The effects of PM2.5 and its components from indoor and outdoor sources on cough and wheeze symptoms in asthmatic children

Infant rhinitis and watery eyes predict school-age exercise-induced wheeze, emergency department visits and respiratory-related hospitalizations

BACKGROUND

Rhinitis and conjunctivitis are often linked to asthma development through an allergic pathway. However, runny nose and watery eyes can result from nonallergic mechanisms. These mechanisms can also underlie exercise-induced wheeze (EIW), which has been associated with urgent medical visits for asthma, independent of other indicators of asthma severity or control.

OBJECTIVE

To test the hypothesis that rhinitis or watery eyes without cold symptoms (RWWC) in infancy predict development of EIW and urgent respiratory-related medical visits at school age, independent of seroatopy.

METHODS

Within a prospective birth cohort of low-income, urban children (n = 332), RWWC was queried during the first year of life. Relative risks (RRs) for EIW, emergency department (ED) visits, and hospitalizations for asthma and other breathing difficulties at 5 to 7 years of age were estimated with multivariable models. Seroatopy was determined at 7 years of age.

RESULTS

Infant RWWC was common (49% of children) and predicted school-age EIW (RR, 2.8; P < .001), ED visits (RR, 1.8; P = .001), and hospitalizations (RR, 9.8; P = .002). These associations were independent of infant wheeze. They were also independent of birth order, an indicator of increased risk of exposure to viruses in infancy, and infant ear infections, an indicator of sequelae of upper airway infections. The association between infant RWWC and ED visits at 5 to 7 years of age was attenuated (RR, 1.2; P = .23) when EIW at 5 to 7 years of age was included in the model, suggesting EIW mediates the association. Adjustment for seroatopy did not diminish the magnitudes of any of these associations.

CONCLUSION

These findings suggest a nonallergic connection between infant nonwheeze symptoms and important consequences of urban respiratory health by school age through EIW.

Seasonal trends in the composition and sources of PM2.5 and carbonaceous aerosol in Tehran, Iran

Currently PM_2.5 is a major air pollution concern in Tehran, Iran due to frequent high levels and possible adverse impacts. In this study, which is the first of its kind to take place in Tehran, composition and sources of PM_2.5 and carbonaceous aerosol were determined, and their seasonal trends were studied. In this regard, fine PM samples were collected every six days at a residential station for one year and the chemical constituents including organic marker species, metals, and ions were analyzed by chemical analysis. The source apportionment was performed using organic molecular marker-based CMB receptor modeling. Carbonaceous compounds were the major contributors to fine particulate mass in Tehran, as OC and EC together comprised on average 29% of PM_2.5 mass. Major portions of OC in Tehran were water insoluble and are mainly attributed to primary sources. Higher levels of several PAHs, which are organic tracers of incomplete combustion, and hopanes and steranes as organic tracers of mobile sources were obtained in cold months and compared to the warm months. The major contributing source to particulate OC was identified as vehicles, which contributed about 72% of measured OC. Among mobile sources, gasoline-fueled vehicles had the highest impact with a mean contribution of 48% to the measured OC. Mobile sources also were the largest contributor to total PM_2.5 (40%), followed by dust (24%) and sulfate (11%). In addition to primary emissions, mobile sources also directly and indirectly played an important role in another 27% of fine particulate mass (secondary organics and ions), which highlights the impact of vehicles in Tehran. Our results highlighted and quantified the role of motor vehicles in fine PM production, particularly during winter time. The results of this study could be used to set more effective regulations and control strategies particularly upon mobile sources.

In Vitro and In Vivo Experimental Studies of PM2.5 on Disease Progression

Air pollution is a very critical issue worldwide, particularly in developing countries. Particulate matter (PM) is a type of air pollution that comprises a heterogeneous mixture of different particle sizes and chemical compositions. There are various sources of fine PM (PM2.5), and the components may also have different effects on people. The pathogenesis of PM2.5 in several diseases remains to be clarified. There is a long history of epidemiological research on PM2.5 in several diseases. Numerous studies show that PM2.5 can induce a variety of chronic diseases, such as respiratory system damage, cardiovascular dysfunction, and diabetes mellitus. However, the epidemiological evidence associated with potential mechanisms in the progression of diseases need to be proved precisely through in vitro and in vivo investigations. Suggested mechanisms of PM2.5 that lead to adverse effects and chronic diseases include increasing oxidative stress, inflammatory responses, and genotoxicity. The aim of this review is to provide a brief overview of in vitro and in vivo experimental studies of PM2.5 in the progression of various diseases from the last decade. The summarized research results could provide clear information about the mechanisms and progression of PM2.5-induced disease.

Cooking behaviors are related to household particulate matter exposure in children with asthma in the urban East Bay Area of Northern California

BACKGROUND

Asthma is a common childhood disease that leads to many missed days of school and parents' work. There are multiple environmental contributors to asthma symptoms and understanding the potential factors inside children's homes is crucial.

METHODS

This is a dual cohort study measuring household particulate matter (PM2.5), behaviors, and factors that influence air quality and asthma symptoms in the urban homes of children (ages 6-10) with asthma; one cohort had cigarette smoke exposure in the home (n = 13) and the other did not (n = 22). Exposure data included measurements every 5 minutes for a month.

RESULTS

In the entire study population, a large contributor to elevations in indoor PM2.5 above 35 μg/m3 was not using the stove hood when cooking (8.5% higher, CI 3.1-13.9%, p<0.005). Median PM values during cooking times were 0.88 μg/m3 higher than those during non-cooking times (95% CI 0.33-1.42). Mean monthly household PM2.5 level was significantly related to the presence of a cigarette smoker in the home (10.1 μg/m3 higher, 95% CI 5.2-15.1, p<0.001) when controlling for use of the stove hood and proximity to major roadway. There was a trend toward increased odds of persistent asthma with increases in average monthly PM2.5 (OR 1.1, 95% CI 0.97-1.3, p = 0.16).

CONCLUSIONS

Consideration of only outdoor PM2.5 may obscure potentially modifiable risks for asthma symptoms. Specifically, this preliminary study suggests that cooking behaviors may contribute to the burden of PM2.5 in the homes of children with asthma and thus to asthma symptoms.

Nitrogen dioxide exposure in school classrooms of inner-city children with asthma

BACKGROUND

Ambient and home exposure to nitrogen dioxide (NO2) causes asthma symptoms and decreased lung function in children with asthma. Little is known about the health effects of school classroom pollution exposure.

OBJECTIVE

We aimed to determine the effect of indoor classroom NO2 on lung function and symptoms in inner-city school children with asthma.

METHODS

Children enrolled in the School Inner-City Asthma Study were followed for 1 academic year. Subjects performed spirometry and had fraction of exhaled nitric oxide values measured twice during the school year at school. Classroom NO2 was collected by means of passive sampling for 1-week periods twice per year, coinciding with lung function testing. Generalized estimating equation models assessed lung function and symptom relationships with the temporally nearest classroom NO2 level.

RESULTS

The mean NO2 value was 11.1 ppb (range, 4.3-29.7 ppb). In total, exposure data were available for 296 subjects, 188 of whom had complete spirometric data. At greater than a threshold of 8 ppb of NO2 and after adjusting for race and season (spirometry standardized by age, height, and sex), NO2 levels were associated highly with airflow obstruction, such that each 10-ppb increase in NO2 level was associated with a 5% decrease in FEV1/forced vital capacity ratio (β = -0.05; 95% CI, -0.08 to -0.02; P = .01). Percent predicted forced expiratory flow between the 25th and 75th percentile of forced vital capacity was also inversely associated with higher NO2 exposure (β = -22.8; 95% CI, -36.0 to -9.7; P = .01). There was no significant association of NO2 levels with percent predicted FEV1, fraction of exhaled nitric oxide, or asthma symptoms. Additionally, there was no effect modification of atopy on lung function or symptom outcomes.

CONCLUSION

In children with asthma, indoor classroom NO2 levels can be associated with increased airflow obstruction.

Aqueous and organic extract of PM2.5 collected in different seasons and cities of Japan differently affect respiratory and immune systems

Particulate matter with diameters <2.5 μm (i.e., PM_2.5) has multiple natural and anthropological sources. The association between PM_2.5 and the exacerbation of respiratory allergy and asthma has been well studied, but the components of PM_2.5 that are responsible for allergies have not yet been determined. Here, we elucidated the effects of aqueous and organic extract of PM_2.5 collected during four seasons in November 2014-December 2015 in two cities (Kawasaki, an industrial area and Fukuoka, an urban area affected by transboundary pollution matter) of Japan on respiratory health. Ambient PM_2.5 was collected by high-volume air samplers and extracted into water soluble and lipid soluble components. Human airway epithelial cells, murine bone marrow-derived antigen-presenting cells (APC) and splenocytes were exposed to PM_2.5 extracts. We measured the cell viability and release of interleukin (IL)-6 and IL-8 from airway epithelial cells, the DEC205 and CD86 expressions on APCs and cell proliferation, and TCR and CD19 expression on splenocytes. The water-soluble or aqueous extracts, especially those from Kawasaki in fall, had a greater cytotoxic effect than the lipid-soluble or organic extracts in airway epithelial cells, but they caused almost no pro-inflammatory response. Extract of fall, especially the aqueous extract from Fukuoka, increased the DEC205 and CD86 expressions on APC. Moreover, aqueous extracts of fall, summer, and spring from Fukuoka significantly increased proliferation of splenocytes. Organic extract of spring and summer from Kawasaki significantly elevated the TCR expression, and organic extract of summer from Kawasaki decreased the CD19 expression. These results suggest that PM_2.5 extract samples are responsible for cytotoxicity in airway epithelial cells and for activating APCs and T-cells, which can contribute to the exacerbation of respiratory diseases such as asthma. These effects can differ by PM_2.5 components, collection areas and seasons.

Quantifying fine particle emission events from time-resolved measurements: Method description and application to 18 California low-income apartments

PM_2.5 exposure is associated with significant health risk. Exposures in homes derive from both outdoor and indoor sources, with emissions occurring primarily in discrete events. Data on emission event magnitudes and schedules are needed to support simulation-based studies of exposures and mitigations. This study applied an identification and characterization algorithm to quantify time-resolved PM_2.5 emission events from data collected during 224 days of monitoring in 18 California apartments with low-income residents. We identified and characterized 836 distinct events with median and mean values of 12 and 30 mg emitted mass, 16 and 23 minutes emission duration, 37 and 103 mg/h emission rates, and pseudo-first-order decay rates of 1.3 and 2.0/h. Mean event-averaged concentrations calculated using the determined event characteristics agreed to within 6% of measured values for 14 of the apartments. There were variations in event schedules and emitted mass across homes, with few events overnight and most emissions occurring during late afternoons and evenings. Event characteristics were similar during weekdays and weekends. Emitted mass was positively correlated with number of residents (Spearman coefficient, ρ=.10), bedrooms (ρ=.08), house volume (ρ=.29), and indoor-outdoor CO₂ difference (ρ=.27). The event schedules can be used in probabilistic modeling of PM_2.5 in low-income apartments.

NIAID, NIEHS, NHLBI, and MCAN Workshop Report: The indoor environment and childhood asthma-implications for home environmental intervention in asthma prevention and management

Environmental exposures have been recognized as critical in the initiation and exacerbation of asthma, one of the most common chronic childhood diseases. The National Institute of Allergy and Infectious Diseases; National Institute of Environmental Health Sciences; National Heart, Lung, and Blood Institute; and Merck Childhood Asthma Network sponsored a joint workshop to discuss the current state of science with respect to the indoor environment and its effects on the development and morbidity of childhood asthma. The workshop included US and international experts with backgrounds in allergy/allergens, immunology, asthma, environmental health, environmental exposures and pollutants, epidemiology, public health, and bioinformatics. Workshop participants provided new insights into the biologic properties of indoor exposures, indoor exposure assessment, and exposure reduction techniques. This informed a primary focus of the workshop: to critically review trials and research relevant to the prevention or control of asthma through environmental intervention. The participants identified important limitations and gaps in scientific methodologies and knowledge and proposed and prioritized areas for future research. The group reviewed socioeconomic and structural challenges to changing environmental exposure and offered recommendations for creative study design to overcome these challenges in trials to improve asthma management. The recommendations of this workshop can serve as guidance for future research in the study of the indoor environment and on environmental interventions as they pertain to the prevention and management of asthma and airway allergies.

The relationship between airborne fine particle matter and emergency ambulance dispatches in a southwestern city in Chengdu, China

High levels of fine particulate matter (PM_2.5) are known to cause adverse effects to human health. The goal of this study was to estimate the acute health effects of short-term exposure to ambient PM_2.5 by analyzing cause-specific emergency ambulance dispatches as the endpoint in Chengdu, a city in Sichuan Province in southwest China. The ambient PM_2.5 concentration of Chengdu reached 63 μg/m³ in 2015. Data related to the causes of specific emergency ambulance dispatches, air pollution, and meteorological conditions were collected from 2013 to 2015 (1095 days). A generalized additive model (GAM) was constructed to control the confounding conditions and to estimate the effects of PM_2.5 on human health conditions. Emergency ambulance dispatches for all causes with (RR for lag0 = 1.0010, 95%CI: 1.0002, 1.0019) or without injuries (RR for lag0 = 1.0012, 95%CI: 1.0002, 1.0022), respiratory diseases (RR for lag0 = 1.0051, 95%CI: 1.0012, 1.0089), and cardiovascular diseases (RR for lag0 = 1.0041, 95%CI: 1.0009, 1.0074) were associated with ambient PM_2.5 concentrations in Chengdu. In addition, the effects of PM_2.5 were not confounded by ozone.

Carbon Nanoparticles Inhibit the Antimicrobial Activities of the Human Cathelicidin LL-37 through Structural Alteration

Host defense peptides, also known as antimicrobial peptides, are key elements of innate host defense. One host defense peptide with well-characterized antimicrobial activity is the human cathelicidin, LL-37. LL-37 has been shown to be upregulated at sites of infection and inflammation and is regarded as one of the primary innate defense molecules against bacterial and viral infection. Human exposure to combustion-derived or engineered nanoparticles is of increasing concern, and the implications of nanomaterial exposure on the human immune response is poorly understood. However, it is widely acknowledged that nanoparticles can interact strongly with several immune proteins of biological significance, with these interactions resulting in structural and functional changes of the proteins involved. This study investigated whether the potent antibacterial and antiviral functions of LL-37 were inhibited by exposure to, and interaction with, carbon nanoparticles, together with characterizing the nature of the interaction. LL-37 was exposed to carbon black nanoparticles in vitro, and the antibacterial and antiviral functions of the peptide were subsequently assessed. We demonstrate a substantial loss of antimicrobial function when the peptide was exposed to low concentrations of nanomaterials, and we further show that the nanomaterial-peptide interaction resulted in a significant change in the structure of the peptide. The human health implications of these findings are significant, as, to our knowledge, this is the first evidence that nanoparticles can alter host defense peptide structure and function, indicating a new role for nanoparticle exposure in increased disease susceptibility.

Estimating PM2.5 Concentrations in the Conterminous United States Using the Random Forest Approach

To estimate PM_2.5 concentrations, many parametric regression models have been developed, while nonparametric machine learning algorithms are used less often and national-scale models are rare. In this paper, we develop a random forest model incorporating aerosol optical depth (AOD) data, meteorological fields, and land use variables to estimate daily 24 h averaged ground-level PM_2.5 concentrations over the conterminous United States in 2011. Random forests are an ensemble learning method that provides predictions with high accuracy and interpretability. Our results achieve an overall cross-validation (CV) R² value of 0.80. Mean prediction error (MPE) and root mean squared prediction error (RMSPE) for daily predictions are 1.78 and 2.83 μg/m³, respectively, indicating a good agreement between CV predictions and observations. The prediction accuracy of our model is similar to those reported in previous studies using neural networks or regression models on both national and regional scales. In addition, the incorporation of convolutional layers for land use terms and nearby PM_2.5 measurements increase CV R² by ∼0.02 and ∼0.06, respectively, indicating their significant contributions to prediction accuracy. A pair of different variable importance measures both indicate that the convolutional layer for nearby PM_2.5 measurements and AOD values are among the most-important predictor variables for the training process.

Comparison of particulate matter exposure estimates in young children from personal sampling equipment and a robotic sampler

Accurate characterization of particulate matter (PM) exposure in young children is difficult, because personal samplers are often too heavy, bulky or impractical to be used. The Pretoddler Inhalable Particulate Environmental Robotic (PIPER) sampler was developed to help address this problem. In this study, we measured inhalable PM exposures in 2-year-olds via a lightweight personal sampler worn in a small backpack and evaluated the use of a robotic sampler with an identical sampling train for estimating PM exposure in this age group. PM mass concentrations measured by the personal sampler ranged from 100 to almost 1,200 μg/m³, with a median value of 331 μg/m³. PM concentrations measured by PIPER were considerably lower, ranging from 14 to 513 μg/m³ with a median value of 56 μg/m³. Floor cleaning habits and activity patterns of the 2-year-olds varied widely by home; vigorous play and recent floor cleaning were most associated with higher personal exposure. Our findings highlight the need for additional characterization of children's activity patterns and their effect on personal exposures.

Air pollution, PM2.5 composition, source factors, and respiratory symptoms in asthmatic and nonasthmatic children in Santiago, Chile

The objective of this study was to determine the association of respiratory symptoms and medication use and exposure to various air pollutants, PM_2.5 components, and source factors in a panel of asthmatic and nonasthmatic children in Santiago, Chile. To this end, 174 children (90 asthmatics and 84 nonasthmatics) were followed throughout the winter months of 2010 and 2011. During the study period, children filled out daily diaries to record respiratory symptoms and medication use. Air pollution data were obtained from government central site measurements and a PM_2.5 characterization campaign. PM_2.5 source factors were obtained using positive matrix factorization (PMF). Associations of symptoms and exposure to pollutants and source-factor daily scores were modeled separately for asthmatic and nonasthmatic children using mixed logistic regression models with random intercepts, controlling for weather, day of the week, year, and viral outbreaks. Overall, high concentrations of air pollutants and PM_2.5 components were observed. Six source factors were identified by PMF (motor vehicles, marine aerosol, copper smelter, secondary sulfates, wood burning, and soil dust). Overall, single pollutant models showed significant and strong associations between 7-day exposures for several criteria pollutants (PM_2.5, NO₂, O₃), PM_2.5 components (OC, K, S, Se, V), and source factors (secondary sulfate) and coughing, wheezing and three other respiratory symptoms in both in asthmatic and nonasthmatic children. No associations were found for use of rescue inhalers in asthmatics. Two-pollutant models showed that several associations remained significant after including PM_2.5, and other criteria pollutants, in the models, particularly components and source factors associated with industrial sources. In conclusion, exposure to air pollutants, especially PM_2.5, NO₂, and O₃, were found to exacerbate respiratory symptoms in both asthmatic and nonasthmatic children. Some of the results suggest that PM_2.5 components associated with a secondary sulfate source may have a greater impact on some symptoms than PM_2.5. In general, the results of this study show important associations at concentrations close or below current air quality standards.

Outdoor Environment and Pediatric Asthma: An Update on the Evidence from North America

Introduction. The evidence about the association between asthma and outdoor environmental factors has been inadequate for certain allergens. Even less is known about how these associations vary across seasons and climate regions. We reviewed recent literature from North America for research related to outdoor environmental factors and pediatric asthma, with attention to spatial-temporal variations of these associations. Method. We included indexed literature between years 2010 and 2015 on outdoor environmental factors and pediatric asthma, by searching PubMed. Results. Our search resulted in 33 manuscripts. Studies about the link between pediatric asthma and traffic-related air pollutants (TRAP) consistently confirmed the correlation between TRAP and asthma. For general air pollution, the roles of PM_2.5 and CO were consistent across studies. The link between asthma and O₃ varied across seasons. Regional variation exists in the role of SO₂. The impact of pollen was consistent across seasons, whereas the role of polycyclic aromatic hydrocarbon was less consistent. Discussion. Recent studies strengthened the evidence about the roles of PM_2.5, TRAP, CO, and pollen in asthma, while the evidence for roles of PM_10-2.5, PM₁₀, O₃, NO₂, SO₂, and polycyclic aromatic hydrocarbon in asthma was less consistent. Spatial-temporal details of the environment are needed in future studies of asthma and environment.

School Environmental Intervention to Reduce Particulate Pollutant Exposures for Children with Asthma

BACKGROUND

Home-based interventions to improve indoor air quality have demonstrated benefits for asthma morbidity, yet little is known about the effect of environmental interventions in the school setting.

OBJECTIVE

We piloted the feasibility and effectiveness of a classroom-based air cleaner intervention to reduce particulate pollutants in classrooms of children with asthma.

METHODS

In this pilot randomized controlled trial, we assessed the effect of air cleaners on indoor air particulate pollutant concentrations in 18 classrooms (9 control, 9 intervention) in 3 urban elementary schools. We enrolled 25 children with asthma (13 control, 12 intervention) aged 6 to 10 years. Classroom air pollutant measurements and spirometry were completed once before and twice after randomization. Asthma symptoms were surveyed every 3 months.

RESULTS

Baseline classroom levels of fine particulate matter (particulate matter with diameter of <2.5 μm [PM2.5]) and black carbon (BC) were 6.3 and 0.41 μg/m3, respectively. When comparing the intervention to the control group, classroom PM2.5 levels were reduced by 49% and 42% and BC levels were reduced by 58% and 55% in the first and second follow-up periods, respectively (P < .05 for all comparisons). When comparing the children randomized to intervention and control classrooms, there was a modest improvement in peak flow, but no significant changes in forced expiratory volume in 1 second (FEV1) and asthma symptoms.

CONCLUSIONS

In this pilot study, a classroom-based air cleaner intervention led to significant reductions in PM2.5 and BC. Future large-scale studies should comprehensively evaluate the effect of school-based environmental interventions on pediatric asthma morbidity.

Health Status and Residential Exposure to Air Toxics: What Are the Effects on Children's Academic Achievement?

This article examines the effects of children's subjective health status and exposure to residential environmental toxins on academic performance for the first time, while adjusting for school-level effects using generalized estimating equations. The analysis employs National Air Toxics Assessment risk estimates and individual-level data collected through a mail survey. Results indicate that poorer subjective health status and higher levels of residential air toxins are statistically significantly associated with lower grade point averages, meaning that there is an independent effect of air pollution on children's academic achievement that cannot be explained by poor health alone.

The health effects of ambient PM2.5 and potential mechanisms

The impacts of ambient PM2.5 on public health have become great concerns worldwide, especially in the developing countries. Epidemiological and toxicological studies have shown that PM2.5 does not only induce cardiopulmonary disorders and/or impairments, but also contributes to a variety of other adverse health effects, such as driving the initiation and progression of diabetes mellitus and eliciting adverse birth outcomes. Of note, recent findings have demonstrated that PM2.5 may still pose a hazard to public health even at very low levels (far below national standards) of exposure. The proposed underlying mechanisms whereby PM2.5 causes adverse effects to public health include inducing intracellular oxidative stress, mutagenicity/genotoxicity and inflammatory responses. The present review aims to provide an brief overview of new insights into the molecular mechanisms linking ambient PM2.5 exposure and health effects, which were explored with new technologies in recent years.

The associations between birth weight and exposure to fine particulate matter (PM2.5) and its chemical constituents during pregnancy: A meta-analysis

We performed this meta-analysis to estimate the associations of maternal exposure to PM2.5 and its chemical constituents with birth weight and to explore the sources of heterogeneity in regard to the findings of these associations. A total of 32 studies were identified by searching the MEDLINE, PUBMED, Embase, China Biological Medicine and Wanfang electronic databases before April 2015. We estimated the statistically significant associations of reduced birth weight (β = -15.9 g, 95% CI: -26.8, -5.0) and LBW (OR = 1.090, 95% CI: 1.032, 1.150) with PM2.5 exposure (per 10 μg/m(3) increment) during the entire pregnancy. Trimester-specific analyses showed negative associations between birth weight and PM2.5 exposure during the second (β = -12.6 g) and third (β = -10.0 g) trimesters. Other subgroup analyses indicated significantly different pooled-effect estimates of PM2.5 exposure on birth weight in studies with different exposure assessment methods, study designs and study settings. We further observed large differences in the pooled effect estimates of the PM2.5 chemical constituents for birth weight decrease and LBW. We concluded that PM2.5 exposure during pregnancy was associated with lower birth weight, and late pregnancy might be the critical window. Some specific PM2.5 constituents may have larger toxic effects on fetal weight. Exposure assessment methods, study designs and study settings might be important sources of the heterogeneity among the included studies.

[Seasonality in asthma: Impact and treatments]

The role of seasons should be taken into account in the management of asthma. The environment varies between seasons and it is well documented that asthma is modulated by environment. Viruses cause asthma exacerbations peak, in winter, in adults while the peak is present in September in children. Allergens are probably a less powerful source of asthma exacerbation than viruses but pollen involvement in spring and summer and dust mites in autumn are indisputable. Air pollutants, present in summer during the hottest periods, are also highly involved in asthma exacerbations. Indoor air pollution, in winter, is also implicated in asthma disease. All these environmental factors are synergistic and increase the risk of asthma exacerbation. Therapies should be adapted to each season depending on environmental factors potentially involved in the asthma disease.

Residential exposure to air toxics is linked to lower grade point averages among school children in El Paso, Texas, USA

Children in low-income neighborhoods tend to be disproportionately exposed to environmental toxicants. This is cause for concern because exposure to environmental toxicants negatively affect health, which can impair academic success. To date, it is unknown if associations between air toxics and academic performance found in previous school-level studies persist when studying individual children. In pairing the National Air Toxics Assessment (NATA) risk estimates for respiratory and diesel particulate matter risk disaggregated by source, with individual-level data collected through a mail survey, this paper examines the effects of exposure to residential environmental toxics on academic performance for individual children for the first time and adjusts for school-level effects using generalized estimating equations. We find that higher levels of residential air toxics, especially those from non-road mobile sources, are statistically significantly associated with lower grade point averages among fourth and fifth grade school children in El Paso (Texas, USA).

Green Buildings and Health

Green building design is becoming broadly adopted, with one green building standard reporting over 3.5 billion square feet certified to date. By definition, green buildings focus on minimizing impacts to the environment through reductions in energy usage, water usage, and minimizing environmental disturbances from the building site. Also by definition, but perhaps less widely recognized, green buildings aim to improve human health through design of healthy indoor environments. The benefits related to reduced energy and water consumption are well-documented, but the potential human health benefits of green buildings are only recently being investigated. The objective of our review was to examine the state of evidence on green building design as it specifically relates to indoor environmental quality and human health. Overall, the initial scientific evidence indicates better indoor environmental quality in green buildings versus non-green buildings, with direct benefits to human health for occupants of those buildings. A limitation of much of the research to date is the reliance on indirect, lagging and subjective measures of health. To address this, we propose a framework for identifying direct, objective and leading "Health Performance Indicators" for use in future studies of buildings and health.

The association between fine particulate matter exposure during pregnancy and preterm birth: a meta-analysis

BACKGROUND

Although several previous studies have assessed the association of fine particulate matter (PM2.5) exposure during pregnancy with preterm birth, the results have been inconsistent and remain controversial. This meta-analysis aims to quantitatively summarize the association between maternal PM2.5 exposure and preterm birth and to further explore the sources of heterogeneity in findings on this association.

METHODS

We searched for all studies published before December 2014 on the association between PM2.5 exposure during pregnancy and preterm birth in the MEDLINE, PUBMED and Embase databases as well as the China Biological Medicine and Wanfang databases. A pooled OR for preterm birth in association with each 10 μg/m(3) increase in PM2.5 exposure was calculated by a random-effects model (for studies with significant heterogeneity) or a fixed-effects model (for studies without significant heterogeneity).

RESULTS

A total of 18 studies were included in this analysis. The pooled OR for PM2.5 exposure (per 10 μg/m(3) increment) during the entire pregnancy on preterm birth was 1.13 (95% CI = 1.03-1.24) in 13 studies with a significant heterogeneity (Q = 80.51, p < 0.001). The pooled ORs of PM2.5 exposure in the first, second and third trimester were 1.08 (95% CI = 0.92-1.26), 1.09 (95% CI = 0.82-1.44) and 1.08 (95% CI = 0.99-1.17), respectively. The corresponding meta-estimates of PM2.5 effects in studies assessing PM2.5 exposure at individual, semi-individual and regional level were 1.11 (95% CI = 0.89-1.37), 1.14 (95% CI = 0.97-1.35) and 1.07 (95% CI = 0.94-1.23). In addition, significant meta-estimates of PM2.5 exposures were found in retrospective studies (OR = 1.10, 95% CI = 1.01-1.21), prospective studies (OR = 1.42, 95% CI = 1.08-1.85), and studies conducted in the USA (OR = 1.16, 95 % CI = 1.05-1.29).

CONCLUSIONS

Maternal PM2.5 exposure during pregnancy may increase the risk of preterm birth,but significant heterogeneity was found between studies. Exposure assessment methods, study designs and study settings might be important sources of heterogeneity, and should be taken into account in future meta-analyses.

Estimation of exposure to atmospheric pollutants during pregnancy integrating space-time activity and indoor air levels: Does it make a difference?

Studies of air pollution effects during pregnancy generally only consider exposure in the outdoor air at the home address. We aimed to compare exposure models differing in their ability to account for the spatial resolution of pollutants, space-time activity and indoor air pollution levels. We recruited 40 pregnant women in the Grenoble urban area, France, who carried a Global Positioning System (GPS) during up to 3 weeks; in a subgroup, indoor measurements of fine particles (PM2.5) were conducted at home (n=9) and personal exposure to nitrogen dioxide (NO2) was assessed using passive air samplers (n=10). Outdoor concentrations of NO2, and PM2.5 were estimated from a dispersion model with a fine spatial resolution. Women spent on average 16 h per day at home. Considering only outdoor levels, for estimates at the home address, the correlation between the estimate using the nearest background air monitoring station and the estimate from the dispersion model was high (r=0.93) for PM2.5 and moderate (r=0.67) for NO2. The model incorporating clean GPS data was less correlated with the estimate relying on raw GPS data (r=0.77) than the model ignoring space-time activity (r=0.93). PM2.5 outdoor levels were not to moderately correlated with estimates from the model incorporating indoor measurements and space-time activity (r=-0.10 to 0.47), while NO2 personal levels were not correlated with outdoor levels (r=-0.42 to 0.03). In this urban area, accounting for space-time activity little influenced exposure estimates; in a subgroup of subjects (n=9), incorporating indoor pollution levels seemed to strongly modify them.

Cough and environmental air pollution in China

With fast-paced urbanization and increased energy consumption in rapidly industrialized modern China, the level of outdoor and indoor air pollution resulting from industrial and motor vehicle emissions has been increasing at an accelerated rate. Thus, there is a significant increase in the prevalence of respiratory symptoms such as coughing, wheezing, and decreased pulmonary function. Experimental exposure research and epidemiological studies have indicated that exposure to particulate matter, ozone, nitrogen dioxide, and environmental tobacco smoke have a harmful influence on development of respiratory diseases and are significantly associated with cough and wheeze. This review mainly discusses the effect of air pollutants on respiratory health, particularly with respect to cough, the links between air pollutants and microorganisms, and air pollutant sources. Particular attention is paid to studies in urban areas of China where the levels of ambient and indoor air pollution are significantly higher than World Health Organization recommendations.

Detailed comparison of OC/EC aerosol at an urban and a rural Czech background site during summer and winter

Winter and summer measurements of organic carbon and elemental carbon (OC and EC) in PM2.5 were performed in parallel at two sites, the rural background station Košetice and the Prague-Suchdol urban background site, with a 2-h time resolution using semi-online field OC/EC analysers. Seasonal and site differences were found in the OC and EC contents of PM2.5. Overall, the highest concentrations of both OC and EC were during winter at the urban site. The average urban impact was 50% for OC and 70% for EC. The summer season gives similar concentrations of OC at both sites. However, higher concentrations of EC, caused by higher traffic, were found at the urban site with an average urban increase of 50%. Moreover, an analysis of four OC fractions depending on the volatility (OC1 - most volatile, OC4 - least volatile) and pyrolytic carbon (PC) is provided. A similar level of each OC fraction at both sites was found in summer, except for higher OC1 at urban and higher PC at the rural site. In winter, the differences between the urban and rural sites were dominated by a large increase of the OC1 fraction in comparison with the rural site. A diurnal pattern of concentration and share of OC1 and PC suggests a prevailing influence of local sources on their concentrations at the urban site in winter. The OC3 and OC4 diurnal cycles suggest their more regional or long range transport origin in both seasons. The prevalent influence of OC1 at any urban site has not been previously reported. The minimisation of semi-volatile carbon losses during semi-continuous sampling and analysis, in comparison with off-line sampling methods, is a probable reason for the observed differences.

Exposure to low doses of formaldehyde during pregnancy suppresses the development of allergic lung inflammation in offspring

Formaldehyde (FA) is an environmental and occupational pollutant, and its toxic effects on the immune system have been shown. Nevertheless, no data are available regarding the programming mechanisms after FA exposure and its repercussions for the immune systems of offspring. In this study, our objective was to investigate the effects of low-dose exposure of FA on pregnant rats and its repercussion for the development of allergic lung inflammation in offspring. Pregnant Wistar rats were assigned in 3 groups: P (rats exposed to FA (0.75 ppm, 1 h/day, 5 days/week, for 21 days)), C (rats exposed to vehicle of FA (distillated water)) and B (rats non-manipulated). After 30 days of age, the offspring was sensitised with ovalbumin (OVA)-alum and challenged with aerosolized OVA (1%, 15 min, 3 days). After 24 h the OVA challenge the parameters were evaluated. Our data showed that low-dose exposure to FA during pregnancy induced low birth weight and suppressed the development of allergic lung inflammation and tracheal hyperresponsiveness in offspring by mechanisms mediated by reduced anaphylactic antibodies synthesis, IL-6 and TNF-alpha secretion. Elevated levels of IL-10 were found. Any systemic alteration was detected in the exposed pregnant rats, although oxidative stress in the uterine environment was evident at the moment of the delivery based on elevated COX-1 expression and reduced cNOS and SOD-2 in the uterus. Therefore, we show the putative programming mechanisms induced by FA on the immune system for the first time and the mechanisms involved may be related to oxidative stress in the foetal microenvironment.