Controlled studies of human exposure to single and combined action of NO2, O3, and SO2

Cumulative exposure to dust and gases as determinants of lung function decline in tunnel construction workers

AIMS

To study the relation between lung function decrease and cumulative exposure to dust and gases in tunnel construction workers.

METHODS

A total of 651 male construction workers (drill and blast workers, tunnel concrete workers, shotcreting operators, and tunnel boring machine workers) were followed up by spirometric measurements in 1989-2002 for an average of six years. Outdoor concrete workers, foremen, and engineers served as a low exposed referent population.

RESULTS

The between worker component of variability was considerably reduced within the job groups compared to the whole population, suggesting that the workers within job groups had similar exposure levels. The annual decrease in FEV1 in low-exposed non-smoking workers was 21 ml and 24 ml in low-exposed ever smokers. The annual decrease in FEV1 in tunnel construction workers was 20-31 ml higher than the low exposed workers depending on job group for both non-smokers and ever smokers. After adjustment for age and observation time, cumulative exposure to nitrogen dioxide showed the strongest association with a decrease in FEV1 in both non-smokers, and ever smokers.

CONCLUSION

Cumulative exposure to nitrogen dioxide appeared to be a major risk factor for lung function decreases in these tunnel construction workers, although other agents may have contributed to the observed effect. Contact with blasting fumes should be avoided, diesel exhaust emissions should be reduced, and respiratory devices should be used to protect workers against dust and nitrogen dioxide exposure.

Determinants of nitrogen dioxide concentrations in indoor ice skating rinks

OBJECTIVES

The combination of poor ventilation and fuel-powered ice resurfacers has resulted in elevated nitrogen dioxide (NO2) concentrations in many indoor ice skating rinks. This study examined the factors influencing concentrations and the effects of various engineering controls in ice rinks with different resurfacer fuels.

METHODS

Indoor NO2 concentrations were measured in 19 enclosed ice skating rinks over 3 winters by means of passive samplers, with 1-week average measurements during the first winter pilot study and single-day working-hour measurements in the final 2 winters. Personal exposures to drivers also were assessed during the last winter.

RESULTS

Rinks in which propane-fueled resurfacers were used had a daily mean indoor NO2 concentration of 206 ppb, compared with 132 ppb for gasoline-fueled and 37 ppb for electric-powered resurfacers. Engineering controls, such as increased ventilation and resurfacer tuning, reduced NO2 concentrations by 65% on average, but outcomes varied widely, and concentrations increased in subsequent months.

CONCLUSIONS

Electric ice resurfacers, increased ventilation, or emission control systems are recommended to protect the health of workers and patrons, with surveillance programs proposed to track implementation and maintain an observer effect.

Exposure-response functions in Air Force toxic risk modeling

A new methodology for estimating the probabilistic risk from acute toxic exposures is planned as a support tool for the Air Force at the Eastern and Western Ranges. Two such methodologies are programs entitled the Launch Area Toxic Analysis program (LATRA) and the Cold Spill Toxic Risk Analysis program (COSTRA). These programs combine probabilistic models of an accident (when applicable), release cloud formation and dispersion (appropriate to the toxic substance and accounting for meteorological conditions), and new exposure-response functions (ERFs) for sensitive and normal exposed populations. These ERFs, anchored on specific exposure standards, estimate the probability of a given severity of health effect in a particular population as a function of the concentration or dose to which it is exposed. The further development and acceptance of these ERFs by the toxicology community, especially for different sensitivities, are key concerns addressed in this paper.

Traffic-related air pollution: exposure and health effects in Copenhagen street cleaners and cemetery workers

This questionnaire-based study found a significantly higher prevalence of chronic bronchitis, asthma, and several other symptoms in 116 Copenhagen street cleaners who were exposed to traffic-related air pollution at levels that were slightly lower than the 1987 World Health Organization-recommended threshold values, compared with 115 Copenhagen cemetery workers exposed to lower pollution levels. Logistic regression analysis, controlling for age and smoking, was conducted, and odds ratios and 95% confidence intervals were calculated to be 2.5 for chronic bronchitis (95% confidence interval = 1.2-5.1), 2.3 for asthma (95% confidence interval = 1.0-5.1), and 1.8-7.9 for other symptoms (95% confidence interval = 1.0-28.2). Except for exposure to air pollution, the two groups were comparable, i.e., they had similar terms of employment and working conditions. The exposure ranges during an 8-h work day, averaged from readings taken at five monitored street positions, were: 41-257 ppb nitric oxide (1-h max: 865 ppb); 23-43 ppb nitrogen dioxide (1-h max: 208 ppb); 1.0-4.3 ppm carbon monoxide (8-h max: 7.1 ppm); 14-28 ppb sulfur dioxide (1-h max: 112 ppb); and 10-38 ppb ozone (1-h max: 72 ppb).

Concentration-response relationships of rat lungs to exposure to oxidant air pollutants: a critical test of Haber's Law for ozone and nitrogen dioxide

Exposure protocols were designed to ask whether lung damage in rats exposed to either ozone or nitrogen dioxide is proportional to dose rate or to cumulative dose. Thus, the response of rats to a constant product of concentration of oxidant air pollutant and time of exposure (C x T) was evaluated for 3-day exposures over a fourfold range of concentrations of ozone (0.2-0.8 ppm) or of nitrogen dioxide (3.6-14.4 ppm) for exposure durations of 6-24 hr per day. The response of rat lungs was quantified by changes in total protein content of lung lavage supernatants or by changes in content of specific cell types in lung lavage pellets. The results of these experiments clearly demonstrate that acute lung damage is a function of cumulative dose (that is, C x T product) for the three highest dose rates tested. However, when exposure duration is extended to include the entire 24-hr period (the lowest dose rate tested), there is a marked attenuation of pulmonary response. Rats were also exposed to mixtures of ozone and nitrogen dioxide with the C x T product held constant. Our results clearly demonstrate that when rats are exposed to combinations of ozone and nitrogen dioxide, lung damage is a function of peak concentration rather than a function of cumulative dose. This deviation from Haber's Law is attributed to a concentration-dependent, synergistic (greater than additive) response to this specific mixture of oxidant air pollutants.

Ambient air pollution and respiratory disease

OBJECTIVE

To review the literature on ambient air pollution and respiratory disease, and to consider the criteria for defining causation.

DATA SOURCES

Medical and scientific journals indexed by Medline, conferences, proceedings and monographs.

STUDY SELECTION

Two kinds of study were selected--(i) controlled clinical trials which have exposed normal or asthmatic subjects and/or patients with chronic obstructive airways disease to sulphur dioxide, nitrogen dioxide or ozone; and (ii) epidemiological studies which have investigated the chronic toxicity of these pollutants, acid aerosols and polycyclic aromatic hydrocarbons.

DATA EXTRACTION AND SYNTHESIS

Experimental studies were tabulated under the headings "Design", "Subjects", "Pollutant concentration", "Duration of exposure", "Outcome measures" and "Conclusions". Epidemiological studies were summarised and compared in an attempt to reconcile conflicting results. (The experimental and epidemiological evidence has been used by regulatory bodies to develop ambient air quality guidelines.)

CONCLUSIONS

At the present state of knowledge, it is not possible to conclude that air pollution can cause respiratory disease de novo, but levels marginally above current guidelines certainly have adverse effects on individuals with pre-existing chronic lung disease.

Pulmonary arachidonic acid metabolism following acute exposures to ozone and nitrogen dioxide

Ozone (O3) and nitrogen dioxide (NO2) are common air pollutants, and exposure to these gases has been shown to affect pulmonary physiology, biochemistry, and structure. This study examined their ability to modulate arachidonic acid metabolites (eicosanoids) in the lungs. Rabbits were exposed for 2 h to O3 at 0.1, 0.3, or 1 ppm; NO2 at 1, 3, or 10 ppm; or to a mixture of 0.3 ppm O3 and 3 ppm NO2. Groups of animals sacrificed either immediately or 24 h after each exposure underwent broncho-pulmonary lavage. Selected eicosanoids were assessed in lavage fluid by radioimmunoassay. Increases in prostaglandins E2 (PGE2) and F2 alpha (PGF2 alpha) were found immediately after exposure to 1 ppm O3. Exposure to 10 ppm NO2 resulted in a depression of 6-keto-PGF1 alpha, while thromboxane B2 (TxB2) was elevated after exposure to 1 ppm NO2 and depressed following 3 and 10 ppm. The O3/NO2 mixture resulted in synergistic increases in PGE2 and PGF2 alpha, with the response appearing to be driven by O3. This study has demonstrated that acute exposure to either O3 or NO2 can alter pulmonary arachidonic acid metabolism and that the responses to these oxidants differ, both quantitatively and qualitatively.

Effects of short-term, single and combined exposure to low-level NO2 and O3 on lung tissue enzyme activities in rats

To examine the pulmonary effects of relatively low levels of NO2 and O3, and test for any possible interaction in their effects, we exposed 3-mo-old male Sprague-Dawley rats, free of specific pathogens, to either filtered room air (control) or 1.20 ppm (2256 micrograms/m3) NO2, 0.30 ppm (588 micrograms/m3) O3, or a combination of the two oxidants continuously for 3 d. We studied a series of parameters in the lung, including lung weight, and enzyme activities related to NADPH generation, sulfhydryl metabolism, and cellular detoxification. The results showed that relative to control, exposure to NO2 caused small but nonsignificant changes in all the parameters; O3 caused significant increases in all the parameters except for superoxide dismutase; and a combination of NO2 and O3 caused increases in all the parameters, and the increases were greater than those caused by NO2 or O3 alone. Statistical analysis of the data showed that the effects of combined exposure were synergistic for 6-phosphogluconate dehydrogenase, isocitrate dehydrogenase, glutathione reductase, and superoxide dismutase activities, and additive for glutathione peroxidase and disulfide reductase activities, but indifferent from those of O3 exposure for other enzyme activities.

Measurements of cardiopulmonary response in awake rats during acute exposure to near-ambient concentrations of ozone

Cardiopulmonary responses during acute exposure to near-ambient (less than or equal to 1.0 ppm) concentrations of ozone (O3) have not been reported for the unanesthetized rat. Such data on species sensitivity are crucial for the extrapolation of animal data to man. Therefore, this study was conducted to obtain functional measurements on awake rats using head-out plethysmographs and intrapleural or carotid artery catheters during a 135-min exposure to 0.0, 0.12, 0.25, 0.5 or 1.0 ppm O3. Carbon dioxide was added during alternate 15-min periods of the exposure to increase ventilation, much like the use of exercise in human O3 exposure studies. The results established that frequency of breathing was increased and tidal volume was decreased as a function of both the concentration and the duration of exposure. Breathing mechanics and cardiopulmonary measures were only marginally affected. Differences in the response of individual rats revealed that as O3 concentration increased, the proportion of rats responding and the magnitude of the response was increased. These data indicate that, for similar functional responses, the rat's sensitivity to O3 is comparable to that observed in man.

Biochemical basis of ozone toxicity

Ozone (O3) is the major oxidant of photochemical smog. Its biological effect is attributed to its ability to cause oxidation or peroxidation of biomolecules directly and/or via free radical reactions. A sequence of events may include lipid peroxidation and loss of functional groups of enzymes, alteration of membrane permeability, and cell injury or death. An acute exposure to O3 causes lung injury involving the ciliated cell in the airways and the type 1 epithelial cell in the alveolar region. The effects are particularly localized at the junction of terminal bronchioles and alveolar ducts, as evident from a loss of cells and accumulation of inflammatory cells. In a typical short-term exposure the lung tissue response is biphasic: an initial injury-phase characterized by cell damage and loss of enzyme activities, followed by a repair-phase associated with increased metabolic activities, which coincide with a proliferation of metabolically active cells, for example, the alveolar type 2 cells and the bronchiolar Clara cells. A chronic exposure to O3 can cause or exacerbate lung diseases, including perhaps an increased lung tumor incidence in susceptible animal models. Ozone exposure also causes extrapulmonary effects involving the blood, spleen, central nervous system, and other organs. A combination of O3 and NO2, both of which occur in photochemical smog, can produce effects which may be additive or synergistic. A synergistic lung injury occurs possibly due to a formation of more powerful radicals and chemical intermediates. Dietary antioxidants, for example, vitamin E, vitamin C, and selenium, can offer a protection against O3 effects.

Biochemical effects of combined gases of nitrogen dioxide and ozone. III. Synergistic effects on lipid peroxidation and antioxidative protective systems in the lungs of rats and guinea pigs

Rats and guinea pigs were exposed continuously to 0.4 ppm NO2, 0.4 ppm O3 or a combination of the two gases for 2 weeks. The concentration of lipid peroxides in lungs of rats and guinea pigs exposed to NO2 alone or O3 alone did not change. The lipid peroxide level of rats inhaling the combined gases also did not change. However, the level of lipid peroxides in guinea pigs exposed to a combination of the two gases was increased to 2.2 times of the control level, showing a synergistic interaction. No increases of antioxidative protective enzyme activities and of antioxidants (such as NPSH, VE, VC) in guinea pigs exposed to NO2, O3 or the combined gases were found. In rats, no changes in enzyme activities and of the antioxidant contents were observed after NO2 alone, but O3 exposure produced slight increases of NPSH, VC, and GPx-H2O2. On the other hand, in rats exposed to the combined gases, marked synergistic increased of many antioxidative factors such as NPSH, VC, G6PD, GPx-cum.OOH and GPx-H2O2 were found. The results show that those animals which are able to increase antioxidative protective factors in the lung following exposure to the combined gases do not respond with a significant increase in lipid peroxides. On the other hand, in animals with poor induction-ability of these factors lipid peroxides are formed. This might explain why guinea pigs were the most sensitive to the effects of the combined gases. Furthermore, it was shown that in guinea pigs the increased level of lipid peroxides and that in rats the increased activities of antioxidative enzymes and the increased contents of the antioxidants were synergistic following exposure to the combined gases.

Exposure-effect relationship of selected pulmonary function measurements in subjects exposed to ozone

Healthy adult male volunteer subjects were exposed to 0.15, 0.3, 0.45 and 0.5 ppm ozone (O3) with and without intermittent light exercise. The results suggest that the subject's level of exercise during exposure is considerably related to the magnitude of changes in lung function and the occurrence rate of respiratory symptoms at any given O3 concentration, and that among healthy subjects there is a considerable range of reactivity to O3 exposure. A level of 0.15 ppm O3 with intermittent light exercise produced a significant decrease of specific airway conductance in most subjects and coughing during deep inspiration in five of 15 subjects, while a level of 0.5 ppm O3 produced fewer effects when the subject did not exercise. The nonsmoker is more reactive to O3 than the smoker. The subject's level of exercise during exposure and his smoking habit are two important factors in evaluating the exposure-effect relationship of O3.

A comparison of biochemical effects of nitrogen dioxide, ozone, and their combination in mouse lung

Swiss Webster mice were exposed to either 4.8 ppm (9024 microgram/m3) nitrogen dioxide (NO2), 0.45 ppm (882 microgram/m3) ozone (O3), or their combination intermittently (8 hr daily) for 7 days, and the effects were studied in the lung by a series of physical and biochemical parameters, including lung weight, DNA and protein contents, oxygen consumption, sulfhydryl metabolism, and activities of NADPH generating enzymes. The results show that exposure to NO2 caused relatively smaller changes than O3, and that the effect of each gas alone under the conditions of exposure was not significant for most of the parameters tested. However, when the two gases were combined, the exposure caused changes that were greater and significant. Statistical analysis of the data shows that the effects of combined exposure were more than additive, i.e., they might be synergistic. The observations suggest that intermittent exposure to NO2 or O3 alone at the concentration used may not cause significant alterations in lung metabolism, but when the two gases are combined the alterations may become significant.

Respiratory symptoms of flight attendants during high-altitude flight: possible relation to cabin ozone exposure

The smaller size and lighter weight of the Boeing 747SP aircraft, introduced into passenger service in 1976, permitted higher-altitude flight than older commercial aircraft and thus potentially greater ozone exposure for those of board. Concerned flight attendants distributed questionnaires relating to symptoms experienced on the Boeing 747SP and/or conventional 747 aircraft to Los Angeles- and New York-based flight attendants. Respondents reported symptoms by frequency and severity and by in-flight and after-flight occurrence. Based on the assessment of three health scientists as to ozone-relatedness, the frequency of "definite" and "probable" ozone-related symptoms of any severity reported by both groups of attendants was significantly associated with 747SP flights (chi-squares: P less than 0.05). After-flight symptoms significantly associated with 747SP experience, although fewer in number than in-flight symptoms, were all in the scientists' "definite" category. In 21 flight attendants who complained of moderate to severe symptoms during 747SP flights, a battery of pulmonary function tests performed approximately two weeks after their last 747SP flight failed to reveal abnormalities. The symptom questionnaire results are consistent with possible exposure of cabin attendants to toxic levels of ozone during the higher-altitude flights of the Boeing 747SP compared to conventional 747 aircraft.

A survey of effects of gaseous and aerosol pollutants on pulmonary function of normal males

A total of 231 normal male human subjects were exposed for 4 hr to air, ozone, nitrogen dioxide, or sulfur dioxide; to sulfuric acid, ammonium bisulfate, ammonium sulfate, or ammonium nitrate aerosols; or to mixtures of these gaseous and aerosol pollutants. Only one concentration of each pollutant was used. This study, therefore, represents a preliminary survey, intended to allow direct comparison of studies to plan future research. During exposure each subject had two 15-min exercise sessions on a treadmill at 4 mph and 10% grade. Environmental conditions were mildly stressful, i.e., temperature = 30 degrees C and relative humidity = 60%. A battery of 19 measurements of pulmonary function was performed just prior to exposure (air control); 2 hr into the exposure, following the first exercise session; 4 hr into the exposure, following the second exercise session; and 24 hr after exposure. Significant differences were noted in specific airway resistance (SRAW), forced vital capacity (FVC), and forced expiratory flow at 50% of FVC (FEF50) and in related measurements in those experimental groups exposed to ozone or to ozone plus aerosols. None of the aerosols alone, nitrogen dioxide or sulfur dioxide alone, or mixtures of nitrogen dioxide or sulfur dioxide with aerosols produced significant effects. A distribution analysis of subject responsivity to ozone gave a normal distribution among subjects not exposed to ozone, and a distribution shifted to the right and skewed to the right among those exposed to ozone alone or in mixture, with no evidence of bimodal distribution of ozone sensitivity.

Airway reactivity and exercise in healthy subjects

The interaction of exercise, methacholine challenge, and beta-adrenergic blockade was investigated in eight healthy subjects. We measured the response to increasing doses of aerosolized methacholine, examining maximum expiratory flow rates. These responses were compared with those obtained on separate days when each methacholine challenge followed submaximal exercise or submaximal exercise in the presence of Beta-blockade. The possible independent effect of increased ventilation (20 +/- 6.7 L/min) was also studied during methacholine challenge. Methacholine-induced bronchospasm was not augmented by exercise alone or by exercise in the presence of beta-blockade, nor was this response significantly altered by hyperventilation during methacholine aerosol challenge. These findings suggest that airway hyperreactivity cannot be induced in healthy subjects by levels of exercise that commonly provoke exercise-induced bronchospasm in asthmatic patients.