Reduced exposure to PM10 and attenuated age-related decline in lung function

Particulate-Matter Related Respiratory Diseases

Particulate matter (PM) is suspended dust that has a diameter of <10 µm and can be inhaled by humans and deposited in the lungs, particularly the alveoli. Recent studies have shown that PM has an adverse effect on respiratory diseases. The aim of this article is to review respiratory diseases associated with PM. According to existing studies, PM is associated with chronic obstructive pulmonary disease, bronchial asthma, and several other respiratory diseases and increases the mortality rates of these diseases. Moreover, increased exposure in the high concentration of atmospheric PM is associated with the development of lung cancer. The most simple and common way to protect an individual from airborne PM is to wear a face mask that filters out PM. In areas of high concentration PM, it is recommended to wear a face mask to minimize the exposure to PM. However, the use of N95 or KF94 masks can interfere with respiration in patients with chronic respiratory diseases who exhibit low pulmonary function, leading to an increased risk of respiratory failure. Conclusionally, reduction of the total amount of PM is considered to be important factor and strengthening the national warning notification system to vulnerable patients and proper early management of exacerbated patients will be needed in the future.

The Potential Effects of Policy-driven Air Pollution Interventions on Childhood Lung Development

Rationale: Although elevated air pollution exposure impairs lung-function development in childhood, it remains a challenge to use this information to estimate the potential public health benefits of air pollution interventions in exposed populations.Objectives: Apply G-computation to estimate hypothetical effects of several realistic scenarios for future air pollution reductions on lung growth.Methods: Mixed-effects linear regression was used to estimate FEV1 and FVC from age 11 to 15 years in 2,120 adolescents across 3 cohorts (1993-2001, 1997-2004, and 2007-2011). Models included regional pollutants (nitrogen dioxide [NO2] or particulate matter with an aerodynamic diameter ≤2.5 μm [PM2.5]) and other important covariates. Using G-computation, a causal inference-based method, we then estimated changes in mean lung growth in our population for hypothetical interventions on either NO2 or PM2.5. Confidence intervals (CIs) were computed by bootstrapping (N = 1,000).Measurements and Main Results: Compared with the effects of exposure from observed NO2 concentrations during the study period, had communities remained at 1994 to 1997 NO2 levels, FEV1 and FVC growth were estimated to have been reduced by 2.7% (95% CI, -3.6 to -1.8) and 4.2% (95% CI, -5.2 to -3.4), respectively. If NO2 concentrations had been reduced by 30%, we estimated a 4.4% increase in FEV1 growth (95% CI, 2.8-5.9) and a 7.1% increase in FVC growth (95% CI, 5.7-8.6). Comparable results were observed for PM2.5 interventions.Conclusions: We estimated that substantial increases in lung function would occur as a result of interventions that reduce NO2 or PM2.5 concentrations. These findings provide a quantification of potential health benefits of air quality improvement.

Estimation of hospital admission respiratory disease cases attributed to exposure to SO2 and NO2 in two different sectors of Egypt

Air Q_2.2.3 was used to predicted hospital admissions respiratory disease cases due to SO₂ and NO₂ exposure in two sectors of Egypt during December 2015 to November 2016. Levels were 19, 22 µg/m³ at Ain Sokhna sector and 92, 78 µg/m³ at Shoubra El-Khaima sector for SO₂ and NO₂, respectively. These levels were less than the Egyptian Permissible limits (125 µg/m³ in urban and 150 µg/m³ in industrial for SO₂, 150 µg/m³ in urban and industrial for NO₂). Results showed that relative risks were 1.0330 (1.0246 - 1.0414) and 1.0229 (1.0171 - 1.0287) at Ain Sokhna sector while they were 1.0261 (1.0195 - 1.0327) and 1.0226 (1.0169 - 1.0283) at Shoubra El-Khaima sector for SO₂ and NO₂, respectively. The highest cases of HARD were found in Shoubra El-Khaima sector; 311 cases at 120 - 129 µg/m3 of SO₂ and 234 cases at 120 - 129 µg/m³ of NO₂. While, in Ain Sokhna, HARD were 18 cases at 50 - 59 µg/m³ of SO₂ and 15 cases at 60 - 69 µg/m³ of NO2. The excess cases found in Shoubra El-Khaima sector as compared to those in Ain Sokhna sector, may be attributed to the higher density of population and industries in Shoubra El-Khaima sector.

Airborne Particulate Matter: Human Exposure and Health Effects

OBJECTIVE

Exposure to airborne particulate matter (PM) is estimated to cause millions of premature deaths annually. This work conveys known routes of exposure to PM and resultant health effects.

METHODS

A review of available literature.

RESULTS

Estimates for daily PM exposure are provided. Known mechanisms by which insoluble particles are transported and removed from the body are discussed. Biological effects of PM, including immune response, cytotoxicity, and mutagenicity, are reported. Epidemiological studies that outline the systemic health effects of PM are presented.

CONCLUSION

While the integrated, per capita, exposure of PM for a large fraction of the first-world may be less than 1 mg per day, links between several syndromes, including attention deficit hyperactivity disorder (ADHD), autism, loss of cognitive function, anxiety, asthma, chronic obstructive pulmonary disease (COPD), hypertension, stroke, and PM exposure have been suggested. This article reviews and summarizes such links reported in the literature.

Air pollution exposure associates with increased risk of neonatal jaundice

Clinical experience suggests increased incidences of neonatal jaundice when air quality worsens, yet no studies have quantified this relationship. Here we reports investigations in 25,782 newborns showing an increase in newborn's bilirubin levels, the indicator of neonatal jaundice risk, by 0.076 (95% CI: 0.027-0.125), 0.029 (0.014-0.044) and 0.009 (95% CI: 0.002-0.016) mg/dL per μg/m3 for PM2.5 exposure in the concentration ranges of 10-35, 35-75 and 75-200 μg/m3, respectively. The response is 0.094 (0.077-0.111) and 0.161 (0.07-0.252) mg/dL per μg/m3 for SO2 exposure at 10-15 and above 15 μg/m3, respectively, and 0.351 (0.314-0.388) mg/dL per mg/m3 for CO exposure. Bilirubin levels increase linearly with exposure time between 0 and 48 h. Positive relationship between maternal exposure and newborn bilirubin level is also quantitated. The jaundice-pollution relationship is not affected by top-of-atmosphere incident solar irradiance and atmospheric visibility. Improving air quality may therefore be key to lowering the neonatal jaundice risk.

Association Between Long-term Exposure to Ambient Air Pollution and Change in Quantitatively Assessed Emphysema and Lung Function

Importance

While air pollutants at historical levels have been associated with cardiovascular and respiratory diseases, it is not known whether exposure to contemporary air pollutant concentrations is associated with progression of emphysema.

Objective

To assess the longitudinal association of ambient ozone (O3), fine particulate matter (PM2.5), oxides of nitrogen (NOx), and black carbon exposure with change in percent emphysema assessed via computed tomographic (CT) imaging and lung function.

Design, Setting, and Participants

This cohort study included participants from the Multi-Ethnic Study of Atherosclerosis (MESA) Air and Lung Studies conducted in 6 metropolitan regions of the United States, which included 6814 adults aged 45 to 84 years recruited between July 2000 and August 2002, and an additional 257 participants recruited from February 2005 to May 2007, with follow-up through November 2018.

Exposures

Residence-specific air pollutant concentrations (O3, PM2.5, NOx, and black carbon) were estimated by validated spatiotemporal models incorporating cohort-specific monitoring, determined from 1999 through the end of follow-up.

Main Outcomes and Measures

Percent emphysema, defined as the percent of lung pixels less than -950 Hounsfield units, was assessed up to 5 times per participant via cardiac CT scan (2000-2007) and equivalent regions on lung CT scans (2010-2018). Spirometry was performed up to 3 times per participant (2004-2018).

Results

Among 7071 study participants (mean [range] age at recruitment, 60 [45-84] years; 3330 [47.1%] were men), 5780 were assigned outdoor residential air pollution concentrations in the year of their baseline examination and during the follow-up period and had at least 1 follow-up CT scan, and 2772 had at least 1 follow-up spirometric assessment, over a median of 10 years. Median percent emphysema was 3% at baseline and increased a mean of 0.58 percentage points per 10 years. Mean ambient concentrations of PM2.5 and NOx, but not O3, decreased substantially during follow-up. Ambient concentrations of O3, PM2.5, NOx, and black carbon at study baseline were significantly associated with greater increases in percent emphysema per 10 years (O3: 0.13 per 3 parts per billion [95% CI, 0.03-0.24]; PM2.5: 0.11 per 2 μg/m3 [95% CI, 0.03-0.19]; NOx: 0.06 per 10 parts per billion [95% CI, 0.01-0.12]; black carbon: 0.10 per 0.2 μg/m3 [95% CI, 0.01-0.18]). Ambient O3 and NOx concentrations, but not PM2.5 concentrations, during follow-up were also significantly associated with greater increases in percent emphysema. Ambient O3 concentrations, but not other pollutants, at baseline and during follow-up were significantly associated with a greater decline in forced expiratory volume in 1 second per 10 years (baseline: 13.41 mL per 3 parts per billion [95% CI, 0.7-26.1]; follow-up: 18.15 mL per 3 parts per billion [95% CI, 1.59-34.71]).

Conclusions and Relevance

In this cohort study conducted between 2000 and 2018 in 6 US metropolitan regions, long-term exposure to ambient air pollutants was significantly associated with increasing emphysema assessed quantitatively using CT imaging and lung function.

Long-Term Exposure to Ambient Air Pollution in Childhood-Adolescence and Lung Function in Adulthood

The aim of the study was to evaluate the effect of air pollution in the dwelling place during childhood-adolescence on respiratory function in early adulthood. The study was conducted in 220 female and 160 male university undergraduates in the cities of Cracow and Wroclaw in Poland and consisted of spirometry to assess lung function. The subjects' exposure to pollution during childhood-adolescence was assessed from the data acquired by the Polish Chief Inspectorate for Environmental Protection. We found differences in all spirometry variables depending on benz[a]piren exposure, in FVC% and FEV₁/%FVC depending on PM_2.5 content, and in FVC% depending on NO₂ content_. Statistically significant differences in spirometry variables were also found in relation to the degree of urbanization of the place of living during the early life period in question. The higher the urbanization, the higher is FEV₁% and FCV%, and the lower FEV₁/%FVC. Additionally, undergraduates of Cracow University had worse lung function compared to those of Wroclaw University. In conclusion, air pollution in the dwelling place during childhood-adolescence has an impact on lung function in early adulthood, independently of the current exposure to pollutants.

Effect of outdoor particulate air pollution on FEV1 in healthy adults: a systematic review and meta-analysis

The effect of acute and long-term exposures to outdoor particulate air pollution on lung function in healthy adults is not well established. The objective of this study was to conduct a systematic literature review and meta-analysis of studies that assessed the relationship of outdoor particulate air pollution and lung function in healthy adults. Studies that contained data on outdoor air particulate matter levels (PM₁₀ or PM_2.5) and forced expiratory volume in 1 s (FEV₁) in healthy adults were eligible for inclusion. Effect estimates, in relation to long-term and acute exposures, were quantified separately using random effects models. A total of 27 effect estimates from 23 studies were included in this review. Acute exposures were typically assessed with PM_2.5, while long-term exposures were predominantly represented by PM₁₀ A 10 µg/m3 increase in short-term PM_2.5 exposure (days) was associated with a -7.02 mL (95% CI -11.75 to -2.29) change in FEV₁ A 10 µg/m³ difference in long-term PM₁₀ exposure was associated with a -8.72 mL (95% CI -15.39 to -2.07) annual change in FEV₁ and an absolute difference in FEV₁ of -71.36 mL (95% CI -134.47 to -8.24). This study provides evidence that acute and long-term exposure to outdoor particulate air pollution are associated with decreased FEV₁ in healthy adults. Residual confounding from other risk factors, such as smoking, may explain some of the effect for long-term exposures. More studies are required to determine the relationship of long-term exposure to PM_2.5 and short-term exposure to PM₁₀, which may have different biologic mechanisms.

The Role of Socioeconomic Status in the Association of Lung Function and Air Pollution-A Pooled Analysis of Three Adult ESCAPE Cohorts

Ambient air pollution is a leading environmental risk factor and its broad spectrum of adverse health effects includes a decrease in lung function. Socioeconomic status (SES) is known to be associated with both air pollution exposure and respiratory function. This study assesses the role of SES either as confounder or effect modifier of the association between ambient air pollution and lung function. Cross-sectional data from three European multicenter adult cohorts were pooled to assess factors associated with lung function, including annual means of home outdoor NO₂. Pre-bronchodilator lung function was measured according to the ATS-criteria. Multiple mixed linear models with random intercepts for study areas were used. Three different factors (education, occupation and neighborhood unemployment rate) were considered to represent SES. NO₂ exposure was negatively associated with lung function. Occupation and neighborhood unemployment rates were not associated with lung function. However, the inclusion of the SES-variable education improved the models and the air pollution-lung function associations got slightly stronger. NO₂ associations with lung function were not substantially modified by SES-variables. In this multicenter European study we could show that SES plays a role as a confounder in the association of ambient NO₂ exposure with lung function.

Benefits of improved air quality on ageing lungs: impacts of genetics and obesity

INTRODUCTION

The beneficial effect of improving air quality on lung function in the elderly remains unclear. We examined associations between decline in air pollutants and lung function, and effect modifications by genetics and body mass index (BMI), in elderly German women.

METHODS

Data were analysed from the prospective SALIA (Study on the influence of Air pollution on Lung function, Inflammation and Aging) study (n=601). Spirometry was conducted at baseline (1985-1994; age 55 years), in 2007-2010 and in 2012-2013. Air pollution concentrations at home addresses were determined for each time-point using land-use regression models. Global Lung Initiative 2012 z-scores were calculated. Weighted genetic risk scores (GRSs) were determined from lung function-related risk alleles and used to investigate interactions with improved air quality. Multiple linear mixed models were fitted.

RESULTS

Air pollution levels decreased substantially during the study period. Reduction of air pollution was associated with an increase in z-scores for forced expiratory volume in 1 s (FEV₁) and the FEV₁/forced vital capacity ratio. For a decrease of 10 µg·m^-3 in nitrogen dioxide (NO₂), the z-score for FEV₁ increased by 0.14 (95% CI 0.01-0.26). However, with an increasing number of lung function-related risk alleles, the benefit from improved air quality decreased (GRS×NO₂ interaction: p=0.029). Interactions with BMI were not significant.

CONCLUSIONS

Reduction of air pollution is associated with a relative improvement of lung function in elderly women, but also depends on their genetic make-up.

COPD Patients as Vulnerable Subpopulation for Exposure to Ambient Air Pollution

PURPOSE OF REVIEW

The prevalence of chronic obstructive pulmonary disease (COPD) is increasing worldwide with no known cure and an increasing number of triggers that exacerbate symptoms and speed up progression. This review aims to summarize the evidence for COPD patients being more vulnerable to air pollution exposure assessed as acute effects.

RECENT FINDINGS

Several recent systematic reviews show consistently increased risks for COPD mortality and COPD hospital admission, ranging between 2 and 3% with increasing PM_2.5 or PM₁₀. Similar adverse impacts were shown for NO_2. Also_, adverse health effects among COPD patients were also found for other gaseous pollutants such as ozone and SO₂; most of these studies could not be included in the meta-analysis we reviewed. Data from ten panel studies of COPD patients reported a small but statistically significant decline of FEV1 [- 3.38 mL (95% CI - 6.39 to - 0.37)] per increment of 10 μg/m³ PM₁₀, supporting an impact on respiratory health with increasing PM₁₀ exposure. The combined information from systematic reviews and more recent findings lead us to conclude that COPD patients are more vulnerable to ambient air pollution than healthier people.

Low to Moderate Air Pollutant Exposure and Acute Respiratory Distress Syndrome after Severe Trauma

RATIONALE

Exposure to air pollution has molecular and physiologic effects on the lung that may increase the risk of acute respiratory distress syndrome (ARDS) after injury.

OBJECTIVES

To determine the association of short- and long-term air pollutant exposures and ARDS risk after severe trauma.

METHODS

We analyzed data from a prospective cohort of 996 critically ill patients presenting with acute trauma and an injury severity score greater than 15. Exposures to ozone, nitrogen dioxide, sulfur dioxide, carbon monoxide, and particulate matter less than 2.5 μm were assessed by weighted averages of daily levels from all monitors within 50 km of the geocoded location of a patient's residence. Patients were followed for 6 days for the development of ARDS according to Berlin Criteria. The association between each exposure and ARDS was determined via multivariable logistic regression adjusting for potential confounders.

MEASUREMENTS AND MAIN RESULTS

ARDS developed in 243 (24%) patients. None of the short-term exposures averaged over the 3 days before presentation was associated with ARDS, except sulfur dioxide, which demonstrated a nonlinear association. Nitrogen dioxide, sulfur dioxide, and particulate matter less than or equal to 2.5 μm in aerodynamic diameter exposure over the 6 weeks before presentation was significantly associated with ARDS (P < 0.05). All long-term exposures (3 yr) were associated with ARDS (P < 0.01) in adjusted models, despite exposure levels largely below U.S. and European Union air quality standards.

CONCLUSIONS

Long-term low- to moderate-level air pollutant exposure is associated with a greater risk of developing ARDS after severe trauma and represents a novel and potentially modifiable environmental risk factor for ARDS.

Role of truncated oxidized phospholipids in acute endothelial barrier dysfunction caused by particulate matter

Particulate matter (PM) air pollution is a global environmental health problem contributing to more severe lung inflammation and injury. However, the molecular and cellular mechanisms of PM-induced exacerbation of lung barrier dysfunction and injury are not well understood. In the current study, we tested a hypothesis that PM exacerbates vascular barrier dysfunction via ROS-induced generation of truncated oxidized phospholipids (Tr-OxPLs). Treatment of human pulmonary endothelial cells with PM caused endothelial cell barrier disruption in a dose-dependent fashion. Biochemical analysis showed destabilization of cell junctions by PM via tyrosine phosphorylation and internalization of VE-cadherin. These events were accompanied by PM-induced generation of Tr-OxPLs, detected by mass spectrometry analysis. Furthermore, purified Tr-OxPLs: POVPC, PGPC and lyso-PC alone, caused a rapid increase in endothelial permeability and augmented pulmonary endothelial barrier dysfunction induced by submaximal doses of PM. In support of a role of TR-OxPLs-dependent mechanism in mediation of PM effects, ectopic expression of intracellular type 2 platelet-activating factor acetylhydrolase (PAFAH2), which specifically hydrolyzes Tr-OxPLs, significantly attenuated PM-induced endothelial hyperpermeability. In summary, this study uncovered a novel mechanism of PM-induced sustained dysfunction of pulmonary endothelial cell barrier which is driven by PM-induced generation of truncated products of phospholipid oxidation causing destabilization of cell junctions.

Perturbation of metabolic pathways mediates the association of air pollutants with asthma and cardiovascular diseases

BACKGROUND

Epidemiologic evidence indicates common risk factors, including air pollution exposure, for respiratory and cardiovascular diseases, suggesting the involvement of common altered molecular pathways.

OBJECTIVES

The goal was to find intermediate metabolites or metabolic pathways that could be associated with both air pollutants and health outcomes ("meeting-in-the-middle"), thus shedding light on mechanisms and reinforcing causality.

METHODS

We applied a statistical approach named 'meet-in-the-middle' to untargeted metabolomics in two independent case-control studies nested in cohorts on adult-onset asthma (AOA) and cardio-cerebrovascular diseases (CCVD). We compared the results to identify both common and disease-specific altered metabolic pathways.

RESULTS

A novel finding was a strong association of AOA with ultrafine particles (UFP; odds ratio 1.80 [1.26, 2.55] per increase by 5000 particles/cm3). Further, we have identified several metabolic pathways that potentially mediate the effect of air pollution on health outcomes. Among those, perturbation of Linoleate metabolism pathway was associated with air pollution exposure, AOA and CCVD.

CONCLUSIONS

Our results suggest common pathway perturbations may occur as a consequence of chronic exposure to air pollution leading to increased risk for both AOA and CCVD.

Inhalational exposure to particulate matter air pollution alters the composition of the gut microbiome

Recent studies suggest an association between particulate matter (PM) air pollution and gastrointestinal (GI) disease. In addition to direct deposition, PM can be indirectly deposited in oropharynx via mucociliary clearance and upon swallowing of saliva and mucus. Within the GI tract, PM may alter the GI epithelium and gut microbiome. Our goal was to determine the effect of PM on gut microbiota in a murine model of PM exposure via inhalation. C57BL/6 mice were exposed via inhalation to either concentrated ambient particles or filtered air for 8-h per day, 5-days a week, for a total of 3-weeks. At exposure's end, GI tract tissues and feces were harvested, and gut microbiota was analyzed. Alpha-diversity was modestly altered with increased richness in PM-exposed mice compared to air-exposed mice in some parts of the GI tract. Most importantly, PM-induced alterations in the microbiota were very apparent in beta-diversity comparisons throughout the GI tract and appeared to increase from the proximal to distal parts. Changes in some genera suggest that distinct bacteria may have the capacity to bloom with PM exposure. Exposure to PM alters the microbiota throughout the GI tract which maybe a potential mechanism that explains PM induced inflammation in the GI tract.

A cross-sectional study on the pulmonary function of residents in two urban areas with different PM10 concentrations: data from the fourth Korea national health and nutrition examination survey (KNHANES) 2007-2009

Background

The present study aims to compare the pulmonary function of residents of Seoul special city (Seoul) and Jeju special self-governing province including Jeju city and Seogwipo city (Jeju), characterized by vastly different annual average airborne particulate matter with an aerodynamic diameter less ≤10 μm (PM₁₀) concentrations, with the annual average PM₁₀ concentration in Seoul being significantly higher than that in Jeju.

Methods

This cross-sectional study analyzed the pulmonary function test results and sociodemographic data of Korean adults ≥19 years of age derived from the 4th KNHANES, 2007–2009. A total of 830 individuals residing in Seoul or Jeju were included in this study. T-tests were used to analyze predicted values of forced expiratory volume in 1 sec (FEV1p), predicted values of forced vital capacity (FVCp) and FEV1/FVC ratio (FEV1/FVC), as dependent variables, to examine the differences in the subjects’ pulmonary function according to the city of residence. Stratified analysis was then performed to adjust for variables potentially affecting pulmonary function. The analysis was performed on subjects as a group and also following stratification according to sex and other variables.

Results

Seoul residents had a significantly lower FVCp than that of the Jeju residents (difference: 3.48%, p = 0.002). FEV1p, FVCp and FEV1/FVC of male Seoul residents were significantly lower than those of male Jeju residents (difference: 6.99, 5.11% and 0.03, respectively; p < 0.001, p = 0.001, p = 0.001). In male subjects, statistically significant results were obtained even after adjusting the influence of other variables through stratified analysis.

Conclusion

The present analysis was based on cross-sectional data collected at one point in time. Therefore, unlike longitudinal studies, it does not establish a clear causal association between the variables. Nevertheless, this study found that pulmonary function among subjects residing in Seoul was significantly decreased compared to that of subjects residing in Jeju.

Residential proximity to agricultural fumigant use and respiratory health in 7-year old children

OBJECTIVES

To examine the relationship between residential proximity to agricultural fumigant use and respiratory symptoms and lung function in 7-year old children.

METHODS

Participants were 294 children living in the agricultural Salinas Valley, California and enrolled in the Center for the Health Assessment of Mothers and Children Of Salinas (CHAMACOS) study. We obtained information on respiratory symptoms and asthma medication use from maternal questionnaires and children performed spirometry to determine the forced expiratory volume in one second (FEV₁), forced vital capacity (FVC), and forced expiratory flow 25-75% (FEF_25-75) at 7-years of age. We estimated agricultural fumigant use within 3, 5 and 8 km of residences during pregnancy and from birth to age 7 using California's Pesticide Use Report data. We evaluated the association between prenatal and postnatal residential proximity to agricultural use of methyl bromide, chloropicrin, metam sodium and 1,3-dichloropropene with respiratory symptoms and use of asthma medication with logistic regression models and continuous lung function measurements with linear regression models adjusted for confounders.

RESULTS

There were no significant associations between residential proximity to use of fumigants and respiratory symptoms or use of asthma medication. We did not observe any adverse relationships between residential proximity to fumigant use and lung function measurements. Unexpectedly, we observed suggestive evidence of improved FEV₁ and FEF_25-75 with higher use of methyl bromide and chloropicrin during the prenatal period. For example, for each 10-fold increase in methyl bromide use during the prenatal development period we observed higher FEV₁ (β = 0.06 L/s; 95% CI: 0.00, 0.12) and higher FEF_25-75 (β = 0.15 L/s; 95% CI: 0.03, 0.27). Maternal report of child allergies (runny nose without a cold during the previous year) modified the relationship between FEV₁ and prenatal proximity to methyl bromide use (p = .07) and we only observed higher FEV₁ among children without allergies (β = 0.08 L/s; 95% CI: 0.02, 0.14 for a 10-fold increase in methyl bromide use during the prenatal period).

CONCLUSIONS

Residential proximity to agricultural fumigant use during pregnancy and childhood did not adversely affect respiratory health in the children through 7 years of age. These findings should be explored in larger studies.

Study on sandstorm PM10 exposure assessment in the large-scale region: a case study in Inner Mongolia

The current exposure-effect curves describing sandstorm PM₁₀ exposure and the health effects are drawn roughly by the outdoor concentration (OC), which ignored the exposure levels of people's practical activity sites. The main objective of this work is to develop a novel approach to quantify human PM₁₀ exposure by their socio-categorized micro-environment activities-time weighed (SCMEATW) in strong sandstorm period, which can be used to assess the exposure profiles in the large-scale region. Types of people's SCMEATW were obtained by questionnaire investigation. Different types of representatives were trackly recorded during the big sandstorm. The average exposure levels were estimated by SCMEATW. Furthermore, the geographic information system (GIS) technique was taken not only to simulate the outdoor concentration spatially but also to create human exposure outlines in a visualized map simultaneously, which could help to understand the risk to different types of people. Additionally, exposure-response curves describing the acute outpatient rate odds by sandstorm were formed by SCMEATW, and the differences between SCMEATW and OC were compared. Results indicated that acute outpatient rate odds had relationships with PM₁₀ exposure from SCMEATW, with a level less than that of OC. Some types of people, such as herdsmen and those people walking outdoors during a strong sandstorm, have more risk than office men. Our findings provide more understanding of human practical activities on their exposure levels; they especially provide a tool to understand sandstorm PM₁₀ exposure in large scale spatially, which might help to perform the different categories population's risk assessment regionally.

Exposure to Traffic Emissions and Fine Particulate Matter and Computed Tomography Measures of the Lung and Airways

BACKGROUND

Exposure to ambient air pollution has been associated with lower lung function in adults, but few studies have investigated associations with radiographic lung and airway measures.

METHODS

We ascertained lung volume, mass, density, visual emphysema, airway size, and airway wall area by computed tomography (CT) among 2,545 nonsmoking Framingham CT substudy participants. We examined associations of home distance to major road and PM2.5 (2008 average from a spatiotemporal model using satellite data) with these outcomes using linear and logistic regression models adjusted for age, sex, height, weight, census tract median household value and population density, education, pack-years of smoking, household tobacco exposure, cohort, and date. We tested for differential susceptibility by sex, smoking status (former vs. never), and cohort.

RESULTS

The mean participant age was 60.1 years (standard deviation 11.9 years). Median PM2.5 level was 9.7 µg/m (interquartile range, 1.6). Living <100 m from a major road was associated with a 108 ml (95% CI = 8, 207) higher lung volume compared with ≥400 m away. There was also a log-linear association between proximity to road and higher lung volume. There were no convincing associations of proximity to major road or PM2.5 with the other pulmonary CT measures. In subgroup analyses, road proximity was associated with lower lung density among men and higher odds of emphysema among former smokers.

CONCLUSIONS

Living near a major road was associated with higher average lung volume, but otherwise, we found no association between ambient pollution and radiographic measures of emphysema or airway disease.

Treatment for moderate to severe atopic dermatitis in alpine and moderate maritime climates differentially affects helper T cells and memory B cells in children

BACKGROUND

Treatment of atopic dermatitis (AD) is focused on topical anti-inflammatory therapy, epidermal barrier repair and trigger avoidance. Multidisciplinary treatment in both moderate maritime and alpine climates can successfully reduce disease activity in children with AD. However, it remains unclear whether abnormalities in B cell and T cell memory normalize and whether this differs between treatment strategies.

OBJECTIVE

To determine whether successful treatment in maritime and alpine climates normalizes B- and T lymphocytes in children with moderate to severe AD.

METHODS

The study was performed in the context of a trial (DAVOS trial, registered at Current Controlled Trials ISCRTN88136485) in which eighty-eight children with moderate to severe AD were randomized to 6 weeks of treatment in moderate maritime climate (outpatient setting) or in the alpine climate (inpatient setting). Before and directly after treatment, disease activity was determined with SA-EASI and serum TARC, and T cell and B cell subsets were quantified in blood.

RESULTS

Both treatment protocols achieved a significant decrease in disease activity, which was accompanied by a reduction in circulating memory Treg, transitional B cell and plasmablast numbers. Alpine climate treatment had a significantly greater effect on disease activity and was accompanied by a reduction in blood eosinophils and increases in memory B cells, CD8+ TemRO, CD4+ Tcm and CCR7+ Th2 subsets.

CONCLUSIONS AND CLINICAL RELEVANCE

Clinically successful treatment of AD induces changes in blood B- and T cell subsets reflecting reduced chronic inflammation. In addition, multidisciplinary inpatient treatment in the alpine climate specifically affects memory B cells, CD8+ T cells and Th2 cells. These cell types could represent good markers for treatment efficacy.

Effect of long-term exposure to fine particulate matter on lung function decline and risk of chronic obstructive pulmonary disease in Taiwan: a longitudinal, cohort study

BACKGROUND

Information on the effects of long-term exposure to fine particulate matter with an aerodynamic diameter of 2·5 μm or less (PM_2·5) on lung health is scarce. We aimed to investigate the associations between long-term exposure to PM_2·5, lung function, and chronic obstructive pulmonary disease (COPD) in a large-scale longitudinal cohort.

METHODS

We included 285 046 participants aged 20 years or older from the Taiwan MJ Health Management Institution cohort, who were recruited between 2001 and 2014 and had spirometric tests during the medical examination visit. We used a satellite-based spatiotemporal model to estimate the 2-year average ground concentration of PM_2·5 (for the calendar year of each participant's medical examination and for the previous year) at each participant's address. We used the generalised linear mixed model to examine the associations between PM_2·5 concentrations and lung function and the Cox proportional hazard regression model with time-dependent covariates to investigate the PM_2·5 effects on COPD development.

FINDINGS

Every 5 μg/m³ increment in PM_2·5 was associated with a decrease of 1·18% for forced vital capacity (FVC), 1·46% for forced expiratory volume in 1 s (FEV₁), 1·65% for maximum mid-expiratory flow (MMEF), and 0·21% for FEV₁:FVC ratio. The decrease accelerated over time. Additional annual declines were observed for FVC (0·14%), FEV₁ (0·24%), MMEF (0·44%), and FEV₁:FVC ratio (0·09%). Compared with the participants exposed to the first quartile of PM_2·5, participants exposed to the fourth, third, and second quartiles of PM_2·5 had a hazard ratio of 1·23 (95% CI 1·09-1·39), 1·30 (1·16-1·46), and 1·39 (1·24-1·56) for COPD development, respectively.

INTERPRETATION

Long-term exposure to ambient PM_2·5 is associated with reduced, and faster declines in, lung function. Long-term exposure to ambient PM_2·5 is also associated with an increased risk of the incidence of COPD. This study reinforces the urgency of global strategies to mitigate air pollution for improvement of pulmonary health and prevention of COPD.

FUNDING

Environmental Health Research Fund of the Chinese University of Hong Kong and PhD Studentship of the Chinese University of Hong Kong.

Chronic airflow obstruction in Tanzania - a cross-sectional study

Background

Chronic obstructive pulmonary disease is a global problem and available data from sub-Saharan Africa is very limited.

Methods

A cross-sectional facility-based pilot study among patients and visitors to an urban and a rural primary healthcare facility was conducted in coastal Tanzania. The primary outcome was the prevalence of chronic airflow obstruction.

Results

The final analysis included 598 participants with valid post-bronchodilator spirometry. Applying ATS/ERS spirometric criteria, chronic airflow obstruction was found in n = 24 (4%, CI₉₅ 2.7–5.9) participants and in n = 30 (5%, CI₉₅ 3.5–7.1) applying GOLD spirometric criteria. To analyse risk factors for chronic airflow obstruction including those not meeting ATS/ERS or GOLD criteria, FEF_25–75 and FEV1% predicted was analysed in participants without evidence of pulmonary restriction among those exposed or not exposed to risk factors (n = 552). FEV1% predicted, but in particular FEF_25–75 decreased with increasing symptom severity of shortness of breath as well as limitations in daily activities of participants. Cooking in general and cooking with biomass fuels vs. gas or electricity was associated with significantly lower FEF_25–75, but not with lower FEV1% predicted. Participants having refrained from taking a job because of shortness of breath exhibited lower FEF_25–75 (p < 0.01). A history of prior active TB was the most relevant risk factor associated with a decrease in FEF_25–75 as well as FEV1% predicted.

Conclusion

This study demonstrated a relevant prevalence of chronic airflow obstruction in primary healthcare attendants and healthy visitors of a Tanzanian hospital. Using the baseline data provided, larger and population-based studies are needed to validate these findings. TB may have more impact on development of chronic airway obstruction than smoking in Africa. Due to the influence of age on the GOLD definition of chronic airflow obstruction, studies should report results using both ATS/ERS and GOLD definitions and include age-stratified analysis. Analysis of FEV1 and in particular FEF_25–75 may yield additional information on risk factors and earlier stages of chronic airflow obstruction.

Consumption of fruit and vegetables might mitigate the adverse effects of ambient PM2.5 on lung function among adults

BACKGROUND

Evidence on the effects of ambient PM_2.5 on lung function is limited among adults and the effect modification by dietary fruit and vegetables remains largely unknown.

METHODS

We interviewed 29,032 participants aged 50 years and older from the WHO Study on global AGEing and adult health. Annual average PM_2.5 levels were estimated for each community using satellite data. We applied multi-level linear regressions to examine the association between ambient PM_2.5 and lung function (forced vital capacity (FVC), forced expiratory volume in 1-sec (FEV₁), FEV₁/FVC ratio, peak expiratory flow (PEF), and forced expiratory flow between 25th and 75th percentiles of FVC (FEF_25-75)).

RESULTS

We found that ambient PM_2.5 was associated with lower lung functions. Each 10μg/m³ increase in PM_2.5 corresponded to reductions of 123.58ml in FVC (95% CI: -185.21, -61.95), 126.64ml in FEV₁ (95% CI: -186.04, -67.23) and 178.93ml/s FEV_25-75 (95% CI: -249.20, -108.66). Lower effect estimates were observed among those with higher consumption of fruit and vegetables.

CONCLUSION

Our study suggests that exposure to ambient PM_2.5 might be one risk factor of reduced lung function in adults and that higher consumption of fruit and vegetables may mitigate this effect.

The air of Europe: where are we going?

Air pollution constitutes one of the main threats to public health in Europe. Significant impacts on the health of Europeans in terms of morbidity and mortality have been observed, even in cases of low exposure and where pollutant levels are within limits set by the European Union (EU). The respiratory system is a primary target of the harmful effects of key air pollutants. Emissions of many air pollutants have decreased substantially over the past decades in Europe, resulting in diminished concentrations and improved air quality. However, in several European cities concentrations still exceed EU reference values and, more often, the stricter World Health Organization air quality guidelines for all regulated air pollutants (particles with 50% cut-off aerodynamic diameters of 10 and 2.5 µm, nitrogen dioxide (NO2), benzo[a]pyrene and ozone (O3)) except sulfur dioxide. In addition, current trends indicate that in the absence of substantial changes, particulate matter, NO2 and O3 will still exceed limits in 2020. Additional efforts must be made to comply with current standards and guidelines. These should include a more accurate and detailed monitoring of air pollutants, reduction of emissions and individual behaviour changes.

Lung function improvement and airways inflammation reduction in asthmatic children after a rehabilitation program at moderate altitude

BACKGROUND

Rehabilitational programs at moderate altitude (1500-2500 m) showed improvement of lung function and reduction in airways inflammation in asthmatic adults. Allergen avoidance was postulated as the major cause of these improvements.

METHODS

Spirometries of 344 and fractional exhaled nitric oxide measurements (FeNO) of 124 asthmatic children and adolescents, staying in a rehabilitation hospital in Davos (1590 m) with at least 14 days between admission and discharge, were analyzed in association with atopic sensitization (skin-prick testing and/or specific IgE), level of asthma control, and inhalative corticosteroid (ICS) dose.

RESULTS

Pulmonary conditions improved significantly on average during the sojourn. Uncontrolled asthmatics benefited most with an absolute increase in predicted FEV₁ , MEF₂₅ , and MEF₇₅ of 7.7%, 9.9%, and 12.7%, respectively (P < .001). FeNO decreased by 36.9 ppb for uncontrolled, by 26.9 ppb for partly controlled, and by 11.8 ppb for controlled asthmatics. In uncontrolled subjects, pulmonary improvement was comparable between patients with and without house dust mites (HDM) sensitization. Pulmonary improvements of pollen-sensitized patients were not dependent on the season of the sojourn. For the group with constant ICS level, the absolute increase in FEV₁ was 4.9% (P < .001) with a FeNO decreased by 32.7 ppb (P < .001). When the ICS dose was elevated by one GINA level, the absolute increase in FEV₁ was slightly higher (6.6%, P < .001), with a FeNO decrease of 31.4 ppb (P < .001).

CONCLUSION

Inpatient rehabilitation at moderate altitude improved pulmonary conditions in asthmatic children and adolescents independent of sensitization status to HDM or pollen. A positive effect was also observed in patients without change in medication.

High Risk Subgroups Sensitive to Air Pollution Levels Following an Emergency Medical Admission

For three cohorts (the elderly, socially deprived, and those with chronic disabling disease), the relationship between the concentrations of particulate matter (PM₁₀), sulphur dioxide (SO₂), or oxides of nitrogen (NO_x) at the time of hospital admission and outcomes (30-day in-hospital mortality) were investigated All emergency admissions (90,423 episodes, recorded in 48,035 patients) between 2002 and 2015 were examined. PM₁₀, SO₂, and NO_x daily levels from the hospital catchment area were correlated with the outcomes for the older admission cohort (>70 years), those of lower socio-economic status (SES), and with more disabling disease. Adjusted for acuity and complexity, the level of each pollutant on the day of admission independently predicted the 30-day mortality: for PM₁₀-OR 1.11 (95% CI: 1.08, 1.15), SO₂-1.20 (95% CI: 1.16, 1.24), and NO_x-1.09 (1.06-1.13). For the older admission cohort (≥70 years), as admission day pollution increased (NO_x quintiles) the 30-day mortality was higher in the elderly (14.2% vs. 11.3%: p < 0.001). Persons with a lower SES were at increased risk. Persons with more disabling disease also had worse outcomes on days with higher admission particulate matter (PM₁₀ quintiles). Levels of pollutants on the day of admission of emergency medical admissions predicted 30-day hospital mortality.

Joint statement for the diagnosis, management, and prevention of chronic obstructive pulmonary disease for Gulf Cooperation Council countries and Middle East-North Africa region, 2017

Smoking and subsequent development of COPD is an ever-increasing epidemic in Arabian Gulf and Middle East countries, with no signs of decline. The important fact to be highlighted is that this COPD epidemic of increasing incidence and prevalence is mostly unrecognized by patients, due to the common attribution of symptoms to "smoker's cough", and the underdiagnosis and undertreatment by physicians because the common signs and symptoms masquerade as asthma. Consequently, there are long-term adverse effects of missing the diagnosis. The purpose of this review article is to focus upon the status of COPD in Arabian Gulf and Middle East countries, stressing the increasing burden of smoking and COPD, to emphasize the specific factors leading to rise in prevalence of COPD, to bring to light the underdiagnosis and undermanagement of COPD, and to treat COPD in conformity with standard guidelines with local and regional modifications. This review ends with suggestions and recommendations to the health department to formulate policies and to generate awareness among the general public about the side effects of smoking and consequences of COPD.

Assessment of hospitalization and mortality from exposure to PM10 using AirQ modeling in Ilam, Iran

The aims of this study were to assess the health impact of PM₁₀ on inhabitants and to investigate the trend of PM₁₀ concentrations in Ilam, Iran, from 2012 to 2015. For these aims, daily average concentration of PM₁₀ was obtained from continuous monitoring stations in the study area. Mortality and morbidity due to PM₁₀ were assessed by AirQ software developed by World Health Organization (WHO). Based on the results, the annual mean concentrations of PM₁₀ in all of years were more than WHO guideline and PM₁₀ concentration had a decreasing trend in this study period. Total mortality attributed to PM₁₀ was found to be 49 cases in 2012, 25 in 2013, and 33 in 2014. Hospital admission due to respiratory diseases was the most impact due to PM_10. Increase in relative risk (RR) with every 10 μg/m³ increase in PM₁₀ from 2012 to 2015 years for total mortality, respiratory disease hospitalization, and hospital admissions were 0.6, 0.8, and 0.9%, respectively. The results of this study indicated that air pollution is one of the major problems in this urban area and AirQ model as simple tool can help to design preventive and controlling programs in order to reduce human health effects of pollutants.

Elemental Sulfur Use and Associations with Pediatric Lung Function and Respiratory Symptoms in an Agricultural Community (California, USA)

BACKGROUND

Elemental sulfur, "the oldest of all pesticides," is the most heavily used agricultural pesticide in California and Europe. Sulfur is considered relatively safe and is used in both conventional and organic farming systems. Adverse respiratory effects have been reported in applicators and animals, but the effect on residential populations, and especially on children living in proximity to fields treated with elemental sulfur, is not known.

OBJECTIVES

We evaluated associations between residential proximity to elemental sulfur applications and respiratory symptoms and spirometry of children living in an agricultural community.

METHODS

Participants were enrolled in the CHAMACOS longitudinal birth cohort. We collected respiratory symptomatology for 347 children at 7 y of age and measured spirometry on a subset of 279. Of these, estimations of proximity to sulfur application and relevant covariate data were available for 237 and 205 children for whom we had symptomatology information and FEV₁ measurements, respectively. Data from the California Pesticide Use Reporting System were used to estimate the amount of elemental sulfur applied within 0.5, 1, and 3km of a child's residence during the week, month, and 12 mo prior to pulmonary evaluation. Regression models controlled for maternal smoking during pregnancy; season of birth; PM_2.5 (particulate matter ≤2.5mm in aerodynamic diameter); breast feeding duration; child's sex, age, and height; technician; and other covariates.

RESULTS

Adverse associations with respiratory outcomes were found for sulfur applications within 0.5- and 1-km radii. Specifically, asthma medication usage and respiratory symptoms increased [OR=3.51; 95% confidence interval (CI): 1.50, 8.23, p=0.004; OR=2.09; 95% CI: 1.27, 3.46, p=0.004, respectively] and FEV₁ decreased (β=−0.143; 95% CI: −0.248, −0.039, p=0.008) per 10-fold increase in the estimated amount of sulfur used within 1 km of child residence during the year prior to pulmonary evaluation.

CONCLUSIONS

This study suggests that elemental sulfur use, allowed in both organic and conventional farming, in close proximity to residential areas, may adversely affect children's respiratory health. https://doi.org/10.1289/EHP528.

Human health impact assessment of exposure to particulate matter: an AirQ software modeling

The aim of this study was to assess the health impacts related to particulate matter less than 10 μm (PM₁₀) exposure in the city of Yazd, Iran. For this aim, AirQ 2.2.3 software was used to model relationship between short-term exposure to PM₁₀ and disease cases proposed by the World Health Organization (WHO). The annual mean concentration of PM₁₀ was 97 μg/m³. The maximum concentration value of PM₁₀ was measured during the summer (731 μg/m³). 4.988% (95%CI: 3.381-6.542%) of the total mortality, 7.3% (95%CI; 4.19-10.21%) of cardiovascular mortality, and 10.21% (95%CI; 4.19-14.89%) of respiratory mortality were related to the PM₁₀ concentrations. Consequently, the AirQ software can provide valuable information about the importance of air pollution and the substantial impacts of PM₁₀ on the society for policymakers.

Prospective evaluation of respiratory health benefits from reduced exposure to airborne particulate matter

We aimed to investigate if short-term exposure to reduced particulate matter (PM) air pollution would affect respiratory function in healthy adults. We followed a cohort of 42 healthy participants from a community afflicted with severe PM air pollution to a substantially less polluted area for nine days. We measured daily airborne PM [with an aerodynamic diameter of less than 2.5 μm (PM_2.5) and 10 μm (PM₁₀)] and PM_2.5 carbon component concentrations. Five repeated respiratory function measurements and fractional exhaled nitric oxide test were made for each participant. Associations between respiratory health and PM exposure were assessed using linear mixed models. Each 10 μg/m³ decrease in same-day PM_2.5 was associated with small but consistent increase in the forced expiratory volume in 1 s (FEV₁) (9.00 mL) and forced vital capacity (14.35 mL). Our observations indicate that respiratory health benefits can be achieved even after a short-term reduction of exposure to PM. Our results provide strong evidence for more rigorous air pollution controls for the health benefit of populations.

Human bronchial epithelium orchestrates dendritic cell activation in severe asthma

The innate immune response is impaired in asthma, with increased epithelial release of C-X-C motif chemokine ligand (CXCL)8, interleukin (IL)-33 and thymic stromal lymphopoietin (TSLP). We hypothesised that dendritic cells might modulate the hyperresponsive epithelium in severe asthma.

For this purpose, we investigated epithelial–dendritic crosstalk in normal and diseased conditions, and because ultrafine particulate matter may affect asthmatic airways, we investigated its impact on this crosstalk. Air–liquid interface cultures of human bronchial epithelial cells (HBEC) of control subjects (cHBEC) or severe asthma patients (saHBEC) were co-cultured with monocyte-derived dendritic cells (moDC).

Increased release of CXCL8, TSLP and IL-33 from saHBEC contrasted with cHBEC producing CXCL10 and CCL2. Regarding moDC activation, saHBEC co-cultures induced only upregulation of CD86 expression, while cHBEC yielded full moDC maturation with HLA-DR, CD80, CD86 and CD40 upregulation. Particulate matter stimulation of HBEC had no effect on cHBEC but stimulated CXCL8 and IL-33 release in saHBEC. Particulate matter impaired epithelium signalling (TSLP, IL-33 and CXCL8) in saHBEC co-cultures despite C-C chemokine ligand 2 induction.

Crosstalk between HBEC and moDC can be establishedin vitro, driving a T1-type response with cHBEC and a T2-type response with saHBEC. Normal or asthmatic status of HBEC differentially shapes the epithelial–dendritic responses. We conclude that control moDC cannot rescue the hyperresponsive airway epithelium of severe asthmatics.

Long-term exposure to diesel engine exhaust induced lung function decline in a cross sectional study

To clarify the effects of lung function following exposure to diesel engine exhaust (DEE), we recruited 137 diesel engine testing workers exposed to DEE and 127 non-DEE-exposed workers as study subjects. We performed lung function tests and measured cytokinesis-block micronucleus (CBMN) cytome index and levels of urinary polycyclic aromatic hydrocarbons (PAHs) metabolites. There was a significant decrease of forced expiratory volume in 1 second (FEV₁), ratio of forced expiratory volume in 1 second to forced vital capacity (FEV₁/ FVC), maximal mid expiratory flow curve (MMF), forced expiratory flow at 50% of FVC (FEF_50%), and forced expiratory flow at 75% of FVC (FEF_75%) in the DEE-exposed workers than non-DEE-exposed workers (all p<0.05). Among all study subjects, the decreases of FEF_75% were associated with the increasing levels of PAHs meta-bolites (p<0.05), and there were negative correlations between FEV₁, FEV₁/FVC, MMF, FEF_50%, and FEF_75% with CBMN cytome index (all p<0.05). Our results show that long-term exposure to DEE can induce lung function decline which shows mainly obstructive changes and influence of small airways function. The decreased lung function is associated with internal dosage of DEE exposure, and accompany with the increasing CBMN cytome index.

Genes Interacting with Occupational Exposures to Low Molecular Weight Agents and Irritants on Adult-Onset Asthma in Three European Studies

BACKGROUND

The biological mechanisms by which cleaning products and disinfectants-an emerging risk factor-affect respiratory health remain incompletely evaluated. Studying genes by environment interactions (G × E) may help identify new genes related to adult-onset asthma.

OBJECTIVES

We identified interactions between genetic polymorphisms of a large set of genes involved in the response to oxidative stress and occupational exposures to low molecular weight (LMW) agents or irritants on adult-onset asthma.

METHODS

Our data came from three large European cohorts: Epidemiological Family-based Study of the Genetics and Environment of Asthma (EGEA), Swiss Cohort Study on Air Pollution and Lung and Heart Disease in Adults (SAPALDIA), and European Community Respiratory Health Survey in Adults (ECRHS). A candidate pathway-based strategy identified 163 genes involved in the response to oxidative stress and potentially related to exposures to LMW agents/irritants. Occupational exposures were evaluated using an asthma job-exposure matrix and job-specific questionnaires for cleaners and healthcare workers. Logistic regression models were used to detect G × E interactions, adjusted for age, sex, and population ancestry, in 2,599 adults (mean age, 47 years; 60% women, 36% exposed, 18% asthmatics). p-Values were corrected for multiple comparisons.

RESULTS

Ever exposure to LMW agents/irritants was associated with current adult-onset asthma [OR = 1.28 (95% CI: 1.04, 1.58)]. Eight single nucleotide polymorphism (SNP) by exposure interactions at five loci were found at p < 0.005: PLA2G4A (rs932476, chromosome 1), near PLA2R1 (rs2667026, chromosome 2), near RELA (rs931127, rs7949980, chromosome 11), PRKD1 (rs1958980, rs11847351, rs1958987, chromosome 14), and PRKCA (rs6504453, chromosome 17). Results were consistent across the three studies and after accounting for smoking.

CONCLUSIONS

Using a pathway-based selection process, we identified novel genes potentially involved in adult asthma by interaction with occupational exposure. These genes play a role in the NF-κB pathway, which is involved in inflammation. Citation: Rava M, Ahmed I, Kogevinas M, Le Moual N, Bouzigon E, Curjuric I, Dizier MH, Dumas O, Gonzalez JR, Imboden M, Mehta AJ, Tubert-Bitter P, Zock JP, Jarvis D, Probst-Hensch NM, Demenais F, Nadif R. 2017. Genes interacting with occupational exposures to low molecular weight agents and irritants on adult-onset asthma in three European studies. Environ Health Perspect 125:207-214; http://dx.doi.org/10.1289/EHP376.

CDH13 gene-by-PM10 interaction effect on lung function decline in Korean men

Lung function can be influenced by genetic factors, which may explain individual differences in susceptibility to the effects of air pollution. This study investigated whether the effect of particulate matter with an aerodynamic diameter ≤10 μm (PM₁₀) on lung function is modified by Cadherin 13 (CDH13) genetic variants in Korean men. This study included a total of 1827 men who were recruited from two health check-up centers, and the annual average PM₁₀ concentrations were used. A total of 200 single-nucleotide polymorphisms (SNPs) of the CDH13 gene were selected for this study. We found that a SNP in CHD13 intron, rs1862830, had the strongest associations with both forced expiratory volume in 1 s (FEV₁) (p_int = 1.90 × 10^-4) and forced vital capacity (FVC) (p_int = 1.88 × 10^-3) by interacting with PM₁₀ in a recessive model. A stratified association analysis according to this SNP showed that PM₁₀ in the AG or GG genotype group was not significantly associated with either FEV₁ or FVC, whereas in homozygous risk-allele carriers (AA), FEV₁ and FVC decreased significantly (by 3.8% and 3.1%, respectively) per 10 μg/m³ of increase in PM₁₀ concentration. This pattern was also reproducible in the independent subgroups that were classified according to recruitment site. The present study replicated the CDH13 gene-by-PM₁₀ interaction effect on lung function at the gene level, revealing that a genetic variant of CDH13 modified the relationship between PM₁₀ and lung function decline in Korean men.

Particulate Matter and Respiratory Symptoms among Adults Living in Windhoek, Namibia: A Cross Sectional Descriptive Study

This study aimed to estimate the prevalence of respiratory symptoms and to assess respiratory health risks associated with Particulate Matter (PM) exposure among the residents of Windhoek, Namibia. Objectives: To measure particulate pollution concentration in Windhoek through monitoring of particulate matter concentration and to identify any associations between particulate pollution, individual location, and respiratory health among the Windhoek resident’s. Methods: an adapted standardized self-administered questionnaire was used to collect respiratory health related data as well as previous exposure, while PM monitoring was done using the ASTM (American Standard Test Method) D1739 reference method. Results: A high prevalence was observed for cough (43%), breathlessness (25%), and asthma (11.2%). PM was found to be a significant risk factor for episodes of coughing and phlegm, while high PM exposure category had an increased odds ratio (OR) for episodes of phlegm and cough (OR: 2.5, 95% CI (95% confidence intervals): 0.8–8.0). No association was observed between location and respiratory health outcomes. Conclusions: The study found high levels of PM concentration across all Windhoek suburbs which were above the German, American, and Environmental Protection Agency (EPA). Enactment of legislation relating to the control and monitoring of PM related emissions at the point of generation is required at both a country and city level.

Chronic effects of air pollution on lung function after lung transplantation in the Systems prediction of Chronic Lung Allograft Dysfunction (SysCLAD) study

An irreversible loss in lung function limits the long-term success in lung transplantation. We evaluated the role of chronic exposure to ambient air pollution on lung function levels in lung transplant recipients (LTRs).The lung function of 520 LTRs from the Cohort in Lung Transplantation (COLT) study was measured every 6 months. The levels of air pollutants (nitrogen dioxide (NO₂), particulate matter with an aerodynamic cut-off diameter of x µm (PM_x) and ozone (O₃)) at the patients' home address were averaged in the 12 months before each spirometry test. The effects of air pollutants on forced expiratory volume in 1 s (FEV₁) and forced vital capacity (FVC) in % predicted were estimated using mixed linear regressions. We assessed the effect modification of macrolide antibiotics in this relationship.Increased 12-month levels of pollutants were associated with lower levels of FVC % pred (-2.56%, 95% CI -3.86--1.25 for 5 µg·m^-3 of PM₁₀; -0.75%, 95% CI -1.38--0.12 for 2 µg·m^-3 of PM_2.5 and -2.58%, 95% CI -4.63--0.53 for 10 µg·m^-3 of NO₂). In patients not taking macrolides, the deleterious association between PM and FVC tended to be stronger and PM₁₀ was associated with lower FEV₁Our study suggests a deleterious effect of chronic exposure to air pollutants on lung function levels in LTRs, which might be modified with macrolides.

A joint ERS/ATS policy statement: what constitutes an adverse health effect of air pollution? An analytical framework

The American Thoracic Society has previously published statements on what constitutes an adverse effect on health of air pollution in 1985 and 2000. We set out to update and broaden these past statements that focused primarily on effects on the respiratory system. Since then, many studies have documented effects of air pollution on other organ systems, such as on the cardiovascular and central nervous systems. In addition, many new biomarkers of effects have been developed and applied in air pollution studies.This current report seeks to integrate the latest science into a general framework for interpreting the adversity of the human health effects of air pollution. Rather than trying to provide a catalogue of what is and what is not an adverse effect of air pollution, we propose a set of considerations that can be applied in forming judgments of the adversity of not only currently documented, but also emerging and future effects of air pollution on human health. These considerations are illustrated by the inclusion of examples for different types of health effects of air pollution.

Use of visual range measurements to predict fine particulate matter exposures in Southwest Asia and Afghanistan

Military personnel deployed to Southwest Asia and Afghanistan were exposed to high levels of ambient particulate matter (PM). However, quantitative ambient exposure data for conducting health studies are limited due to a lack of PM monitoring stations. Since visual range (VR) is proportional to particle light extinction, VR can serve as a surrogate for PM_2.5 (particulate matter with an aerodynamic diameter ≤2.5 µm) concentrations. We used data on VR, relative humidity (RH), and PM_2.5 ground measurements collected in Kuwait from years 2004-2005 to establish the relationship between PM_2.5 and VR. Model validation obtained by regressing trimester average PM_2.5 predictions against PM_2.5 measurements in Kuwait produced an r² value of 0.84. Cross validation of urban and rural sites in Kuwait also revealed good model fit. We applied this relationship to location-specific visibility data at 104 regional sites between years 2000-2012 to estimate monthly average PM_2.5 concentrations. Monthly averages at sites in Iraq, Afghanistan, United Arab Emirates, Kuwait, Djibouti, and Qatar ranged from 10 to 365 µg/m3 during this period, while site averages ranged from 22 to 80 µg/m3, indicating considerable spatial and temporal heterogeneity in ambient PM_2.5 across these regions. These data support the use of historical visibility data to estimate location-specific PM_2.5 concentrations for application in epidemiological studies.

IMPLICATIONS

This study demonstrates the ability to use airport visibility to estimate PM_2.5 concentrations in Southwest Asian and Afghanistan. This supports the use of historical and ongoing visibility data to estimate PM_2.5 exposure in this region of the world, where PM exposure information is otherwise scarce. This is of high utility to epidemiologists investigating the relationship between chronic exposure to PM_2.5 and respiratory diseases among deployed military personnel stationed at various military bases throughout the region. Such information will enable the drafting of improved policies relating to military health.

Susceptibility Factors Relevant for the Association Between Long-Term Air Pollution Exposure and Incident Asthma

In this review, we identified 15 studies in children and 10 studies in adults that assessed the association between long-term exposure to air pollution and incident asthma and that conducted stratified analyses to explore potential susceptibility factors. Overall, adult never-/former smokers seem to be at higher risk of incident asthma due to air pollution. Children without atopy and children from low socioeconomic status families also seem to be at higher risk of incident asthma due to air pollution. While interaction between air pollution and genes involved in the response to oxidative stress pathways have been explored, results are somewhat inconsistent and in need of replication. To evaluate interactions, large sample sizes are necessary, and much more research, including data pooling from existing studies, is needed to further explore susceptibility factors for asthma incidence due to long-term air pollution exposure.

Particulate Matter and Subclinical Atherosclerosis: Associations between Different Particle Sizes and Sources with Carotid Intima-Media Thickness in the SAPALDIA Study

BACKGROUND

Subclinical atherosclerosis has been associated with long-term exposure to particulate matter (PM), but the relevance of particle size and sources of exposure remains unclear.

OBJECTIVES

We investigated the association of long-term exposure to PM10 (≤ 10 μm), PM2.5 (≤ 2.5 μm: total mass, vehicular, and crustal sources), and ultrafine particles [UFP < 0.1 μm: particle number concentration (PNC) and lung-deposited surface area (LDSA)] with carotid intima-media thickness (CIMT).

METHODS

We used data from 1,503 participants ≥ 50 years old who participated in the third examination of the Swiss SAPALDIA cohort. Exposures were obtained from dispersion models and land-use regression models. Covariate information, including previous cardiovascular risk factors, was obtained from the second and third SAPALDIA examinations.

RESULTS

The adjusted percent difference in CIMT associated with an exposure contrast between the 10th and 90th percentile was 1.58% (95% CI: -0.30, 3.47%) for PM10, 2.10% (95% CI: 0.04, 4.16%) for PM2.5, 1.67% (95% CI: -0.13, 3.48%) for the vehicular source of PM2.5, -0.58% (95% CI: -3.95, 2.79%) for the crustal source of PM2.5, 2.06% (95% CI: 0.03, 4.10%) for PNC, and 2.32% (95% CI: 0.23, 4.40%) for LDSA. Stronger associations were observed among diabetics, subjects with low-educational level, and those at higher cardiovascular risk.

CONCLUSIONS

CIMT was associated with exposure to PM10, PM2.5, and UFP. The PM2.5 source-specific analysis showed a positive association for the vehicular source but not for the crustal source. Although the effects of PNC and LDSA were similar in magnitude, two-pollutant and residual-based models suggested that LDSA may be a better marker for the health relevance of UFP. Citation: Aguilera I, Dratva J, Caviezel S, Burdet L, de Groot E, Ducret-Stich RE, Eeftens M, Keidel D, Meier R, Perez L, Rothe T, Schaffner E, Schmit-Trucksäss A, Tsai MY, Schindler C, Künzli N, Probst-Hensch N. 2016. Particulate matter and subclinical atherosclerosis: associations between different particle sizes and sources with carotid intima-media thickness in the SAPALDIA study. Environ Health Perspect 124:1700-1706; http://dx.doi.org/10.1289/EHP161.

Lung function reductions associated with motor vehicle density in chronic obstructive pulmonary disease: a cross-sectional study

Background

Motor vehicle-related air pollution can potentially impair lung function. The effect of pollution in people with compromised pulmonary function such as in COPD has not been previously investigated. To examine the association of lung function with motor vehicle density in people with spirometrically determined COPD in a cross-sectional study.

Methods

In 2004–06, The North West Adelaide Health Study (NWAHS), a biomedical cohort of adults assessed pre and post-bronchodilator spirometry (n = 3,103). Traffic density, obtained from the motor vehicle inventory maintained by the South Australian Environment Protection Authority, was expressed as the daily numbers of vehicles travelling within a 200 m diameter zone around participants’ geocoded residences.

Results

In subjects with COPD (FEV₁/FVC <0.7, n = 221, 7.1 %), increasing daily vehicle density was associated with statistically significant decreases in lung function parameters after adjustment for smoking and socio-economic variables. Mean (95 % CI) post-bronchodilator % predicted FEV₁ was 81 % (76–87) in the low (≤7179/day) compared with 71 % (67–75) in the high (≥15,270/day) vehicle exposure group (p < 0.05). Linear regression analysis in all subjects with COPD showed significant decrements in post-bronchodilator FEV₁/FVC ratio and % predicted FEV₁ of 0.03 and 0.05 % respectively per daily increase in 1000 vehicles. In men with COPD (n = 150), the corresponding reductions were 0.03 and 0.06 %. Smaller, non-significant decrements were seen in females. No difference was seen in those without COPD.

Conclusions

Vehicle traffic density was associated with significant reductions in lung function in people with COPD. Urban planning should consider the health impacts for those with pre-existing respiratory conditions.

Electronic supplementary material

The online version of this article (doi:10.1186/s12931-016-0451-3) contains supplementary material, which is available to authorized users.

Association between Traffic Air Pollution and Reduced Forced Vital Capacity: A Study Using Personal Monitors for Outdoor Workers

Background

The effects of outdoor air pollution on lung function in adults are still controversial.

Objective

Evaluate the effects of exposure to different levels of traffic-generated PM_2.5 on workers’ lung functions in São Paulo, Brazil.

Methods

To cover a wide range of exposures, 101 non-smoking workers from three occupations (taxi drivers, traffic controllers, and forest rangers) were selected for the study. After clinical evaluation, the participants were scheduled to attend four consecutive weekly visits in which they received a 24-hour personal PM_2.5 sampler and had lung function tests measured on the following day. The association between the spirometric variables and the averaged PM_2.5 levels was assessed using robust regression models adjusted for age, waist circumference, time at the job, daily work hours, diabetes or hypertension and former smoking habits.

Results

Relative to workers in the lowest exposed group (all measures < 25 μg/m³), those with the highest level of exposure (all measures > 39.6 μg/m³) showed a reduction of predicted FVC (-12.2%; CI 95%: [-20.0% to -4.4%]), a marginal reduction of predicted FEV₁ (-9.1%; CI 95%: [-19.1% to 0.9%]) and an increase of predicted FEF_25-75%/FVC (14.9%; CI 95%: [2.9% to 26.8%]) without changes of FEV₁/FVC.

Conclusions

Exposure to vehicular traffic air pollution is associated with a small but significant reduction of FVC without a reduction of FEV₁/FVC.

A systematic review of early life factors which adversely affect subsequent lung function

It has been known for many years that multiple early life factors can adversely affect lung function and future respiratory health. This is the first systematic review to attempt to analyse all these factors simultaneously. We adhered to strict a priori criteria for inclusion and exclusion of studies. The initial search yielded 29,351 citations of which 208 articles were reviewed in full and 25 were included in the review. This included 6 birth cohorts and 19 longitudinal population studies. The 25 studies reported the effect of 74 childhood factors (on their own or in combinations with other factors) on subsequent lung function reported as percent predicted forced expiration in one second (FEV₁). The childhood factors that were associated with a significant reduction in future FEV₁ could be grouped as: early infection, bronchial hyper-reactivity (BHR) / airway lability, a diagnosis of asthma, wheeze, family history of atopy or asthma, respiratory symptoms and prematurity / low birth weight. A complete mathematical model will only be possible if the raw data from all previous studies is made available. This highlights the need for increased cooperation between researchers and the need for international consensus about the outcome measures for future longitudinal studies.