Issue link: http://www.e-digitaleditions.com/i/579724
"Vog" and increasing respiratory disease in Hawaii The Hawaiian Islands, to most peo- ple, conjure up a picture of tropical bliss comprising endless sunshine, clear skies accompanied by lots of heat and, of course, the endless azure Pacific Ocean. The reality is that this vision would be com- pletely true, but for the presence of Kiluaea, a volcano continuously erupting since 1983, on the south- east corner of the Big Island. The volcano's activity results in a plume of airborne emissions (Figure 1) comprising a mixture of sulfur dioxide, sulfuric acid and other acidic species, combined with ultra- fine particulates, that results in a blue-ish haze termed "vog" or v o l c a n i c a l l y - g e n e r a t e d s m o g (Figure 2). When the northeasterly trade winds blow, the vog plume drifts away from the Hawaiian Islands, dispersing harmlessly into the ocean. However, it can also spread up the island chain in a north to northwesterly direction when so- called "Kona" winds blow, as for example frequently occurs ahead of the trailing cold fronts that sweep down from the North Pacific in wintertime. The result is poor air quality 1 that can compare with that of Los Angeles or London, UK on a hot summer's day. Taken with the high proportion of older people in the islands who have obstructive lung diseases from cigarette smok- ing, this is a recipe that results in a significant minority of the resident population having exacerbations associated with lung-related dis- eases. The prevalence of asthma and COPD-related conditions, such as emphysema and chronic bronchitis, was estimated to be close to 125,000 in 2010. 2 Thus, about 4.4% (age-adjusted = 4.2%) of adult Hawai'i residents surveyed in 2011 reported having been told by a healthcare professional that they have COPD. 3 A report issued in 2010 on the burden of COPD in the islands noted that social, eco- nomic and demographic variation, interspersed with a rapidly-expand- ing, older-adult population, means that COPD prevalence, morbidity and mortality will continue to increase in the years ahead. 4 A need for education on inhaled medical aerosols The Daniel K. Inouye College of Pharmacy (DKICP) of the Univer- sity of Hawai'i system was estab- lished about eight years ago to pro- vide tertiary-level education in the pharmaceutical sciences to under- graduate and postgraduate students, who would otherwise have been forced to travel more than 2,500 miles to study in the nearest loca- tions offering similar courses on the US mainland. Over the intervening years, student numbers have steadily increased. The college now has sev- eral hundred undergraduates drawn, not only from the US Pacific territo- ries, but also from the US mainland. At the same time, faculty have been recruited to develop research pro- grams, publishing findings in high quality, peer-reviewed, medical journals, with the aim of developing the facility into a full-service univer- sity environment (Figure 3). When guest lecturing in 2011, I (Jolyon Mitchell) quickly became aware that there was almost no teaching in place about the inhaled route of administration for pharma- ceuticals. By late 2014, Associate Professor Mahavir Chougule and Professor Ken Morris (now Depart- ment Head) and I therefore crafted a new elective course for PharmD and PhD students that focused on the Inhaled medical aerosols: A new training course in the Hawaiian Islands Mahavir B. Chougule, PhD, Ken Morris, PhD and Jolyon P. Mitchell, PhD, FRSC(UK), CChem, CSci Daniel K. Inouye College of Pharmacy, University of Hawai'i, Hilo Campus, Big Island B a c k P a g e 28 OCTOBER2015 Inhalation continued on page 26 Figure 1 Kiluaea volcano has been erupting contin- uously since 1983. Airborne emissions have significantly increased since 2011. A night- time view from Halemaumau, the main vent. (Image courtesy of Jolyon Mitchell.) Figure 2 The blue-ish haze of the vog (volcanicall- gen- erated smog) emitted from Halemaumau indi- cates the presence of predominantly sub-100 nm particles that get transported many miles from their source by prevailing winds. (Image courtesy of Jolyon Mitchell.)