ArcelorMittal Tubarão has signed a cooperation agreement worth R$3.9 million with the State of Espirito Santo Federal University to support their study to identify the relationship between pollutants and asthma cases in Vitoria, Brazil. 

For the next three years, 20 engineering and health specialists from the State of Espírito Santo Federal University (UFES) in Vitoria, will develop an unprecedented study in Brazil. They are going to identify which pollutants, from particulate matters and gases, most influence the intensifying of asthma symptoms in children and adolescents.

This is significant because ArcelorMittal Tubarão is the only site in our group supporting research methods using primary data, genetics testing and air quality testing in subjects' homes and will build trust with its stakeholders by demonstrating it takes air pollution seriously.  

"This study, coordinated by the State of Espirito Santo Federal University, a highly competent and independent institution, adds knowledge, governance, integrity and transparency to air quality and its effects on human health, an issue widely discussed in the Vitoria Metropolitan Area. We have searched, through a strategy of engagement with stakeholders, to join the medical and academic communities to carry out an unprecedented study which will incorporate a mobile air monitoring network that will monitor air quality inside participants' residences. This initiative of ArcelorMittal Tubarão was very well received by the State and Federal Public Ministries and can eventually be used in the preparations of public policies related to the issue", said João Bosco Reis da Silva, ArcelorMittal Tubarão sustainability and institutional relations manager.

Health data collection is to start by the end of the year. Equipment to monitor air quality and to study subjects' respiratory function must first be purchased and imported. The study will have a multidisciplinary team of approximately 12 health-related professionals such as physicians, nurses and physical therapists, as well as eight engineering professionals to collect and analyse air quality data.  

Because of this has not been done before, it took the project team approximately 18 months to define the best methodology to use. Professor José Geraldo Mill, head of the Physiological Sciences Department Health Science Centre at UFES, explains how the study will be carried out:

"The study subjects will be children and adolescents with mild or moderate asthma treated in clinics and public health units. They will be referred by their physicians to undergo initial tests at UFES to check if they meet all the requirements to take part in the study. Over a period of 10 to 15 days, each study subject will be monitored at home daily by filling in a diary and taking spirometry measures (pulmonary testing) in the morning and at night both in summer and winter months". These measurements, according to him, will make it possible to determine more precisely which pollutant components contribute to asthma's main symptom: difficulty breathing. 

Other data to be analysed in the study is related to the field of genetics. "Considering the number of variables which can influence the triggering of an asthma attack, a comprehensive collection of co-variables will be carried out, including the analysis of genes that in other populations have shown connection with onset or severity of the disease", explained Mill.

At the same time, the quality of the air breathed by the study subjects will be continuously monitored by equipment measuring particle concentration in the air as well as some gases (sulphur dioxide, carbon dioxide, carbon monoxide, ozone and nitrogen oxides).

According to Professor Jane Meri Santos, head of the Environmental Engineering Department of UFES Technological Centre and Chemical Engineering PhD by the Manchester University in England, both the concentration of pollutants inside the residences and the exposure of the study subjects over the day will be measured by portable devices.      

The professors highlighted that the main difference of this study from other studies already carried out, associating pollutants to the incidence of cases of asthma, lies on the way the data will be collected. "Most studies on the impact of air pollution on asthma have been carried out using secondary data, that is, calculating hospital stays or emergency rooms visits. This study will work with primary data, that is, collected straight from the patients in their own homes".  

The goal of the study is to generate knowledge and information that make it possible to guide other regulatory agencies to establish maximum pollution limits tolerable for the population, thus helping to determine prevention policies based on qualitative data. "Environmental regulation agencies need concrete and objective information to establish pollutant control guidelines for air, water, soil, that is, the ecosystem we live in. The lack of this data leads to policies that are created based on theories, and which may not be adequate for society", informed professor Mill. He also affirmed that the state medical societies are among the entities supporting the study because they feel the need to deepen local knowledge related to this area of human health".  

Besides making it possible to know in greater detail the factors which contribute to triggering asthma attacks and its symptoms, the study will also be disclosed in scientific congresses and through theses, dissertations and articles. "All these forms of disclosure have an assessment and review body comprising Brazilian and international scientists working in this field of study providing transparency and credibility to the goals, methods and results obtained. Moreover, any person interested in knowing the goals and proposed methodologies or even the costs of the study will have free access to the information. After all, as it is a partnership with a governmental institution, transparency law ensures all citizens have free access to the documents of the partnership", added professor Jane Meri Santos.

Chronic Disease

Asthma is the most common chronic disease in children and adolescents and its incidence has grown almost all over the word. Considered a complex pathology, as it depends both on genetic predisposition and environmental factors, asthma has raised concerns among the most important regulatory health agencies such as the World Health Organization.    

From what is already known about the causes that trigger asthma attacks, these factors are different in different countries and regions. What is valid for asthma studies in the United States and China, for example, is not directly applicable to Brazil. "Hence, the need for local knowledge. The air in the Vitoria Metropolitan area is complex in terms of pollutants due to a diversity of origins and components. Therefore, the decision to conduct a study here was a courageous one, the result of a partnership between ArcelorMittal Tubarão and UFES", affirmed professor Mill. 

Professor Mill emphasises the importance of involving society in the study, "The development of the study will represent a big challenge. We need the support of health professionals, especially those taking care of children with asthma in the public health units in Vitoria, the Vitoria Municipal Health Secretariat, the environmentalists, and especially, the parents of the children taking part in the study. After all, it will be their responsibility to monitor the filling in of the diaries and to carry out, with the help of the nursing professionals working on the study, the daily examinations of the children and adolescents at home. There is no research involving human beings that is carried out without the help of the study subjects. It is from them we need the most support. In this area, money is necessary, but not enough".

The Researchers

The main researchers involved in the study collectively have six publications, seven doctorate theses and master's dissertations showing the effects of air pollution on human health in Vitória. They are:

• Professor Jane Meri Santos – coordinator – air pollution, Environmental Engineering Department/UFES
• Professor PhD José Geraldo Mill – coordinator – health, Physiological Sciences Department/UFES
• Professor PhD Neyval Costa Reis Jr, assistant coordinator, Environmental Engineering Department/UFES
• Professor PhD Valdério Reisen – researcher, Statistics Department/UFES
• M.D. Faradiba Sarquis Serpa – researcher, Medical Clinic Department/Emescam