Análisis de la relación entre la enfermedad pulmonar obstructiva crónica y los contaminantes atmosféricos atendiendo al origen y trayectoria de las masas de aire en el Norte de España

Environmental pollution in North-Eastern Italy and its influence on chronic obstructive pulmonary disease: time series modelling and analysis using visibility graphs

The impact on human health from environmental pollution is receiving increasing attention. In the case of respiratory diseases such as chronic obstructive pulmonary disease (COPD), the relationship is now well documented. However, few studies have been carried out in areas with low population density and low industrial production, such as the province of Belluno (North-Eastern Italy). The aim of the study was to analyze the effect of exposure to certain pollutants on the temporal dynamics of hospital admissions for COPD in the province of Belluno. Daily air pollution concentration, humidity, precipitations, and temperature were collected from the air monitoring stations in Belluno. Generalized additive mixed models (GAMM) and visibility graphs were used to determine the effects of the short-term exposure to environmental agents on hospital admissions associated to COPD. In the case of the city of Belluno, the GAMM showed that hospital admissions were associated with NO₂, PM₁₀, date, and temperature, while for the city of Feltre, GAMM produced no associated variables. Several visibility graph indices (average edge overlap and interlayer mutual information) showed a significant overlap between environmental agents and hospital admission for both cities. Our study has shown that visibility graphs can be useful in establishing associations between environmental agents and COPD hospitalization in sparsely populated areas.

Exposure to particulate matter: Direct and indirect role in the COVID-19 pandemic

Knowing the transmission factors and the natural environment that favor the spread of a viral infection is crucial to stop outbreaks and develop effective preventive strategies. This work aims to evaluate the role of Particulate Matter (PM) in the COVID-19 pandemic, focusing especially on that of PM as a vector for SARS-CoV-2. Exposure to PM has been related to new cases and to the clinical severity of people infected by SARS-CoV-2, which can be explained by the oxidative stress and the inflammatory response generated by these particles when entering the respiratory system, as well as by the role of PM in the expression of ACE-2 in respiratory cells in human hosts. In addition, different authors have detected SARS-CoV-2 RNA in PM sampled both in outdoor and indoor environments. The results of various studies lead to the hypothesis that the aerosols emitted by an infected person could be deposited in other suspended particles, sometimes of natural but especially of anthropogenic origin, that form the basal PM. However, the viability of the virus in PM has not yet been demonstrated. Should PM be confirmed as a vector of transmission, prevention strategies ought to be adapted, and PM sampling in outdoor environments could become an indicator of viral load in a specific area.

Electric charge of atmospheric nanoparticles and its potential implications with human health

This research presents a pilot project developed within the framework of the COST Action 15,211 in which atmospheric nanoparticles were measured in July 2018, in a maritime environment in the city of Santander in Northern Spain. ELPI® + (Electrical Low-Pressure Impactor) was used to measure nanoparticle properties (electric charge, number, size distribution and surface area) from 6 nm to 10,000 nm with 14 size channels. This study focused on the range between 6 and 380 nm. It considered atmospheric nanoparticle electric charge with surface area, deposited and number by size distribution at human respiratory tract regions in a standard person in Santander according to the human respiratory tract model of ICRP 94. An empirical distribution of nanoparticles deposited in the human respiratory tract model and its electric charge is presented for the city of Santander as the main output. Percentages of total and regional deposition in human respiratory tract model were calculated for the Atlantic climate. Nanoparticles have shown an alveolar surface area deposition plateau with a size distribution range between 6 nm to 150 nm. Negative charge of nanoparticles was clearly associated with primary atmospheric nanoparticles being mainly deposited in the alveolar region where a Brownian mechanism of deposition is predominant. We can demonstrate that electric charge may be a key element in explaining Brownian deposition of the smallest particles in the human respiratory tract and that it can be linked to theoretical positive and negative impacts on human health according to several biometeorological studies. To support our analysis, aerosol samples were characterized with transmission electron microscopy and Confocal Raman spectrometer to determinate morphology, size, chemical composition, and structure. The toxicological effects of the samples with the alveolar surface area had a greater deposition, remain to be studied.

Concentration-response relationships between hourly particulate matter and ischemic events: A case-crossover analysis of effect modification by season and air-mass origin

Most studies linking cardiovascular disease with particulate matter (PM) exposures have focused on total mass concentrations, regardless of their origin. However, the origin of an air mass is inherently linked to particle composition and possible toxicity. We examine how the concentration-response relation between hourly PM exposure and ischemic events is modified by air-mass origin and season. Using telemedicine data, we conducted a case-crossover study of 1855 confirmed ischemic cardiac events in Israel (2005-2013). Based on measurements at three fixed-sites in Tel Aviv and Haifa, ambient PM with diameter < 2.5 μm (PM_2.5) and 2.5-10 μm (PM_10-2.5) concentrations during the hours before event onset were compared with matched control periods using conditional logistic regression that allowed for non-linearity. We also examined effect modification of these associations based on the geographical origin of each air mass by season. Independent of the geographical origin of the air mass, we observed concentration-response curves that were supralinear. For example, the overall odds ratios (ORs) of ischemic events for an increase of 10-μg/m³ in the 2-h average of PM_10-2.5 were 1.08 (95% confidence interval (CI): 1.03-1.14) and 1.00 (0.99-1.01) at the median (17.8 μg/m³) and 95th percentile (82.3 μg/m³) values, respectively. Associations were strongest at low levels of PM_10-2.5 when air comes from central Europe in the summer (OR: 1.27; 95% CI: 1.06, 1.52). Our study demonstrates that hourly associations between PM_2.5 and PM_10-2.5 and ischemic cardiac events are supralinear during diverse pollution conditions in a single population that experiences a wide range of exposure levels.

Air pollution and occupational accidents in the Community of Madrid, Spain

Spain is the EU member country with the third highest total number of accidents in work and has the third highest incidence rate. We have performed a descriptive analysis of occupational accidents in the Community of Madrid (Spain) between 2005 and 2013 to study the impact of air quality on the prevalence of occupational accidents, clarifying how vulnerable to air pollution outdoor workers are. In order to evaluate the association between each air pollutant and work accidents, a quasi-Poisson generalized additive model was fitted. The accident rate followed a downward and statistically significant trend (p = 0.001). The year with the highest accident rate was 2006, with 4981 occupational accidents per 100,000. Occupational accidents follow a temporary pattern (there are differences in the number of accidents according to the month of the year and to the day of the week). Exposure to PM10 and NO₂ increases the risk of having an accident at work, especially for outdoor workers. An increase of 10 μg/m³ in daily concentration resulted in increases in accidents for outdoor workers of 2.5% for PM10 and 6.4% for NO₂.

Application of mindfulness techniques in patients with asthma or COPD

OBJECTIVE

Mindfulness is the ability to pay attention to the present moment without judgment. Mindfulness interventions have proved to be effective in improving the management of psychological symptoms of chronic patients. The objective of this work is to update the evidence about the effects of mindfulness interventions on psychological symptoms in patients with asthma and chronic obstructive pulmonary disease (COPD).

METHODOLOGY

Data sources were PubMed and PsycInfo. From a first set of 109 articles, 12 about mindfulness-interventions in adult populations with asthma or COPD were finally included in the review.

RESULTS

Of the total of 12 studies included, 5 were qualitative and 6 quantitative (5 randomized controlled trials). One quantitative study reported long-term psychological effects in asthma patients, two studies reported short-term psychological effects in COPD patients. Relevant themes identified in qualitative studies included increased awareness, development of new relationships with dyspnea, including new cognitive strategies, and slowing down.

CONCLUSIONS

Mindfulness interventions could increase psychological resources in situations related to asthma and COPD symptoms. More randomized control trials are needed.

Electrical characterization of circulation weather types in Northern Spain based on atmospheric nanoparticles measurements: A pilot study

The electrical component of the atmosphere is a key element to understand bio-effects of atmospheric processes. In this paper an attempt was made to find possible interactions between air masses arriving in Santander, Northern Spain, and electrical properties of nanoparticles measured in this zone. A methodological approach is proposed to characterize electrically the predominant weather types in the study area. An electrical low pressure impactor device (ELPI®+) was used to measure atmospheric particles net charge and particle net charge distribution in real time in July 2018, among other parameters. Data from two specific channels [0.054-0.071 μm] and [2.5-3.0 μm] has been initially used. Atmospheric circulation was defined attending to two, subjective and objective, weather type classifications. Back trajectories of nanoparticles were also computed by the Hybrid Single-Particle Lagrangian Integrated Trajectory model. Results confirm that atmospheric nanoparticles charge varies according to their size. The highest mean absolute charge is associated with local circulation in Santander for both channels. The studied nanoparticles show a quicker reaction to weather conditions than microparticles. They also have a significant correlation with meteorological variables for 18 synoptic groups found, but humidity. Microparticles [2.5-3.0 μm] are negatively related with air humidity, mainly with S-SE circulation pattern.

Risk factors of chronic obstructive pulmonary disease exacerbations

Chronic Obstructive Pulmonary Disease (COPD) is a chronic respiratory disease characterised by persistent respiratory symptoms and airflow limitation. COPD has a major impact on public health, mainly because of its increasing prevalence, morbidity and mortality. The natural course of COPD is aggravated by episodes of respiratory symptom worsening termed exacerbations that contribute to disease progression. Acute Exacerbations of COPD (AECOPD) can be triggered by a multitude of different factors, including respiratory tract infections, various exposures, prior exacerbations, non-adherence to treatment and associated comorbidities. AECOPD are associated with an inexorable decline of lung function and a significantly worse survival outcome. This review will summarise the most important aspects regarding the impact of different factors that contribute to COPD exacerbations.

Quantification of inaccurate diagnosis of COPD in primary care medicine: an analysis of the COACH clinical audit

Background: Inaccurate diagnosis in COPD is a current problem with relevant consequences in terms of inefficient health care, which has not been thoroughly studied in primary care medicine. The aim of the present study was to evaluate the degree of inaccurate diagnosis in Primary Care in Spain and study the determinants associated with it. Methods: The Community Assessment of COPD Health Care (COACH) study is a national, observational, randomized, non-interventional, national clinical audit aimed at evaluating clinical practice for patients with COPD in primary care medicine in Spain. For the present analysis, a correct diagnosis was evaluated based on previous exposure and airway obstruction with and without the presence of symptoms. The association of patient-level and center-level variables with inaccurate diagnosis was studied using multivariate multilevel binomial logistic regression models. Results: During the study 4,307 cases from 63 centers were audited. The rate of inaccurate diagnosis was 82.4% (inter-regional range from 76.8% to 90.2%). Patient-related interventions associated with inaccurate diagnosis were related to active smoking, lung function evaluation, and specific therapeutic interventions. Center-level variables related to the availability of certain complementary tests and different aspects of the resources available were also associated with an inaccurate diagnosis. Conclusions: The prevalence data for the inaccurate diagnosis of COPD in primary care medicine in Spain establishes a point of reference in the clinical management of COPD. The descriptors of the variables associated with this inaccurate diagnosis can be used to identify cases and centers in which inaccurate diagnosis is occurring considerably, thus allowing for improvement.