Case Study #2

1. www.environmentalhealthproject.org Case Study #2 Child with Recurrent Sinus Infections

2. 724.260.5504 Onset • Mom and dad and 4 year old • Child has been having four upper respiratory infections in last 6 months • Diagnosed with otitis and sinusitis

3. 724.260.5504 History • Family moved last year from Maryland to find jobs in Pennsylvania • Father has secured a job at a water withdrawal station • They live adjacent to a compressor station

4. 724.260.5504 History (continued) • Mother reports that when crossing the yard she has a funny taste in mouth • Father smokes outside the home • Child did not have any upper respiratory infections prior to moving to Pennsylvania • What other pieces of information do you want to know?

5. 724.260.5504 Exam • Playful child • Afebrile • Normal growth chart • Normal HEENT except some crusting nasal discharge • Occasional coarse upper respiratory sounds • Why are children not small adults?

6. 724.260.5504 Children’s Susceptibility To Air Hazards • Have increased respiratory rate and breathe in more (i.e. more toxins) per body weight than adults • Play vigorously for long time periods • Developmental stages predispose them to activities and behaviors conducive to environmental exposures • Have little knowledge or awareness of environmental hazards

7. 724.260.5504 Known Emissions from Compressors • Compressors and motors on the drilling and production sites, injection well disposal sites and along pipelines release combustion products and volatile organic hydrocarbons into the air and degrade the air quality • These combustion products also combine with the volatile organic chemicals in the presence of heat and sunlight to produce ground level ozone

8. 724.260.5504 Ground Level Ozone Formation

9. 724.260.5504 Potential for Air Pollution- VOC & PM 2.5 • Ground level ozone exacerbates underlying asthma and COPD and causes lung injury • PM2.5 when inhaled lodge in the deep lung (bronchioles and alveoli) • PM2.5 carbonaecous core adsorbs PAH, nitro-PAH and heavy metals • PM2.5 invoke an inflammatory response and contain probable lung carcinogens (IARC)

10. 724.260.5504 Units at Compressor Stations & Gas Metering Stations Releasing Emissions into the Air • Compressor Engines • Compressor Blowdowns • Condensate Tanks • Storage Tanks • Truck Loading Racks • Glycol Dehydration Units • Amine Units • Separators • Fugitive Emission Sources • 90% of individuals reported experiencing odor events from these facilities From survey conducted by Earthworks

11. 724.260.5504 Examples of Chemicals Detected in Air • Xylene • Ethane • Isobutane • Methane • Propane • Propylene • Nitrogen Oxide • Carbon Monoxide • Sulfur Dioxide

12. 724.260.5504 Sample Air Test What is elevated in this sample and what does the elevation mean?

13. 724.260.5504 Important Variables with Air Testing • Type of air monitor: summa canister, H2S monitor, 24 hour personal air monitor • Direction of wind, weather pattern that day • Location sampled • Beware of sample contamination especially with summa and what each air monitor tests

14. 724.260.5504 MorePotential for Air Pollution • Diesel trucks traffic • Flaring • H2S • Preexisting air quality from coal industry

15. 724.260.5504 Recommendations • Air filters- incoming air vents or free standing in bedrooms • Avoid ionizers • Monitor for signs of asthma • Decrease second hand tobacco exposure • Father to change attire prior to coming inside home after work

16. 724.260.5504 Answer Key • See Handout