Effect of exposure to traffic on lung development from 10 to 18 years of age: a cohort study

Particulate matter, the newborn methylome, and cardio-respiratory health outcomes in childhood

Ambient air pollution is associated with adverse health outcomes including cardio-respiratory diseases. Epigenetic mechanisms such as DNA methylation may play a role in driving such associations. We investigated the effects of prenatal particulate matter (PM) exposure on DNA methylation of 178,309 promoter regions in 240 newborns using the Infinium HumanMethylation450 BeadChip, using a generalized linear regression model with a quasi-binomial link family, adjusted for gender, plate, and cell types. PM-associated CpG loci were then investigated for their associations with childhood asthma, carotid intima-media thickness (CIMT), and blood pressure (BP) using logistic or linear regression. Thirty-one loci were associated with either PM₁₀ or PM_2.5 using FDR-corrected p-values of less than 0.15. Two loci were evaluated for replication in a separate population of 280 Children's Health Study (CHS) subjects using Pyrosequencing, of which one successfully replicated (COLEC11 cg03579365). Three of the 31 loci were also associated with physician-diagnosed asthma at 6 years old, two were associated with CIMT and one with systolic BP at 10 years old. A higher methylation level in TM9SF2 (cg02015529) and UBE2S (cg00035623), respectively, was associated with a 2SD increase in prenatal PM and was also associated with 36% and 98% increased odds of asthma; whereas methylation of TDRD6 (cg22329831) was negatively associated with PM and a 24% decreased odds of asthma. Prenatal PM exposure was associated with altered DNA methylation in newborn blood in a small number of gene promoters, some of which were also associated with cardio-respiratory health outcomes later in childhood. Keywords: methylation, particulate matter, air pollution, asthma, cardiovascular.

Interactions between traffic air pollution and glutathione S-transferase genes on childhood asthma

AIM: To evaluate the role of glutathione S-transferase P1 (GSTP1) genetic polymorphisms potentially modifying the association between NO₂ and asthma/wheeze in Taiwanese children.

METHODS: We investigated 3714 schoolchildren in Taiwan Children Health Study from 14 communities. Children’s information was measured from questionnaire by parents. The traffic air pollutant was available from Environmental Protection Administration monitoring stations.

RESULTS: A two-stage hierarchical model and a multiple logistic regression model were fitted to estimate the effects of NO₂ exposures and GSTs polymorphisms on the prevalence of asthma and wheeze. Among children with GSTP1 Ile/Val or Val/Val genotypes, those residing in high-NO₂ communities had significantly increased risks of asthma (OR = 1.76, 95%CI: 1.15-2.70), late-onset asthma (OR = 2.59, 95%CI: 1.24-5.41), active asthma (OR = 1.93, 95%CI: 1.05-3.57), asthma under medication (OR = 2.95, 95%CI: 1.37-6.32) and wheeze (OR = 1.54, 95%CI: 1.09-2.18) when compared with children in low-NO₂ communities. Significant interactions were noted between ambient NO₂ and GSTP1 on asthma, late-onset asthma, asthma under medication and wheeze (P for interaction < 0.05). However, we did not find any association with polymorphisms in GSTM1 and GSTT1.

CONCLUSION: Children under high traffic air pollution exposure are more susceptible to asthma, especially among those with GSTP1 Val allele.

Associations of short-term exposure to traffic-related air pollution with cardiovascular and respiratory hospital admissions in London, UK

OBJECTIVES

There is evidence of adverse associations between short-term exposure to traffic-related pollution and health, but little is known about the relative contribution of the various sources and particulate constituents.

METHODS

For each day for 2011-2012 in London, UK over 100 air pollutant metrics were assembled using monitors, modelling and chemical analyses. We selected a priori metrics indicative of traffic sources: general traffic, petrol exhaust, diesel exhaust and non-exhaust (mineral dust, brake and tyre wear). Using Poisson regression models, controlling for time-varying confounders, we derived effect estimates for cardiovascular and respiratory hospital admissions at prespecified lags and evaluated the sensitivity of estimates to multipollutant modelling and effect modification by season.

RESULTS

For single day exposure, we found consistent associations between adult (15-64 years) cardiovascular and paediatric (0-14 years) respiratory admissions with elemental and black carbon (EC/BC), ranging from 0.56% to 1.65% increase per IQR change, and to a lesser degree with carbon monoxide (CO) and aluminium (Al). The average of past 7 days EC/BC exposure was associated with elderly (65+ years) cardiovascular admissions. Indicated associations were higher during the warm period of the year. Although effect estimates were sensitive to the adjustment for other pollutants they remained consistent in direction, indicating independence of associations from different sources, especially between diesel and petrol engines, as well as mineral dust.

CONCLUSIONS

Our results suggest that exhaust related pollutants are associated with increased numbers of adult cardiovascular and paediatric respiratory hospitalisations. More extensive monitoring in urban centres is required to further elucidate the associations.

Minimizing Air Pollution Exposure: A Practical Policy to Protect Vulnerable Older Adults from Death and Disability

Air pollution causes an estimated 200,000 deaths per year in the United States alone. Older adults are at greater risk of mortality caused by air pollution. Here we quantify the number of older adult facilities in Los Angeles County that are exposed to high levels of traffic derived air pollution, and propose policy solutions to reduce pollution exposure to this vulnerable subgroup. Distances between 20,362 intersections and 858 elder care facilities were estimated, and roads or highways within 500 of facilities were used to estimate traffic volume exposure. Of the 858 facilities, 54 were located near at least one major roadway, defined as a traffic volume over 100,000 cars/day. These 54 facilities house approximately 6,000 older adults. Following standards established for schools, we recommend legislation mandating the placement of new elder care facilities a minimum of 500 feet from major roadways in order to reduce unnecessary mortality risk from pollution exposure.

Ambient air pollution, lung function, and airway responsiveness in asthmatic children

BACKGROUND

Although ambient air pollution has been linked to reduced lung function in healthy children, longitudinal analyses of pollution effects in asthmatic patients are lacking.

OBJECTIVE

We sought to investigate pollution effects in a longitudinal asthma study and effect modification by controller medications.

METHODS

We examined associations of lung function and methacholine responsiveness (PC20) with ozone, carbon monoxide (CO), nitrogen dioxide, and sulfur dioxide concentrations in 1003 asthmatic children participating in a 4-year clinical trial. We further investigated whether budesonide and nedocromil modified pollution effects. Daily pollutant concentrations were linked to ZIP/postal code of residence. Linear mixed models tested associations of within-subject pollutant concentrations with FEV1 and forced vital capacity (FVC) percent predicted, FEV1/FVC ratio, and PC20, adjusting for seasonality and confounders.

RESULTS

Same-day and 1-week average CO concentrations were negatively associated with postbronchodilator percent predicted FEV1 (change per interquartile range, -0.33 [95% CI, -0.49 to -0.16] and -0.41 [95% CI, -0.62 to -0.21], respectively) and FVC (-0.19 [95% CI, -0.25 to -0.07] and -0.25 [95% CI, -0.43 to -0.07], respectively). Longer-term 4-month CO averages were negatively associated with prebronchodilator percent predicted FEV1 and FVC (-0.36 [95% CI, -0.62 to -0.10] and -0.21 [95% CI, -0.42 to -0.01], respectively). Four-month averaged CO and ozone concentrations were negatively associated with FEV1/FVC ratio (P < .05). Increased 4-month average nitrogen dioxide concentrations were associated with reduced postbronchodilator FEV1 and FVC percent predicted. Long-term exposures to sulfur dioxide were associated with reduced PC20 (percent change per interquartile range, -6% [95% CI, -11% to -1.5%]). Treatment augmented the negative short-term CO effect on PC20.

CONCLUSIONS

Air pollution adversely influences lung function and PC20 in asthmatic children. Treatment with controller medications might not protect but rather worsens the effects of CO on PC20. This clinical trial design evaluates modification of pollution effects by treatment without confounding by indication.

Fine and ultrafine particulate organic carbon in the Los Angeles basin: Trends in sources and composition

In this study, PM2.5 and PM0.18 (particles with dp<2.5 μm and dp<0.18 μm, respectively) were collected during 2012-2013 in Central Los Angeles (LA) and 2013-2014 in Anaheim. Samples were chemically analyzed for carbonaceous species (elemental and organic carbons) and individual organic compounds. Concentrations of organic compounds were reported and compared with many previous studies in Central LA to quantify the impact of emissions control measurements that have been implemented for vehicular emissions over the past decades in this area. Moreover, a novel hybrid approach of molecular marker-based chemical mass balance (MM-CMB) analysis was conducted, in which a combination of source profiles that were previously obtained from a Positive Matrix Factorization (PMF) model in Central LA, were combined with some traditional source profiles. The model estimated the relative contributions from mobile sources (including gasoline, diesel, and smoking vehicles), wood smoke, primary biogenic sources (including emissions from vegetative detritus, food cooking, and re-suspended soil dust), and anthropogenic secondary organic carbon (SOC). Mobile sources contributed to 0.65 ± 0.25 μg/m(3) and 0.32 ± 0.25 μg/m(3) of PM2.5 OC in Central LA and Anaheim, respectively. Primary biogenic and anthropogenic SOC sources were major contributors to OC concentrations in both size fractions and sites. Un-apportioned OC ("other OC") accounted for an average 8.0 and 26% of PM2.5 OC concentration in Central LA and Anaheim, respectively. A comparison with previous studies in Central LA revealed considerable reduction of EC and OC, along with tracers of mobile sources (e.g. PAHs, hopanes and steranes) as a result of implemented regulations on vehicular emissions. Given the significant reduction of the impacts of mobile sources in the past decade in the LA Basin, the impact of SOC and primary biogenic emissions have a larger relative impact and the new hybrid model allows the impact of these sources to be better quantified.

Different effects of long-term exposures to SO2 and NO2 air pollutants on asthma severity in young adults

Numerous studies demonstrated that exposure to ambient air pollutants contributes to severity and frequency of asthma exacerbations. However, whether common air pollutants, such as nitrogen dioxide (NO2) and sulfur dioxide (SO2), exert differential effects on asthma occurrence and severity is unclear. The aim of this investigation was to determine whether exposure to NO2 and/or SO2 may initiate different long-term effects on prevalence and severity of asthma in young adults. Medical records of 137,040 males, 17 years old, who underwent standard premilitary service health examinations during 1999-2008 were examined. Air-pollution data for NO2 and SO2 were linked to the place of residence of each subject. The influence of specific air pollutants on asthma prevalence and severity was evaluated using bivariate logistic regression, controlling for individuals' sociodemographic attributes. For both ambient air pollutants, there was a significant dose-response effect on severity of asthma at ambient concentrations below the current National Ambient Air Quality Standards. However, in residential areas with high levels of SO2 (13.3-592.7µg/m(3)) and high levels of NO2 (27.2-43.2µg/m(3)) the risk of asthma occurrence was significantly higher than that in residential areas with high levels of NO2 (27.2-43.2 µg/m(3)) and intermediate levels (6.7-13.3 µg/m(3)) of SO2 pollution. The effects of exposure to SO2 and NO2 air pollutants on the respiratory airways system appear to differ, with possible implications regarding medical management, even in cases of exposure to mixtures of these pollutants.

Respiratory effects of air pollution on children

A substantial proportion of the global burden of disease is directly or indirectly attributable to exposure to air pollution. Exposures occurring during the periods of organogenesis and rapid lung growth during fetal development and early post-natal life are especially damaging. In this State of the Art review, we discuss air toxicants impacting on children's respiratory health, routes of exposure with an emphasis on unique pathways relevant to young children, methods of exposure assessment and their limitations and the adverse health consequences of exposures. Finally, we point out gaps in knowledge and research needs in this area. A greater understanding of the adverse health consequences of exposure to air pollution in early life is required to encourage policy makers to reduce such exposures and improve human health.

Effects on asthma and respiratory allergy of Climate change and air pollution

The major changes to our world are those involving the atmosphere and the climate, including global warming induced by anthropogenic factors, with impact on the biosphere and human environment. Studies on the effects of climate changes on respiratory allergy are still lacking and current knowledge is provided by epidemiological and experimental studies on the relationship between allergic respiratory diseases, asthma and environmental factors, like meteorological variables, airborne allergens and air pollution. Epidemiologic studies have demonstrated that urbanization, high levels of vehicle emissions and westernized lifestyle are correlated with an increased frequency of respiratory allergy, mainly in people who live in urban areas in comparison with people living in rural areas. However, it is not easy to evaluate the impact of climate changes and air pollution on the prevalence of asthma in general and on the timing of asthma exacerbations, although the global rise in asthma prevalence and severity could be also considered an effect of air pollution and climate changes. Since airborne allergens and air pollutants are frequently increased contemporaneously in the atmosphere, enhanced IgE-mediated response to aeroallergens and enhanced airway inflammation could account for the increasing frequency of respiratory allergy and asthma in atopic subjects in the last five decades. Pollen allergy is frequently used to study the interrelationship between air pollution and respiratory allergic diseases such as rhinitis and bronchial asthma. Climatic factors (temperature, wind speed, humidity, thunderstorms, etc) can affect both components (biological and chemical) of this interaction. Scientific societies should be involved in advocacy activities, such as those realized by the Global Alliance against chronic Respiratory Diseases (GARD).

A modeling framework for characterizing near-road air pollutant concentration at community scales

In this study, we combine information from transportation network, traffic emissions, and dispersion model to develop a framework to inform exposure estimates for traffic-related air pollutants (TRAPs) with a high spatial resolution. A Research LINE source dispersion model (R-LINE) is used to model multiple TRAPs from roadways at Census-block level for two U.S. regions. We used a novel Space/Time Ordinary Kriging (STOK) approach that uses data from monitoring networks to provide urban background concentrations. To reduce the computational burden, we developed and applied the METeorologically-weighted Averaging for Risk and Exposure (METARE) approach with R-LINE, where a set of selected meteorological data and annual average daily traffic (AADT) are used to obtain annual averages. Compared with explicit modeling, using METARE reduces CPU-time by 88-fold (46.8h versus 32min), while still retaining accuracy of exposure estimates. We show two examples in the Piedmont region in North Carolina (~105,000 receptors) and Portland, Maine (~7000 receptors) to characterize near-road air quality. Concentrations for NOx, PM2.5, and benzene in Portland drop by over 40% within 200m away from the roadway. The concentration drop in North Carolina is less than that in Portland, as previously shown in an observation-based study, showing the robustness of our approach. Heavy-duty diesel vehicles (HDDV) contribute over 55% of NOx and PM2.5 near interstate highways, while light-duty gasoline vehicles (LDGV) contribute over 50% of benzene to urban areas where multiple roadways intersect. Normalized mean error (NME) between explicit modeling and METARE in Portland ranges from 12.6 to 14.5% and normalized mean bias (NMB) ranges from -12.9 to -11.2%. When considering a static emission rate (i.e. the emission does not have temporal variability), both NME and NMB improved (10.5% and -9.5%). Modeled concentrations in Detroit, Michigan at an array of near-road monitors are within a factor of 2 of observed values for CO but not NOx.

Air pollution and allergic diseases

PURPOSE OF REVIEW

Exposure to traffic-related air pollutants (TRAPs) has been implicated in asthma development, persistence, and exacerbation. This exposure is highly significant because increasingly large segments of the population worldwide reside in zones that have high levels of TRAP, including children, as schools are often located in high traffic pollution exposure areas.

RECENT FINDINGS

Recent findings include epidemiologic and mechanistic studies that shed new light on the impact of traffic pollution on allergic diseases and the biology underlying this impact. In addition, new innovative methods to assess and quantify traffic pollution have been developed to assess exposure and identify vulnerable populations and individuals.

SUMMARY

This review will summarize the most recent findings in each of these areas. These findings will have a substantial impact on clinical practice and research by the development of novel methods to quantify exposure and identify at-risk individuals, as well as mechanistic studies that identify new targets for intervention for individuals most adversely affected by TRAP exposure.

Prevalence and severity of asthma among Indian school children aged between 6 and 14 years: associations with parental smoking and traffic pollution

OBJECTIVE

Phase three of the International Study of Asthma and Allergy in Children (ISAAC) was carried out at various sites in India. The prevalence of asthma symptoms in school children and the effect of environmental tobacco smoke and traffic pollution on the occurrence of asthma were analysed.

METHODS

Two groups of school children, aged 6-7 yr and 13-14 yr, participated according to the ISAAC protocol. Schools were randomly selected and responses to the ISAAC questionnaire were recorded.

RESULTS

The prevalence of asthma was 5.35% in the 6-7 yr age group and 6.05% in the 13-14 yr age group. The odds ratios (ORs) for the risk of asthma in children with exposure to mild, moderate and heavy traffic pollution compared with minimal traffic pollution were 1.63 (95% CI: 1.43, 1.85), 1.71 (95% CI: 1.49, 1.96) and 1.53 (95% CI: 1.31, 1.78), respectively, in the younger group. Similarly, in the older group, they were 1.19 (95% CI: 1.04, 1.36), 1.51 (95% CI: 1.31, 1.75) and 1.51 (95% CI: 1.29, 1.76). Asthma was associated with maternal smoking [6-7 yr group: OR = 2.72 (2.05, 3.6); 13-14 yr group: OR = 2.14 (1.72, 2.66)] and paternal smoking [6-7 yr group: OR = 1.9 (1.70, 2.11); 13-14 yr group: OR = 1.21 (1.09, 1.34)].

CONCLUSIONS

The prevalence of asthma was lower in the 6-7 than the 13-14 yr age group. Environmental tobacco smoke and traffic pollution were the factors most strongly associated with asthma in Indian children.

[Effects of outdoor pollutants on the respiratory health of children]

The exposure against common air pollutants such as NO2, PM10 and SO2 has decreased in the last decades due to efforts of the EC to reduce emissions of industrial or traffic related origins. However, ozone exposure demonstrates an upward trend. New epidemiologic studies use geographical information systems for a more precise special and temporal categorisation of exposure. They show adverse effects of ultrafine particles as well as elemental carbon on the respiratory system of children. Children growing up next to busy traffic routes are most affected. Adverse effects include respiratory symptoms as well as a delay in lung growth. Intrauterine exposure against PM10 seems to effect lung function in newborns. There is a lack of data about other organic substances widely used in synthetic materials in the outdoor air such as phthalates or bisphenols, some studies show detrimental effects.

Effect of geocoding errors on traffic-related air pollutant exposure and concentration estimates

Exposure to traffic-related air pollutants is highest very near roads, and thus exposure estimates are sensitive to positional errors. This study evaluates positional and PM2.5 concentration errors that result from the use of automated geocoding methods and from linearized approximations of roads in link-based emission inventories. Two automated geocoders (Bing Map and ArcGIS) along with handheld GPS instruments were used to geocode 160 home locations of children enrolled in an air pollution study investigating effects of traffic-related pollutants in Detroit, Michigan. The average and maximum positional errors using the automated geocoders were 35 and 196 m, respectively. Comparing road edge and road centerline, differences in house-to-highway distances averaged 23 m and reached 82 m. These differences were attributable to road curvature, road width and the presence of ramps, factors that should be considered in proximity measures used either directly as an exposure metric or as inputs to dispersion or other models. Effects of positional errors for the 160 homes on PM2.5 concentrations resulting from traffic-related emissions were predicted using a detailed road network and the RLINE dispersion model. Concentration errors averaged only 9%, but maximum errors reached 54% for annual averages and 87% for maximum 24-h averages. Whereas most geocoding errors appear modest in magnitude, 5% to 20% of residences are expected to have positional errors exceeding 100 m. Such errors can substantially alter exposure estimates near roads because of the dramatic spatial gradients of traffic-related pollutant concentrations. To ensure the accuracy of exposure estimates for traffic-related air pollutants, especially near roads, confirmation of geocoordinates is recommended.

Land Use Regression Models of On-Road Particulate Air Pollution (Particle Number, Black Carbon, PM2.5, Particle Size) Using Mobile Monitoring

Land Use Regression (LUR) models typically use fixed-site monitoring; here, we employ mobile monitoring as a cost-effective alternative for LUR development. We use bicycle-based, mobile measurements (∼85 h) during rush-hour in Minneapolis, MN to build LUR models for particulate concentrations (particle number [PN], black carbon [BC], fine particulate matter [PM2.5], particle size). We developed and examined 1224 separate LUR models by varying pollutant, time-of-day, and method of spatial and temporal smoothing of the time-series data. Our base-case LUR models had modest goodness-of-fit (adjusted R(2): ∼0.5 [PN], ∼0.4 [PM2.5], 0.35 [BC], ∼0.25 [particle size]), low bias (<4%) and absolute bias (2-18%), and included predictor variables that captured proximity to and density of emission sources. The spatial density of our measurements resulted in a large model-building data set (n = 1101 concentration estimates); ∼25% of buffer variables were selected at spatial scales of <100m, suggesting that on-road particle concentrations change on small spatial scales. LUR model-R(2) improved as sampling runs were completed, with diminishing benefits after ∼40 h of data collection. Spatial autocorrelation of model residuals indicated that models performed poorly where spatiotemporal resolution of emission sources (i.e., traffic congestion) was poor. Our findings suggest that LUR modeling from mobile measurements is possible, but that more work could usefully inform best practices.

Elements and polycyclic aromatic hydrocarbons in exhaust particles emitted by light-duty vehicles

The main purpose of this work was to evaluate the chemical composition of particulate matter (PM) emitted by eight different light-duty vehicles. Exhaust samples from petrol and diesel cars (Euro 3 to Euro 5) were collected in a chassis dynamometer facility. To simulate the real-world driving conditions, three ARTEMIS cycles were followed: road, to simulate a fluid traffic flow and urban with hot and cold starts, to simulate driving conditions in cities. Samples were analysed for the water-soluble ions, for the elemental composition and for polycyclic aromatic hydrocarbons (PAHs), respectively, by ion chromatography, inductively coupled plasma atomic emission spectroscopy (ICP-AES), inductively coupled plasma mass spectrometry (ICP-MS) and gas chromatography-mass spectrometry (GC-MS). Nitrate and phosphate were the major water-soluble ions in the exhaust particles emitted from diesel and petrol vehicles, respectively. The amount of material emitted is affected by the vehicle age. For vehicles ≥Euro 4, most elements were below the detection limits. Sodium, with emission factors in the ranges 23.5-62.4 and 78.2-227μg km(-1), for petrol and diesel Euro 3 vehicles, respectively, was the major element. The emission factors of metallic elements indicated that diesel vehicles release three to five times more than petrol automobiles. Element emissions under urban cycles are higher than those found for on-road driving, being three or four times higher, for petrol vehicles, and two or three times, for diesel vehicles. The difference between cycles is mainly due to the high emissions for the urban cycle with hot start-up. As registered for elements, most of the PAH emissions for vehicles ≥Euro 4 were also below the detection limits. Regardless of the vehicle models or driving cycles, the two- to four-ring PAHs were always dominant. Naphthalene, with emission factors up to 925 μg km(-1), was always the most abundant PAH. The relative cancer risk associated with naphthalene was estimated to be up to several orders of magnitude higher than any of the chemical species found in the PM phase. The highest PAH emission factors were registered for diesel-powered vehicles. The condition of the vehicle can exert a decisive influence on both element and PAH emissions.

Long-term air pollution exposure and lung function in 15 year-old adolescents living in an urban and rural area in Germany: The GINIplus and LISAplus cohorts

INTRODUCTION

The impact of outdoor air pollution exposure on long-term lung development and potential periods of increased lung susceptibility remain unknown. This study assessed associations between early-life and current residential exposure to air pollution and lung function at 15-years of age in two German birth cohorts.

METHODS

Fifteen year-old participants living in an urban and rural area in Germany underwent spirometry before and after bronchodilation (N=2266). Annual average (long-term) exposure to nitrogen dioxide (NO(2)), particles with aerodynamic diameters less than 2.5 μg/m(3) (PM2.5) mass and less than 10 μg/m(3) (PM(10)) mass, PM(2.5) absorbance and ozone were estimated to each participant's birth-, 10- and 15-year home address using land-use regression and kriging (ozone only) modelling. Associations between lung function variables and long-term pollutant concentrations were assessed using linear regression models adjusted for host and environmental covariates and recent short-term air pollution exposures.

RESULTS

Long-term air pollution concentrations assessed to the birth-, 10- and 15-year home addresses were not associated with lung function variables, before and after bronchodilation, in the complete or study area specific populations. However, several lung function variables were negatively associated with long-term NO2 concentrations among asthmatics. For example, NO(2) estimated to the 15-year home address was associated with the ratio of forced expiratory volume in one second to forced vital capacity (FEV(1)/FVC) and the mean flow rate between 25% and 75% of FVC (-3.5%, 95% confidence interval [-6.0, -1.0] and -297.4 ml/s [-592.6, -2.1] per 5.9 μg/m(3) increase in NO(2), respectively). Nearly all effect estimates for the associations between the short-term PM(2.5) mass, PM(10) mass and ozone concentrations and the lung function variables were negative in the complete population.

CONCLUSIONS

Early-life and current long-term air pollution exposures and lung function at the age of 15 years were not associated in the complete study population. Asthmatics may represent a vulnerable group.

Exposure to traffic and lung function in adults: a general population cohort study

OBJECTIVES

To investigate the association between living near dense traffic and lung function in a cohort of adults from a single urban region.

DESIGN

Cross-sectional results from a cohort study.

SETTING

The adult-onset asthma and exhaled nitric oxide (ADONIX) cohort, sampled during 2001-2008 in Gothenburg, Sweden. Exposure was expressed as the distance from participants' residential address to the nearest road with dense traffic (>10,000 vehicles per day) or very dense traffic (>30,000 vehicles per day). The exposure categories were: low (>500 m; reference), medium (75-500 m) or high (<75 m).

PARTICIPANTS

The source population was a population-based cohort of adults (n=6153). The study population included 5441 participants of European descent with good quality spirometry and information about all outcomes and covariates.

OUTCOME MEASURES

Forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1) were measured at a clinical examination. The association with exposure was examined using linear regression adjusting for age, gender, body mass index, smoking status and education in all participants and stratified by sex, smoking status and respiratory health status.

RESULTS

We identified a significant dose-response trend between exposure category and FEV1 (p=0.03) and borderline significant trend for FVC (p=0.06) after adjusting for covariates. High exposure was associated with lower FEV1 (-1.0%, 95% CI -2.5% to 0.5%) and lower FVC (-0.9%, 95% CI -2.2% to 0.4%). The effect appeared to be stronger in women. In highly exposed individuals with current asthma or chronic obstructive pulmonary disease, FVC was lower (-4.5%, 95% CI -8.8% to -0.1%).

CONCLUSIONS

High traffic exposure at the residential address was associated with lower than predicted FEV1 and FVC lung function compared with living further away in a large general population cohort. There were particular effects on women and individuals with obstructive disease.

Air pollution and adverse cardiac remodeling: clinical effects and basic mechanisms

Exposure to air pollution has long been known to trigger cardiovascular events, primarily through activation of local and systemic inflammatory pathways that affect the vasculature. Detrimental effects of air pollution exposure on heart failure and cardiac remodeling have also been described in human populations. Recent studies in both human subjects and animal models have provided insights into the basic physiological, cellular and molecular mechanisms that play a role in adverse cardiac remodeling. This review will give a brief overview of the relationship between air pollution and cardiovascular disease, describe the clinical effects of air pollution exposure on cardiac remodeling, describe the basic mechanisms that affect remodeling as described in human and animal systems and will discuss future areas of investigation.

Traffic, air pollution, minority and socio-economic status: addressing inequities in exposure and risk

Higher levels of nearby traffic increase exposure to air pollution and adversely affect health outcomes. Populations with lower socio-economic status (SES) are particularly vulnerable to stressors like air pollution. We investigated cumulative exposures and risks from traffic and from MNRiskS-modeled air pollution in multiple source categories across demographic groups. Exposures and risks, especially from on-road sources, were higher than the mean for minorities and low SES populations and lower than the mean for white and high SES populations. Owning multiple vehicles and driving alone were linked to lower household exposures and risks. Those not owning a vehicle and walking or using transit had higher household exposures and risks. These results confirm for our study location that populations on the lower end of the socio-economic spectrum and minorities are disproportionately exposed to traffic and air pollution and at higher risk for adverse health outcomes. A major source of disparities appears to be the transportation infrastructure. Those outside the urban core had lower risks but drove more, while those living nearer the urban core tended to drive less but had higher exposures and risks from on-road sources. We suggest policy considerations for addressing these inequities.

Measuring Particulate Emissions of Light Duty Passenger Vehicles Using Integrated Particle Size Distribution (IPSD)

The California Air Resources Board (ARB) adopted the low emission vehicle (LEV) III particulate matter (PM) standards in January 2012, which require, among other limits, vehicles to meet 1 mg/mi over the federal test procedure (FTP). One possible alternative measurement approach evaluated to support the implementation of the LEV III standards is integrated particle size distribution (IPSD), which reports real-time PM mass using size distribution and effective density. The IPSD method was evaluated using TSI's engine exhaust particle sizer (EEPS, 5.6-560 nm) and gravimetric filter data from more than 250 tests and 34 vehicles at ARB's Haagen-Smit Laboratory (HSL). IPSD mass was persistently lower than gravimetric mass by 56-75% over the FTP tests and by 81-84% over the supplemental FTP (US06) tests. Strong covariance between the methods suggests test-to-test variability originates from actual vehicle emission differences rather than measurement accuracy, where IPSD offered no statistical improvement over gravimetric measurement variability.

Effect of Traffic-Related Air Pollution on Allergic Disease: Results of the Children's Health and Environmental Research

Purpose

This study evaluated the relationship of living near to main roads to allergic diseases, airway hyperresponsiveness (AHR), allergic sensitization, and lung function in Korean children.

Methods

A total of 5,443 children aged 6-14 years from 33 elementary schools in 10 cities during 2005-2006 were included in a baseline survey of the Children's Health and Environmental Research. We assessed association of traffic-related air pollution (TAP) exposure with the distance to the nearest main road, total road length of main roads and the proportion of the main road area within the 200-m home area.

Results

Positive exposure-response relationships were found between the length of the main road within the 200-m home area and lifetime wheeze (adjusted prevalence ratio [PR] for comparison of the longest to the shortest length categories=1.24; 95% CIs, 1.04-1.47; P for trend=0.022) and diagnosed asthma (PR=1.42; 95% CIs, 1.08-1.86; P for trend=0.011). Living less than 75 m from the main road was significantly associated with lifetime allergic rhinitis (AR), past-year AR symptoms, diagnosed AR, and treated AR. The distance to the main road (P for trend=0.001), the length of the main road (P for trend=0.041), and the proportion of the main road area (P for trend=0.006) had an exposure-response relationship with allergic sensitization. A strong inverse association was observed between residential proximity to the main load and lung function, especially FEV1, FEV1/FVC, and FEF_25-75. The length of the main road and the proportion of the main road area were associated with reduced FEV1 in schoolchildren.

Conclusions

The results of this study suggest that exposure to traffic-related air pollution may be associated with increased risk of asthma, AR, and allergic sensitization, and with reduced lung function in schoolchildren.

Proximity to blue spaces and risk of infection with Pseudomonas aeruginosa in cystic fibrosis: A case-control analysis

BACKGROUND

The acquisition of Pseudomonas aeruginosa in cystic fibrosis (CF) is associated with lower survival, decreased lung function, worse radiological scores, increased exacerbations and reduced nutritional status. Open water is a known reservoir and a potential source of exposure to P. aeruginosa.

METHODS

Twenty eight adult CF patients who had no history of P. aeruginosa and had negative P. aeruginosa IgG antibody levels, were matched by age and sex with 28 CF patients with chronic P. aeruginosa colonization. Straight line and closest walking distance from patient's residence to the nearest "blue space", i.e. surface water as determined by Google Earth, were compared between the two groups, and odds ratios (OR) were estimated using conditional logistic regression.

RESULTS

Patients who were never infected with P. aeruginosa lived significantly further away from a natural water source than P. aeruginosa colonized patients, both when considering shortest walking distance (mean 487 m vs 308 m, p=0.014) and beeline (mean 324 m vs 202 m, p=0.021). Conditional logistic regression (correcting for FEV1%) revealed ORs for chronic P. aeruginosa colonization of 0.35 (95% CI 0.13-0.98; p=0.045) and 0.12 (95% CI 0.02-0.81; p=0.028) for each doubling in the beeline or walking distance, respectively, between residence and open water.

CONCLUSION

We discovered that adult CF patients without P. aeruginosa infection live significantly further from blue space than CF patients with chronic P. aeruginosa colonization. Within the limitations of a case-control study, this may indicate that natural open water represents a source of infection by P. aeruginosa in CF.

REGISTRATION

The study was approved by the local ethical committee of the UZ Leuven, Belgium (ML-5028).

Ambient polycyclic aromatic hydrocarbons and pulmonary function in children

Few studies have examined the relationship between ambient polycyclic aromatic hydrocarbons (PAHs) and pulmonary function in children. Major sources include vehicular emissions, home heating, wildland fires, agricultural burning, and power plants. PAHs are an important component of fine particulate matter that has been linked to respiratory health. This cross-sectional study examines the relationship between estimated individual exposures to the sum of PAHs with 4, 5, or 6 rings (PAH456) and pulmonary function tests (forced expiratory volume in one second (FEV1) and forced expiratory flow between 25% and 75% of vital capacity) in asthmatic and non-asthmatic children. We applied land-use regression to estimate individual exposures to ambient PAHs for averaging periods ranging from 1 week to 1 year. We used linear regression to estimate the relationship between exposure to PAH456 with pre- and postbronchodilator pulmonary function tests in children in Fresno, California (N=297). Among non-asthmatics, there was a statistically significant association between PAH456 during the previous 3 months, 6 months, and 1 year and postbronchodilator FEV1. The magnitude of the association increased with the length of the averaging period ranging from 60 to 110 ml decrease in FEV1 for each 1 ng/m(3) increase in PAH456. There were no associations with PAH456 observed among asthmatic children. We identified an association between annual PAHs and chronic pulmonary function in children without asthma. Additional studies are needed to further explore the association between exposure to PAHs and pulmonary function, especially with regard to differential effects between asthmatic and non-asthmatic children.

A longitudinal cohort study of body mass index and childhood exposure to secondhand tobacco smoke and air pollution: the Southern California Children's Health Study

BACKGROUND

Childhood body mass index (BMI) and obesity prevalence have been associated with exposure to secondhand smoke (SHS), maternal smoking during pregnancy, and vehicular air pollution. There has been little previous study of joint BMI effects of air pollution and tobacco smoke exposure.

METHODS

Information on exposure to SHS and maternal smoking during pregnancy was collected on 3,318 participants at enrollment into the Southern California Children's Health Study. At study entry at average age of 10 years, residential near-roadway pollution exposure (NRP) was estimated based on a line source dispersion model accounting for traffic volume, proximity, and meteorology. Lifetime exposure to tobacco smoke was assessed by parent questionnaire. Associations with subsequent BMI growth trajectory based on annual measurements and attained BMI at 18 years of age were assessed using a multilevel modeling strategy.

RESULTS

Maternal smoking during pregnancy was associated with estimated BMI growth over 8-year follow-up (0.72 kg/m2 higher; 95% CI: 0.14, 1.31) and attained BMI (1.14 kg/m2 higher; 95% CI: 0.66, 1.62). SHS exposure before enrollment was positively associated with BMI growth (0.81 kg/m2 higher; 95% CI: 0.36, 1.27) and attained BMI (1.23 kg/m2 higher; 95% CI: 0.86, 1.61). Growth and attained BMI increased with more smokers in the home. Compared with children without a history of SHS and NRP below the median, attained BMI was 0.80 kg/m2 higher (95% CI: 0.27, 1.32) with exposure to high NRP without SHS; 0.85 kg/m2 higher (95% CI: 0.43, 1.28) with low NRP and a history of SHS; and 2.15 kg/m2 higher (95% CI: 1.52, 2.77) with high NRP and a history of SHS (interaction p-value 0.007). These results suggest a synergistic effect.

CONCLUSIONS

Our findings strengthen emerging evidence that exposure to tobacco smoke and NRP contribute to development of childhood obesity and suggest that combined exposures may have synergistic effects.

High resolution spatial and temporal mapping of traffic-related air pollutants

Vehicle traffic is one of the most significant emission sources of air pollutants in urban areas. While the influence of mobile source emissions is felt throughout an urban area, concentrations from mobile emissions can be highest near major roadways. At present, information regarding the spatial and temporal patterns and the share of pollution attributable to traffic-related air pollutants is limited, in part due to concentrations that fall sharply with distance from roadways, as well as the few monitoring sites available in cities. This study uses a newly developed dispersion model (RLINE) and a spatially and temporally resolved emissions inventory to predict hourly PM_2.5 and NO_x concentrations across Detroit (MI, USA) at very high spatial resolution. Results for annual averages and high pollution days show contrasting patterns, the need for spatially resolved analyses, and the limitations of surrogate metrics like proximity or distance to roads. Data requirements, computational and modeling issues are discussed. High resolution pollutant data enable the identification of pollutant “hotspots”, “project-level” analyses of transportation options, development of exposure measures for epidemiology studies, delineation of vulnerable and susceptible populations, policy analyses examining risks and benefits of mitigation options, and the development of sustainability indicators integrating environmental, social, economic and health information.

Association of improved air quality with lung development in children

BACKGROUND

Air-pollution levels have been trending downward progressively over the past several decades in southern California, as a result of the implementation of air quality-control policies. We assessed whether long-term reductions in pollution were associated with improvements in respiratory health among children.

METHODS

As part of the Children's Health Study, we measured lung function annually in 2120 children from three separate cohorts corresponding to three separate calendar periods: 1994-1998, 1997-2001, and 2007-2011. Mean ages of the children within each cohort were 11 years at the beginning of the period and 15 years at the end. Linear-regression models were used to examine the relationship between declining pollution levels over time and lung-function development from 11 to 15 years of age, measured as the increases in forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC) during that period (referred to as 4-year growth in FEV1 and FVC).

RESULTS

Over the 13 years spanned by the three cohorts, improvements in 4-year growth of both FEV1 and FVC were associated with declining levels of nitrogen dioxide (P<0.001 for FEV1 and FVC) and of particulate matter with an aerodynamic diameter of less than 2.5 μm (P= 0.008 for FEV1 and P<0.001 for FVC) and less than 10 μm (P<0.001 for FEV1 and FVC). These associations persisted after adjustment for several potential confounders. Significant improvements in lung-function development were observed in both boys and girls and in children with asthma and children without asthma. The proportions of children with clinically low FEV1 (defined as <80% of the predicted value) at 15 years of age declined significantly, from 7.9% to 6.3% to 3.6% across the three periods, as the air quality improved (P = 0.001).

CONCLUSIONS

We found that long-term improvements in air quality were associated with statistically and clinically significant positive effects on lung-function growth in children. (Funded by the Health Effects Institute and others.).

Chronic effects of air pollution on respiratory health in Southern California children: findings from the Southern California Children's Health Study

Outdoor air pollution is one of the leading contributors to adverse respiratory health outcomes in urban areas around the world. Children are highly sensitive to the adverse effects of air pollution due to their rapidly growing lungs, incomplete immune and metabolic functions, patterns of ventilation and high levels of outdoor activity. The Children's Health Study (CHS) is a continuing series of longitudinal studies that first began in 1993 and has focused on demonstrating the chronic impacts of air pollution on respiratory illnesses from early childhood through adolescence. A large body of evidence from the CHS has documented that exposures to both regional ambient air and traffic-related pollutants are associated with increased asthma prevalence, new-onset asthma, risk of bronchitis and wheezing, deficits of lung function growth, and airway inflammation. These associations may be modulated by key genes involved in oxidative-nitrosative stress pathways via gene-environment interactions. Despite successful efforts to reduce pollution over the past 40 years, air pollution at the current levels still brings many challenges to public health. To further ameliorate adverse health effects attributable to air pollution, many more toxic pollutants may require regulation and control of motor vehicle emissions and other combustion sources may need to be strengthened. Individual interventions based on personal susceptibility may be needed to protect children's health while control measures are being implemented.

Relationship between exposure to fine particulates and ozone and reduced lung function in children

BACKGROUND

A limited number of studies have reported an association between long-term exposure to ambient air pollutants and lung function growth among children, with inconclusive results.

OBJECTIVES

To assess the relationship between air pollutant exposure and lung function growth, and to examine potential sex differences in the susceptibility of lung function growth to air pollution.

METHODS

We conducted a two-year prospective cohort study of Taiwanese children aged 12 at baseline who were followed from October 1, 2007 to November 31, 2009. The study population comprised 2941 non-smoking children who completed pulmonary function tests at both baseline and follow-up surveys. We applied spatial modeling for individual-level exposure assessment to capture relevant exposures and also attempted to eliminate potential community-level confounding. The exposure parameters were annual averages and values calculated from 24-hourly PM2.5 and 8-hourly ozone (O3) concentrations, corresponding to the residential addresses over the study period. The effect estimates were presented as lung function growth deficits per interquartile range (IQR) for PM2.5 and O3.

RESULTS

In a multiple linear mixed effect model, adjusted for confounding, growth deficits in the forced vital capacity (FVC), forced expiration volume in 1s (FEV1), and forced expiratory flow between the 25th and 75th percentiles of the FVC were associated with increased exposure to PM2.5 and O3. For example, greater exposure to PM2.5 (IQR, 17.92μg/m(3)) was associated with an annual deficit in FVC growth of 75mL in boys and 61mL in girls (p for interaction <0.05). Similar associations were found for O3.

CONCLUSIONS

The study provides evidence that long-term exposure to PM2.5 and O3 may have a detrimental effect on the development of lung function in children. The estimated deficits were generally larger in boys, compared to girls.

Carbon loading in airway macrophages as a biomarker for individual exposure to particulate matter air pollution - A critical review

Exposure to particulate matter (PM) is associated with adverse health effects, including chronic lung diseases, lung cancer and cardiovascular disease. Personal exposure varies depending on the generation of particles locally, background levels, activity patterns and meteorology. Carbon loading in airway macrophages (AM) is a novel marker to assess personal exposure to combustion-derived particles. This review summarizes the published evidence and describes the validity and reliability of this marker with a focus on the technical aspects. Carbon loading in AM is reported in nine published studies assessing personal exposure to particulate air pollution. The carbon content is quantified by image analysis and is suggested to be suited to assess cumulative exposures. While there is some variation in study technique, these studies each indicate that internal AM carbon reflects either external exposure or important health effects. However, some uncertainty remains regarding potentially confounding materials within particles, the time frame of exposures that this technique reflects, and the optimal strategy to accurately quantify AM carbon. These aspects need to be clarified or optimized before applying this technique in larger populations.

Air pollution and the development of posttransplant chronic lung allograft dysfunction

Chronic lung allograft dysfunction (CLAD) is the leading cause of mortality following lung transplantation. We conducted a retrospective cohort study including 397 bilateral lung recipients transplanted in from 1996 to 2009 to determine the association between ambient air pollution, CLAD and mortality. Pollution exposure was assessed using satellite-based estimates of nitrogen dioxide, distance to major roadway and total length of roadways around a patient's home. Cumulative exposures to ozone and particulate matter were estimated from concentrations measured at fixed-site stations near patients' homes using inverse distance weighted interpolation. Cox proportional hazards models were used to estimate the associations of CLAD with air pollution exposure, adjusting for various individual and neighborhood characteristics. During the follow-up, 185 patients developed CLAD (47%) and 101 patients died (25%). Fifty-four deaths (53%) were due to CLAD. We observed an association between CLAD development and road density within 200 m of a patient's home (HR 1.30 [95% CI 1.07-1.58]). Although based on a subgroup of 14 patients, living within 100 m of a highway was associated with a high risk for developing CLAD (HR 4.91 [95% CI 2.22, 10.87]). These data suggest that exposure to traffic-related air pollution is associated with development of CLAD among lung transplant recipients.

Assessment of the effect of population and diary sampling methods on estimation of school-age children exposure to fine particles

Population and diary sampling methods are employed in exposure models to sample simulated individuals and their daily activity on each simulation day. Different sampling methods may lead to variations in estimated human exposure. In this study, two population sampling methods (stratified-random and random-random) and three diary sampling methods (random resampling, diversity and autocorrelation, and Markov-chain cluster [MCC]) are evaluated. Their impacts on estimated children's exposure to ambient fine particulate matter (PM2.5 ) are quantified via case studies for children in Wake County, NC for July 2002. The estimated mean daily average exposure is 12.9 μg/m(3) for simulated children using the stratified population sampling method, and 12.2 μg/m(3) using the random sampling method. These minor differences are caused by the random sampling among ages within census tracts. Among the three diary sampling methods, there are differences in the estimated number of individuals with multiple days of exposures exceeding a benchmark of concern of 25 μg/m(3) due to differences in how multiday longitudinal diaries are estimated. The MCC method is relatively more conservative. In case studies evaluated here, the MCC method led to 10% higher estimation of the number of individuals with repeated exposures exceeding the benchmark. The comparisons help to identify and contrast the capabilities of each method and to offer insight regarding implications of method choice. Exposure simulation results are robust to the two population sampling methods evaluated, and are sensitive to the choice of method for simulating longitudinal diaries, particularly when analyzing results for specific microenvironments or for exposures exceeding a benchmark of concern.

Effects of particulate air pollution on nasal and lung function development among Greek children: a 19-year cohort study

The aim was to investigate respiratory symptoms, lung function and nasal airflow development among a cohort of children who were exposed to particulate air pollution. We used questionnaires, spirometry and rhinomanometry, while central-monitored PM10 concentrations were used for exposure assessment. We initially examined 1046 children (10-12 year old) in the heavily polluted town of Ptolemaida, Greece, and 379 children in the cleaner town of Grevena (control group). We re-evaluated 312 of the former and 119 of the latter after 19 years. PM10 concentrations were above permissible levels in Ptolemaida during all study period. At both visits, nasal flow was significantly lower in the study sample. At the follow-up visit, 34.3% had severe nasal obstruction (< 500 ml/s) and 38.5% reported chronic nasal symptoms. Spirometric parameters did not differ compared to the control group. Particulate air pollution had significant and negative effects on nasal but not on lung function development.

Biological dose response to PM2.5: effect of particle extraction method on platelet and lung responses

Particulate matter (PM) exposure contributes to respiratory diseases and cardiopulmonary mortality. PM toxicity is related to sources and composition, such as abundance of polycyclic aromatic hydrocarbons (PAHs). We exposed adult male BALB/c mice, via oropharyngeal aspiration, to a range of doses of PM2.5 collected during the winter in downtown Sacramento near a major freeway interchange (SacPM). Two preparation methods (spin-down and multi-solvent extraction) were tested to remove particles from collection filters. Three doses were analyzed 24 h after treatment for (1) leukocytes and total protein in bronchoalveolar lavage fluid (BALF), (2) airway-specific and whole lobe expression of PAH-sensitive genes (CYP1B1 and CYP1A1) and IL-1 b, (3) lung histology, and (4) platelet function. Both extraction methods stimulated biological responses, but the spin-down method was more robust at producing IL-1 b and CYP1B1 gene responses and the multi-solvent extraction induced whole lung CYP1A1. Neutrophils in the BALF were increased 5- to 10-fold at the mid and high dose for both preparations. Histopathology scores indicated dose-dependent responses and increased pathology associated with spin-down-derived PM exposure. In microdissected airways, spin-down PM increased CYP1B1 gene expression significantly, but multi-solvent extracted PM did not. Platelet responses to the physiological agonist thrombin were approximately twice as potent in the spin-down preparation as in the multi-solvent extract. We conclude (1) the method of filter extraction can influence the degree of biological response, (2) for SacPM the minimal effective dose is 27.5-50 µg based on neutrophil recruitment, and (3) P450s are upregulated differently in airways and lung parenchyma in response to PAH-containing PM.

Correlation of noise levels and particulate matter concentrations near two major freeways in Los Angeles, California

Near-freeway environments are important from public health and environmental justice perspectives. This study investigated the spatial profile of and correlations between noise levels and particulate matter concentrations near two major freeways in Los Angeles, CA. Five minutes averages of A-weighted equivalent continuous sound level (LeqA), ultrafine particle (UFP) number concentrations, and fine particle (PM2.5) mass concentrations were measured concurrently at increasing distances from the freeways on four streets with or without sound wall. Under upwind conditions, UFP showed relatively low concentrations and no obvious gradient, while LeqA showed decay with increasing distance as it did under downwind conditions. Moderate correlations between LeqA and UFP were observed under downwind conditions on all four streets. The presence of a sound wall changed the linear relationship between LeqA and UFP. These data may be used to study the independent and synergistic health impacts of noise and air pollutants near roadways.

Distinguishing adult-onset asthma from COPD: a review and a new approach

Adult-onset asthma and chronic obstructive pulmonary disease (COPD) are major public health burdens. This review presents a comprehensive synopsis of their epidemiology, pathophysiology, and clinical presentations; describes how they can be distinguished; and considers both established and proposed new approaches to their management. Both adult-onset asthma and COPD are complex diseases arising from gene-environment interactions. Early life exposures such as childhood infections, smoke, obesity, and allergy influence adult-onset asthma. While the established environmental risk factors for COPD are adult tobacco and biomass smoke, there is emerging evidence that some childhood exposures such as maternal smoking and infections may cause COPD. Asthma has been characterized predominantly by Type 2 helper T cell (Th2) cytokine-mediated eosinophilic airway inflammation associated with airway hyperresponsiveness. In established COPD, the inflammatory cell infiltrate in small airways comprises predominantly neutrophils and cytotoxic T cells (CD8 positive lymphocytes). Parenchymal destruction (emphysema) in COPD is associated with loss of lung tissue elasticity, and small airways collapse during exhalation. The precise definition of chronic airflow limitation is affected by age; a fixed cut-off of forced expiratory volume in 1 second/forced vital capacity leads to overdiagnosis of COPD in the elderly. Traditional approaches to distinguishing between asthma and COPD have highlighted age of onset, variability of symptoms, reversibility of airflow limitation, and atopy. Each of these is associated with error due to overlap and convergence of clinical characteristics. The management of chronic stable asthma and COPD is similarly convergent. New approaches to the management of obstructive airway diseases in adults have been proposed based on inflammometry and also multidimensional assessment, which focuses on the four domains of the airways, comorbidity, self-management, and risk factors. Short-acting beta-agonists provide effective symptom relief in airway diseases. Inhalers combining a long-acting beta-agonist and corticosteroid are now widely used for both asthma and COPD. Written action plans are a cornerstone of asthma management although evidence for self-management in COPD is less compelling. The current management of chronic asthma in adults is based on achieving and maintaining control through step-up and step-down approaches, but further trials of back-titration in COPD are required before a similar approach can be endorsed. Long-acting inhaled anticholinergic medications are particularly useful in COPD. Other distinctive features of management include pulmonary rehabilitation, home oxygen, and end of life care.

Changes in air quality at near-roadway schools after a major freeway expansion in Las Vegas, Nevada

Near-roadway ambient black carbon (BC) and carbon monoxide (CO) concentrations were measured at two schools adjacent to a freeway and at an urban background school 2 km from the freeway to determine the change in concentrations attributable to vehicle emissions after the three-lane expansion of U.S. Highway 95 (US 95) in Las Vegas, Nevada. Between summer 2007 and summer 2008, average weekday small-vehicle volume increased by 40% +/- 2% (standard error). Average weekday large-vehicle volume decreased by 17% +/- 5%, due to a downturn in the economy and an associated decline in goods movement. Average vehicle speed increased from 58 to 69 mph, a 16% +/- 1% increase. The authors compared BC and CO concentrations in summer 2007 with those in summer 2008 to understand what effect the expansion of the freeway may have had on ambient concentrations: BC and CO were measured 17 m north of the freeway sound wall, CO was measured 20 m south of the sound wall, and BC was measured at an urban background site 2 km south of the freeway. Between summer 2007 and summer 2008, median BC decreased at the near-road site by 40% +/- 2% and also decreased at the urban background site by 24% +/- 4%, suggesting that much of the change was due to decreases in emissions throughout Las Vegas, rather than only on US 95. CO concentrations decreased by 14% +/- 2% and 10% +/- 3% at the two near-road sites. The decrease in BC concentrations after the expansion is likely due to the decrease in medium- and heavy-duty-vehicle traffic resulting from the economic recession. The decrease in CO concentrations may be a result of improved traffic flow, despite the increase in light-duty-vehicle traffic. Implications: Monitoring of BC and CO at near-road locations in Las Vegas demonstrated the impacts of changes in traffic volume and vehicle speed on near-road concentrations. However, urban-scale declines in concentrations were larger than near-road changes due to the impacts of the economic recession that occurred contemporaneously with the freeway expansion.

Asthma morbidity and ambient air pollution: effect modification by residential traffic-related air pollution

BACKGROUND

Ambient air pollution has been associated with asthma-related hospital admissions and emergency department visits (hospital encounters). We hypothesized that higher individual exposure to residential traffic-related air pollutants would enhance these associations.

METHODS

We studied 11,390 asthma-related hospital encounters among 7492 subjects 0-18 years of age living in Orange County, California. Ambient exposures were measured at regional air monitoring stations. Seasonal average traffic-related exposures (PM2.5, ultrafine particles, NOx, and CO) were estimated near subjects' geocoded residences for 6-month warm and cool seasonal periods, using dispersion models based on local traffic within 500 m radii. Associations were tested in case-crossover conditional logistic regression models adjusted for temperature and humidity. We assessed effect modification by seasonal residential traffic-related air pollution exposures above and below median dispersion-modeled exposures. Secondary analyses considered effect modification by traffic exposures within race/ethnicity and insurance group strata.

RESULTS

Asthma morbidity was positively associated with daily ambient O3 and PM2.5 in warm seasons and with CO, NOx, and PM2.5 in cool seasons. Associations with CO, NOx, and PM2.5 were stronger among subjects living at residences with above-median traffic-related exposures, especially in cool seasons. Secondary analyses showed no consistent differences in association, and 95% confidence intervals were wide, indicating a lack of precision for estimating these highly stratified associations.

CONCLUSIONS

Associations of asthma with ambient air pollution were enhanced among subjects living in homes with high traffic-related air pollution. This may be because of increased susceptibility (greater asthma severity) or increased vulnerability (meteorologic amplification of local vs. correlated ambient exposures).

Serum levels of club cell secretory protein (Clara) and short- and long-term exposure to particulate air pollution in adolescents

BACKGROUND

Studies in populations have shown that particulate air pollution is associated with changes in lung function in adolescents.

OBJECTIVE

We investigated the effect of short- and long-term exposure to particulate matter (PM10) on the pulmonary health of adolescents, using serum lung club cell secretory protein (Clara) (CC16) as a biomarker for respiratory epithelium integrity.

METHODS

We measured serum CC16 in 825 adolescents (57% girls, mean age: 15 years). Short-term and long-term exposure to ambient PM10 was estimated for each participant's home address using a kriging interpolation method. To explore the association between PM10 and serum CC16 we applied restricted cubic splines with 5 knots located at the 5th, 25th, 50th, 75th and 95th percentiles of the PM10 distribution. The explorative analyses showed a change in the slope of this association, after which a change-point analysis was performed.

RESULTS

After adjustment for potential covariates, the analysis showed strong associations between PM10 concentrations, averaged over the week preceding the clinical examination, and serum CC16 levels. Each 5 μg/m(3) increase in mean PM10 concentration in the week before the clinical examination was associated with a substantial increase of 0.52 μg/l (95% confidence interval: 0.31 to 0.73; p<0.0001) in serum CC16 levels. The association appears nonlinear with a flattening out of the slope at mean week PM10 levels above 37 μg/m(3). There was no evidence of an association between long-term exposure to PM10 and serum CC16 concentrations.

CONCLUSIONS

Our findings suggest that short-term exposure to particulate air pollution may compromise the integrity of the lung epithelium and lead to increased epithelial barrier permeability in the lungs of adolescents, even at low concentrations.

Les résidences pour personnes âgées de l’île de Montréal appartenant aux parcs social et privé : une exposition inéquitable à la pollution de l’air ?

La qualité des milieux à proximité des résidences pour personnes âgées sur l’île de Montréal, tant celles du parc privé que du parc social, est analysée sous l’angle de la pollution générée par la circulation automobile. Deux types d’indicateurs de polluants sont utilisés pour évaluer la pollution. Les premiers sont basés sur la proximité des axes majeurs de circulation et les seconds estiment, dans un rayon de 200 m, la concentration de NO2. Nos résultats montrent que les résidences privées et celles du parc social se localisent plus souvent à proximité d’axes majeurs de circulation que les résidences de l’ensemble de la population et de la population âgée. Les résidences privées se caractérisent toutefois par des concentrations moindres de NO2 comparativement à ces deux mêmes populations, alors qu’on observe l’inverse pour les résidences du parc social. Ceci s’explique notamment par leur distribution respective au sein du territoire urbanisé.

Quantifying traffic exposure

Living near traffic adversely affects health outcomes. Traffic exposure metrics include distance to high-traffic roads, traffic volume on nearby roads, traffic within buffer distances, measured pollutant concentrations, land-use regression estimates of pollution concentrations, and others. We used Geographic Information System software to explore a new approach using traffic count data and a kernel density calculation to generate a traffic density surface with a resolution of 50 m. The density value in each cell reflects all the traffic on all the roads within the distance specified in the kernel density algorithm. The effect of a given roadway on the raster cell value depends on the amount of traffic on the road segment, its distance from the raster cell, and the form of the algorithm. We used a Gaussian algorithm in which traffic influence became insignificant beyond 300 m. This metric integrates the deleterious effects of traffic rather than focusing on one pollutant. The density surface can be used to impute exposure at any point, and it can be used to quantify integrated exposure along a global positioning system route. The traffic density calculation compares favorably with other metrics for assessing traffic exposure and can be used in a variety of applications.

Proximity of US schools to major roadways: a nationwide assessment

Long-term exposure to traffic pollution has been associated with adverse health outcomes in children and adolescents. A significant number of schools may be located near major roadways, potentially exposing millions of children to high levels of traffic pollution, but this hypothesis has not been evaluated nationally. We obtained data on the location and characteristics of 114,644 US public and private schools, grades prekindergarten through 12, and calculated their distance to the nearest major roadway. In 2005-2006, 3.2 million students (6.2%) attended 8,424 schools (7.3%) located within 100 m of a major roadway, and an additional 3.2 million (6.3%) students attended 8,555 (7.5%) schools located 100-250 m from a major roadway. Schools serving predominantly Black students were 18% (95% CI, 13-23%) more likely to be located within 250 m of a major roadway. Public schools eligible for Title I programs and those with a majority of students eligible for free/reduced price meals were also more likely to be near major roadways. In conclusion, 6.4 million US children attended schools within 250 m of a major roadway and were likely exposed to high levels of traffic pollution. Minority and underprivileged children were disproportionately affected, although some results varied regionally.

Urban particulate matter induces pro-remodeling factors by airway epithelial cells from healthy and asthmatic children

CONTEXT

Chronic exposure to ambient particulate matter pollution during childhood is associated with decreased lung function growth and increased prevalence of reported respiratory symptoms. The role of airway epithelium-derived factors has not been well determined.

OBJECTIVE

To determine if urban particulate matter (UPM) stimulates production of vascular endothelial growth factor (VEGF) and transforming growth factor-β2 (TGF-β2), and gene expression of mucin 5AC (MUC5AC) and interleukin-(IL)-8 by primary airway epithelial cells (AECs) obtained from carefully phenotyped healthy and atopic asthmatic school-aged children.

METHODS

Primary AECs from 9 healthy and 14 asthmatic children were differentiated in air--liquid interface (ALI) culture. The apical surface was exposed to UPM suspension or phosphate buffered saline (PBS) vehicle control for 96 h. VEGF and TGF-β2 concentrations in cell media at baseline, 48 and 96 h were measured via ELISA. MUC5AC and IL-8 expression by AECs at 96 h was measured via quantitative polymerase chain reaction.

RESULTS

Baseline concentrations of VEGF, but not TGF-β2, were significantly higher in asthmatic versus healthy cultures. UPM stimulated production of VEGF, but not TGF-β2, at 48 and 96 h; the magnitude of change was comparable across groups. At 96 h there was greater MUC5AC and IL-8 expression by UPM exposed compared to PBS exposed AECs.

CONCLUSIONS

Induction of the pro-remodeling cytokine VEGF may be a potential mechanism by which UPM influences lung function growth in children irrespective of asthma status. Respiratory morbidity associated with UPM exposure in children may be related to increased expression of MUC5AC and IL-8.