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Tullis B, Mace JC, Hagedorn R, Nguyen C, Stockard R, Massey C, Ramakrishnan VR, Beswick DM, Soler ZM, Smith TL, Alt JA, Gill AS. The Impact of Acute Peri-operative Particulate Matter Exposure on Endoscopic Sinus Surgery Outcomes: A Preliminary Multi-site Investigation. Am J Rhinol Allergy 2024; 38:237-244. [PMID: 38623645 DOI: 10.1177/19458924241246371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/17/2024]
Abstract
BACKGROUND Environmental exposures have been postulated to play an important role in the pathophysiology of chronic rhinosinusitis (CRS). Particulate matter (PM) is one of the most widely studied ambient air pollutants, but its peri-operative impact on CRS is unknown. OBJECTIVE To determine the effect of acute, peri-operative PM exposure on outcomes after endoscopic sinus surgery (ESS). METHODS Participants with CRS who self-selected ESS were prospectively enrolled. The 22-item SinoNasal Outcome Test (SNOT-22) and Medical Outcomes Study Questionnaire Short-Form 6-D (SF-6D) health utility values scores were recorded. Using residence zip codes, a secondary analysis of patient exposure to PM <2.5 μm and <10 μm (PM2.5 and PM10, respectively) was performed for the month of surgery utilizing data from Environmental Protection Agency air quality monitors. Spearman's correlation coefficients (ρ), 95% confidence intervals (CIs), and effect estimates (β) were used to determine the magnitudes of association. Simple, multivariate regression analysis was also completed. RESULTS One hundred and seven patients from four geographically unique institutions across the US were enrolled with a follow-up of 6 months. Patients with higher peri-operative PM2.5 exposure had less improvement in their SNOT-22 scores after ESS compared to those with less exposure using both univariate analysis (ρ = 0.26, 95% CI: 0.08, 0.43; P = .01) and after covariate adjustment with multivariate analysis (B = 1.06, 95% CI: 0.001, 2.14, P = .05). Similar associations were not found with SF-6D outcomes or with PM10 as an exposure of interest. No significant correlations were found between peri-operative PM levels and Lund-Kennedy endoscopy scores post-operatively. CONCLUSION Preliminary data from this pilot study reveal that PM exposure at the time of ESS may negatively associate with post-operative improvement in sinonasal quality-of-life. Larger, population-based studies with more standardized PM exposure windows are needed to confirm the clinical significance of the present findings.
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Affiliation(s)
- Benton Tullis
- Department of Otolaryngology - Head and Neck Surgery, University of Utah, Salt Lake City, Utah, USA
| | - Jess C Mace
- Division of Rhinology and Sinus Surgery/Oregon Sinus Center, Department of Otolaryngology - Head and Neck Surgery, Oregon Health & Science University (OHSU), Portland, OR, USA
| | - Robert Hagedorn
- Department of Otolaryngology - Head and Neck Surgery, University of Utah, Salt Lake City, Utah, USA
| | - Cassidy Nguyen
- Department of Otolaryngology - Head and Neck Surgery, University of Utah, Salt Lake City, Utah, USA
| | - Ryan Stockard
- Department of Otolaryngology - Head and Neck Surgery, University of Utah, Salt Lake City, Utah, USA
| | - Conner Massey
- Department of Otolaryngology - Head and Neck Surgery, University of Utah, Salt Lake City, Utah, USA
| | - Vijay R Ramakrishnan
- Department of Otolaryngology - Head and Neck Surgery, University of Indiana, Indianapolis, IN, USA
| | - Daniel M Beswick
- Department of Otolaryngology - Head and Neck Surgery, University of California, Los Angeles, CA, USA
| | - Zachary M Soler
- Department of Otolaryngology -Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Timothy L Smith
- Division of Rhinology and Sinus Surgery/Oregon Sinus Center, Department of Otolaryngology - Head and Neck Surgery, Oregon Health & Science University (OHSU), Portland, OR, USA
| | - Jeremiah A Alt
- Department of Otolaryngology - Head and Neck Surgery, University of Utah, Salt Lake City, Utah, USA
| | - Amarbir S Gill
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan, Ann Arbor, MI, USA
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Hagedorn R, Tullis B, Nguyen C, Stockard R, Mace JC, Ramakrishnan VR, Beswick DM, Soler ZM, Smith TL, Alt JA, Gill AS. Does air pollutant exposure impact disease severity or outcomes in chronic rhinosinusitis? Int Forum Allergy Rhinol 2024; 14:755-764. [PMID: 37555485 DOI: 10.1002/alr.23250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 07/26/2023] [Accepted: 08/04/2023] [Indexed: 08/10/2023]
Abstract
BACKGROUND Poor air quality increases the risk of developing chronic rhinosinusitis (CRS) and other airway diseases. However, there are limited data on air pollutants and CRS-specific disease severity. We assessed the impact of air pollutants on sinonasal-specific and general quality-of-life (QOL) measures in a multi-institutional cohort of patients with CRS. METHODS Participants with CRS were prospectively enrolled in a cross-sectional study and self-selected continued appropriate medical therapy or endoscopic sinus surgery (ESS). The 22-item SinoNasal Outcome Test (SNOT-22) and Medical Outcomes Study Questionnaire Short-Form 6-D (SF-6D) health utility value scores were recorded. Patient exposure to air pollutants was determined using residence zip codes. Unadjusted group differences were compared, and correlation coefficients were evaluated to identify the magnitude of bivariate association. RESULTS A total of 486 patients were enrolled and followed for a mean of 6.9 (standard deviation [SD] ± 2.3) months. Pollutant exposure did not significantly correlate with baseline SNOT-22 or SF-6D scores. Revision ESS was associated with higher median fine particulate matter (PM2.5; Δ = 0.12, [95% confidence interval {CI}: 0.003, 0.234]; p = 0.006) compared with primary surgery. PM2.5, PM10, and nitrogen dioxide concentrations (μg/m3) did not correlate with change in total SNOT-22 or SF-6D scores after treatment. Nevertheless, sulfur dioxide (SNOT-22: ρ = -0.121 [95% CI: -0.210, -0.030]; p = 0.007; SF-6D: ρ = 0.095 [95% CI: 0.002, 0.186]; p = 0.04) and carbon monoxide (SNOT-22: ρ = -0.141 [95% CI: -0.230, 0.050]; p = 0.002) exposure did correlate with these outcome measures. CONCLUSION Air pollutants may contribute, at least in part, to disease severity in CRS; future investigation is needed to further elucidate the nature of this relationship.
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Affiliation(s)
- Robert Hagedorn
- Department of Otolaryngology - Head and Neck Surgery, University of Utah, Salt Lake City, Utah, USA
| | - Benton Tullis
- Department of Otolaryngology - Head and Neck Surgery, University of Utah, Salt Lake City, Utah, USA
| | - Cassidy Nguyen
- Department of Otolaryngology - Head and Neck Surgery, University of Utah, Salt Lake City, Utah, USA
| | - Ryan Stockard
- Department of Otolaryngology - Head and Neck Surgery, University of Utah, Salt Lake City, Utah, USA
| | - Jess C Mace
- Division of Rhinology and Sinus Surgery/Oregon Sinus Center, Department of Otolaryngology - Head and Neck Surgery, Oregon Health & Science University (OHSU), Portland, Oregon, USA
| | - Vijay R Ramakrishnan
- Department of Otolaryngology - Head and Neck Surgery, University of Indiana, Indianapolis, Indiana, USA
| | - Daniel M Beswick
- Department of Otolaryngology - Head and Neck Surgery, University of California, Los Angeles, California, USA
| | - Zachary M Soler
- Department of Otolaryngology -Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Timothy L Smith
- Division of Rhinology and Sinus Surgery/Oregon Sinus Center, Department of Otolaryngology - Head and Neck Surgery, Oregon Health & Science University (OHSU), Portland, Oregon, USA
| | - Jeremiah A Alt
- Department of Otolaryngology - Head and Neck Surgery, University of Utah, Salt Lake City, Utah, USA
| | - Amarbir S Gill
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA
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Kendzerska T, Szyszkowicz M, Saymeh M, Mallick R, Carlsten C, Ayas NT, Laratta CR, Orach J, Dales R. Air pollution, weather and positive airway pressure treatment adherence in adults with sleep apnea: a retrospective community-based repeated-measures longitudinal study. J Sleep Res 2024:e14183. [PMID: 38439127 DOI: 10.1111/jsr.14183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 01/15/2024] [Accepted: 02/12/2024] [Indexed: 03/06/2024]
Abstract
We assessed the relation between air pollution, weather, and adherence to positive airway pressure (PAP) therapy in a retrospective community-based repeated-measures study of adults with obstructive sleep apnea who purchased PAP devices from a registered provider between 2013 and 2017 (Ottawa, Ontario, Canada) and had at least one day of data. Daily PAP-derived data, air pollution, and weather databases were linked using postal code. The exposures were mean nocturnal (8:00 p.m. to 8:00 a.m.) (i) residential concentrations of nitrogen dioxide (NO2 ), fine particulate matter <=2.5 μm (PM2.5 ), ozone (O3 ), and Air Quality Health Index (AQHI), and (ii) temperature, relative humidity, and barometric pressure. Covariates in the main model were demographics, season, exposure year, and PAP therapy mode. We analysed 8148 adults (median age of 54 years and 61% men) and 2,071,588 days of data. Based on daily data, the median (interquartile range) daily PAP usage was 416 (323-487) min. Using mixed-effect regression analyses to incorporate daily data and clustering by individuals, we found a statistically significant decrease in adherence for increased levels of NO2 , PM2.5 , and AQHI. The largest effect was for NO2 : a decrease in daily PAP use while comparing the highest versus lowest quartiles (Qs) was 3.4 (95% confidence interval [CI] 2.8-3.9) min. Decreased PAP adherence was also associated with increased temperature (Q4 versus Q1: 2.6 [95% CI: 1.5-3.7] min) and decreased barometric pressure (Q1 versus Q4: 2.0 [95% CI 1.5-2.5] min). We observed modest but statistically significant acute effects of air pollution and weather on daily PAP adherence.
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Affiliation(s)
- Tetyana Kendzerska
- Faculty of Medicine, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Mieczysław Szyszkowicz
- Environmental Health Science and Research Bureau, Healthy Environments and Consumer Safety Branch, Healthy Canada, Ottawa, Ontario, Canada
| | - Mouaz Saymeh
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | | | - Christopher Carlsten
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Najib T Ayas
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Cheryl R Laratta
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Juma Orach
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Robert Dales
- Faculty of Medicine, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Environmental Health Science and Research Bureau, Healthy Environments and Consumer Safety Branch, Healthy Canada, Ottawa, Ontario, Canada
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Rodríguez-Fernández P, Romero-Andrada I, Molina-Moya B, Latorre I, Lacoma A, Prat-Aymerich C, Tabernero L, Domínguez J. Impact of diesel exhaust particles on infections with Mycobacterium bovis BCG in in vitro human macrophages and an in vivo Galleria mellonella model. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2024; 341:122597. [PMID: 37741543 PMCID: PMC10804993 DOI: 10.1016/j.envpol.2023.122597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 08/23/2023] [Accepted: 09/19/2023] [Indexed: 09/25/2023]
Abstract
There are strong suggestions for a link between pulmonary tuberculosis (TB) and air quality. Diesel exhaust is one of the main contributors to pollution and it is reported to be able to modify susceptibility to lung infections. In this study we exposed THP-1 human macrophages and Mycobacterium bovis BCG to diesel exhaust particles (DEPs). High cytotoxicity and activation of apoptosis was found in THP-1 cells at 3 and 6 days, but no effect was found on the growth of M. bovis BCG. Infection of THP-1 cells exposed to a non-cytotoxic DEP concentration showed a limited capacity to engulf latex beads. However, M. bovis BCG infection of macrophages did not result in an increase in the bacterial burden, but it did result in an increase in the bacteria recovered from the extracellular media, suggesting a poor contention of M. bovis BCG. We also observed that DEP exposure limited the production of cytokines. Using the Galleria mellonella model of infection, we observed that larvae exposed to low levels of DEPs were less able to survive after infection with M. bovis BCG and had a higher internal bacterial load after 4 days of infection. Unraveling the links between air pollution and impairment of human antimycobacterial immunity is vital, because pollution is rapidly increasing in areas where TB incidence is extremely high.
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Affiliation(s)
- Pablo Rodríguez-Fernández
- Germans Trias i Pujol Research Institute (IGTP), CIBER Enfermedades Respiratorias (CIBERES), Universitat Autònoma de Barcelona, Barcelona, Badalona, Spain; Core Technology Facility, School of Biological Sciences, Faculty of Biology Medicine and Health, University of Manchester, Manchester, UK.
| | - Iris Romero-Andrada
- Germans Trias i Pujol Research Institute (IGTP), CIBER Enfermedades Respiratorias (CIBERES), Universitat Autònoma de Barcelona, Barcelona, Badalona, Spain
| | - Bárbara Molina-Moya
- Germans Trias i Pujol Research Institute (IGTP), CIBER Enfermedades Respiratorias (CIBERES), Universitat Autònoma de Barcelona, Barcelona, Badalona, Spain
| | - Irene Latorre
- Germans Trias i Pujol Research Institute (IGTP), CIBER Enfermedades Respiratorias (CIBERES), Universitat Autònoma de Barcelona, Barcelona, Badalona, Spain
| | - Alícia Lacoma
- Germans Trias i Pujol Research Institute (IGTP), CIBER Enfermedades Respiratorias (CIBERES), Universitat Autònoma de Barcelona, Barcelona, Badalona, Spain
| | - Cristina Prat-Aymerich
- Germans Trias i Pujol Research Institute (IGTP), CIBER Enfermedades Respiratorias (CIBERES), Universitat Autònoma de Barcelona, Barcelona, Badalona, Spain
| | - Lydia Tabernero
- Core Technology Facility, School of Biological Sciences, Faculty of Biology Medicine and Health, University of Manchester, Manchester, UK; Lydia Becker Institute for Immunology and Inflammation, University of Manchester, Manchester, UK
| | - José Domínguez
- Germans Trias i Pujol Research Institute (IGTP), CIBER Enfermedades Respiratorias (CIBERES), Universitat Autònoma de Barcelona, Barcelona, Badalona, Spain.
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Yu SE, Athni TS, Mitchell MB, Zhou X, Chiang S, Lee SE. The Impact of Ambient and Wildfire Air Pollution on Rhinosinusitis and Olfactory Dysfunction. Curr Allergy Asthma Rep 2023; 23:665-673. [PMID: 38047993 DOI: 10.1007/s11882-023-01110-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2023] [Indexed: 12/05/2023]
Abstract
PURPOSE OF REVIEW With increasing industrialization, exposure to ambient and wildfire air pollution is projected to increase, necessitating further research to elucidate the complex relationship between exposure and sinonasal disease. This review aims to summarize the role of ambient and wildfire air pollution in chronic rhinosinusitis (CRS) and olfactory dysfunction and provide a perspective on gaps in the literature. RECENT FINDINGS Based on an emerging body of evidence, exposure to ambient air pollutants is correlated with the development of chronic rhinosinusitis in healthy individuals and increased symptom severity in CRS patients. Studies have also found a robust relationship between long-term exposure to ambient air pollutants and olfactory dysfunction. Ambient air pollution exposure is increasingly recognized to impact the development and sequelae of sinonasal pathophysiology. Given the rising number of wildfire events and worsening impacts of climate change, further study of the impact of wildfire-related air pollution is a crucial emerging field.
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Affiliation(s)
- Sophie E Yu
- Division of Otolaryngology-Head & Neck Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Tejas S Athni
- Division of Otolaryngology-Head & Neck Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Margaret B Mitchell
- Division of Otolaryngology-Head & Neck Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Otolaryngology-Head & Neck Surgery, Massachusetts Eye & Ear, Boston, USA
| | - Xiaodan Zhou
- Department of Statistics, North Carolina State University, Raleigh, NC, USA
| | - Simon Chiang
- Division of Otolaryngology-Head & Neck Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Stella E Lee
- Division of Otolaryngology-Head & Neck Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
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Dilger AE, Bergmark RW. Environmental sustainability in otolaryngologic surgery. Curr Opin Otolaryngol Head Neck Surg 2023. [DOI: 10.1097/moo.0000000000000888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
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Siegel J, Gill N, Ramanathan M, Patadia M. Unified Airway Disease. Otolaryngol Clin North Am 2023; 56:39-53. [DOI: 10.1016/j.otc.2022.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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8
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Sierra-Vargas MP, Montero-Vargas JM, Debray-García Y, Vizuet-de-Rueda JC, Loaeza-Román A, Terán LM. Oxidative Stress and Air Pollution: Its Impact on Chronic Respiratory Diseases. Int J Mol Sci 2023; 24:853. [PMID: 36614301 PMCID: PMC9821141 DOI: 10.3390/ijms24010853] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 12/20/2022] [Accepted: 12/22/2022] [Indexed: 01/05/2023] Open
Abstract
Redox regulation participates in the control of various aspects of metabolism. Reactive oxygen and nitrogen species participate in many reactions under physiological conditions. When these species overcome the antioxidant defense system, a distressed status emerges, increasing biomolecular damage and leading to functional alterations. Air pollution is one of the exogenous sources of reactive oxygen and nitrogen species. Ambient airborne particulate matter (PM) is important because of its complex composition, which includes transition metals and organic compounds. Once in contact with the lungs' epithelium, PM components initiate the synthesis of inflammatory mediators, macrophage activation, modulation of gene expression, and the activation of transcription factors, which are all related to the physiopathology of chronic respiratory diseases, including cancer. Even though the pathophysiological pathways that give rise to the development of distress and biological damage are not fully understood, scientific evidence indicates that redox-dependent signaling pathways are involved. This article presents an overview of the redox interaction of air pollution inside the human body and the courses related to chronic respiratory diseases.
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Affiliation(s)
- Martha Patricia Sierra-Vargas
- Departmento de Investigación en Toxicología y Medicina Ambiental, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas (INER), Ciudad de México 14080, Mexico
| | - Josaphat Miguel Montero-Vargas
- Departmento de Investigación en Inmunogenética y Alergia, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas (INER), Ciudad de México 14080, Mexico
| | - Yazmín Debray-García
- Departmento de Investigación en Toxicología y Medicina Ambiental, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas (INER), Ciudad de México 14080, Mexico
| | - Juan Carlos Vizuet-de-Rueda
- Departmento de Investigación en Inmunogenética y Alergia, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas (INER), Ciudad de México 14080, Mexico
| | - Alejandra Loaeza-Román
- Departmento de Investigación en Toxicología y Medicina Ambiental, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas (INER), Ciudad de México 14080, Mexico
| | - Luis M. Terán
- Departmento de Investigación en Inmunogenética y Alergia, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas (INER), Ciudad de México 14080, Mexico
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Song Y, Chen X, Zhang Z, Cao S, Du T, Guo H. Research on a push-pull industrial trough-side exhaust hood based on CFD simulation and experiment. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 827:154265. [PMID: 35259371 DOI: 10.1016/j.scitotenv.2022.154265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 02/21/2022] [Accepted: 02/27/2022] [Indexed: 06/14/2023]
Abstract
The traditional industrial trough-side exhaust hood requires large energy consumption for one-way airflow because the air inlet and outlet are on both sides of the industrial slot. In this research, based on the improvement of the traditional push-pull trough-side exhaust hood, a double-sided symmetrical push-pull industrial trough-side exhaust hood is researched. Simulation software ICEM and FLUENT were used to research the relationship between the distance of air inlet and outlet and the air volume ratio, and the relationship between the air volume ratio and mass fraction of pollutant gases, using carbon monoxide as the pollutant gas. The research found that when the pollutant mass fraction reaches the specified level, the air inlet and outlet distance is quadratically related to the air volume ratio. When the distance between the inlet and outlet is 0.12 m and the corresponding minimum flow ratio is 1.7, the interference of the suction air outlet pressure on the blowing air outlet jet reaches the minimum. By comparing the energy consumption with the traditional industrial trough-side exhaust hood, the energy saving rate is 75.8% with the same pollutant control effect. The double-sided symmetrical push-pull industrial trough-side exhaust hood reduce the cost of treating and discharging pollutants and provides a new idea for industrial pollutant treatment.
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Affiliation(s)
- Yanli Song
- Northeastern University, Shenyang, China
| | - Xin Chen
- Shenyang Jianzhu University, Shenyang, China
| | - Zhao Zhang
- Shenyang Jianzhu University, Shenyang, China
| | - Shi Cao
- Shenyang Jianzhu University, Shenyang, China
| | - Tao Du
- Northeastern University, Shenyang, China.
| | - Haifeng Guo
- Shenyang Jianzhu University, Shenyang, China
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10
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Leland EM, Vohra V, Seal SM, Zhang Z, Ramanathan M. Environmental air pollution and chronic rhinosinusitis: A systematic review. Laryngoscope Investig Otolaryngol 2022; 7:349-360. [PMID: 35434330 PMCID: PMC9008184 DOI: 10.1002/lio2.774] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 02/25/2022] [Accepted: 03/01/2022] [Indexed: 11/07/2022] Open
Abstract
Objective Chronic rhinosinusitis (CRS) is a highly prevalent and burdensome disease. The pathophysiology is not fully elucidated, but environmental pollutants have been suggested to impact the inflammatory component of the disease process. This review aims to summarize the role of environmental pollution in CRS onset and disease severity. Methods A systematic review was performed following Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines. PubMed, EMBASE, Cochrane Library, Web of Science, and Scopus databases were queried in August 2021. Original articles reporting on air pollution exposure in CRS were included. Other forms of sinonasal disease were excluded. Results Literature search produced 11,983 articles, of which 10 met inclusion criteria. Outcomes evaluated included incidence/prevalence, disease severity, quality of life, and histopathologic/microbial changes. Air pollutant exposure was associated with higher odds of CRS, particularly with particulate matter (PM) exposure. Increasing air pollution exposure was also associated with worsened disease severity and detectable histopathologic changes. Impact on quality of life was less clear. Conclusion Air pollution (particularly PM) is correlated with CRS incidence/prevalence and disease severity, with evidence of histopathologic changes in CRS tissue samples. Further research is warranted to better understand the mechanisms by which air pollution components may cause CRS and type 2 inflammation. Level of Evidence 3a Recent evidence suggests a role for air pollution in the onset and severity of CRS, most notably with relation to PM2.5 exposure. This systematic review supports previous in vitro and in vivo models of pollution in CRS. This study further adds to the existing body of literature demonstrating the many negative health impacts of exposure to air pollution, including impacts on upper airway disease, lower airway disease, cardiac disease, and overall morbidity and mortality.
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Affiliation(s)
- Evelyn M. Leland
- Department of Otolaryngology‐Head and Neck Surgery Johns Hopkins University Baltimore Maryland USA
| | - Varun Vohra
- Department of Otolaryngology‐Head and Neck Surgery Johns Hopkins University Baltimore Maryland USA
| | - Stella M. Seal
- Welch Medical Library Johns Hopkins University School of Medicine Baltimore Maryland USA
| | - Zhenyu Zhang
- Department of Global Health School of Public Health, Peking University Beijing China
- Institute for Global Health and Development Peking University Beijing China
| | - Murugappan Ramanathan
- Department of Otolaryngology‐Head and Neck Surgery Johns Hopkins University Baltimore Maryland USA
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11
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Velasquez N, Gardiner L, Cheng TZ, Moore JA, Boudreau RM, Presto AA, Lee SE. Relationship between socioeconomic status, exposure to airborne pollutants, and chronic rhinosinusitis disease severity. Int Forum Allergy Rhinol 2021; 12:172-180. [PMID: 34510788 DOI: 10.1002/alr.22884] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 07/01/2021] [Accepted: 07/23/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Air pollution directly interacts with airway mucosa, yet little is known about how pollutants affect upper airway inflammation. Studies have shown increased incidence of chronic rhinosinusitis (CRS), rhinitis, and asthma in areas with higher traffic pollution, and these neighborhoods are often associated with lower socioeconomic status (SES). The Area Deprivation Index (ADI) assesses neighborhood-level SES by zip code. The purpose of this study was to assess the relationship between SES and exposure to inhaled pollutants and CRS disease severity. METHODS CRS patients with and without nasal polyps (CRSwNP and CRSsNP, respectively) were identified (total patients = 234; CRSwNP patients = 138; CRSsNP patients = 96). Pollutant concentrations, including particulate matter 2.5 (PM2.5 ), black carbon (BC), and nitrogen dioxide (NO2 ), were measured at 70 sites within the defined countywide sites and used to estimate patient exposures. SES was measured by ADI state deciles. Disease severity metrics included the modified Lund-Mackay score (LMS), the need for systemic steroids, and functional endoscopic sinus surgery (FESS). Associations were analyzed and identified using linear, logistic, and Poisson multivariable regression. RESULTS The distribution of CRSsNP and CRSwNP patients across ADI state deciles was similar. ADI, however, was a predictor of exposure to airborne pollutants (PM2.5 , BC, and NO2 ) with a 1.39%, 2.39%, and 2.49% increase in PM2.5 , BC, and NO2 per increasing decile increment (p < 0.0001), respectively, which demonstrated a direct correlation between deprived neighborhoods and higher levels of exposure to PM2.5 , BC, and NO2 with an increase in pollutant levels per increase in ADI decile. Furthermore, ADI was a predictor for increased steroid treatment. CONCLUSION Lower SES predicted higher exposure to air pollution and increased disease severity in patients with CRS as demonstrated by the increased need for steroid treatment.
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Affiliation(s)
| | - Lauren Gardiner
- Department of Otolaryngology, University of Pittsburgh, Pittsburgh, PA
| | - Tracy Z Cheng
- Department of Otolaryngology, University of Pittsburgh, Pittsburgh, PA
| | - John A Moore
- Department of Otolaryngology, University of Pittsburgh, Pittsburgh, PA
| | - Robert M Boudreau
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA
| | - Albert A Presto
- Center for Atmospheric Particle Studies and Department of Mechanical Engineering, Carnegie Mellon University, Pittsburgh, PA
| | - Stella E Lee
- Department of Otolaryngology, University of Pittsburgh, Pittsburgh, PA
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Leland EM, Zhang Z, Kelly KM, Ramanathan M. Role of Environmental Air Pollution in Chronic Rhinosinusitis. Curr Allergy Asthma Rep 2021; 21:42. [PMID: 34499234 DOI: 10.1007/s11882-021-01019-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2021] [Indexed: 01/19/2023]
Abstract
PURPOSE OF REVIEW Chronic rhinosinusitis (CRS) is a highly prevalent disease with large social and financial burdens. The pathophysiology is multifactorial. Environmental pollutants have been suggested to play a role in the inflammatory component of the disease process. RECENT FINDINGS Recent work has focused on exposure to various pollutants, primarily particulate matter (PM). Exposure to environmental pollutants leads to upregulation of inflammatory markers and ciliary dysfunction at the cellular level. Mouse models suggest a role for epithelial barrier dysfunction contributing to inflammatory changes after pollutant exposure. Clinical studies support the role of pollutants contributing to disease severity in certain populations, but the role in CRS incidence or prevalence is less clear. Research is limited by the retrospective nature of most studies. This review focuses on recent advancements in our understanding of the impact of environmental pollutants in CRS, limitations of the available data, and potential opportunities for future studies.
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Affiliation(s)
- Evelyn M Leland
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, 601 N. Caroline St. JHOC 6263, Baltimore, MD, USA
| | - Zhenyu Zhang
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, 601 N. Caroline St. JHOC 6263, Baltimore, MD, USA
| | - Kathleen M Kelly
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, 601 N. Caroline St. JHOC 6263, Baltimore, MD, USA
| | - Murugappan Ramanathan
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, 601 N. Caroline St. JHOC 6263, Baltimore, MD, USA.
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13
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Borker PV, Carmona E, Essien UR, Saeed GJ, Nouraie SM, Bakker JP, Stitt CJ, Aloia MS, Patel SR. Neighborhoods with Greater Prevalence of Minority Residents Have Lower Continuous Positive Airway Pressure Adherence. Am J Respir Crit Care Med 2021; 204:339-346. [PMID: 33689593 DOI: 10.1164/rccm.202009-3685oc] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Rationale: Limited data suggest racial disparities in continuous positive airway pressure (CPAP) adherence exist.Objectives: To assess whether CPAP adherence varies by neighborhood racial composition at a national scale.Methods: Telemonitoring data from a CPAP manufacturer database were used to assess adherence in adult patients initiating CPAP therapy between November 2015 and October 2018. Mapping ZIP code to ZIP code tabulation areas, age- and sex-adjusted CPAP adherence data at a neighborhood level was computed as a function of neighborhood racial composition. Secondary analyses adjusted for neighborhood education and poverty.Measurements and Main Results: Among 787,236 patients living in 26,180 ZIP code tabulation areas, the prevalence of CPAP adherence was 1.3% (95% confidence interval [CI], 1.0-1.6%) lower in neighborhoods with high (⩾25%) versus low (<1%) percentages of Black residents and 1.2% (95% CI, 0.9-1.5%) lower in neighborhoods with high versus low percentages of Hispanic residents (P < 0.001 for both), even after adjusting for neighborhood differences in poverty and education. Mean CPAP usage was similar across neighborhoods for the first 2 days, but by 90 days, differences in CPAP usage increased to 22 minutes (95% CI, 18-27 min) between neighborhoods with high versus low percentages of Black residents and 22 minutes (95% CI 17-27 min) between neighborhoods with high versus low percentages of Hispanic residents (P < 0.001 for both).Conclusions: CPAP adherence is lower in neighborhoods with greater proportions of Black and Hispanic residents, independent of education or poverty. These differences lead to a lower likelihood of meeting insurance coverage requirements for CPAP therapy, potentially exacerbating sleep health disparities.
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Affiliation(s)
- Priya V Borker
- Center for Sleep and Cardiovascular Outcomes Research.,Division of Pulmonary Allergy and Critical Care Medicine
| | - Emely Carmona
- Center for Sleep and Cardiovascular Outcomes Research
| | - Utibe R Essien
- Center for Health Equity and Promotion, and.,Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania; and
| | | | | | | | | | | | - Sanjay R Patel
- Center for Sleep and Cardiovascular Outcomes Research.,Division of Pulmonary Allergy and Critical Care Medicine
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14
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Billings ME, Thornton JD. The Legacy of Racial and Ethnic Segregation on Health: The Story of Continuous Positive Airway Pressure Use. Am J Respir Crit Care Med 2021; 204:252-254. [PMID: 33844933 PMCID: PMC8513586 DOI: 10.1164/rccm.202103-0649ed] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Martha E Billings
- Division of Pulmonary, Critical Care and Sleep Medicine University of Washington School of Medicine Seattle, Washington
| | - J Daryl Thornton
- Center for Reducing Health Disparities and.,Division of Pulmonary, Critical Care, and Sleep Medicine MetroHealth Campus of Case Western Reserve University Cleveland, Ohio
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15
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Zhang Z, Kamil RJ, London NR, Lee SE, Sidhaye VK, Biswal S, Lane AP, Pinto JM, Ramanathan M. Long-Term Exposure to Particulate Matter Air Pollution and Chronic Rhinosinusitis in Non-Allergic Patients. Am J Respir Crit Care Med 2021; 204:859-862. [PMID: 34181862 DOI: 10.1164/rccm.202102-0368le] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Zhenyu Zhang
- Johns Hopkins University Bloomberg School of Public Health, 25802, Baltimore, Maryland, United States
| | - Rebecca J Kamil
- Johns Hopkins Medicine, 1501, Otolaryngology Head and Neck Surgery, Baltimore, Maryland, United States
| | - Nyall R London
- Johns Hopkins Medicine, 1501, Otolaryngology Head and Neck Surgery, Baltimore, Maryland, United States
| | - Stella E Lee
- University of Pittsburgh Medical Center, 6595, Otolaryngology Head and Neck Surgery, Pittsburgh, Pennsylvania, United States
| | - Venkataramana K Sidhaye
- Johns Hopkins Medical Institutions Campus, 1501, Medicine, Division of Pulmonary and Critical Care, Baltimore, Maryland, United States
| | - Shyam Biswal
- Johns Hopkins University Bloomberg School of Public Health, 25802, Environmental Health Sciences, Baltimore, Maryland, United States
| | - Andrew P Lane
- Johns Hopkins University School of Medicine, 1500, Otolaryngology - Head and Neck Surgery, Baltimore, Maryland, United States
| | - Jayant M Pinto
- University of Chicago Pritzker School of Medicine, 12246, Department of Surgery, Chicago, Illinois, United States
| | - Murugappan Ramanathan
- Johns Hopkins Medicine, 1501, Otolaryngology Head and Neck Surgery, Baltimore, Maryland, United States;
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16
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Jang DW, Lee HJ, Chen PG, Cohen SM, Scales CD. Geographic Variations in Healthcare Utilization and Expenditure for Chronic Rhinosinusitis: A Population-Based Approach. Laryngoscope 2021; 131:2641-2648. [PMID: 33904602 DOI: 10.1002/lary.29588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 04/07/2021] [Accepted: 04/16/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVES/HYPOTHESIS Chronic rhinosinusitis (CRS) is a common and costly health problem in the United States. A better understanding of healthcare resource utilization (HCRU) and healthcare expenditure (HCE) pertaining to CRS is required. The objective of this study is to investigate geographic variations in HCRU and HCE for CRS. STUDY TYPE/DESIGN Retrospective study of administrative database. METHODS Patients meeting pre-defined diagnostic criteria for CRS with continuous 1-year pre-index and 2-year post-index data were identified on IBM® Marketscan Research Databases over a 5-year period (2013-2017). Data pertaining to demographics, HCRU, and HCE were analyzed according to geographic region. Multivariable generalized linear models accounted for age, sex, baseline medication utilization, and co-morbidities. RESULTS About 237,969 patients were included. Antibiotics were the most commonly prescribed medication (95%). Surgery rate (11%), immunotherapy (9.2%), oral steroid use (66%), and antibiotic utilization (mean 6.3 prescriptions) were highest in the South. However, visits with an otolaryngologist were considerably higher in the Northeast (62%). The Northeast region had the highest mean HCE ($2,449), which was 13% greater than HCE for the North Central region ($2,172). HCRU and HCE were higher in urban areas across all metrics, with 2-year HCE being 18% greater in urban areas ($2,374 vs. $2,019). Significant geographic variation in HCE was observed even after adjusting for covariates. CONCLUSION Significant geographic variations in HCRU and HCE exist for CRS even after adjusting for covariates. Future studies are needed to help direct quality improvement and cost-saving efforts as well as efficient resource allocation in an era of value-based care. LEVEL OF EVIDENCE 4 Laryngoscope, 2021.
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Affiliation(s)
- David W Jang
- Department of Head and Neck Surgery & Communication Sciences, Duke University, Durham, North Carolina, U.S.A
| | - Hui Jie Lee
- Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina, U.S.A.,Surgery Center for Outcomes Research, Duke University, Durham, North Carolina, U.S.A
| | - Philip G Chen
- Department of Otolaryngology, University of Texas Health at San Antonio, San Antonio, Texas, U.S.A
| | - Seth M Cohen
- Department of Head and Neck Surgery & Communication Sciences, Duke University, Durham, North Carolina, U.S.A
| | - Charles D Scales
- Surgery Center for Outcomes Research, Duke University, Durham, North Carolina, U.S.A.,Department of Surgery, Duke University, Durham, North Carolina, U.S.A
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Orlandi RR, Kingdom TT, Smith TL, Bleier B, DeConde A, Luong AU, Poetker DM, Soler Z, Welch KC, Wise SK, Adappa N, Alt JA, Anselmo-Lima WT, Bachert C, Baroody FM, Batra PS, Bernal-Sprekelsen M, Beswick D, Bhattacharyya N, Chandra RK, Chang EH, Chiu A, Chowdhury N, Citardi MJ, Cohen NA, Conley DB, DelGaudio J, Desrosiers M, Douglas R, Eloy JA, Fokkens WJ, Gray ST, Gudis DA, Hamilos DL, Han JK, Harvey R, Hellings P, Holbrook EH, Hopkins C, Hwang P, Javer AR, Jiang RS, Kennedy D, Kern R, Laidlaw T, Lal D, Lane A, Lee HM, Lee JT, Levy JM, Lin SY, Lund V, McMains KC, Metson R, Mullol J, Naclerio R, Oakley G, Otori N, Palmer JN, Parikh SR, Passali D, Patel Z, Peters A, Philpott C, Psaltis AJ, Ramakrishnan VR, Ramanathan M, Roh HJ, Rudmik L, Sacks R, Schlosser RJ, Sedaghat AR, Senior BA, Sindwani R, Smith K, Snidvongs K, Stewart M, Suh JD, Tan BK, Turner JH, van Drunen CM, Voegels R, Wang DY, Woodworth BA, Wormald PJ, Wright ED, Yan C, Zhang L, Zhou B. International consensus statement on allergy and rhinology: rhinosinusitis 2021. Int Forum Allergy Rhinol 2021; 11:213-739. [PMID: 33236525 DOI: 10.1002/alr.22741] [Citation(s) in RCA: 374] [Impact Index Per Article: 124.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 11/09/2020] [Indexed: 02/06/2023]
Abstract
I. EXECUTIVE SUMMARY BACKGROUND: The 5 years since the publication of the first International Consensus Statement on Allergy and Rhinology: Rhinosinusitis (ICAR-RS) has witnessed foundational progress in our understanding and treatment of rhinologic disease. These advances are reflected within the more than 40 new topics covered within the ICAR-RS-2021 as well as updates to the original 140 topics. This executive summary consolidates the evidence-based findings of the document. METHODS ICAR-RS presents over 180 topics in the forms of evidence-based reviews with recommendations (EBRRs), evidence-based reviews, and literature reviews. The highest grade structured recommendations of the EBRR sections are summarized in this executive summary. RESULTS ICAR-RS-2021 covers 22 topics regarding the medical management of RS, which are grade A/B and are presented in the executive summary. Additionally, 4 topics regarding the surgical management of RS are grade A/B and are presented in the executive summary. Finally, a comprehensive evidence-based management algorithm is provided. CONCLUSION This ICAR-RS-2021 executive summary provides a compilation of the evidence-based recommendations for medical and surgical treatment of the most common forms of RS.
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Affiliation(s)
| | | | | | | | | | - Amber U Luong
- University of Texas Medical School at Houston, Houston, TX
| | | | - Zachary Soler
- Medical University of South Carolina, Charleston, SC
| | - Kevin C Welch
- Feinberg School of Medicine, Northwestern University, Chicago, IL
| | | | | | | | | | - Claus Bachert
- Ghent University, Ghent, Belgium.,Karolinska Institute, Stockholm, Sweden.,Sun Yatsen University, Gangzhou, China
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - David A Gudis
- Columbia University Irving Medical Center, New York, NY
| | - Daniel L Hamilos
- Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | | | - Richard Harvey
- University of New South Wales and Macquarie University, Sydney, New South Wales, Australia
| | | | | | | | | | - Amin R Javer
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | | | | | | | | | | | | | | | | | - Valerie Lund
- Royal National Throat Nose and Ear Hospital, UCLH, London, UK
| | - Kevin C McMains
- Uniformed Services University of Health Sciences, San Antonio, TX
| | | | - Joaquim Mullol
- IDIBAPS Hospital Clinic, University of Barcelona, Barcelona, Spain
| | | | | | | | | | | | | | | | | | | | - Alkis J Psaltis
- University of Adelaide, Adelaide, South Australia, Australia
| | | | | | | | - Luke Rudmik
- University of Calgary, Calgary, Alberta, Canada
| | - Raymond Sacks
- University of New South Wales, Sydney, New South Wales, Australia
| | | | | | | | | | | | | | | | | | | | | | | | | | - De Yun Wang
- National University of Singapore, Singapore, Singapore
| | | | | | | | - Carol Yan
- University of California San Diego, La Jolla, CA
| | - Luo Zhang
- Capital Medical University, Beijing, China
| | - Bing Zhou
- Capital Medical University, Beijing, China
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18
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Kennedy DW. Management of the visual field in endoscopic sinus surgery. Int Forum Allergy Rhinol 2021; 10:139-140. [PMID: 32086999 DOI: 10.1002/alr.22527] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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