Health Effects of Haze (and How You Can

Protect Yourself)
Learn the health impact of haze and what you can do to protect you and your loved ones.

Haze is an atmospheric condition where particles, smoke, dust and moisture suspend in the
air obscuring visibility.

Sources of haze include emissions from power plants, industrial activities, traffic as well as
farming practices.

Forest fires in countries like the US, Australia and Europe during the hot and dry summer
season are also a source of haze.

In Southeast Asia, haze poses a serious and recurring problem every year, particularly
between May to October, due to the burning of forests in some countries to clear land.

How Haze Can Affect Your Health

In the 1997 Southeast Asian haze which affected a number of countries in the region, an
increase in air pollutants from 50 to 150 μg/m3 is significantly associated with increases of 12%
of upper respiratory tract illness, 19% asthma and 26% nasal inflammation (1).

Depending on how sensitive you are, the severity of the haze and the time of exposure, you
may experience the following short-term adverse effects:
  Irritated eyes, watering eyes, and/or conjunctivitis (a type of eye inflammation);

 Running nose, stuffy nose, sneezing, and/or post-nasal drip;

 Throat irritation, dry throat, sore throat and/or coughing;

 Headache, dizziness and/or fatigue;

 Decreased lung function, depressed respiratory immune defenses, chest pain, and/or
bronchitis (lung inflammation);

 Diarrhea and/or stomach upset, if drinking water sources are contaminated by dense
haze and the water is consumed without further treatment;

 Anxiety, stress and/or depression-like symptoms such as insomnia, feelings of

helplessness, loss of interest in daily activities and irritability.

These symptoms are usually mild and will subside when you stay indoor and limit your
exposure to haze.

However, in susceptible individuals and those suffering from chronic disease, especially
respiratory and heart disease (e.g. coronary artery disease, asthma and chronic
obstructive pulmonary disease), their condition may be worsened by haze. They are
more likely to experience more severe haze-related effects than healthy people.

Long-Term Effects

As much as 94% of the particles in a haze are below 2.5 micrometers in diameter (see: How
small is one micrometer?), that is, particles that are 30 times smaller than the width of a
human hair.

Due to their small size, these ultra-small particles stay in the air longer and are easily carried
over long distances, increasing their chances of being inhaled by animals and humans.

Known as PM2.5 or fine particles, those particles emitted by forest fires are toxic to the lungs,
and are more harmful than particulate matter collected from ambient air from the same region
(2).

Fine particles can also bypass normal body defense mechanisms and penetrate deep into the
lungs due to their minute size. When inhaled, they can enter the bloodstream and get
absorbed by underlying tissue, potentially interacting with other compounds and substances
in the body, such as LDL or ‘bad’ cholesterol, to produce damaging effects such as
inflammation.

Below are some of the long-term risks associated with fine particles:
  In a large prospective cohort study of adults without pre-existing cardiovascular disease,
individuals with higher exposure to fine particles (measured by PM2.5 readings)
experience a faster rate of thickening of the arteries compared to others living within the
same city (3). This implies that higher long-term PM2.5 exposures could promote the
development of vascular disease.

 Long-term exposure to fine particles increases the risk of death by cardiovascular

disease and reduces life expectancy by several months to a few years (4).

 Living in real-world levels of PM2.5 for 10 weeks promotes liver fibrosis, also known as
liver scarring, and increases the risk of metabolic disease and liver dysfunction, as
suggested by this animal study.

 Long-term exposure to PM2.5 pollutants may induce insulin resistance, inflammation and
contribute to the development of diabetes (5, 6). A US epidemiologic study found that
for every 10 μg/m3 increase of PM2.5, there could be a resulting increase of about 10,000
diagnosed cases of diabetes, or 1% increase in diabetes prevalence (7). Interestingly, an
increase in diabetes risk exists even among areas that are below the US authority’s legal
limits for PM2.5 (15 μg/m3). Populations living in areas that are near, but still below, the
limits show a more than 20% higher diabetes prevalence compared with those in cleaner
areas, an association that persisted after controlling for diabetes risk factors.

 A study comparing the respiratory health of common residents and traffic policemen,
who are exposed to higher levels of PM2.5 due to their duties, found that the latter are
more likely to suffer from respiratory symptoms and impaired pulmonary function (8).
Other studies also linked increased chronic exposures to PM2.5 to population sinusitis in
adults (9) and respiratory illness in infants (10).

 Exposure to polluted air by expecting mothers has also been associated with
spontaneous abortion, under-weight infants, birth defects and infant death (11).

 A US study published in 2015 found that exposure to air pollution can make the brain
age faster. Researchers found that for every 3.49 ug/cm3 increase in cumulative
exposure to PM2.5, there is a 6.23 cm3 decrease in white matter. This is equivalent to
about 1 ‐ 2 years of brain aging.

How is Haze Monitored

An air quality index is commonly used to indicate the amount of pollutants in the air
over a specified period of time.

Each country has its own index that corresponds to a national air quality standard.

For instance, air quality in Malaysia is reported as the Air Pollutant Index (API) which
measures carbon monoxide (CO), ozone (O3), nitrogen dioxide (NO2), sulfur dioxide (SO2)
and particles that are 10 micrometers or less in width (PM10). Singapore uses the Pollutant
Standards Index (PSI) which includes PM2.5 in addition to PM10, CO, O3, NO2 and SO2.
In other countries, the air quality index is known by different names. For example, in Canada
and Hong Kong, it is called the Air Quality Health Index (AQHI), while in India and the
United States, it is simply known as Air Quality Index (AQI).

Air quality index values are usually grouped into ranges. Each range is assigned a descriptor
or severity, a color code, and a cautionary statement.

Given an air quality index value, you can get a general idea of the air quality, the possible
health effects associated with it and the precautions you may need to take.

This provides an easy mean to communicate the quality of the air to the general public and
helps them to adjust their activity levels during increased levels of air pollution.

An air quality index may look like the one below. (The table below is meant for illustration
purposes only.)

Index
Descriptor General Health Effects Health Advisory
Value

Up to
Good Little or no risk None for the general population
50

Some pollutants may be a moderate

Unusually sensitive people should
51 to health concern for a small number of
Moderate consider reducing prolonged or heavy
100 people who are unusually sensitive to
exertion.
air pollution

Mild aggravation of symptoms among

Elderly, children and people with
susceptible persons i.e. those with
existing heart or respiratory ailments
underlying conditions such as chronic
101 to should reduce physical exertion and
Unhealthy heart or lung ailments; transient
200 outdoor activity. The general
symptoms of irritation e.g. eye
population should reduce vigorous
irritation, sneezing or coughing in some
outdoor activity.
of the healthy population.

Elderly, children and persons with

Significant aggravation of symptoms,
existing heart or lung disease should
decreased tolerance and premature
stay indoors and reduce physical
201 to Very mortality in persons with heart or lung
exertion and outdoor activity. The
300 Unhealthy disease ; more widespread symptoms of
general population should avoid
transient irritation in the healthy
vigorous outdoor activity and
population.
prolonged exertion.
 Early onset of certain diseases in
addition to significant aggravation of
301 to
Hazardous symptoms and premature mortality in
400
susceptible persons; and decreased
exercise tolerance in healthy persons.
Children, elderly and persons with
existing diseases should stay indoors
and avoid outdoor activity. The
general population should avoid all
unnecessary outdoor activity.

Everyone should avoid any outdoor

Index value above 400 may be life- exertion. Children, elderly and
Over Very threatening to ill and elderly persons. persons with existing diseases should
400 Hazardous Healthy people may experience adverse remain indoors, keeping the windows
symptoms that affect normal activity. and doors closed and avoiding
physical exertion as far as possible.

How to Protect Yourself from Haze

The main pollutants in a haze that have the greatest health impact are those particles
that are less than 2.5 micrometer.

Their effects depend very much on the severity of the haze and how long one has been
exposed to them.

During a prolonged haze period when the air quality is poor, take the following precautions to
protect yourself:

 Pay attention to local air quality updates. Recommended precautions you should take
will usually be given in the form of advisories based on the latest air condition. So it is
recommended that you keep track of the latest air quality update regularly. Here are
some websites to check for the following countries:

 Canada: Air Quality Health Index

 Malaysia: Air Pollutant Index

 Singapore: Pollutant Standards Index | PM2.5 Readings

 United States: AIRNow

 Avoid outdoor activities, especially outdoor sports. Children, pregnant women, the
elderly, and those suffering from chronic illnesses, especially heart and respiratory
disease, should remain indoors when haze hits unhealthy levels. Healthy adults should
avoid unnecessary outdoor activities. If you must exercise outdoor, avoid exercising in
highly congested areas near busy roads and freeways, particularly during rush hours.
Read more: Is Running in a Haze Bad for Health?

 Close all windows, doors and any openings that may allow haze to enter your
home and office. Turn on the air conditioner if you have one. Note: If the weather is
 unusually warm, it can become dangerous if you stay indoor with no fresh air intake
and no air conditioner. In this case, seek alternative shelter.

 Use an air purifier to keep the particulate levels low. Choose an air purifier that is
suitable for the size and type of your home. Avoid air cleaners that generate ozone as
they may generate more air pollutants. If you have multiple rooms, each room may need
to be equipped with one air purifier to ensure the air is cleaned efficiently. Regularly
replace the filters in the air purifier according to manufacturer’s instructions.

 Keep air conditioner in tip-top working condition with regular cleaning and
servicing. Fine particles can enter an air-conditioned building through the fresh air
intake as well as any openings and gaps.

 If you are staying in a building with a central air conditioning system, install an air
cleaning device. This helps to reduce the amount of air contaminants that may be
circulating in the building.

 Take your medication regularly if you are suffering from an existing disease,
especially heart disease and respiratory disease. If you feel breathless at any point in
time, seek medical attention immediately.

 Drink more water and increase the intake of fresh fruits and vegetables. They help
the body to flush out toxins absorbed through the skin and lungs, and improve the
immune system. Taking more anti-inflammatory fruits and vegetables also help to
reduce inflammation that may be triggered by harmful fine particles in the air. Cut
down on alcohol and coffee as they promote fluid loss and may leach nutrients from the
body.

 Limit or avoid smoking indoor and the use of gas stove, wood fireplace, candles,
incense and anything that burns and emits smoke. In an enclosed area, smoke, gases
and pollutants emitted from burning sources are trapped indoor and can build up to
hazardous level if they continue to burn for an extended period of time.

 Avoid driving if visibility is bad. When visibility is severely limited by the haze, avoid
driving and use the public transport if you really need to get around. If you cannot avoid
driving, do not speed, and drive at a speed that suits the road conditions. Roll up all the
windows, turn on the headlight and avoid changing lanes, passing and crossing traffic.
Increase your following distance and stay alert.

 Under severe haze condition, wear a respirator if you must go outside. Respirators
work better than surgical masks as they seal better and restrict more polluted air from
entering the nose and mouth. They also come with the right filter to remove fine
particles found in a haze. If you stayed indoor, but still experience haze-related
conditions, it may be necessary to use respirators indoor as well. Read more: How to
Choose the Right Mask to Protect Yourself From Haze.

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