Acute respiratory effects of particulate air pollution.

In the 1930s, 40s, and 50s, several episodes of extreme air pollution focused attention on the potential for adverse health effects of air pollution. These included an episode in the Meuse Valley, Belgium, in December 1930 ( 15), an episode in Donora, Pennsylvania in 1948 (36), and several episodes in London, England (23, 44). The sudden large increases in sickness and death that accompanied such episodes demonstrated that air pollution can adversely affect human health. The increased mortality associated with such episodes provided the first quantitative measure of the adverse effects of air pollution. By the 1970s, a link had been well established between respiratory disease and particulate and/or sulfur-oxide air pollution, but still there remained disagreement as to the level of pollution that would significantly affect human health. In reviewing research published between 1968 and 1977, Holland and several other prominent British scientists ( 19) concluded that particulate and related air pollution at high levels pose hazards to human health, but that health effects of particulate pollution at lower concentrations could not be "disentangled" from health effects of other factors. Shy (45) responded by asserting that the review by Holland et al systematically discounted evidence of pollution-related health effects at contemporary pollution levels. Shy, and other reviewers ( 1, 12, 45, 54), contended that the cumulative weight of evidence provided sound reasons to believe that

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