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Norbäck D, Hashim JH, Hashim Z, Jalaludin J, Ismail R, Wieslander G, Wispriyono B, Sary L, Pratama S, Sari M, Sisinta T, Putra H, Perdana AA, Muhani N, Lestari SMP, Wulandari R, Nurmala EE. Fractional exhaled nitric oxide (FeNO) among school children in Java and Sumatra, Indonesia: associations with respiratory symptoms, house dust mite sensitization and the home environment. J Asthma 2024:1-9. [PMID: 39066997 DOI: 10.1080/02770903.2024.2383627] [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: 03/26/2024] [Revised: 07/12/2024] [Accepted: 07/19/2024] [Indexed: 07/30/2024]
Abstract
OBJECTIVE To study associations between fractional exhaled nitric oxide (FeNO) and asthma, airway symptoms, sensitization to common allergens, outdoor pollution and home environment among 380 students in eight junior high schools in two areas in Indonesia. METHODS Data on health and home were collected by a face-to face interview before measuring FeNO and performing skin prick test against common allergens. Exploratory linear mixed and logistic regression models were employed. RESULTS Geometric mean of FeNO was 17.8 ppb (GSD 2.09) and 139 students (36.6%) had elevated FeNO (>20 ppb). In total, 107 students (28.2%) were sensitized to house dust mite (HDM) (Der p1 or Der f1), 4 (1.1%) to cat and 3 (0.8%) to mold (Cladosporium or Alternaria). Moreover, 20 students (5.3%) had diagnosed asthma, 38 (10.0%) had current wheeze, and 107 (28.2%) had current rhinitis. HDM sensitization, diagnosed asthma, current wheeze, and current rhinitis were associated with FeNO. In total, 281 students (73.9%) had mold or dampness, 232 (61.1%) had environmental tobacco smoke (ETS) and 43 (11.3%) had other odor at home. Indoor mold or dampness and other odor at home were associated with FeNO. ETS was negatively associated with FeNO. CONCLUSION HDM sensitization and elevated FeNO can be common among children in this part of Indonesia. The high prevalence of elevated FeNO indicate that undiagnosed childhood asthma is common. Dampness, mold and odor at home can be associated with increased FeNO while ETS can be associated with decreased FeNO.
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Affiliation(s)
- Dan Norbäck
- Uppsala University, Department of Medical Science, Occupational and Environmental Medicine, University Hospital, Uppsala, Sweden
| | - Jamal Hisham Hashim
- United Nations University-International Institute for Global Health, Kuala Lumpur, Malaysia
- Department of Environmental Health and Occupational Safety, Faculty of Health Sciences, Universiti Selangor, Shah Alam, Selangor, Malaysia
| | - Zailina Hashim
- Department of Environmental and Occupational Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Juliana Jalaludin
- Department of Environmental and Occupational Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Rohaida Ismail
- Environmental Health Research Centre, Institute for Medical Research, National Institues for Health, Ministry of Health, Setia Alam, Selangor, Malaysia
| | - Gunilla Wieslander
- Uppsala University, Department of Medical Science, Occupational and Environmental Medicine, University Hospital, Uppsala, Sweden
| | - Bambang Wispriyono
- Center for Industrial and Environmental Health, Faculty of Public Health, University of Indonesia, Depok, Indonesia
| | - Lolita Sary
- Faculty of Medicine, Universitas Malahayati, Bandar Lampung, Indonesia
| | - Satria Pratama
- Faculty of Military Medicine, Indonesia Defense University, Jakarta, Indonesia
| | - Meliana Sari
- FIKES Universitas Islam Syarif Hidayatullah, Jakarta, Indonesia
| | | | | | - Agung Aji Perdana
- Faculty of Medicine, Universitas Malahayati, Bandar Lampung, Indonesia
| | - Nova Muhani
- Faculty of Medicine, Universitas Malahayati, Bandar Lampung, Indonesia
| | | | - Ririn Wulandari
- Faculty of Medicine, Universitas Malahayati, Bandar Lampung, Indonesia
| | - Eliza Eka Nurmala
- Faculty of Medicine, Universitas Malahayati, Bandar Lampung, Indonesia
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Dhar R, Talwar D, Christopher DJ, Dumra H, Koul PA, Chhajed PN, Chowdhury SR, Arjun P, Guleria R. Expert opinion on diagnosis and management of Severe Asthma in low and middle income countries (LMIC) with focus on India. J Asthma 2024:1-13. [PMID: 38767570 DOI: 10.1080/02770903.2024.2349614] [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: 01/28/2024] [Accepted: 04/25/2024] [Indexed: 05/22/2024]
Abstract
OBJECTIVE In this document, 9 Indian experts have evaluated the factors specific to LMICs when it came to Severe Asthma (SA) diagnosis, evaluation, biologic selection, non-biologic treatment options, and follow-up. DATA SOURCES A search was performed using 50 keywords, focusing on the Indian/LMICs perspective, in PubMed, Cochrane Library, and Google Scholar. The key areas of the search were focused on diagnosis, phenoendotyping, non-biological therapies, selecting a biologic, assessment of treatment response, and management of exacerbation. STUDY SELECTIONS The initial search revealed 1826 articles, from these case reports, observational studies, cohort studies, non-English language papers, etc., were excluded and we short-listed 20 articles for each area. Five relevant articles were selected by the experts for review. RESULTS In LMICs, SA patients may be referred to the specialist for evaluation a little late for Phenoendotyping of SA. While biologic therapy is now a standard of care, pulmonologists in LMICs may not have access to all the investigations to phenoendotype SA patients like fractional exhaled nitric oxide (FeNO), skin prick test (SPT), etc., but phenotyping of SA patients can also be done with simple blood investigations, eosinophil count and serum immunoglobulin E (IgE). Choosing a biologic in the overlapping phenotype of SA and ACO patients is also a challenge in the LMICs. CONCLUSIONS Given the limitations of LMIC, it is important to select the right patient and explain the potential benefits of biological therapy. Non-biologic add-on therapies can be attempted in a resource-limited setting where biological therapy is not available/feasible for patients.
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Affiliation(s)
- Raja Dhar
- Department of Pulmonology, CK BIRLA Hospitals, Kolkata, India
| | | | | | - Harjit Dumra
- Sparsh Chest Disease Centre, Navrangpura, Ahmedabad, India
| | - Parvaiz A Koul
- Department of Pulmonary Medicine, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Prashant N Chhajed
- Department of Lung Care and Sleep Center, Institute of Pulmonology, Medical Research and Development, Fortis Hiranandani Hospital, Vashi, Mumbai, India
- Department of Respiratory Medicine, Dr. Balabhai Nanavati Hospital and Lilavati Hospital, Mumbai, Maharashtra, India
| | | | - Padmanabhan Arjun
- Department of Respiratory Medicine, Kerala Institute of Medical Sciences, Thiruvananthapuram, Kerala, India
| | - Randeep Guleria
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi, India
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Kress S, Lane TJ, Brown D, Smith CL, Gao CX, McCrabb T, Thomas M, Borg BM, Thompson BR, Abramson MJ. Association between PM 2.5 from a coal mine fire and FeNO concentration 7.5 years later. BMC Pulm Med 2024; 24:272. [PMID: 38844929 PMCID: PMC11157905 DOI: 10.1186/s12890-024-03075-w] [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] [Received: 03/13/2024] [Accepted: 05/26/2024] [Indexed: 06/09/2024] Open
Abstract
BACKGROUND AND AIM There are few long-term studies of respiratory health effects of landscape fires, despite increasing frequency and intensity due to climate change. We investigated the association between exposure to coal mine fire PM2.5 and fractional exhaled nitric oxide (FeNO) concentration 7.5 years later. METHODS Adult residents of Morwell, who were exposed to the 2014 Hazelwood mine fire over 6 weeks, and unexposed residents of Sale, participated in the Hazelwood Health Study Respiratory Stream in 2021, including measurements of FeNO concentration, a marker of eosinophilic airway inflammation. Individual exposure to coal mine fire PM2.5 was modelled and mapped to time-location diaries. The effect of exposure to PM2.5 on log-transformed FeNO in exhaled breath was investigated using multivariate linear regression models in the entire sample and stratified by potentially vulnerable subgroups. RESULTS A total of 326 adults (mean age: 57 years) had FeNO measured. The median FeNO level (interquartile range [IQR]) was 17.5 [15.0] ppb, and individual daily exposure to coal mine fire PM2.5 was 7.2 [13.8] µg/m3. We did not identify evidence of association between coal mine fire PM2.5 exposure and FeNO in the general adult sample, nor in various potentially vulnerable subgroups. The point estimates were consistently close to zero in the total sample and subgroups. CONCLUSION Despite previous short-term impacts on FeNO and respiratory health outcomes in the medium term, we found no evidence that PM2.5 from the Hazelwood coal mine fire was associated with any long-term impact on eosinophilic airway inflammation measured by FeNO levels.
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Affiliation(s)
- Sara Kress
- IUF - Leibniz Research Institute for Environmental Medicine, Düsseldorf, Germany
| | - Tyler J Lane
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia
| | - David Brown
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia
| | - Catherine L Smith
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia
| | - Caroline X Gao
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- , Orygen, Parkville, VIC, Australia
| | - Thomas McCrabb
- Respiratory Medicine, Alfred Health, Melbourne, VIC, Australia
| | | | - Brigitte M Borg
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia
- Respiratory Medicine, Alfred Health, Melbourne, VIC, Australia
| | - Bruce R Thompson
- Melbourne School of Health Sciences, University of Melbourne, Parkville, VIC, Australia
| | - Michael J Abramson
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia.
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Anand A, Castiglia E, Zamora ML. The Association Between Personal Air Pollution Exposures and Fractional Exhaled Nitric Oxide (FeNO): A Systematic Review. Curr Environ Health Rep 2024; 11:210-224. [PMID: 38386269 PMCID: PMC11180488 DOI: 10.1007/s40572-024-00430-1] [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: 01/19/2024] [Indexed: 02/23/2024]
Abstract
PURPOSE OF REVIEW Airway inflammation is a common biological response to many types of environmental exposures and can lead to increased nitric oxide (NO) concentrations in exhaled breath. In recent years, several studies have evaluated airway inflammation using fractional exhaled nitric oxide (FeNO) as a biomarker of exposures to a range of air pollutants. This systematic review aims to summarize the studies that collected personal-level air pollution data to assess the air pollution-induced FeNO responses and to determine if utilizing personal-level data resulted in an improved characterization of the relationship between air pollution exposures and FeNO compared to using only ambient air pollution exposure data. RECENT FINDINGS Thirty-six eligible studies were identified. Overall, the studies included in this review establish that an increase in personal exposure to particulate and gaseous air pollutants can significantly increase FeNO. Nine out of the 12 studies reported statistically significant FeNO increases with increasing personal PM2.5 exposures, and up to 11.5% increase in FeNO per IQR increase in exposure has also been reported between FeNO and exposure to gas-phase pollutants, such as ozone, NO2, and benzene. Furthermore, factors such as chronic respiratory diseases, allergies, and medication use were found to be effect modifiers for air pollution-induced FeNO responses. About half of the studies that compared the effect estimates using both personal and ambient air pollution exposure methods reported that only personal exposure yielded significant associations with FeNO response. The evidence from the reviewed studies confirms that FeNO is a sensitive biomarker for air pollutant-induced airway inflammation. Personal air pollution exposure assessment is recommended to accurately assess the air pollution-induced FeNO responses. Furthermore, comprehensive adjustments for the potential confounding factors including the personal exposures of the co-pollutants, respiratory disease status, allergy status, and usage of medications for asthma and allergies are recommended while assessing the air pollution-induced FeNO responses.
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Affiliation(s)
- Abhay Anand
- Department of Public Health Sciences, UConn School of Medicine, UConn Health, 263 Farmington Avenue, Farmington, CT, 06030-6325, USA
| | - Elliana Castiglia
- Department of Public Health Sciences, UConn School of Medicine, UConn Health, 263 Farmington Avenue, Farmington, CT, 06030-6325, USA
| | - Misti Levy Zamora
- Department of Public Health Sciences, UConn School of Medicine, UConn Health, 263 Farmington Avenue, Farmington, CT, 06030-6325, USA.
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Lei J, Liu C, Meng X, Sun Y, Huang S, Zhu Y, Gao Y, Shi S, Zhou L, Luo H, Kan H, Chen R. Associations between fine particulate air pollution with small-airway inflammation: A nationwide analysis in 122 Chinese cities. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2024; 344:123330. [PMID: 38199484 DOI: 10.1016/j.envpol.2024.123330] [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: 08/19/2023] [Revised: 11/24/2023] [Accepted: 01/06/2024] [Indexed: 01/12/2024]
Abstract
Alveolar nitric oxide is a non-invasive indicator of small-airway inflammation, a key pathophysiologic mechanism underlying lower respiratory diseases. However, no epidemiological studies have investigated the impact of fine particulate matter (PM2.5) exposure on the concentration of alveolar nitric oxide (CANO). To explore the associations between PM2.5 exposure in multiple periods and CANO, we conducted a nationwide cross-sectional study in 122 Chinese cities between 2019 and 2021. Utilizing a satellite-based model with a spatial resolution of 1 × 1 km, we matched long-term, mid-term, and short-term PM2.5 exposure for 28,399 individuals based on their home addresses. Multivariable linear regression models were applied to estimate the associations between PM2.5 at multiple exposure windows and CANO. Stratified analyses were also performed to identify potentially vulnerable subgroups. We found that per interquartile range (IQR) unit higher in 1-year average, 1-month average, and 7-day average PM2.5 concentration was significantly associated with increments of 17.78% [95% confidence interval (95%CI): 12.54%, 23.26%], 8.76% (95%CI: 7.35%, 10.19%), and 4.00% (95%CI: 2.81%, 5.20%) increment in CANO, respectively. The exposure-response relationship curves consistently increased with the slope becoming statistically significant beyond 20 μg/m3. Males, children, smokers, individuals with respiratory symptoms or using inhaled corticosteroids, and those living in Southern China were more vulnerable to PM2.5 exposure. In conclusion, our study provided novel evidence that PM2.5 exposure in long-term, mid-term, and short-term periods could significantly elevate small-airway inflammation represented by CANO. Our results highlight the significance of CANO measurement as a non-invasive tool for early screening in the management of PM2.5-related inflammatory respiratory diseases.
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Affiliation(s)
- Jian Lei
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education, NHC Key Lab of Health Technology Assessment, Fudan University, Shanghai, 200032, China; Department of Occupational and Environmental Health, Key Laboratory of Environment and Genes Related to Diseases, Ministry of Education, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, 710061, China.
| | - Cong Liu
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education, NHC Key Lab of Health Technology Assessment, Fudan University, Shanghai, 200032, China.
| | - Xia Meng
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education, NHC Key Lab of Health Technology Assessment, Fudan University, Shanghai, 200032, China
| | - Yiqing Sun
- Eberly College of Science, The Pennsylvania State University, University Park, PA, 16802, USA
| | - Suijie Huang
- Guangzhou Homesun Medical Technology Co., Ltd, Guangdong, 518040, China
| | - Yixiang Zhu
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education, NHC Key Lab of Health Technology Assessment, Fudan University, Shanghai, 200032, China
| | - Ya Gao
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education, NHC Key Lab of Health Technology Assessment, Fudan University, Shanghai, 200032, China
| | - Su Shi
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education, NHC Key Lab of Health Technology Assessment, Fudan University, Shanghai, 200032, China
| | - Lu Zhou
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education, NHC Key Lab of Health Technology Assessment, Fudan University, Shanghai, 200032, China
| | - Huihuan Luo
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education, NHC Key Lab of Health Technology Assessment, Fudan University, Shanghai, 200032, China
| | - Haidong Kan
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education, NHC Key Lab of Health Technology Assessment, Fudan University, Shanghai, 200032, China
| | - Renjie Chen
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education, NHC Key Lab of Health Technology Assessment, Fudan University, Shanghai, 200032, China.
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Tsai YG, Chio CP, Yang KD, Lin CH, Yeh YP, Chang YJ, Chien JW, Wang SL, Huang SK, Chan CC. Long-term PM 2.5 exposure is associated with asthma prevalence and exhaled nitric oxide levels in children. Pediatr Res 2024:10.1038/s41390-023-02977-5. [PMID: 38263452 DOI: 10.1038/s41390-023-02977-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 10/19/2023] [Accepted: 11/26/2023] [Indexed: 01/25/2024]
Abstract
BACKGROUND Exhaled nitric oxide concentration (FENO) is a marker of airway inflammation. This study aimed to evaluate the association of air pollution exposure with FENO levels and asthma prevalence with respiratory symptoms in school children. METHODS We analyzed 4736 school children who reside in six townships near industrial areas in central Taiwan. We evaluated asthmatic symptoms, FENO, and conducted the environmental questionnaire. The personal exposure of PM2.5, NO, and SO2 was estimated using land-use regression models data on children's school and home addresses. RESULTS Annual exposure to PM2.5 was associated with increased odds of physician-diagnosed asthma (OR = 1.595), exercise-induced wheezing (OR = 1.726), itchy eyes (OR = 1.417), and current nasal problems (OR = 1.334) (P < 0.05). FENO levels in the absence of infection were positively correlated with age, previous wheezing, allergic rhinitis, atopic eczema, near the road, and for children with high exposure to PM2.5 (P < 0.05). An increase of 1 μg/m3 PM2.5 exposure was significantly associated with a 1.0% increase in FENO levels for children after adjusting for potential confounding variables, including exposures to NO and SO2. CONCLUSIONS Long-term exposures to PM2.5 posed a significant risk of asthma prevalence and airway inflammation in a community-based population of children. IMPACT Annual exposure to PM2.5 was associated with increased odds of physician-diagnosed asthma and nasal problems and itchy eyes. Long-term exposures to PM2.5 were significantly associated with FENO levels after adjusting for potential confounding variables. This is first study to assess the association between FENO levels and long-term air pollution exposures in children near coal-based power plants. An increase of 1 μg/m3 annual PM2.5 exposure was significantly associated with a 1.0% increase in FENO levels. Long-term exposures to PM2.5 posed a significant risk of asthma prevalence and airway inflammation in a community-based population of children.
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Affiliation(s)
- Yi-Giien Tsai
- Department of Pediatrics, Changhua Christian Children's Hospital, Changhua, Taiwan, ROC
- School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan, ROC
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan, ROC
| | - Chia-Pin Chio
- Department of Medical Research, Tungs' Taichung MetroHarbor Hospital, Taichung, Taiwan, ROC
- Institute of Environmental and Occupational Health Sciences, College of Public Health, National Taiwan University, Taipei, Taiwan, ROC
| | - Kuender D Yang
- Department of Pediatrics, Mackay Memorial Hospital, and Department of Microbiology & Immunology, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Ching-Hsiung Lin
- Division of Chest Medicine, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan, ROC
- Institute of Genomics and Bioinformatics, National Chung Hsing University, Taichung, Taiwan, ROC
- Ph.D. Program in Translational Medicine, National Chung Hsing University, Taichung, Taiwan, ROC
- Department of Recreation and Holistic Wellness, MingDao University, Changhua, Taiwan, ROC
| | - Yen-Po Yeh
- Changhua County Public Health Bureau, Changhua, Taiwan, ROC
| | - Yu-Jun Chang
- Epidemiology and Biostatistics Center, Changhua Christian Hospital, Changhua, Taiwan, ROC
| | - Jien-Wen Chien
- Department of Pediatrics, Changhua Christian Children's Hospital, Changhua, Taiwan, ROC
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan, ROC
| | - Shu-Li Wang
- National Institute of Environmental Health Sciences, National Health Research Institutes, 35 Keyan Rd, Zhunan, Miaoli County, Miaoli, Taiwan, ROC.
| | - Shau-Ku Huang
- National Institute of Environmental Health Sciences, National Health Research Institutes, 35 Keyan Rd, Zhunan, Miaoli County, Miaoli, Taiwan, ROC.
- Johns Hopkins Asthma and Allergy Center, School of Medicine, Johns Hopkins University, Baltimore, MD, USA.
| | - Chang-Chuan Chan
- Institute of Environmental and Occupational Health Sciences, College of Public Health, National Taiwan University, Taipei, Taiwan, ROC.
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Percival E, Collison AM, da Silva Sena CR, De Queiroz Andrade E, De Gouveia Belinelo P, Gomes GMC, Oldmeadow C, Murphy VE, Gibson PG, Karmaus W, Mattes J. The association of exhaled nitric oxide with air pollutants in young infants of asthmatic mothers. Environ Health 2023; 22:84. [PMID: 38049853 PMCID: PMC10696885 DOI: 10.1186/s12940-023-01030-6] [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: 05/03/2023] [Accepted: 11/08/2023] [Indexed: 12/06/2023]
Abstract
BACKGROUND Exhaled nitric oxide is a marker of airway inflammation. Air pollution induces airway inflammation and oxidative stress. Little is known about the impact of air pollution on exhaled nitric oxide in young infants. METHODS The Breathing for Life Trial recruited pregnant women with asthma into a randomised controlled trial comparing usual clinical care versus inflammometry-guided asthma management in pregnancy. Four hundred fifty-seven infants from the Breathing for Life Trial birth cohort were assessed at six weeks of age. Exhaled nitric oxide was measured in unsedated, sleeping infants. Its association with local mean 24-h and mean seven-day concentrations of ozone, nitric oxide, nitrogen dioxide, carbon monoxide, sulfur dioxide, ammonia, particulate matter less than 10 μm (PM10) and less than 2.5 μm (PM2.5) in diameter was investigated. The air pollutant data were sourced from local monitoring sites of the New South Wales Air Quality Monitoring Network. The association was assessed using a 'least absolute shrinkage and selection operator' (LASSO) approach, multivariable regression and Spearman's rank correlation. RESULTS A seasonal variation was evident with higher median exhaled nitric oxide levels (13.6 ppb) in warmer months and lower median exhaled nitric oxide levels (11.0 ppb) in cooler months, P = 0.008. LASSO identified positive associations for exhaled nitric oxide with 24-h mean ammonia, seven-day mean ammonia, seven-day mean PM10, seven-day mean PM2.5, and seven-day mean ozone; and negative associations for eNO with seven-day mean carbon monoxide, 24-h mean nitric oxide and 24-h mean sulfur dioxide, with an R-square of 0.25 for the penalized coefficients. These coefficients selected by LASSO (and confounders) were entered in multivariable regression. The achieved R-square was 0.27. CONCLUSION In this cohort of young infants of asthmatic mothers, exhaled nitric oxide showed seasonal variation and an association with local air pollution concentrations.
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Affiliation(s)
- Elizabeth Percival
- Asthma & Breathing Research Centre, Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW, Australia
| | - Adam M Collison
- Asthma & Breathing Research Centre, Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW, Australia
| | - Carla Rebeca da Silva Sena
- Asthma & Breathing Research Centre, Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW, Australia
| | - Ediane De Queiroz Andrade
- Asthma & Breathing Research Centre, Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW, Australia
| | - Patricia De Gouveia Belinelo
- Asthma & Breathing Research Centre, Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW, Australia
| | - Gabriela Martins Costa Gomes
- Asthma & Breathing Research Centre, Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW, Australia
| | | | - Vanessa E Murphy
- Asthma & Breathing Research Centre, Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW, Australia
| | - Peter G Gibson
- Asthma & Breathing Research Centre, Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW, Australia
- Department of Respiratory and Sleep Medicine, John Hunter Hospital, Newcastle, NSW, Australia
| | - Wilfried Karmaus
- Division of Epidemiology, School of Public Health, and Environmental Health Science, University of Memphis, BiostatisticsMemphis, TN, 38152, USA
| | - Joerg Mattes
- Asthma & Breathing Research Centre, Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW, Australia.
- Department of Paediatric Respiratory & Sleep Medicine, John Hunter Children's Hospital, Newcastle, NSW, Australia.
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Wei T, Chen C, Yang Y, Li L, Wang J, Ye M, Kan H, Yang D, Song Y, Cai J, Hou D. Associations between short-term exposure to ambient air pollution and lung function in adults. JOURNAL OF EXPOSURE SCIENCE & ENVIRONMENTAL EPIDEMIOLOGY 2023:10.1038/s41370-023-00550-0. [PMID: 37179406 DOI: 10.1038/s41370-023-00550-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 04/06/2023] [Accepted: 04/17/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND Evidence of the acute effects of high-level air pollution on small airway function and systemic inflammation in adults is scarce. OBJECTIVE To examined the associations of short-term (i.e., daily) exposure to multiple air pollutants with lung function and inflammatory markers. METHODS We assessed short-term (daily) effects of air pollutants, including particulate matter with aerodynamic diameter less than 2.5 μm (PM2.5) and 10 μm (PM10), nitrogen dioxide (NO2), sulfur dioxide (SO2) and carbon monoxide (CO), on lung function and peripheral immune cell counts over various lag times using generalized linear regression models. RESULTS A total of 4764 adults were included from the general community-dwelling population in Shanghai, China. Exposure to air pollutants and lung function were negatively correlated. Decline in FEF between 25% and 75% of vital capacity (FEF25-75%) were found associated with PM2.5, SO2, and CO, and decline in forced expiratory volume in 3 s (FEV3) to forced vital capacity (FVC) ratio were associated with all examined pollutants, indicating obstruction in small airways. Obstructed airflow in large and middle airways as indicated by decline in FEV1/FVC were also associated with all pollutants. In subgroup analysis, significant negative associations between the five pollutants and SAD parameters were found only in males but not in females. The difference in the associations of SO2 with FEF75% between males and females achieved statistical significance. Additionally, all examined pollutants were significantly associated with lower peripheral neutrophil count. IMPACT STATEMENT Acute exposure to air pollutants were associated with airflow-limitation. Both small airways and proximal airways were affected. Acute exposure to air pollutants were accompanied with a lower neutrophil count.
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Affiliation(s)
- Tingting Wei
- Shanghai Key Laboratory of Lung Inflammation and Injury, Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Cuicui Chen
- Shanghai Key Laboratory of Lung Inflammation and Injury, Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Yanjie Yang
- Shanghai Key Laboratory of Lung Inflammation and Injury, Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Li Li
- Shanghai Key Laboratory of Lung Inflammation and Injury, Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Jian Wang
- Shanghai Key Laboratory of Lung Inflammation and Injury, Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Maosong Ye
- Shanghai Key Laboratory of Lung Inflammation and Injury, Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Haidong Kan
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education and NHC Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, China
| | - Dong Yang
- Shanghai Key Laboratory of Lung Inflammation and Injury, Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Yuanlin Song
- Shanghai Key Laboratory of Lung Inflammation and Injury, Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
- National and Shanghai Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, 200040, China
| | - Jing Cai
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education and NHC Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, China.
- Shanghai Typhoon Institute/CMA, Shanghai Key Laboratory of Meteorology and Health, Shanghai, China.
| | - Dongni Hou
- Shanghai Key Laboratory of Lung Inflammation and Injury, Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.
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Aftabi Y, Amiri-Sadeghan A, Gilani N, Zahedi T, Khodayari MT, Faramarzi E, Seyedrezazadeh E, Ansarin K. Male-biased association of endothelial nitric oxide synthase Asp298Glu substitution ( NOS3-c.894G/T) with asthma risk and severity. J Asthma 2023:1-12. [PMID: 36971059 DOI: 10.1080/02770903.2023.2196689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
OBJECTIVE The nitric-oxide pathway plays a crucial role in the pathogeneses of asthma and NOS3-encoded endothelial nitric oxide synthase is one of the main components of the pathway. Variants of NOS3 are known to contribute to asthma development and pathophysiology. METHODS We investigated the association of NOS3-c.894G/T (rs1799983) with asthma risk and severity by studying frequencies of its genotypes and alleles in 555 asthmatics (93 intermittent, 240 mild, 158 moderate, and 64 severe asthma cases) and 351 control participants using the PCR-FRLP method, logistic regression analysis and generalized ordered logit estimates. RESULTS GT genotype (ORadj: 1.39; CI: 1.04-1.85; p = 0.026), dominant model GT + TT (ORadj: 1.41; CI: 1.07-1.87; p = 0.015), and T allele (ORadj: 1.32; CI: 1.05-1.67; p = 0.018) was associated with increased ORs in asthmatics. Also, the frequency of GT + TT (ORadj: 1.55; CI: 1.01-2.38; p = 0.044) was significantly higher in males. Furthermore, GT genotype (ORadj: 1.39; CI: 1.04-1.85; p = 0.024), GT + TT (ORadj: 1.42; CI: 1.07-1.87; p = 0.014), and T allele (ORadj: 1.32; CI: 1.05-1.66; p = 0.018) in total population and GT + TT (ORadj: 1.56; CI: 1.02-2.37; p = 0.04) in males were significantly associated with increased risk of severe, moderate, mild, intermittent asthma vs. controls. Also, GT genotype (ORadj: 1.39; CI: 1.02-1.91; p = 0.039) was significantly more frequent in severe, moderate grades vs. lower severity grades in the total population. Frequencies of GT genotype (ORadj: 1.77; CI: 1.05-3.00; p = 0.032) and GT + TT (ORadj: 1.74; CI: 1.04-2.90; p = 0.036) in total population and GT genotype (ORadj: 2.40; CI: 1.16-4.97; p = 0.018) and GT + TT (ORadj: 2.30; CI: 1.12-4.74; p = 0.023) in male subpopulation were significantly higher in severe cases compared to lower grades. CONCLUSIONS NOS3-c.894G/T may be associated with asthma risk and its severer grades, with greater effects in men.
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Yang YS, Pei YH, Gu YY, Zhu JF, Yu P, Chen XH. Association between short-term exposure to ambient air pollution and heart failure: An updated systematic review and meta-analysis of more than 7 million participants. Front Public Health 2023; 10:948765. [PMID: 36755739 PMCID: PMC9900180 DOI: 10.3389/fpubh.2022.948765] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 12/29/2022] [Indexed: 01/24/2023] Open
Abstract
Introduction Exposure to air pollution has been linked to the mortality of heart failure. In this study, we sought to update the existing systematic review and meta-analysis, published in 2013, to further assess the association between air pollution and acute decompensated heart failure, including hospitalization and heart failure mortality. Methods PubMed, Web of Science, EMBASE, and OVID databases were systematically searched till April 2022. We enrolled the studies regarding air pollution exposure and heart failure and extracted the original data to combine and obtain an overall risk estimate for each pollutant. Results We analyzed 51 studies and 7,555,442 patients. Our results indicated that heart failure hospitalization or death was associated with increases in carbon monoxide (3.46% per 1 part per million; 95% CI 1.0233-1.046, P < 0.001), sulfur dioxide (2.20% per 10 parts per billion; 95% CI 1.0106-1.0335, P < 0.001), nitrogen dioxide (2.07% per 10 parts per billion; 95% CI 1.0106-1.0335, P < 0.001), and ozone (0.95% per 10 parts per billion; 95% CI 1.0024-1.0166, P < 0.001) concentrations. Increases in particulate matter concentration were related to heart failure hospitalization or death (PM2.5 1.29% per 10 μg/m3, 95% CI 1.0093-1.0165, P < 0.001; PM10 1.30% per 10 μg/m3, 95% CI 1.0102-1.0157, P < 0.001). Conclusion The increase in the concentration of all pollutants, including gases (carbon monoxide, sulfur dioxide, nitrogen dioxide, ozone) and particulate matter [(PM2.5), (PM10)], is positively correlated with hospitalization rates and mortality of heart failure. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/, identifier: CRD42021256241.
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Affiliation(s)
- Yu-shan Yang
- First Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, China,Department of Cardiology, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - Ying-hao Pei
- Department of Intensive Care Unit, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Yuan-yuan Gu
- First Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, China,Department of Cardiology, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - Jun-feng Zhu
- First Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, China,Department of Cardiology, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - Peng Yu
- Department of Cardiology, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China,*Correspondence: Peng Yu ✉
| | - Xiao-hu Chen
- Department of Cardiology, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China,Xiao-hu Chen ✉
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11
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Isa KNM, Jalaludin J, Hashim Z, Than LTL, Hashim JH, Norbäck D. Fungi composition in settled dust associated with fractional exhaled nitric oxide in school children with asthma. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 853:158639. [PMID: 36089033 DOI: 10.1016/j.scitotenv.2022.158639] [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: 07/13/2022] [Revised: 09/01/2022] [Accepted: 09/06/2022] [Indexed: 06/15/2023]
Abstract
Fungi exposure has been significantly linked to respiratory illness. However, numerous fungi taxa that are potentially allergenic still undocumented and leave a barrier to establishing a clear connection between exposure and health risks. This study aimed to evaluate the association of fungi composition in settled dust with fractional exhaled nitric oxide (FeNO) levels among school children with doctor-diagnosed asthma. A cross-sectional study was undertaken among secondary school students in eight schools in the urban area of Hulu Langat, Selangor, Malaysia. A total of 470 school children (aged 14 years old) were randomly selected and their FeNO levels were measured and allergic skin prick tests were conducted. The settled dust samples were collected and analysed by using metagenomic technique to determine the fungi composition. The general linear regression with complex sampling was employed to determine the interrelationship. In total, 2645 fungal operational taxonomic units (OTUs) were characterised from the sequencing process which belongs to Ascomycota (60.7 %), Basidiomycota (36.4 %), Glomeromycota (2.9 %) and Chytridiomycota (0.04 %). The top five mostly abundance in all dust samples were Aspergillus clavatus (27.2 %), followed by Hyphoderma multicystidium (12.2 %), Verrucoconiothyrium prosopidis (9.4 %), Ganoderma tuberculosum (9.2 %), and Heterochaete shearii (7.2 %). The regression results indicated that A. clavatus, Brycekendrickomyces acaciae, Candida parapsilosis, Hazslinszkyomyces aloes, H. multicystidium, H. shearii, Starmerella meliponinorum, V. prosopidis were associated in increased of FeNO levels among the asthmatic group at 0.992 ppb (95 % CI = 0.34-1.68), 2.887 ppb (95 % CI = 2.09-3.76), 0.809 ppb (95 % CI = 0.14-1.49), 0.647 ppb (95 % CI = 0.36-0.94), 1.442 ppb (95 % CI = 0.29-2.61), 1.757 ppb (95 % CI = 0.59-2.87), 1.092 ppb (95 % CI = 0.43-1.75) and 1.088 ppb (95 % CI = 0.51-1.62), respectively. To our knowledge, this is a new finding. The findings pointed out that metagenomics profiling of fungi could enhance our understanding of a complex interrelation between rare and unculturable fungi with airway inflammation.
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Affiliation(s)
- Khairul Nizam Mohd Isa
- Department of Environmental and Occupational Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, UPM, 43400 Serdang, Selangor, Malaysia; Environmental Health Research Cluster (EHRc), Environmental Healthcare Section, Institute of Medical Science Technology, Universiti Kuala Lumpur, 43000 Kajang, Selangor, Malaysia
| | - Juliana Jalaludin
- Department of Environmental and Occupational Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, UPM, 43400 Serdang, Selangor, Malaysia.
| | - Zailina Hashim
- Department of Environmental and Occupational Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, UPM, 43400 Serdang, Selangor, Malaysia
| | - Leslie Thian Lung Than
- Department of Medical Microbiology & Parasitology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, UPM, 43400 Serdang, Selangor, Malaysia
| | - Jamal Hisham Hashim
- Department of Health Sciences, Faculty of Engineering and Life Science, Universiti Selangor, Shah Alam Campus, Seksyen 7, 40000 Shah Alam, Selangor, Malaysia
| | - Dan Norbäck
- Department of Medical Science, Occupational and Environmental Medicine, Uppsala University Hospital, Uppsala University, 75185 Uppsala, Sweden
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Chen P, Yuan Z, Miao L, Yang L, Wang H, Xu D, Lin Z. Acute cardiorespiratory response to air quality index in healthy young adults. ENVIRONMENTAL RESEARCH 2022; 214:113983. [PMID: 35948148 DOI: 10.1016/j.envres.2022.113983] [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: 02/01/2022] [Revised: 06/27/2022] [Accepted: 07/22/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Little is known about the acute health impacts of air quality index (AQI) on cardiorespiratory risk factors. OBJECTIVES To assess the short-term links of AQI with cardiorespiratory risk factors in young healthy adults. METHODS We performed a longitudinal panel study with 4 repeated visits in 40 healthy young adults in Hefei, Anhui Province, China from August to October 2021. Cardiorespiratory factors included systolic blood pressure (BP), diastolic BP (DBP), mean arterial pressure (MAP) and fractional exhaled nitric oxide (FeNO). We collected hourly AQI data from a nearby air quality monitoring site. Linear mixed-effects model was applied to assess the effects of AQI on BP and FeNO. RESULTS The study participants (75.0% females) provided 160 pairs of valid health measurements with average age of 24 years. The mean AQI level was 44.43 during the study period. There were significant positive associations of AQI with three BP parameters and FeNO at different lag periods. For example, an interquartile range increase in AQI (26.54 unit) over lag 0-24 h was associated with increments of 6.69 mmHg (95%CI: 2.95-10.44), 5.71 mmHg (95%CI: 3.30-8.13), 6.04 mmHg (95%CI: 3.46-8.62) and 5.67% (95%CI: 1.05%-16.05%) in SBP, DBP, MAP and FeNO, respectively. The results were robust after controlling for PM1. We did not find effect modifications by gender, BMI, physical activity, or AQI category level on the associations. CONCLUSIONS The current findings on associations of AQI with cardiorespiratory factors might add evidence of the acute adverse cardiorespiratory consequences following air pollution.
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Affiliation(s)
- Ping Chen
- Department of Toxicology, School of Public Health, Anhui Medical University, Hefei, 230032, China
| | - Zhi Yuan
- Department of Toxicology, School of Public Health, Anhui Medical University, Hefei, 230032, China
| | - Lin Miao
- Department of Toxicology, School of Public Health, Anhui Medical University, Hefei, 230032, China
| | - Liyan Yang
- Department of Toxicology, School of Public Health, Anhui Medical University, Hefei, 230032, China
| | - Hua Wang
- Department of Toxicology, School of Public Health, Anhui Medical University, Hefei, 230032, China; Key Laboratory of Environmental Toxicology of Anhui Higher Education Institutes, Anhui Medical University, Hefei, 230032, China
| | - Dexiang Xu
- Department of Toxicology, School of Public Health, Anhui Medical University, Hefei, 230032, China; Key Laboratory of Environmental Toxicology of Anhui Higher Education Institutes, Anhui Medical University, Hefei, 230032, China.
| | - Zhijing Lin
- Department of Toxicology, School of Public Health, Anhui Medical University, Hefei, 230032, China; Key Laboratory of Environmental Toxicology of Anhui Higher Education Institutes, Anhui Medical University, Hefei, 230032, China.
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Chen J, Jahn HJ, Sun HZ, Ning Z, Lu W, Ho KF, Ward TJ. Validity of using ambient concentrations as surrogate exposures at the individual level for fine particle and black carbon: A systematic review and meta-analysis. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2022; 312:120030. [PMID: 36037851 DOI: 10.1016/j.envpol.2022.120030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Revised: 08/13/2022] [Accepted: 08/20/2022] [Indexed: 06/15/2023]
Abstract
Exposure measurement error is an important source of bias in epidemiological studies. We assessed the validity of employing ambient (outdoor) measurements as proxies of personal exposures at individual levels focusing on fine particles (PM2.5) and black carbon (BC)/elemental carbon (EC) on a global scale. We conducted a systematic review and meta-analysis and searched databases (ISI Web of Science, Scopus, PubMed, Ovid MEDLINE®, Ovid Embase, and Ovid BIOSIS) to retrieve observational studies in English language published from 1 January 2006 until 5 May 2021. Correlation coefficients (r) between paired ambient (outdoor) concentration and personal exposure for PM2.5 or BC/EC were standardized as effect size. We used random-effects meta-analyses to pool the correlation coefficients and investigated the causes of heterogeneity and publication bias. Furthermore, we employed subgroup and meta-regression analyses to evaluate the modification of pooled estimates by potential mediators. This systematic review identified thirty-two observational studies involving 1744 subjects from ten countries, with 28 studies for PM2.5 and 11 studies for BC/EC. Personal PM2.5 exposure is more strongly correlated with ambient (outdoor) concentrations (0.63, 95% confidence interval [CI]: 0.57-0.68) than personal BC/EC exposure (0.49, 95% CI: 0.38-0.59), with significant differences in ṝ (0.14, 95% CI: 0.03-0.25; p < 0.05). The results demonstrated that the health status of participants was a significant modifier of pooled correlations. In addition, the personal to ambient (P/A) ratio for PM2.5 and average ambient BC/EC levels were potential effect moderators of the pooled ṝ. The funnel plots and Egger's regression test indicated inevident publication bias. The pooled estimates were robust through sensitivity analyses. The results support the growing consensus that the validity coefficient of proxy measures should be addressed when interpreting results from epidemiological studies to better understand how strong health outcomes are affected by different levels of PM2.5 and their components.
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Affiliation(s)
- Jiayao Chen
- Department of Real Estate and Construction, Faculty of Architecture, The University of Hong Kong, Hong Kong, China; Shenzhen Institute of Research and Innovation, The University of Hong Kong, Shenzhen, China.
| | - Heiko J Jahn
- Faculty of Human Sciences, University of Kassel, Kassel, Germany
| | - Haitong Zhe Sun
- Centre for Atmospheric Science, Yusuf Hamied Department of Chemistry, University of Cambridge, Cambridge CB2 1EW, UK; Department of Earth Sciences, University of Cambridge, Cambridge CB2 3EQ, UK
| | - Zhi Ning
- Division of Environment and Sustainability, Hong Kong University of Science and Technology, Hong Kong, China
| | - Weisheng Lu
- Department of Real Estate and Construction, Faculty of Architecture, The University of Hong Kong, Hong Kong, China
| | - Kin Fai Ho
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Tony J Ward
- School of Public and Community Health Sciences, University of Montana, Missoula, MT, USA
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Kress S, Kilanowski A, Wigmann C, Zhao Q, Zhao T, Abramson MJ, Gappa M, Standl M, Unfried K, Schikowski T. Airway inflammation in adolescents and elderly women: Chronic air pollution exposure and polygenic susceptibility. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 841:156655. [PMID: 35697214 DOI: 10.1016/j.scitotenv.2022.156655] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 06/01/2022] [Accepted: 06/08/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND AND AIM The fractional exhaled nitric oxide (FeNO) concentration in the exhaled breath is a biomarker for eosinophilic airway inflammation. We explored the interplay between chronic air pollution exposure and polygenic susceptibility to airway inflammation at different critical age stages. METHODS Adolescents (15 yr) enrolled in the GINIplus/LISA birth cohorts (n = 2434) and 220 elderly women (75 yr on average) enrolled in the SALIA cohort with FeNO measurements available were investigated. Environmental main effects of the mean of ESCAPE land-use regression air pollutant concentrations within a time window of 15 years and main effects of the polygenic risk scores (PRS) using internal weights from elastic net regression of genome-wide derived single nucleotide polymorphisms were investigated. Furthermore, we examined gene-environment interaction (GxE) effects on natural log-transformed FeNO levels by adjusted linear regression models. RESULTS While we observed no significant environmental and polygenic main effects on airway inflammation in either age group, we found robust harmful effects of chronic nitrogen dioxide (NO2) exposure in the GxE models for elderly women (16.2 % increase in FeNO, p-value = 0.027). Stratified analyses found GxE effects between the PRS and chronic NO2 exposure in never-smoker elderly women and in adolescents without any inflammatory respiratory conditions. CONCLUSIONS FeNO measurement is a useful biomarker to detect higher risk of NO2-induced eosinophilic airway inflammation in the elderly. There was limited evidence for GxE effects on airway inflammation in adolescents or the elderly. Further GxE studies in subpopulations should be conducted to investigate the assumption that susceptibility to airway inflammation differs between age stages.
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Affiliation(s)
- Sara Kress
- IUF - Leibniz Research Institute for Environmental Medicine, Auf'm Hennekamp 50, Düsseldorf 40225, Germany; Medical Research School Düsseldorf, Heinrich Heine University, Universitätsstraße 1, Düsseldorf 40225, Germany.
| | - Anna Kilanowski
- Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Ingolstädter Landstr. 1, Neuherberg 85764, Germany; Institute for Medical Information Processing, Biometry, and Epidemiology; Pettenkofer School of Public Health, LMU Munich, Geschwister-Scholl-Platz 1, Munich 80539, Germany; Division of Metabolic and Nutritional Medicine, Dr. von Hauner Children's Hospital, University of Munich Medical Center, Lindwurmstr. 4, Munich 80337, Germany.
| | - Claudia Wigmann
- IUF - Leibniz Research Institute for Environmental Medicine, Auf'm Hennekamp 50, Düsseldorf 40225, Germany.
| | - Qi Zhao
- IUF - Leibniz Research Institute for Environmental Medicine, Auf'm Hennekamp 50, Düsseldorf 40225, Germany; Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, 44 West Wenhua Road, Jinan City 250012, Shandong Province, China; School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, VIC 3004, Australia.
| | - Tianyu Zhao
- Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Ingolstädter Landstr. 1, Neuherberg 85764, Germany.
| | - Michael J Abramson
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, VIC 3004, Australia.
| | - Monika Gappa
- Department of Paediatrics, Evangelisches Krankenhaus, Kirchfeldstraße 40, Düsseldorf 40217, Germany.
| | - Marie Standl
- Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Ingolstädter Landstr. 1, Neuherberg 85764, Germany; German Center for Lung Research (DZL), Aulweg 130, Gießen 35392, Germany.
| | - Klaus Unfried
- IUF - Leibniz Research Institute for Environmental Medicine, Auf'm Hennekamp 50, Düsseldorf 40225, Germany.
| | - Tamara Schikowski
- IUF - Leibniz Research Institute for Environmental Medicine, Auf'm Hennekamp 50, Düsseldorf 40225, Germany.
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Zhang Z, Zhang H, Yang L, Chen X, Norbäck D, Zhang X. Associations between outdoor air pollution, ambient temperature and fraction of exhaled nitric oxide (FeNO) in university students in northern China - A panel study. ENVIRONMENTAL RESEARCH 2022; 212:113379. [PMID: 35513063 DOI: 10.1016/j.envres.2022.113379] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 03/31/2022] [Accepted: 04/25/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Northern China has severe air pollution, especially in winter. Fractional exhaled nitric oxide (FeNO) is an established biomarker of airway inflammation. AIM To study associations between ambient temperature, air pollution and FeNO in university students in northern China. METHODS We performed a panel study in 67 university students without asthma diagnosis in the city of Taiyuan. FeNO was measured 6 times, over one heating season. Outdoor PM10, PM2.5, SO2, NO2 and O3 were measured at a fixed location in the campus. SO2, NO2 and O3 were measured 7 days (24 h/day) before the FeNO test. PM2.5 and PM10 were measured at different lag times (lag 1 day to lag 7 days). Temperature and carbon monoxide (CO) data were collected from a nearby monitoring station (lag 7). Linear mixed models were applied to study associations between exposure and FeNO, adjusting for gender, age, current smoking, height and furry pet or pollen allergy. RESULTS The overall geometric mean (GM) of FeNO was 17.2 ppb. GM of FeNO was lowest (12.9 ppb) in January and highest (20.0 ppb) in April. The range of lag 7 pollution was 105.0-339.0 μg/m3 for PM10, 72.0-180.0 μg/m3 for PM2.5, 36.0-347.0 μg/m3 for SO2, 26.0-69.0 μg/m3 for NO2, 31.0-163.0 μg/m3 for O3 and 0.93-3.14 mg/m3 for CO. The lag 7 temperature ranged from -4.5 to 20.1 °C. FeNO was consistently higher at higher outdoor temperature (p < 0.001). In multi-pollutant models with temperature adjustment, PM10, PM2.5 and SO2 were associated with FeNO (all p-values <0.001). In contrast, CO was negatively associated (protective) with FeNO (p < 0.001). Associations between exposure and FeNO were similar in men and women. CONCLUSION PM10, PM2.5 and SO2 and outdoor temperature can be associated with airway inflammation, measured as FeNO, in young adults in northern China while CO could be negatively associated with FeNO.
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Affiliation(s)
- Zefei Zhang
- Guangdong Key Laboratory of Environmental Catalysis and Health Risk Control, School of Environmental Science and Engineering, Institute of Environmental Health and Pollution Control, Guangdong University of Technology, Guangzhou, China; Institute of Environmental Science, Shanxi Laboratory for Yellow River, Shanxi University, Taiyuan, China
| | - Huilin Zhang
- Institute of Environmental Science, Shanxi Laboratory for Yellow River, Shanxi University, Taiyuan, China
| | - Liu Yang
- Institute of Environmental Science, Shanxi Laboratory for Yellow River, Shanxi University, Taiyuan, China
| | - Xingyi Chen
- Institute of Environmental Science, Shanxi Laboratory for Yellow River, Shanxi University, Taiyuan, China
| | - Dan Norbäck
- Institute of Environmental Science, Shanxi Laboratory for Yellow River, Shanxi University, Taiyuan, China; Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
| | - Xin Zhang
- Guangdong Key Laboratory of Environmental Catalysis and Health Risk Control, School of Environmental Science and Engineering, Institute of Environmental Health and Pollution Control, Guangdong University of Technology, Guangzhou, China; Institute of Environmental Science, Shanxi Laboratory for Yellow River, Shanxi University, Taiyuan, China.
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Zhou X, Gao Y, Wang D, Chen W, Zhang X. Association Between Sulfur Dioxide and Daily Inpatient Visits With Respiratory Diseases in Ganzhou, China: A Time Series Study Based on Hospital Data. Front Public Health 2022; 10:854922. [PMID: 35433609 PMCID: PMC9008542 DOI: 10.3389/fpubh.2022.854922] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 03/01/2022] [Indexed: 12/21/2022] Open
Abstract
Background Sulfur dioxide (SO2) has been reported to be related to the mortality of respiratory diseases, but the relationship between SO2 and hospital inpatient visits with respiratory diseases and the potential impact of different seasons on this relationship is still unclear. Methods The daily average concentrations of air pollutants, including SO2 and meteorological data in Ganzhou, China, from 2017 to 2019 were collected. The data on daily hospitalization for respiratory diseases from the biggest hospital in the city were extracted. The generalized additive models (GAM) and the distributed lag non-linear model (DLNM) were employed to evaluate the association between ambient SO2 and daily inpatient visits for respiratory diseases. Stratified analyses by gender, age, and season were performed to find their potential effects on this association. Results There is a positive exposure-response relationship between SO2 concentration and relative risk of respiratory inpatient visits. Every 10 μg/m3 increase in SO2 was related to a 3.2% (95% CI: 0.6–6.7%) exaltation in daily respiratory inpatient visits at lag3. In addition, SO2 had a stronger association with respiratory inpatient visits in women, older adults (≥65 years), and warmer season (May-Oct) subgroups. The relationship between SO2 and inpatient visits for respiratory diseases was robust after adjusting for other air pollutants, including PM10, NO2, O3, and CO. Conclusion This time-series study showed that there is a positive association between short-term SO2 exposure and daily respiratory inpatient visits. These results are important for local administrators to formulate environmental public health policies.
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Affiliation(s)
- Xingye Zhou
- School of Public Health and Health Management, Gannan Medical University, Ganzhou, China
| | - Yanfang Gao
- School of Public Health and Health Management, Gannan Medical University, Ganzhou, China
| | - Dongming Wang
- Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Key Laboratory of Environment and Health, Ministry of Education, Ministry of Environmental Protection, State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Weihong Chen
- Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Key Laboratory of Environment and Health, Ministry of Education, Ministry of Environmental Protection, State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaokang Zhang
- School of Public Health and Health Management, Gannan Medical University, Ganzhou, China
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Mohd Isa KN, Jalaludin J, Mohd Elias S, Mohamed N, Hashim JH, Hashim Z. Evaluation of the Relationship between Fractional Exhaled Nitric Oxide (FeNO) with Indoor PM 10, PM 2.5 and NO 2 in Suburban and Urban Schools. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19084580. [PMID: 35457448 PMCID: PMC9031949 DOI: 10.3390/ijerph19084580] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 03/02/2022] [Accepted: 03/03/2022] [Indexed: 12/31/2022]
Abstract
Numerous epidemiological studies have evaluated the association of fractional exhaled nitric oxide (FeNO) and indoor air pollutants, but limited information available of the risks between schools located in suburban and urban areas. We therefore investigated the association of FeNO levels with indoor particulate matter (PM10 and PM2.5), and nitrogen dioxide (NO2) exposure in suburban and urban school areas. A comparative cross-sectional study was undertaken among secondary school students in eight schools located in the suburban and urban areas in the district of Hulu Langat, Selangor, Malaysia. A total of 470 school children (aged 14 years old) were randomly selected, their FeNO levels were measured, and allergic skin prick tests were conducted. The PM2.5, PM10, NO2, and carbon dioxide (CO2), temperature, and relative humidity were measured inside the classrooms. We found that the median of FeNO in the school children from urban areas (22.0 ppb, IQR = 32.0) were slightly higher as compared to the suburban group (19.5 ppb, IQR = 24.0). After adjustment of potential confounders, the two-level hierarchical multiple logistic regression models showed that the concentrations of PM2.5 were significantly associated with elevated of FeNO (>20 ppb) in school children from suburban (OR = 1.42, 95% CI = 1.17−1.72) and urban (OR = 1.30, 95% CI = 1.10−1.91) areas. Despite the concentrations of NO2 being below the local and international recommendation guidelines, NO2 was found to be significantly associated with the elevated FeNO levels among school children from suburban areas (OR = 1.11, 95% CI = 1.06−1.17). The findings of this study support the evidence of indoor pollutants in the school micro-environment associated with FeNO levels among school children from suburban and urban areas.
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Affiliation(s)
- Khairul Nizam Mohd Isa
- Department of Environmental and Occupational Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, UPM, Serdang 43400, Selangor, Malaysia; (K.N.M.I.); (S.M.E.); (Z.H.)
- Environmental Health Research Cluster (EHRc), Environmental Healthcare Section, Institute of Medical Science Technology, Universiti Kuala Lumpur, Kajang 43000, Selangor, Malaysia
| | - Juliana Jalaludin
- Department of Environmental and Occupational Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, UPM, Serdang 43400, Selangor, Malaysia; (K.N.M.I.); (S.M.E.); (Z.H.)
- Correspondence: ; Tel.: +603-97692397
| | - Saliza Mohd Elias
- Department of Environmental and Occupational Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, UPM, Serdang 43400, Selangor, Malaysia; (K.N.M.I.); (S.M.E.); (Z.H.)
| | - Norlen Mohamed
- Environmental Health Unit, Level 2, E3, Disease Control Division, Ministry of Health, Putrajaya 62590, Wilayah Persekutuan Putrajaya, Malaysia;
| | - Jamal Hisham Hashim
- Department of Health Sciences, Faculty of Engineering and Life Science, Universiti Selangor, Shah Alam Campus, Seksyen 7, Shah Alam 40000, Selangor, Malaysia;
| | - Zailina Hashim
- Department of Environmental and Occupational Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, UPM, Serdang 43400, Selangor, Malaysia; (K.N.M.I.); (S.M.E.); (Z.H.)
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Sabeti Z, Ansarin K, Seyedrezazadeh E, Jafarabadi MA, Zafari V, Dastgiri S, Shakerkhatibi M, Gholampour A, Khamnian Z, Sepehri M, Dahim M, Sharbafi J, Hakimi D. Acute responses of airway oxidative stress, inflammation, and hemodynamic markers to ambient PM 2.5 and their trace metal contents among healthy adolescences: A panel study in highly polluted versus low polluted regions. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2021; 288:117797. [PMID: 34329054 DOI: 10.1016/j.envpol.2021.117797] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 07/12/2021] [Accepted: 07/14/2021] [Indexed: 06/13/2023]
Abstract
Particulate air pollutants are known contributors to global cardiorespiratory mortality through several pathways. We examined the effects of varied exposure to PM2.5 and trace metals on biological markers of airway inflammation, oxidative stress, and hemodynamic function of young individuals living in two different exposure settings. We enrolled and followed a panel of 97 healthy nonsmoking participants aged 15-18 years living in a highly polluted metropolitan city of Tabriz (TBZ) and a much less polluted semi-urban town of Hadishahr (HDS). For five consecutive months, the subjects were examined by a physician, and fractional exhaled nitric oxide levels (FENO) were measured. Samples of exhaled breath condensation (EBC) were obtained for measuring interleukin 6 (IL-6), tumor necrosis factor α (TNF-α), and total nitric oxide (NOx). We measured daily outdoor PM2.5 mass concentration in a fixed station in each location for all this period. The PM-metal content was analyzed by ICP-MS. The linear mixed-effects regression models were applied for data analysis. The averages of PM2.5 mass and total metals in TBZ were nearly two and four times higher than in HDS, respectively. In TBZ, an increased IQR of PM2.5 mass during 0-5 days was -correlated with a significant rise in diastolic blood pressure, heart rate, TNF-α, FENO, and NOx and reduction of IL-6. Moreover, exposure to low PM2.5 concentration is significantly -correlated with an elevation in diastolic blood pressure in HDS. We also observed that exposure to metal constituents in the highly polluted region is correlated with increased TNF-α and IL-6 with 131.80% (95% CI: 56.01, 244.39) and 47.51% (95% CI: 33.01, 62.05) per IQR of Hg, respectively. This study suggests that exposure to ambient PM2.5 and their metal contents in highly polluted areas may incite significant changes in airway inflammation, oxidative stress, and hemodynamic parameters in healthy subjects.
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Affiliation(s)
- Zahra Sabeti
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Khalil Ansarin
- Rahat Breath and Sleep Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ensiyeh Seyedrezazadeh
- Tuberculosis and Lung Disease Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohammad Asghari Jafarabadi
- Department of Statistics and Epidemiology, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran; Center for the Development of Interdisciplinary Research in Islamic Sciences and Health Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Venus Zafari
- Tuberculosis and Lung Disease Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Saeed Dastgiri
- Tabriz Health Services Management Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohammad Shakerkhatibi
- Health and Environment Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Akbar Gholampour
- Health and Environment Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Zhila Khamnian
- Department of Community Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Maryam Sepehri
- Social Determinants of Health Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mahin Dahim
- East Azerbaijan Province Health Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Jabraeil Sharbafi
- East Azerbaijan Province Health Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Daryoush Hakimi
- Health Office, Education Department of East Azerbaijan, Tabriz, Iran
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Prapamontol T, Norbäck D, Thongjan N, Suwannarin N, Somsunun K, Ponsawansong P, Khuanpan T, Kawichai S, Naksen W. Fractional exhaled nitric oxide (FeNO) in students in Northern Thailand: associations with respiratory symptoms, diagnosed allergy and the home environment. J Asthma 2021; 59:1787-1795. [PMID: 34435554 DOI: 10.1080/02770903.2021.1968424] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE There are few studies on fractional exhaled nitric oxide (FeNO) among children in subtropical areas. We studied associations between FeNO and respiratory symptoms, reported diagnosed allergies and indoor and outdoor environmental factors in first grade junior high school students (N = 270) in upper northern Thailand. METHODS Data on demographics, health and home environment were collected by a questionnaire distributed in dry season (February-March 2018). FeNO was measured when the research team visited the school. Daily outdoor pollution data (PM10 and ozone) were collected from the nearest monitoring station 3 days (lag 3) and 7 days (lag 7) before the FeNO measurements. Two-level (student, school) linear mixed models were used to analyze associations, adjusting for gender and family education level. RESULTS In total, 29.6% had elevated FeNO level (>20 ppb) and 7.8% reported any allergy diagnosed by a doctor. Male gender (p = 0.02), diagnosed allergy (p = 0.001), especially to cat (p = 0.001) and house dust mite (HDM) allergies (p = 0.001) were associated with FeNO. Eye symptoms (p = 0.01), rhinitis symptoms (p = 0.03) and dyspnea (p = 0.05) in the last 3 days were associated with FeNO. Household indoor mold (p = 0.03), gas cooking (p = 0.03) and PM10 (lag 3 and lag 7) were negatively (protective) associated with FeNO. CONCLUSIONS Diagnosed allergy, especially to cat and HDM, can be associated with increased FeNO. Indoor mold and gas cooking can be associated with lower FeNO. Ocular, nasal and dyspnea symptoms reported by students in dry season in northern Thailand can be associated with FeNO, a biomarker of Th2 driven airway inflammation.
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Affiliation(s)
- Tippawan Prapamontol
- Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Dan Norbäck
- Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand.,Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Nathaporn Thongjan
- Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Neeranuch Suwannarin
- Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Kawinwut Somsunun
- Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
| | | | - Tosabhorn Khuanpan
- Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Sawaeng Kawichai
- Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Warangkana Naksen
- Faculty of Public Health, Chiang Mai University, Chiang Mai, Thailand
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Czubaj-Kowal M, Kurzawa R, Mazurek H, Sokołowski M, Friediger T, Polak M, Nowicki GJ. Relationship Between Air Pollution and the Concentration of Nitric Oxide in the Exhaled Air (FeNO) in 8-9-Year-Old School Children in Krakow. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18136690. [PMID: 34206247 PMCID: PMC8296872 DOI: 10.3390/ijerph18136690] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 06/13/2021] [Accepted: 06/20/2021] [Indexed: 11/16/2022]
Abstract
The consequences of air pollution pose one of the most serious threats to human health, and especially impact children from large agglomerations. The measurement of nitric oxide concentration in exhaled air (FeNO) is a valuable biomarker in detecting and monitoring airway inflammation. However, only a few studies have assessed the relationship between FeNO and the level of air pollution. The study aims to estimate the concentration of FeNO in the population of children aged 8–9 attending the third grade of public primary schools in Krakow, as well as to determine the relationship between FeNO concentration and dust and gaseous air pollutants. The research included 4580 children aged 8–9 years who had two FeNO measurements in the winter–autumn and spring–summer periods. The degree of air pollution was obtained from the Regional Inspectorate of Environmental Protection in Krakow. The concentration of pollutants was obtained from three measurement stations located in different parts of the city. The FeNO results were related to air pollution parameters. The study showed weak but significant relationships between FeNO and air pollution parameters. The most significant positive correlations were found for CO8h (r = 0.1491, p < 0.001), C6H6 (r = 0.1420, p < 0.001), PM10 (r = 0.1054, p < 0.001) and PM2.5 (r = 0.1112, p < 0.001). We suggest that particulate and gaseous air pollutants impact FeNO concentration in children aged 8–9 years. More research is needed to assess the impact of air pollution on FeNO concentration in children. The results of such studies could help to explain the increase in the number of allergic and respiratory diseases seen in children in recent decades.
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Affiliation(s)
- Marta Czubaj-Kowal
- Department of Paediatrics, Stefan Żeromski Specialist Hospital in Krakow, Na Skarpie 66 Str., PL-31-913 Krakow, Poland;
- Correspondence: ; Tel.: +48-604-433-428
| | - Ryszard Kurzawa
- Department of Alergology and Pneumonology, Institute of Tuberculosis and Lung Disorders, Prof. Jana Rudnika 3B Str., PL-34-700 Rabka-Zdrój, Poland;
| | - Henryk Mazurek
- Department of Pneumonology and Cystic Fibrosis, Institute of Tuberculosis and Lung Disorders, Prof. Jana Rudnika 3B Str., PL-34-700 Rabka-Zdrój, Poland;
| | - Michał Sokołowski
- Department of Paediatrics, Stefan Żeromski Specialist Hospital in Krakow, Na Skarpie 66 Str., PL-31-913 Krakow, Poland;
| | - Teresa Friediger
- Faculty of Health, Catholic University in Ruzomberok, Námestie A. Hlinku 48 Str., SK-034 01 Ruzomberok, Slovakia;
| | - Maciej Polak
- Department of Epidemiology and Population Studies, Jagiellonian University Medical College, Grzegórzecka 20 Str., PL-31-531 Krakow, Poland;
| | - Grzegorz Józef Nowicki
- Department of Family Medicine and Community Nursing, Medical University of Lublin, Staszica 6 Str., PL-20-081 Lublin, Poland;
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21
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Association between exposure to ambient air pollution and hospital admission, incidence, and mortality of stroke: an updated systematic review and meta-analysis of more than 23 million participants. Environ Health Prev Med 2021; 26:15. [PMID: 33499804 PMCID: PMC7839211 DOI: 10.1186/s12199-021-00937-1] [Citation(s) in RCA: 68] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 01/10/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Previous studies have suggested that exposure to air pollution may increase stroke risk, but the results remain inconsistent. Evidence of more recent studies is highly warranted, especially gas air pollutants. METHODS We searched PubMed, Embase, and Web of Science to identify studies till February 2020 and conducted a meta-analysis on the association between air pollution (PM2.5, particulate matter with aerodynamic diameter less than 2.5 μm; PM10, particulate matter with aerodynamic diameter less than 10 μm; NO2, nitrogen dioxide; SO2, sulfur dioxide; CO, carbon monoxide; O3, ozone) and stroke (hospital admission, incidence, and mortality). Fixed- or random-effects model was used to calculate pooled odds ratios (OR)/hazard ratio (HR) and their 95% confidence intervals (CI) for a 10 μg/m3 increase in air pollutant concentration. RESULTS A total of 68 studies conducted from more than 23 million participants were included in our meta-analysis. Meta-analyses showed significant associations of all six air pollutants and stroke hospital admission (e.g., PM2.5: OR = 1.008 (95% CI 1.005, 1.011); NO2: OR = 1.023 (95% CI 1.015, 1.030), per 10 μg/m3 increases in air pollutant concentration). Exposure to PM2.5, SO2, and NO2 was associated with increased risks of stroke incidence (PM2.5: HR = 1.048 (95% CI 1.020, 1.076); SO2: HR = 1.002 (95% CI 1.000, 1.003); NO2: HR = 1.002 (95% CI 1.000, 1.003), respectively). However, no significant differences were found in associations of PM10, CO, O3, and stroke incidence. Except for CO and O3, we found that higher level of air pollution (PM2.5, PM10, SO2, and NO2) exposure was associated with higher stroke mortality (e.g., PM10: OR = 1.006 (95% CI 1.003, 1.010), SO2: OR = 1.006 (95% CI 1.005, 1.008). CONCLUSIONS Exposure to air pollution was positively associated with an increased risk of stroke hospital admission (PM2.5, PM10, SO2, NO2, CO, and O3), incidence (PM2.5, SO2, and NO2), and mortality (PM2.5, PM10, SO2, and NO2). Our study would provide a more comprehensive evidence of air pollution and stroke, especially SO2 and NO2.
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