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June 2014

June 2014

ATS is Joined by the American Medical Association in Supporting the EPA's Proposed Rules to Limit Carbon Emissions from Existing Power Plants

June 11, 2014 -- The American Thoracic Society welcomes today’s action by the American Medical Association House of Delegates reaffirming their support for efforts by the U.S. Environmental Protection Agency (EPA) to limit carbon pollution from existing power plants. The resolution adopted by the AMA House of Delegates further noted AMA’s intent to submit formal comments during the public comment period to “to underscore the need to keep the standards strong and protective of public health.” The action taken by the AMA House of Delegates follows the EPA’s recent proposed “Clean Power Plan” to reduce carbon pollution from existing power plants. Announced on June 2, 2014, the EPA proposal outlines a state-federal partnership under which states will develop tailored plans to reduce carbon emissions from existing power plants in their states, resulting in a nationwide carbon emissions reduction of 30% (below 2005 levels) from the power sector. EPA projects that actions to reduce carbon pollution would also cut particle pollution, nitrogen oxides, and sulfur dioxide by more than 25%. This important effort by the Administration to address global climate change and improve air quality is supported by a number of national public health groups, including the ATS. “The ATS supports the efforts of President Obama and the EPA to reduce the harmful emissions of carbon pollution from power plants. This new rule is a step in the right direction toward mitigating climate change,” said ATS President Tom Ferkol, MD, who is professor of pediatrics, cell biology, and physiology and director of the multidisciplinary Division of Pediatric Allergy, Immunology, and Pulmonary Medicine at the Washington University School of Medicine. “What often gets lost in the discussion is that reducing carbon emissions also decreases other noxious pollutants like mercury, ozone and particulate matter,” noted Ferkol. Mercury, ozone and particular matter are known pollutants that cause neurological damage, respiratory and cardiovascular disease. “By reducing carbon pollution today, our children will enjoy the benefits of cleaner air while we address a major cause of global warming.” George D. Thurston, ScD, vice chair of the ATS Environmental Health Policy Committee and professor at NYU Langone Medical Center’s Institute of Environmental Medicine, is available to comment on the new EPA rules. Dr. Thurston can be reached at gdt1@nyu.edu and Dr. Ferkol can be reached at Ferkol_T@kids.wustl.edu.

Sleep Apnea Tied to Diabetes in Large Study

In the largest study to date of the relationship between sleep apnea and diabetes, a new study of more than 8,500 Canadian patients has demonstrated a link between obstructive sleep apnea (OSA) and the development of diabetes, confirming earlier evidence of such a relationship from smaller studies with shorter follow-up periods. 

“Our study, with a larger sample size and a median follow-up of 67 months was able to address some of the limitations of earlier studies on the connection between OSA and diabetes,” said lead author Tetyana Kendzerska, MD, PhD, of the University of Toronto. “We found that among patients with OSA, the initial severity of the disease predicted the subsequent risk for incident diabetes.”

The findings were published online ahead of print publication in the American Thoracic Society’s American Journal of Respiratory and Critical Care Medicine.

The study included 8,678 adults with suspected OSA without diabetes at baseline who underwent a diagnostic sleep study between 1994 and 2010 and were followed through May 2011 using provincial health administrative data to examine the occurrence of diabetes. Sleep apnea severity was assessed with the apnea-hypopnea index (AHI), which indicates severity based on the number of apneas (complete cessation of airflow) and hypopneas (partial cessation of airflow) per hour of sleep. Patients were classified as not having OSA (AHI < 5), or having mild (AHI 5-14.9), moderate (AHI 15-30) or severe (AHI>30) OSA.

During follow-up, 1,017 (11.7%) patients developed diabetes. In analyses adjusting for known risk factors for diabetes, including age, sex, body mass index, neck circumference, smoking, income status and comorbidities at baseline, patients with an AHI>30 had a 30% higher risk of developing diabetes than those with an AHI <5. Patients with mild or moderate OSA had a 23% increased risk of developing diabetes.

Other risk factors for diabetes included AHI during rapid eye movement sleep and measures of the physiologic consequences of OSA, including oxygen desaturation, sleep deprivation and activation of the sympathetic nervous system, as indicated by a higher mean heart rate during sleep.

“After adjusting for other potential causes, we were able to demonstrate a significant association between OSA severity and the risk of developing diabetes,” said Dr. Kendzerska. “Our findings that prolonged oxygen desaturation, shorter sleep time and higher heart rate were associated with diabetes are consistent with the pathophysiological mechanisms thought to underlie the relationship between OSA and diabetes.”

The study had a few limitations, including a lack of data on some potential confounders, including family history of diabetes and race, and the possible misclassification of some subjects due to the limitations of the administrative health data used.

“The OSA-related predictors of increased diabetes risk that we found in our study may allow for early preventative interventions in these patients,” said Dr. Kendzerska.

ATS Welcomes EPA's Proposed Rules to Limit Carbon Emissions from Existing Power Plants

June 2, 2014 -- The American Thoracic Society is pleased that the Environmental Protection Agency is taking action to address carbon pollution.  The proposed rules released today by the EPA to reduce carbon pollution from existing power plants are an important next step in the Administration’s efforts to address global climate change and improve air quality. 

“As a pediatric pulmonologist who cares for children with severe health problems, we are beginning to recognize the health effects of global warming in our practices,” said ATS President Tom Ferkol, MD, who is professor of pediatrics, cell biology, and physiology and director of the multidisciplinary Division of Pediatric Allergy, Immunology, and Pulmonary Medicine at the Washington University School of Medicine. “The ATS strongly supports the efforts of President Obama and the EPA to reduce the harmful emissions of greenhouse gasses from power plants.Today’s rules are a step in the right direction toward mitigating climate change.

“What often gets lost in the discussion is that reducing carbon emissions also decreases other noxious pollutants like mercury, ozone and particulate matter,” noted Ferkol. Mercury, ozone and particular matter are known pollutants that cause neurological damage, respiratory and cardiovascular disease. “By reducing carbon pollution today, our children will enjoy the benefits of cleaner air while we address a major cause of global warming.”

George D. Thurston, ScD, vice chair of the ATS Environmental Health Policy Committee and professor at NYU Langone Medical Center’s Institute of Environmental Medicine, said: “The evidence base supporting the link between climate change and adverse health consequences, which comes from a number of scientific disciplines, is extensive.”

A recent ATS workshop report on the Respiratory Health Effects of Global Climate Change enumerated a number of the adverse effects on respiratory health of global climate change, which  include: 

  • changing pollen releases impact asthma and allergic rhinitis,
  • heat waves cause critical care–related diseases,
  • climate-driven air pollution exacerbates a number of pulmonary conditions, such as asthma, chronic obstructive pulmonary disease, and associated cardiovascular diseases,
  • desertification increases particulate matter (PM) exposures, and
  • climate-related changes in food and water security are associated with infectious respiratory diseases through malnutrition.

For further comment, Dr. Thurston can be reached at gdt1@nyu.edu and Dr. Ferkol can be reached at Ferkol_T@kids.wustl.edu