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Air pollutants and the respiratory tract
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    Air pollutants and the respiratory tract Edited by: david l swift, w michael foster. (Pp 374; $175.00) 1999. New York: Marcel Dekker. ISBN 0-8247-9521-0.

    This three part book was in the process of preparation when the untimely death of David Swift occurred. The first part is an overview of air pollution with four general essays on the nature of air pollution, respiratory exposure to air pollutants, bioavailability of particle adsorbed air pollutants, and the detection of respiratory responses to air pollutants. The second part deals with individual pollutants and specific responses, with five essays on irritant air pollutants, the effects of oxidants, lung cancer, fibre aerosols, and biological pollutants; and the third part is a long and detailed discussion of health risk assessments and regulatory considerations. There are 15 contributors in all, with six based at the Johns Hopkins Medical School.

    Most of the essays include acceptable summaries of existing knowledge, and in some of them, interesting and important points are made. What is disappointing is that many of the current critical issues are not discussed in detail. Thus there is no critical description of time series analyses and the inherent limitations of attributing effects to highly correlated but very different pollutants, such as oxides of nitrogen and particles; nor is there an up to date discussion of the strengths and limitations of epidemiological data as a whole. Time series studies have shown their strength in avoiding many of the confounders of cross sectional comparisons. Indeed by their consistency in many different regions and by their coherence in terms of different health outcomes, they have served to illustrate the weakness of the more traditional methods of community comparison.

    It is also unfortunately true that one can discuss the nature of pollutants in exhaustive detail, and describe such issues as particle deposition in the lung under different conditions, without providing any guidance as to why inhaled particles of a certain size range might aggravate asthma or provide a stress for a person with cardiovascular disease. With the exception of more recent epidemiological studies, the book is generally well referenced, and many of the individual essays are useful summaries of existing information. The last section will be valuable to those unfamiliar with the philosophy and politics that underlie the regulation process in the United States.

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