas. Difficulties regarding adjustment for socio-economic confounding factors were raised. It was noted that a 'within region' effect would not be confounded by regional socio-economic status variations but that between regional effects might be. It was noted that those living at altitude (greater than 6,000 feet) tended to have larger lung volumes than those living at sea level: the significance of this for the Gauderman study was unknown. It was agreed that Professor Laxen would contribute a note summarising his remarks and that Professor David Strachan and Mr Ben Armstrong would also contribute notes. It was agreed that the Secretariat would use these contributions in compiling the letter to the Department of Health. ACTION: SECRETARIAT Miller Paper ACTION: SECRETARIAT 10. It was agreed that the Secretariat would produce a note listing possible reasons why the coefficient reported in the Miller paper was so large. This would not be possible until a response from Professor Philip Poole-Wilson has been received. 11. It was considered important to put the paper in the context of other studies. This led on to a discussion of whether a pattern could be seen in the mixed results for the size of the coefficients. It was agreed that more studies would be needed before this could be properly examined. This was a possible future area of work. Five Year Review 12. Doctor Roy Hamlet from the Radiological Protection Division (HPA) was undertaking the review. He had met the Secretariat and would meet the Chairman, Dr Martin Williams and Dr Louise Newport. Roy Hamlet noted that guidance was available from the Cabinet Office regarding the functioning of committees such as COMEAP. He commented that the report should be available within three months. Buncefield Fire 13. The Secretariat reported on a meeting with the Met. Office. New modelling had been done and sent to Prof. Virginia Murray. The Secretariat had agreed to meet staff from HPA (CHaPD) London to follow up on health impact calculations. Bob Maynard, Roy Harrison, Helen Webster and Isabella Myers had contributed a note on Atmospheric Stability in connection with the Buncefield Fire incident for publication in the Chemical Hazards & Poisons report. ACTION: SECRETARIAT TO CIRCULATE THIS PAPER TO MEMBERS. 14. Members raised the question of population data in the area potentially affected by an incident at Buncefield. The Secretariat agreed to check this and noted that population data might be useful for impact calculations. ITEM 4. UPDATES ON COMMITTEE REPORTS QUARK Mortality report 15. The Secretariat reported that the QUARK mortality report (final version for comment) had been to the Chairman and that it was intended to publish the report in the second week of July allowing six weeks for comment. The chapter on long term exposure to Ozone (ozone report) would be published at the same time. QUARK Morbidity report 16. The Secretariat reported that a meeting of the Morbidity Working Group had been held on 29th May. Authors had been allocated chapters. The Secretariat would be writing to Members with guidance on production of the report in the next month or so. ITEM 5. DEFRA AIR POLLUTION INFORMATION SERVICE - INFORMATION BULLETINS AND PM10 MEASUREMENTS (COMEAP/2007/05) 17. The Chairman welcomed Dr Dixon from Defra to the meeting. Dr Dixon outlined the contents of the paper (COMEAP/2007/5) which dealt with the need to amend the banding system for particles as a result of changes in the way in which concentrations were measured. It was noted that changes in the measurement method had led to higher figures being reported for the mass concentration of particles measured as PM10. Attention focused on the table provided at Annex 2 of the paper (COMEAP 2007/05) it being agreed that the numbers given in the right hand column of the table should be adopted. These numbers were scaled to be equivalent to the original bandings recommended by COMEAP. Measurements made using the new measurement method (known as FDMS) would be compared directly with the figures in the right hand column at Annex 2. Measurements made using the old measurement method (TEOM) would be scaled using the equation described in COMEAP/2007/05 before being compared with the right hand column. It was agreed that Dr Dixon should set out the arguments for adopting the numbers suggested in the right hand column of the table given at Annex 2 and that this should be presented in a form likely to be accessible to the public. It was agreed that the Chairman and Dr Tim King would work on the statement as necessary. ACTION: DR DIXON 18. It was also noted that a full examination of the banding system was needed and that this would be taken up in due course. ITEM 6. DRAFT STATEMENT ON THE EFFECTS OF AIR POLLUTION ON CHILDREN'S HEALTH (COMEAP/2007/06) 19. The Secretariat reminded Members
that COMEAP had been asked to provide advice on the effects of air pollutants
on child health as a contribution to the HPA/DH work on the Children's Environment
and Health Action Plan for Europe. It had been agreed that the WHO report on air
pollution and children's health would form the basis of the Committee's thinking
and that re-writing this report would be an unnecessary exercise. The Secretariat
noted that Professor Holgate had offered to provide an update on material published
since the mechanisms section of the WHO report was written. 20. Members noted that, in any report such as that contributed by WHO, conclusions regarding, for example, causality of associations would be likely to depend on the opinion of Members present at the relevant meetings. It was noted that another group of experts might well have come to a slightly different view. The WHO report had been based only in part on a systematic review of published studies; in other areas the approach was narrative. It was noted that this did not mean that the wrong conclusions had been reached. Members asked whether the WHO report could be regarded as acceptably up to date and how this could be decided without reviewing, in some detail, literature which had accumulated since the report was published. 21. The Secretariat reported that a statement had been drafted (COMEAP/2007/06) and that the subgroup, led by Professor Dafydd Walters, would be reviewing this and would report back to the Committee. Members raised a number of specific points for consideration .
ACTION: SUB-GROUP MEMBERS 22. There was a general discussion of the scope of the statement. There were 3 aspects to be considered:
23. It was suggested that giving conclusions and recommendations separately might give the recommendations more emphasis. 24.
Professor Anderson offered to send the Secretariat the abstracts from a seminar
in Munich on air pollution and birth outcomes. 25.
An updated version of the statement would be provided for the next meeting. 26. It was agreed that, if asked for the COMEAP view on child health, the Secretariat should advise that both the WHO report and the COMEAP statement (when available) should be considered. ITEM 7. DRAFT STATEMENT ON ASTHMA AND EXPOSURE TO CHLORINE AND ASSOCIATED REACTION PRODUCTS AT SWIMMING POOLS (2) 27. A Statement provided by the Secretariat was discussed. A number of points regarding the use of CC16 as an indicator of damage were raised. A recent paper by Professor Holgate casting some doubt on the value on CC16 as an indicator of lung cell damage was noted. The possibility that CC16 could be raised as a result of physiological processes, for example during exercise, was noted. Members agreed that it was important not to inhibit the use of swimming as an exercise for asthmatic subjects and also that maintaining an adequate standard of disinfection by the use of chlorine was important. A number of minor changes to the statement were made (see Annex 1). It was agreed that a final version would be agreed with the Chairman, who would write to Sir William Stewart, and that the statement would then be put on the website. ITEM 8. PAPERS FOR INFORMATION. 28. Papers by O'Neill et al (2007) (Occup. Environ. Med. 64: 373-379) on particulate air pollution and adhesion molecules in patients with Type 2 diabetes and by Fogarty et al (2007) (Thorax 62: 515-520) on the lack of an association between increased serum levels of C-reactive protein and a decline in lung function in a prospective cohort were discussed. ITEM 9. ANY OTHER BUSINESS 29. A meeting between the Chairmen of COMEAP and EPAQS and the relevant Secretariats to discuss the work of the new subgroup on standards would be arranged. It was noted that the sub-group would be permanent (and therefore different from ad-hoc sub groups). ITEM 10. DATE OF NEXT MEETING 30. Next meeting to be held at Skipton House, Department of Health on 12th October 2007. SUGGESTED AMENDMENTS TO DRAFT COMEAP STATEMENT ON ASTHMA AND EXPOSURE TO CHLORINE AND ASSOCIATED REACTION PRODUCTS AT SWIMMING POOLS (2) Paragraph 7, first sentence: delete 'measurement of' before GDP and delete 'undertaken and' before 'used as a basis'. Paragraph 9, first sentence: delete 'far previous' before 'use of indoor' and add 'that had occurred at a much earlier time' at the end of the sentence. Paragraph 10: add a comma after 'damage' and amend 'not' to 'nor'. Paragraph 12, second sentence: amend 'causes childhood asthma' to 'causes healthy children to become asthmatic' Paragraph 14: delete 'carefully controlled according to current guidelines'; replace 'possible' with 'is'.
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