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Fitzpatrick AM, Mohammad AF, Desher K, Mutic AD, Stephenson ST, Dallalio GA, Grunwell JR. Clinical and inflammatory features of traffic-related diesel exposure in children with asthma. Ann Allergy Asthma Immunol 2024; 133:393-402.e4. [PMID: 39074656 PMCID: PMC11410514 DOI: 10.1016/j.anai.2024.07.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Revised: 07/17/2024] [Accepted: 07/17/2024] [Indexed: 07/31/2024]
Abstract
BACKGROUND Epidemiologic studies have revealed associations between traffic-related pollutants such as diesel particulate matter (PM) and asthma outcomes in children, but the inflammatory features associated with diesel PM exposure in children with asthma are not understood. OBJECTIVE To evaluate symptoms, exacerbations, and lung function measures in children with uncontrolled asthma and their associations with residential proximity to major roadways and to determine associations between diesel PM exposure and systemic inflammatory cytokines, circulating markers of T-cell activation and exhaustion, and metabolomic features using biomarker studies. METHODS Children 5 to 17 years of age with physician-diagnosed, uncontrolled asthma despite treatment with an asthma controller medication completed a research visit involving questionnaires, lung function testing, and venipuncture for biomarker studies. Geocoding was performed to quantify residential proximity to major roadways and pollutant exposure. RESULTS A total of 447 children with uncontrolled asthma were enrolled. Children living closer to highly trafficked roadways were more disadvantaged and had more exposure to diesel PM, more exacerbations prompting an emergency department visit, and lower lung function measures. Children with the highest diesel PM exposure, compared with children with the lowest diesel PM exposure, also had blunted cytokine secretion and evidence of T-cell exhaustion, including disturbances in several metabolites associated with glutathione formation and oxidative stress. CONCLUSION Traffic-related diesel PM exposure in children with poorly controlled asthma is associated with poorer clinical outcomes and unique patterns of inflammation and oxidative stress. These findings argue for continued mitigation efforts to improve traffic-related air quality and health equity in children with asthma.
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Affiliation(s)
- Anne M Fitzpatrick
- Department of Pediatrics, Emory University, Atlanta, Georgia; Division of Pulmonary Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia.
| | | | - Kaley Desher
- Department of Pediatrics, Emory University, Atlanta, Georgia
| | - Abby D Mutic
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia
| | | | - Gail A Dallalio
- Department of Pediatrics, Emory University, Atlanta, Georgia
| | - Jocelyn R Grunwell
- Department of Pediatrics, Emory University, Atlanta, Georgia; Division of Critical Care Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia
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2
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Shacham E, Scroggins SE, Gilmore A, Cheng J, Nava R. Predictors of Pediatric Asthma Management: Identifying Actionable Results With Geographic Determinants. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2024:00124784-990000000-00355. [PMID: 39259970 DOI: 10.1097/phh.0000000000001982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/13/2024]
Abstract
BACKGROUND Pediatric asthma remains one of the most prominent chronic health conditions among US youth. Geographic determinants such as air pollutants have been identified as playing a role in asthma development and exacerbation. The purpose of this study was to determine geospatial predictors of pediatric asthma exacerbation events and to prioritize housing remediation resources. METHODS Electronic medical records were abstracted from a health plan in Southern California. The inclusion criteria that created a sample of 51 557 members were those aged 21 years and younger, who had at least 1 asthma-related encounter between January 2019 and December 2021. Diagnoses, age, number of clinic and emergency department visits, and home addresses were included. The air quality index from the closest monitoring station during the study period, residential distance from a primary roadway, and residential distance from manufacturing sites were included in the spatial analysis. RESULTS The average number of asthma-related clinic visits was 2 across the sample. Individuals with more asthma-related clinic visits residing in public housing were more likely to live within 4 km of industrial manufacturing locations (P < .001), reside closer to a major roadway (P < .001), and experience a higher number of poor air quality days (P < .001). Modeling results show these factors were also significantly predictive of an increase of asthma-related health care encounters. CONCLUSIONS The findings of this study were consistent with previous studies linking asthma and poor air quality and further highlighted some of the additive and potentially exponential challenges that public housing, major roadways, and manufacturing sites provide communities in their proximity. This research can guide environmental interventions, including the frequency of public housing inspections, community outreach, and the development of communication strategies, to reduce asthma-related experiences across neighborhoods.
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Affiliation(s)
- Enbal Shacham
- Author Affiliations: Saint Louis University College for Public Health and Social Justice, St. Louis, Missouri (Drs Shacham and Scroggins and Mr Gilmore); and Inland Empire Health Plan Rancho Cucamonga, California (Mss Cheng and Nava)
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3
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Matthaios VN, Holland I, Kang CM, Hart JE, Hauptman M, Wolfson JM, Gaffin JM, Phipatanakul W, Gold DR, Koutrakis P. The effects of urban green space and road proximity to indoor traffic-related PM 2.5, NO 2, and BC exposure in inner-city schools. JOURNAL OF EXPOSURE SCIENCE & ENVIRONMENTAL EPIDEMIOLOGY 2024; 34:745-752. [PMID: 38615139 PMCID: PMC11446814 DOI: 10.1038/s41370-024-00669-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 03/24/2024] [Accepted: 03/27/2024] [Indexed: 04/15/2024]
Abstract
BACKGROUND Since there are known adverse health impacts of traffic-related air pollution, while at the same time there are potential health benefits from greenness, it is important to examine more closely the impacts of these factors on indoor air quality in urban schools. OBJECTIVE This study investigates the association of road proximity and urban greenness to indoor traffic-related fine particulate matter (PM2.5), nitrogen dioxide (NO2), and black carbon (BC) in inner-city schools. METHODS PM2.5, NO2, and BC were measured indoors at 74 schools and outdoors at a central urban over a 10-year period. Seasonal urban greenness was estimated using the Normalized Difference Vegetation Index (NDVI) with 270 and 1230 m buffers. The associations between indoor traffic-related air pollution and road proximity and greenness were investigated with mixed-effects models. RESULTS The analysis showed linear decays of indoor traffic-related PM2.5, NO2, and BC by 60%, 35%, and 22%, respectively for schools located at a greater distance from major roads. The results further showed that surrounding school greenness at 270 m buffer was significantly associated (p < 0.05) with lower indoor traffic-related PM2.5: -0.068 (95% CI: -0.124, -0.013), NO2: -0.139 (95% CI: -0.185, -0.092), and BC: -0.060 (95% CI: -0.115, -0.005). These associations were stronger for surrounding greenness at a greater distance from the schools (buffer 1230 m) PM2.5: -0.101 (95% CI: -0.156, -0.046) NO2: -0.122 (95% CI: -0.169, -0.075) BC: -0.080 (95% CI: -0.136, -0.026). These inverse associations were stronger after fully adjusting for regional pollution and meteorological conditions. IMPACT STATEMENT More than 90% of children under the age of 15 worldwide are exposed to elevated air pollution levels exceeding the WHO's guidelines. The study investigates the impact that urban infrastructure and greenness, in particular green areas and road proximity, have on indoor exposures to traffic-related PM2.5, NO2, and BC in inner-city schools. By examining a 10-year period the study provides insights for air quality management, into how road proximity and greenness at different buffers from the school locations can affect indoor exposure.
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Affiliation(s)
- V N Matthaios
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
- Department of Public Health Policy and Systems, University of Liverpool, Liverpool, UK.
| | - I Holland
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, 181 Longwood Avenue, Boston, MA, USA
| | - C M Kang
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - J E Hart
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, 181 Longwood Avenue, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - M Hauptman
- Harvard Medical School, Boston, MA, USA
- Division of General Pediatrics, Boston Children's Hospital, Boston, MA, USA
| | - J M Wolfson
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - J M Gaffin
- Harvard Medical School, Boston, MA, USA
- Division of Pulmonary Medicine, Boston Children's Hospital, Boston, MA, USA
| | - W Phipatanakul
- Harvard Medical School, Boston, MA, USA
- Division of Immunology, Boston Children's Hospital, Boston, MA, USA
| | - D R Gold
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, 181 Longwood Avenue, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - P Koutrakis
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Rosser F. Outdoor Air Pollution and Pediatric Respiratory Disease. Clin Chest Med 2024; 45:531-541. [PMID: 39069319 PMCID: PMC11286236 DOI: 10.1016/j.ccm.2024.02.025] [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] [Indexed: 07/30/2024]
Abstract
Outdoor air pollution is ubiquitous, and no safe level of exposure has been identified for the most common air pollutants such as ozone and particle pollution. Children are uniquely more susceptible to the harms of outdoor air pollution, which can cause and exacerbate respiratory disease. Although challenging to identify the effects of outdoor air pollution on individual patients, understanding the basics of outdoor air pollution is essential for pediatric respiratory health care providers. This review covers basic information regarding outdoor air pollution, unique considerations for children, mechanisms for increased susceptibility, and association with incident and exacerbation of respiratory disease in children.
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Affiliation(s)
- Franziska Rosser
- Division of Pulmonary Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine, 4401 Penn Avenue, Pittsburgh, PA 15224, USA.
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Akenroye A, Banzon TM, Phipatanakul W. Socioeconomic status is of higher importance than air pollution and environmental factors in childhood asthma prevalence in urban Australia. J Allergy Clin Immunol 2024; 154:278-279. [PMID: 38830511 PMCID: PMC11307243 DOI: 10.1016/j.jaci.2024.05.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 05/16/2024] [Accepted: 05/23/2024] [Indexed: 06/05/2024]
Affiliation(s)
- Ayobami Akenroye
- Division of Allergy and Clinical Immunology, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass; Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, Mass; Harvard Medical School, Boston, Mass.
| | - Tina M Banzon
- Harvard Medical School, Boston, Mass; Division of Immunology, Boston Children's Hospital, Boston, Mass
| | - Wanda Phipatanakul
- Harvard Medical School, Boston, Mass; Division of Immunology, Boston Children's Hospital, Boston, Mass
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Patti MA, Henderson NB, Phipatanakul W, Jackson-Browne M. Recommendations for Clinicians to Combat Environmental Disparities in Pediatric Asthma: A Review. Chest 2024:S0012-3692(24)04845-1. [PMID: 39059578 DOI: 10.1016/j.chest.2024.07.143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 07/04/2024] [Accepted: 07/06/2024] [Indexed: 07/28/2024] Open
Abstract
TOPIC IMPORTANCE Asthma is a common and complex lung disease in children, with disproportionally higher prevalence and related adverse outcomes among children in racial and ethnic minority groups, and of lower socioeconomic position. Environmental factors, including unhealthy housing and school-based exposures, can contribute to increased asthma morbidity and widening disparities. This underscores a significant environmental justice issue and suggests the need for clinical interventions to reduce sources of environmental exposures and ultimately diminish the observed disparities in childhood asthma. REVIEW FINDINGS Unhealthy housing conditions, including secondhand tobacco smoke, allergen exposure, and indoor air pollution, can exacerbate asthma symptoms in children. Although unhealthy housing can occur anywhere, such situations most frequently occur in urban, low-income environments where renting is common. To reduce environmental triggers, clinicians can recommend smoking cessation, cleaning techniques to mitigate exposure, and even directly contacting landlords to address poor housing conditions. Children spend much of their time in schools, where this built environment is also a source of asthma triggers (eg, poor ventilation) and allergens (eg, mold and pests, chemicals). As such, a multidisciplinary approach is needed to adequately address the burden of childhood asthma to equitably reduce disparities to both harmful exposures and negative health outcomes. SUMMARY Racial, ethnic, and socioeconomic disparities exist in asthma morbidity in children, and such disparities are driven in part by environmental factors at the housing and school level. Clinicians can make evidence-based recommendations to drive effective exposure reduction strategies to mitigate asthma morbidity and reduce observed disparities.
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Affiliation(s)
- Marisa A Patti
- AJ Drexel Autism Institute, Drexel University, Philadelphia, PA
| | - Noelle B Henderson
- Department of Environmental Health, Boston University School of Public Health, Boston, MA
| | - Wanda Phipatanakul
- Division of Allergy and Immunology, Boston Children's Hospital, Boston, MA; Harvard Medical School, Boston, MA
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Jung KH, Argenio KL, Jackson DJ, Miller RL, Perzanowski MS, Rundle AG, Bacharier LB, Busse WW, Cohen RT, Visness CM, Gill MA, Gruchalla RS, Hershey GK, Kado RK, Sherenian MG, Liu AH, Makhija MM, Pillai DK, Rivera-Spoljaric K, Gergen PJ, Altman MC, Sandel MT, Sorkness CA, Kattan M, Lovinsky-Desir S. Home and school pollutant exposure, respiratory outcomes, and influence of historical redlining. J Allergy Clin Immunol 2024:S0091-6749(24)00679-1. [PMID: 38992473 DOI: 10.1016/j.jaci.2024.06.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 06/24/2024] [Accepted: 06/26/2024] [Indexed: 07/13/2024]
Abstract
BACKGROUND The discriminatory and racist policy of historical redlining in the United States during the 1930s played a role in perpetuating contemporary environmental health disparities. OBJECTIVE Our objectives were to determine associations between home and school pollutant exposure (fine particulate matter [PM2.5], NO2) and respiratory outcomes (Composite Asthma Severity Index, lung function) among school-aged children with asthma and examine whether associations differed between children who resided and/or attended school in historically redlined compared to non-redlined neighborhoods. METHODS Children ages 6 to 17 with moderate-to-severe asthma (N = 240) from 9 US cities were included. Combined home and school exposure to PM2.5 and NO2 was calculated based on geospatially assessed monthly averaged outdoor pollutant concentrations. Repeated measures of Composite Asthma Severity Index and lung function were collected. RESULTS Overall, 37.5% of children resided and/or attended schools in historically redlined neighborhoods. Children in historically redlined neighborhoods had greater exposure to NO2 (median: 15.4 vs 12.1 parts per billion) and closer distance to a highway (median: 0.86 vs 1.23 km), compared to those in non-redlined neighborhoods (P < .01). Overall, PM2.5 was not associated with asthma severity or lung function. However, among children in redlined neighborhoods, higher PM2.5 was associated with worse asthma severity (P < .005). No association was observed between pollutants and lung function or asthma severity among children in non-redlined neighborhoods (P > .005). CONCLUSIONS Our findings highlight the significance of historical redlining and current environmental health disparities among school-aged children with asthma, specifically, the environmental injustice of PM2.5 exposure and its associations with respiratory health.
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Affiliation(s)
- Kyung Hwa Jung
- Division of Pediatric Pulmonology, Department of Pediatrics, College of Physicians and Surgeons, Columbia University, New York, NY
| | - Kira L Argenio
- Division of Pediatric Pulmonology, Department of Pediatrics, College of Physicians and Surgeons, Columbia University, New York, NY
| | - Daniel J Jackson
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wis
| | - Rachel L Miller
- Division of Clinical Immunology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Matthew S Perzanowski
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY
| | - Andrew G Rundle
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
| | - Leonard B Bacharier
- Department of Pediatrics, Monroe Carell Jr Children's Hospital at Vanderbilt, Nashville, Tenn
| | - William W Busse
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wis
| | - Robyn T Cohen
- Department of Pediatrics, Boston University School of Medicine, Boston, Mass
| | | | - Michelle A Gill
- Department of Pediatrics, Washington University, St Louis, Mo
| | - Rebecca S Gruchalla
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Tex
| | - Gurjit K Hershey
- Division of Asthma Research, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Rachel K Kado
- Division of Allergy and Immunology, Department of Internal Medicine, Henry Ford Health System, Sterling Heights, Mich
| | - Michael G Sherenian
- Division of Asthma Research, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Andrew H Liu
- Division of Pediatric Pulmonology, Department of Pediatrics, College of Physicians and Surgeons, Columbia University, New York, NY
| | - Melanie M Makhija
- Division of Allergy and Immunology, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Ill
| | - Dinesh K Pillai
- Division of Pulmonary Medicine, Children's National Medical Center, Washington, DC; Pulmonary Medicine, Pediatric Specialists of Virginia, Fairfax, Va
| | | | - Peter J Gergen
- National Institute of Allergy and Infectious Diseases, Bethesda, Md
| | - Matthew C Altman
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington School of Medicine, Seattle, Wash; Immunology Division, Benaroya Research Institute Systems, Seattle, Wash
| | - Megan T Sandel
- Department of Pediatrics, Boston University School of Medicine, Boston, Mass
| | - Christine A Sorkness
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wis
| | - Meyer Kattan
- Division of Pediatric Pulmonology, Department of Pediatrics, College of Physicians and Surgeons, Columbia University, New York, NY
| | - Stephanie Lovinsky-Desir
- Division of Pediatric Pulmonology, Department of Pediatrics, College of Physicians and Surgeons, Columbia University, New York, NY; Division of Clinical Immunology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY.
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Domingo KN, Gabaldon KL, Hussari MN, Yap JM, Valmadrid LC, Robinson K, Leibel S. Impact of climate change on paediatric respiratory health: pollutants and aeroallergens. Eur Respir Rev 2024; 33:230249. [PMID: 39009406 PMCID: PMC11262702 DOI: 10.1183/16000617.0249-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 03/07/2024] [Indexed: 07/17/2024] Open
Abstract
Paediatric populations are particularly vulnerable to respiratory diseases caused and exacerbated by aeroallergens, pollutants and infectious agents. Worsening climate change is expected to increase the prevalence of pollutants and aeroallergens while amplifying disease severity and causing disproportionate effects in under-resourced areas. The purpose of this narrative review is to summarise the role of anthropogenic climate change in the literature examining the future impact of aeroallergens, pollutants and infectious agents on paediatric respiratory diseases with a focus on equitable disease mitigation. The aeroallergens selected for discussion include pollen, dust mites and mould as these are prevalent triggers of paediatric asthma worldwide. Human rhinovirus and respiratory syncytial virus are key viruses interacting with climate change and pollution and are primary causal agents of viral respiratory disease. Within this review, we present the propensity for aeroallergens, climate change and pollution to synergistically exacerbate paediatric respiratory disease and outline measures that can ameliorate the expected increase in morbidity and severity of disease through a health equity lens. We support shifting from fossil fuels to renewable energy worldwide, across sectors, as a primary means of reducing increases in morbidity.
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Affiliation(s)
- Karyssa N Domingo
- School of Medicine, University of California San Diego, La Jolla, CA, USA
- K.N. Domingo and K.L. Gabaldon contributed equally
| | - Kiersten L Gabaldon
- School of Medicine, University of California San Diego, La Jolla, CA, USA
- K.N. Domingo and K.L. Gabaldon contributed equally
| | | | - Jazmyn M Yap
- School of Medicine, University of California San Diego, La Jolla, CA, USA
| | | | - Kelly Robinson
- Department of Pediatrics, Division of Allergy and Immunology, University of California San Diego, La Jolla, CA, USA
| | - Sydney Leibel
- Department of Pediatrics, Division of Allergy and Immunology, University of California San Diego, La Jolla, CA, USA
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, USA
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9
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Finkelstein JB, Hauptman M, Acosta K, Flanagan S, Cahill D, Smith B, Bernstein A, Shah SH, Kaur R, Meyers H, Shah AS, Meara JG, Estrada CR. Environmental Impact of a Pediatric and Young Adult Virtual Medicine Program: A Lesson from the COVID-19 Pandemic. Acad Pediatr 2024; 24:408-416. [PMID: 37499794 PMCID: PMC10809144 DOI: 10.1016/j.acap.2023.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 07/16/2023] [Accepted: 07/22/2023] [Indexed: 07/29/2023]
Abstract
OBJECTIVES The Coronavirus Disease 2019 (COVID-19) pandemic led to the expansion of virtual medicine as a method to provide patient care. We aimed to determine the impact of pediatric and young adult virtual medicine use on fossil fuel consumption, greenhouse gas, and nongreenhouse traffic-related air pollutant emissions. METHODS We conducted a retrospective analysis of all virtual medicine patients at a single quaternary-care children's hospital with a geocoded address in the Commonwealth of Massachusetts prior to (March 16, 2019-March 15, 2020) and during the COVID-19 pandemic (March 16, 2020-March 15, 2021). Primary outcomes included patient travel distance, gasoline consumption, carbon dioxide and fine particulate matter emissions as well as savings in main hospital energy use. RESULTS There were 3,846 and 307,273 virtual visits performed with valid Massachusetts geocoded addresses prior to and during the COVID-19 pandemic, respectively. During 1 year of the pandemic, virtual medicine services resulted in a total reduction of 620,231 gallons of fossil fuel use and $1,620,002 avoided expenditure as well as 5,492.9 metric tons of carbon dioxide and 186.3 kg of fine particulate matter emitted. There were 3.1 million fewer kilowatt hours used by the hospital intrapandemic compared to the year prior. Accounting for equipment emissions, the combined intrapandemic emission reductions are equivalent to the electricity required by 1,234 homes for 1 year. CONCLUSIONS Widespread pediatric institutional use of virtual medicine provided environmental benefits. The true potential of virtual medicine for decreasing the environmental footprint of health care lies in scaling this mode of care to patient groups across the state and nation when medically feasible.
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Affiliation(s)
- Julia B Finkelstein
- Department of Urology (JB Finkelstein and CR Estrada), Boston Children's Hospital, Boston, Mass; Department of Surgery (JB Finkelstein, CR Estrada, and JG Meara), Harvard Medical School, Boston, Mass
| | - Marissa Hauptman
- Division of General Pediatrics (M Hauptman, K Acosta, S Flanagan, A Bernstein, and SH Shah), Boston Children's Hospital, Boston, Mass; Department of Pediatrics (M Hauptman, S Flanagan, A Bernstein, and SH Shah), Harvard Medical School, Boston, Mass; Region 1 New England Pediatric Environmental Health Specialty Unit (M Hauptman, K Acosta, S Flanagan, A Bernstein, SH Shah), Boston, Mass.
| | - Keith Acosta
- Division of General Pediatrics (M Hauptman, K Acosta, S Flanagan, A Bernstein, and SH Shah), Boston Children's Hospital, Boston, Mass; Region 1 New England Pediatric Environmental Health Specialty Unit (M Hauptman, K Acosta, S Flanagan, A Bernstein, SH Shah), Boston, Mass
| | - Shelby Flanagan
- Division of General Pediatrics (M Hauptman, K Acosta, S Flanagan, A Bernstein, and SH Shah), Boston Children's Hospital, Boston, Mass; Department of Pediatrics (M Hauptman, S Flanagan, A Bernstein, and SH Shah), Harvard Medical School, Boston, Mass; Region 1 New England Pediatric Environmental Health Specialty Unit (M Hauptman, K Acosta, S Flanagan, A Bernstein, SH Shah), Boston, Mass
| | | | - Brian Smith
- Department of Engineering (B Smith), Boston Children's Hospital, Boston, Mass
| | - Aaron Bernstein
- Division of General Pediatrics (M Hauptman, K Acosta, S Flanagan, A Bernstein, and SH Shah), Boston Children's Hospital, Boston, Mass; Department of Pediatrics (M Hauptman, S Flanagan, A Bernstein, and SH Shah), Harvard Medical School, Boston, Mass; Region 1 New England Pediatric Environmental Health Specialty Unit (M Hauptman, K Acosta, S Flanagan, A Bernstein, SH Shah), Boston, Mass; Center for Climate, Health, and the Global Environment (C-CHANGE) (A Bernstein), Harvard T.H. Chan School of Public Health, Boston, Mass
| | - Shalini H Shah
- Division of General Pediatrics (M Hauptman, K Acosta, S Flanagan, A Bernstein, and SH Shah), Boston Children's Hospital, Boston, Mass; Department of Pediatrics (M Hauptman, S Flanagan, A Bernstein, and SH Shah), Harvard Medical School, Boston, Mass; Region 1 New England Pediatric Environmental Health Specialty Unit (M Hauptman, K Acosta, S Flanagan, A Bernstein, SH Shah), Boston, Mass
| | - Ravneet Kaur
- Innovation and Digital Health Accelerator (R Kaur and H Meyers), Boston Children's Hospital, Boston, Mass
| | - Heather Meyers
- Innovation and Digital Health Accelerator (R Kaur and H Meyers), Boston Children's Hospital, Boston, Mass
| | - Ankoor S Shah
- Department of Ophthalmology (AS Shah), Boston Children's Hospital, Harvard Medical School, Boston, Mass
| | - John G Meara
- Department of Surgery (JB Finkelstein, CR Estrada, and JG Meara), Harvard Medical School, Boston, Mass; Department of Plastic & Oral Surgery (JG Meara), Boston Children's Hospital, Boston, Mass
| | - Carlos R Estrada
- Department of Urology (JB Finkelstein and CR Estrada), Boston Children's Hospital, Boston, Mass; Department of Surgery (JB Finkelstein, CR Estrada, and JG Meara), Harvard Medical School, Boston, Mass
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10
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Yarsky E, Banzon TM, Phipatanakul W. Effects of Allergen Exposure and Environmental Risk Factors in Schools on Childhood Asthma. Curr Allergy Asthma Rep 2023; 23:613-620. [PMID: 37651001 PMCID: PMC11262705 DOI: 10.1007/s11882-023-01108-8] [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: 08/16/2023] [Indexed: 09/01/2023]
Abstract
PURPOSE OF REVIEW This review aims to assess the prevalence of common allergen exposures and environmental risk factors for asthma in schools, examine the underlying mechanisms of these environmental risk factors, and explore possible prevention strategies. RECENT FINDINGS Cockroach, mouse, dust mites, fungi, viral infections, ozone pollution, and cleaning products are common allergen exposures and environmental risk factors in schools which may affect asthma morbidity. Novel modifiable environmental risk factors in schools are also being investigated to identify potential associations with increased asthma morbidity. While several studies have investigated the benefit of environmental remediation strategies in schools and their impact on asthma morbidity, future studies are warranted to further define the effects of modifiable risk factors in schools and determine whether school mitigation strategies may help improve asthma symptoms in students with asthma.
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Affiliation(s)
- Eva Yarsky
- Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Tina M Banzon
- Division of Allergy and Immunology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Wanda Phipatanakul
- Division of Allergy and Immunology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
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11
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Goobie GC. Where you live matters: Roadways, air pollution and lung function in patients with idiopathic pulmonary fibrosis. Respirology 2023; 28:906-908. [PMID: 37536709 DOI: 10.1111/resp.14565] [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: 07/23/2023] [Accepted: 07/26/2023] [Indexed: 08/05/2023]
Abstract
See related article
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Affiliation(s)
- Gillian C Goobie
- Division of Respiratory Medicine, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Heart Lung Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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12
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Abstract
PURPOSE OF REVIEW Asthma is the most common chronic disease of childhood. Environmental exposures, such as allergens and pollutants, are ubiquitous factors associated with asthma development and asthma morbidity. In this review, we highlight the most recent studies relevant to childhood asthma risk, onset, and exacerbation related to air pollution exposure. RECENT FINDINGS In this article, we review current research that has been published between 2021 and 2022, demonstrating the effects of early-life exposure to key air pollutants (e.g., particulate matter (PM), nitrogen dioxide (NO 2 ), sulfur dioxide (SO 2 ) and ground-level ozone (O 3 ), environmental tobacco smoke, radon, and volatile organic compounds (VOC) on respiratory health. SUMMARY Air pollution continues to be a global burden with serious consequences related to respiratory health. Interventions aimed at reducing air pollution in the environment must be achieved in an effort to improve asthma outcomes and pediatric health.
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Affiliation(s)
- Lana Mukharesh
- Division of Pulmonary Medicine, Boston Children's Hospital
- Harvard Medical School
| | - Wanda Phipatanakul
- Harvard Medical School
- Division of Allergy and Immunology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Jonathan M Gaffin
- Division of Pulmonary Medicine, Boston Children's Hospital
- Harvard Medical School
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13
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Chakraborty J, Aun JJ. Social Inequities in Exposure to Traffic-Related Air and Noise Pollution at Public Schools in Texas. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5308. [PMID: 37047923 PMCID: PMC10094516 DOI: 10.3390/ijerph20075308] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 03/21/2023] [Accepted: 03/24/2023] [Indexed: 06/19/2023]
Abstract
Although children are particularly vulnerable to the adverse impacts of vehicular pollution and spend significant portions of their time at school, previous studies have not examined or compared school-level social inequities in exposure to both traffic-related air and noise pollution in the same study area. We addressed this gap through a case study in Texas-the second-largest US state based on total population and number of children. Vehicular pollution exposure was measured using: (1) outdoor concentrations of nitrogen dioxide (NO2), a widely used proxy for traffic-related air pollution; and (2) road noise estimates from the US Department of Transportation's National Transportation Noise Mapping Tool. These variables were linked to data on locations and sociodemographic characteristics of children enrolled in Texas public schools. We found children attending schools with the highest exposure to both NO2 and road noise (top 25%) were significantly more likely to be Black, Hispanic, and eligible for free/reduced lunches (socioeconomically deprived). Results from multivariable generalized estimating equations that control for spatial clustering and other relevant factors revealed that schools with greater NO2 exposure were significantly more likely to serve racial/ethnic minority and younger students, while schools with greater exposure to road noise were significantly more likely to serve socioeconomically deprived and older students. These findings underscore the urgent need to reduce both air pollution and noise exposure at school locations, especially in schools attended by higher proportions of socially disadvantaged children that are often additionally burdened with other challenges.
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14
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Burbank AJ, Hernandez ML, Jefferson A, Perry TT, Phipatanakul W, Poole J, Matsui EC. Environmental justice and allergic disease: A Work Group Report of the AAAAI Environmental Exposure and Respiratory Health Committee and the Diversity, Equity and Inclusion Committee. J Allergy Clin Immunol 2023; 151:656-670. [PMID: 36584926 PMCID: PMC9992350 DOI: 10.1016/j.jaci.2022.11.025] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 10/31/2022] [Accepted: 11/29/2022] [Indexed: 12/29/2022]
Abstract
Environmental justice is the concept that all people have the right to live in a healthy environment, to be protected against environmental hazards, and to participate in decisions affecting their communities. Communities of color and low-income populations live, work, and play in environments with disproportionate exposure to hazards associated with allergic disease. This unequal distribution of hazards has contributed to health disparities and is largely the result of systemic racism that promotes segregation of neighborhoods, disinvestment in predominantly racial/ethnic minority neighborhoods, and discriminatory housing, employment, and lending practices. The AAAAI Environmental Exposure and Respiratory Health Committee and Diversity, Equity and Inclusion Committee jointly developed this report to improve allergy/immunology specialists' awareness of environmental injustice, its roots in systemic racism, and its impact on health disparities in allergic disease. We present evidence supporting the relationship between exposure to environmental hazards, particularly at the neighborhood level, and the disproportionately high incidence and poor outcomes from allergic diseases in marginalized populations. Achieving environmental justice requires investment in at-risk communities to increase access to safe housing, clean air and water, employment opportunities, education, nutrition, and health care. Through policies that promote environmental justice, we can achieve greater health equity in allergic disease.
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Affiliation(s)
- Allison J Burbank
- Division of Pediatric Allergy and Immunology, University of North Carolina School of Medicine, Children's Research Institute, Chapel Hill, NC.
| | - Michelle L Hernandez
- Division of Pediatric Allergy and Immunology, University of North Carolina School of Medicine, Children's Research Institute, Chapel Hill, NC
| | - Akilah Jefferson
- University of Arkansas for Medical Sciences, Little Rock, Ark; Arkansas Children's Research Institute, Little Rock, Ark
| | - Tamara T Perry
- University of Arkansas for Medical Sciences, Little Rock, Ark; Arkansas Children's Research Institute, Little Rock, Ark
| | - Wanda Phipatanakul
- Division of Asthma, Allergy and Immunology, Boston Children's Hospital, Harvard Medical School, Boston, Mass
| | - Jill Poole
- Department of Internal Medicine, Division of Allergy and Immunology, University of Nebraska Medical Center, Omaha, Neb
| | - Elizabeth C Matsui
- Departments of Population Health and Pediatrics, Dell Medical School at University of Texas at Austin, Austin, Tex
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15
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Cheeseman MJ, Ford B, Anenberg SC, Cooper MJ, Fischer EV, Hammer MS, Magzamen S, Martin RV, van Donkelaar A, Volckens J, Pierce JR. Disparities in Air Pollutants Across Racial, Ethnic, and Poverty Groups at US Public Schools. GEOHEALTH 2022; 6:e2022GH000672. [PMID: 36467256 PMCID: PMC9714311 DOI: 10.1029/2022gh000672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 08/31/2022] [Accepted: 09/01/2022] [Indexed: 06/17/2023]
Abstract
We investigate socioeconomic disparities in air quality at public schools in the contiguous US using high resolution estimates of fine particulate matter (PM2.5) and nitrogen dioxide (NO2) concentrations. We find that schools with higher proportions of people of color (POC) and students eligible for the federal free or reduced lunch program, a proxy for poverty level, are associated with higher pollutant concentrations. For example, we find that the median annual NO2 concentration for White students, nationally, was 7.7 ppbv, compared to 9.2 ppbv for Black and African American students. Statewide and regional disparities in pollutant concentrations across racial, ethnic, and poverty groups are consistent with nationwide results, where elevated NO2 concentrations were associated with schools with higher proportions of POC and higher levels of poverty. Similar, though smaller, differences were found in PM2.5 across racial and ethnic groups in most states. Racial, ethnic, and economic segregation across the rural-urban divide is likely an important factor in pollution disparities at US public schools. We identify distinct regional patterns of disparities, highlighting differences between California, New York, and Florida. Finally, we highlight that disparities exist not only across urban and non-urban lines but also within urban environments.
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Affiliation(s)
| | - Bonne Ford
- Department of Atmospheric ScienceColorado State UniversityFort CollinsCOUSA
| | - Susan C. Anenberg
- Milken Institute School of Public HealthGeorge Washington UniversityWashingtonDCUSA
| | - Matthew J. Cooper
- Air Emission Priorities DivisionEnvironment Climate Change CanadaDartmouthNSCanada
| | - Emily V. Fischer
- Department of Atmospheric ScienceColorado State UniversityFort CollinsCOUSA
| | - Melanie S. Hammer
- Department of Energy, Environmental, and Chemical EngineeringWashington University in St. LouisSt. LouisMOUSA
| | - Sheryl Magzamen
- Department of Environmental and Radiological Health SciencesColorado State UniversityFort CollinsCOUSA
| | - Randall V. Martin
- Department of Energy, Environmental, and Chemical EngineeringWashington University in St. LouisSt. LouisMOUSA
| | - Aaron van Donkelaar
- Department of Energy, Environmental, and Chemical EngineeringWashington University in St. LouisSt. LouisMOUSA
| | - John Volckens
- Department of Mechanical EngineeringColorado State UniversityFort CollinsCOUSA
| | - Jeffrey R. Pierce
- Department of Atmospheric ScienceColorado State UniversityFort CollinsCOUSA
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16
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Putra IGNE, Astell-Burt T, Feng X. Caregiver perceptions of neighbourhood green space quality, heavy traffic conditions, and asthma symptoms: Group-based trajectory modelling and multilevel longitudinal analysis of 9,589 Australian children. ENVIRONMENTAL RESEARCH 2022; 212:113187. [PMID: 35358543 DOI: 10.1016/j.envres.2022.113187] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 03/06/2022] [Accepted: 03/23/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND This study assessed the associations between changes in exposure to green space quality, heavy traffic conditions, and asthma symptoms among children. METHODS 10-year cohort data of 9589 children, retrieved from the Longitudinal Study of Australian Children, were analysed. Caregiver-reported neighbourhood green space quality, heavy traffic conditions, and asthma symptoms were measured biennially. Group-based trajectory mixture models were used to develop trajectory groups, denoting different patterns of, or changes in, exposure to green space quality, heavy traffic conditions, and asthma symptoms across childhood. Multilevel multinomial logistic regression was used to identify factors associated with trajectory group membership and examine the confounders-adjusted associations between trajectory groups of green space quality, heavy traffic conditions, and asthma symptoms. RESULTS Four trajectory groups for each green space quality and heavy traffic conditions, and five trajectory groups for asthma symptoms were developed. Children in less disadvantaged areas were more likely to be in trajectory groups with exposure to quality green space, but less likely to be exposed to heavy neighbourhood traffic. Living in more remote areas was associated with the decreased likelihood to be in groups with exposure to both quality green space and heavy traffic conditions over time. Accumulation of exposure to quality green space across childhood was not found to be protective against asthma symptoms. However, children whose caregiver perceptions of heavy traffic conditions trended from low to moderate levels; or were consistently in high levels across childhood had a higher likelihood to be in trajectory groups with a higher risk of asthma symptoms. CONCLUSION Exposure to quality green space was not associated with the reduced risk of asthma symptoms. The accumulation of exposure to heavy traffic conditions increased the likelihood of asthma symptoms among children. Reducing the presence of heavy traffic in neighbourhoods might reduce the risk of childhood asthma.
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Affiliation(s)
- I Gusti Ngurah Edi Putra
- Population Wellbeing and Environment Research Lab (PowerLab), NSW, Australia; School of Health and Society, Faculty of the Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, NSW, Australia
| | - Thomas Astell-Burt
- Population Wellbeing and Environment Research Lab (PowerLab), NSW, Australia; School of Health and Society, Faculty of the Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, NSW, Australia
| | - Xiaoqi Feng
- Population Wellbeing and Environment Research Lab (PowerLab), NSW, Australia; School of Health and Society, Faculty of the Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, NSW, Australia; School of Population Health, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia.
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17
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Mortelliti CL, Banzon TM, Phipatanakul W, Vieira CZ. Environmental Exposures Impact Pediatric Asthma Within the School Environment. Immunol Allergy Clin North Am 2022; 42:743-760. [DOI: 10.1016/j.iac.2022.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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18
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Candeias J, Zimmermann EJ, Bisig C, Gawlitta N, Oeder S, Gröger T, Zimmermann R, Schmidt-Weber CB, Buters J. The priming effect of diesel exhaust on native pollen exposure at the air-liquid interface. ENVIRONMENTAL RESEARCH 2022; 211:112968. [PMID: 35240115 DOI: 10.1016/j.envres.2022.112968] [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: 11/08/2021] [Revised: 02/05/2022] [Accepted: 02/14/2022] [Indexed: 06/14/2023]
Abstract
UNLABELLED Pollen related allergic diseases have been increasing for decades. The reasons for this increase are unknown, but environmental pollution like diesel exhaust seem to play a role. While previous studies explored the effects of pollen extracts, we studied here for the first time priming effects of diesel exhaust on native pollen exposure using a novel experimental setup. METHODS Human bronchial epithelial BEAS-2B cells were exposed to native birch pollen (real life intact pollen, not pollen extracts) at the air-liquid interface (pollen-ALI). BEAS-2B cells were also pre-exposed in a diesel-ALI to diesel CAST for 2 h (a model for diesel exhaust) and then to pollen in the pollen-ALI 24 h later. Effects were analysed by genome wide transcriptome analysis after 2 h 25 min, 6 h 50 min and 24 h. Selected genes were confirmed by qRT-PCR. RESULTS Bronchial epithelial cells exposed to native pollen showed the highest transcriptomic changes after about 24 h. About 3157 genes were significantly up- or down-regulated for all time points combined. After pre-exposure to diesel exhaust the maximum reaction to pollen had shifted to about 2.5 h after exposure, plus the reaction to pollen was desensitised as only 560 genes were differentially regulated. Only 97 genes were affected synergistically. Of these, enrichment analysis showed that genes involved in immune and inflammatory response were involved. CONCLUSION Diesel exhaust seems to prime cells to react more rapidly to native pollen exposure, especially inflammation related genes, a factor known to facilitate the development of allergic sensitization. The marker genes here detected could guide studies in humans when investigating whether modern and outdoor diesel exhaust exposure is still detrimental for the development of allergic disease.
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Affiliation(s)
- Joana Candeias
- Center Allergy & Environment (ZAUM), Member of the German Center for Lung Research (DZL), Technical University Munich / Helmholtz Center Munich, Germany
| | - Elias J Zimmermann
- Joint Mass Spectrometry Center (JMSC) at Comprehensive Molecular Analytics (CMA), Helmholtz Center Munich, Ingolstädter Landstraße 1, D-85764, Neuherberg, Germany; Joint Mass Spectrometry Center (JMSC) at Analytical Chemistry, Institute of Chemistry, University of Rostock, Dr. Lorenzweg 2, D-18051, Rostock, Germany
| | - Christoph Bisig
- Joint Mass Spectrometry Center (JMSC) at Comprehensive Molecular Analytics (CMA), Helmholtz Center Munich, Ingolstädter Landstraße 1, D-85764, Neuherberg, Germany
| | - Nadine Gawlitta
- Joint Mass Spectrometry Center (JMSC) at Comprehensive Molecular Analytics (CMA), Helmholtz Center Munich, Ingolstädter Landstraße 1, D-85764, Neuherberg, Germany; Joint Mass Spectrometry Center (JMSC) at Analytical Chemistry, Institute of Chemistry, University of Rostock, Dr. Lorenzweg 2, D-18051, Rostock, Germany
| | - Sebastian Oeder
- Joint Mass Spectrometry Center (JMSC) at Comprehensive Molecular Analytics (CMA), Helmholtz Center Munich, Ingolstädter Landstraße 1, D-85764, Neuherberg, Germany
| | - Thomas Gröger
- Joint Mass Spectrometry Center (JMSC) at Comprehensive Molecular Analytics (CMA), Helmholtz Center Munich, Ingolstädter Landstraße 1, D-85764, Neuherberg, Germany
| | - Ralf Zimmermann
- Joint Mass Spectrometry Center (JMSC) at Comprehensive Molecular Analytics (CMA), Helmholtz Center Munich, Ingolstädter Landstraße 1, D-85764, Neuherberg, Germany; Joint Mass Spectrometry Center (JMSC) at Analytical Chemistry, Institute of Chemistry, University of Rostock, Dr. Lorenzweg 2, D-18051, Rostock, Germany
| | - Carsten B Schmidt-Weber
- Center Allergy & Environment (ZAUM), Member of the German Center for Lung Research (DZL), Technical University Munich / Helmholtz Center Munich, Germany
| | - Jeroen Buters
- Center Allergy & Environment (ZAUM), Member of the German Center for Lung Research (DZL), Technical University Munich / Helmholtz Center Munich, Germany.
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19
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Samuels EA, Taylor RA, Pendyal A, Shojaee A, Mainardi AS, Lemire ER, Venkatesh AK, Bernstein SL, Haber AL. Mapping emergency department asthma visits to identify poor-quality housing in New Haven, CT, USA: a retrospective cohort study. Lancet Public Health 2022; 7:e694-e704. [PMID: 35907420 PMCID: PMC9387147 DOI: 10.1016/s2468-2667(22)00143-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 05/24/2022] [Accepted: 05/31/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Housing conditions are a key driver of asthma incidence and severity. Previous studies have shown increased emergency department visits for asthma among residents living in poor-quality housing. Interventions to improve housing conditions have been shown to reduce emergency department visits for asthma, but identification and remediation of poor housing conditions is often delayed or does not occur. This study evaluates whether emergency department visits for asthma can be used to identify poor-quality housing to support proactive and early intervention. METHODS We conducted a retrospective cohort study of children and adults living in and around New Haven, CT, USA, who were seen for asthma in an urban, tertiary emergency department between March 1, 2013, and Aug 31, 2017. We geocoded and mapped patient addresses to city parcels, and calculated a composite estimate of the incidence of emergency department use for asthma for each parcel (Nv × Np/log2[P], where Nv is the estimated mean number of visits per patient, Np is the number of patients, and P is the estimated population). To determine whether parcel-level emergency department use for asthma was associated with public housing inspection scores, we used regression analyses, adjusting for neighbourhood-level and individual-level factors contributing to emergency department use for asthma. Public housing complex inspection scores were obtained from standardised home inspections, which are conducted every 1-3 years for publicly funded housing. We used a sliding-window approach to estimate how far in advance of a failed inspection the model could identify elevated use of emergency departments for asthma, using the city-wide 90th percentile as a cutoff for elevated incidence. FINDINGS 11 429 asthma-related emergency department visits from 6366 unique patients were included in the analysis. Mean patient age was 32·4 years (SD 12·8); 3836 (60·3%) patients were female, 2530 (39·7%) were male, 3461 (57·2%) were Medicaid-insured, and 2651 (41·6%) were Black. Incidence of emergency department use for asthma was strongly correlated with lower housing inspection scores (Pearson's r=-0·55 [95% CI -0·70 to -0·35], p=3·5 × 10-6), and this correlation persisted after adjustment for patient-level and neighbourhood-level demographics using a linear regression model (r=-0·54 [-0·69 to -0·33], p=7·1 × 10-6) and non-linear regression model (r=-0·44 [-0·62 to -0·21], p=3·8 × 10-4). Elevated asthma incidence rates were typically detected around a year before a housing complex failed a housing inspection. INTERPRETATION Emergency department visits for asthma are an early indicator of failed housing inspections. This approach represents a novel method for the early identification of poor housing conditions and could help to reduce asthma-related morbidity and mortality. FUNDING Harvard-National Institute of Environmental Health Sciences (NIEHS) Center for Environmental Health.
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Affiliation(s)
- Elizabeth A Samuels
- Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI, USA
| | | | - Akshay Pendyal
- Novant Health Heart and Vascular Institute, Presbyterian Medical Center, Charlotte, NC, USA
| | - Abbas Shojaee
- Center for Genomics and Systems Biology, Department of Biology, New York University, New York, NY, USA
| | - Anne S Mainardi
- Department of Medicine, University of Tennessee Health Sciences Center, College of Medicine Chattanooga, Chattanooga, TN, USA
| | - Evan R Lemire
- Department of Environmental Health, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Arjun K Venkatesh
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Steven L Bernstein
- Emergency Medicine, Geisel School of Medicine at Dartmouth, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Adam L Haber
- Department of Environmental Health, Harvard T H Chan School of Public Health, Boston, MA, USA.
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20
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Banzon TM, Phipatanakul W. Environmental Interventions for Asthma. Semin Respir Crit Care Med 2022; 43:720-738. [PMID: 35803266 DOI: 10.1055/s-0042-1749453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Exposure and sensitization to environmental factors play a fundamental role in asthma development and is strongly associated with asthma morbidity. While hereditary factors are critical determinants of asthma, exposures to environmental factors are implicated in the phenotypic expression of asthma and have been strongly associated in the risk of its development. Significant interest has thus been geared toward potentially modifiable environmental exposures which may lead to the development of asthma. Allergen exposure, in particular indoor allergens, plays a significant role in the pathogenesis of asthma, and remediation is a primary component of asthma management. In the home, multifaceted and multitargeted environmental control strategies have been shown to reduce home exposures and improve asthma outcomes. In addition to the home environment, assessment of the school, daycare, and workplace environments of patients with asthma is necessary to ensure appropriate environmental control measures in conjunction with medical care. This article will discuss the role of the environment on asthma, review targeted environmental therapy, and examine environmental control measures to suppress environmental exposures in the home and school setting.
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Affiliation(s)
- Tina M Banzon
- Deparmtent of Allergy and Immunology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Wanda Phipatanakul
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts.,Division of Immunology, Clinical Research Center, Boston Children's Hospital, Asthma, Allergy and Immunology, Boston, Massachusetts
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21
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Fecho K, Ahalt SC, Knowles M, Krishnamurthy A, Leigh M, Morton K, Pfaff E, Wang M, Yi H. Leveraging Open Electronic Health Record Data and Environmental Exposures Data to Derive Insights Into Rare Pulmonary Disease. Front Artif Intell 2022; 5:918888. [PMID: 35837616 PMCID: PMC9274244 DOI: 10.3389/frai.2022.918888] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 05/31/2022] [Indexed: 11/30/2022] Open
Abstract
Research on rare diseases has received increasing attention, in part due to the realized profitability of orphan drugs. Biomedical informatics holds promise in accelerating translational research on rare disease, yet challenges remain, including the lack of diagnostic codes for rare diseases and privacy concerns that prevent research access to electronic health records when few patients exist. The Integrated Clinical and Environmental Exposures Service (ICEES) provides regulatory-compliant open access to electronic health record data that have been integrated with environmental exposures data, as well as analytic tools to explore the integrated data. We describe a proof-of-concept application of ICEES to examine demographics, clinical characteristics, environmental exposures, and health outcomes among a cohort of patients enriched for phenotypes associated with cystic fibrosis (CF), idiopathic bronchiectasis (IB), and primary ciliary dyskinesia (PCD). We then focus on a subset of patients with CF, leveraging the availability of a diagnostic code for CF and serving as a benchmark for our development work. We use ICEES to examine select demographics, co-diagnoses, and environmental exposures that may contribute to poor health outcomes among patients with CF, defined as emergency department or inpatient visits for respiratory issues. We replicate current understanding of the pathogenesis and clinical manifestations of CF by identifying co-diagnoses of asthma, chronic nasal congestion, cough, middle ear disease, and pneumonia as factors that differentiate patients with poor health outcomes from those with better health outcomes. We conclude by discussing our preliminary findings in relation to other published work, the strengths and limitations of our approach, and our future directions.
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Affiliation(s)
- Karamarie Fecho
- Renaissance Computing Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Stanley C. Ahalt
- Renaissance Computing Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Michael Knowles
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Ashok Krishnamurthy
- Renaissance Computing Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Margaret Leigh
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | | | - Emily Pfaff
- North Carolina Clinical and Translational Sciences Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Max Wang
- CoVar Applied Technologies, Durham, NC, United States
| | - Hong Yi
- Renaissance Computing Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
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22
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Fecho K, Ahalt SC, Appold S, Arunachalam S, Pfaff E, Stillwell L, Valencia A, Xu H, Peden DB. Development and Application of an Open Tool for Sharing and Analyzing Integrated Clinical and Environmental Exposures Data: Asthma Use Case. JMIR Form Res 2022; 6:e32357. [PMID: 35363149 PMCID: PMC9015759 DOI: 10.2196/32357] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 12/21/2021] [Accepted: 12/22/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The Integrated Clinical and Environmental Exposures Service (ICEES) serves as an open-source, disease-agnostic, regulatory-compliant framework and approach for openly exposing and exploring clinical data that have been integrated at the patient level with a variety of environmental exposures data. ICEES is equipped with tools to support basic statistical exploration of the integrated data in a completely open manner. OBJECTIVE This study aims to further develop and apply ICEES as a novel tool for openly exposing and exploring integrated clinical and environmental data. We focus on an asthma use case. METHODS We queried the ICEES open application programming interface (OpenAPI) using a functionality that supports chi-square tests between feature variables and a primary outcome measure, with a Bonferroni correction for multiple comparisons (α=.001). We focused on 2 primary outcomes that are indicative of asthma exacerbations: annual emergency department (ED) or inpatient visits for respiratory issues; and annual prescriptions for prednisone. RESULTS Of the 157,410 patients within the asthma cohort, 26,332 (16.73%) had 1 or more annual ED or inpatient visits for respiratory issues, and 17,056 (10.84%) had 1 or more annual prescriptions for prednisone. We found that close proximity to a major roadway or highway, exposure to high levels of particulate matter ≤2.5 μm (PM2.5) or ozone, female sex, Caucasian race, low residential density, lack of health insurance, and low household income were significantly associated with asthma exacerbations (P<.001). Asthma exacerbations did not vary by rural versus urban residence. Moreover, the results were largely consistent across outcome measures. CONCLUSIONS Our results demonstrate that the open-source ICEES can be used to replicate and extend published findings on factors that influence asthma exacerbations. As a disease-agnostic, open-source approach for integrating, exposing, and exploring patient-level clinical and environmental exposures data, we believe that ICEES will have broad adoption by other institutions and application in environmental health and other biomedical fields.
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Affiliation(s)
- Karamarie Fecho
- Renaissance Computing Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Stanley C Ahalt
- Renaissance Computing Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Stephen Appold
- Kenan-Flagler Business School, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Saravanan Arunachalam
- Institute for the Environment, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Emily Pfaff
- North Carolina Translational and Clinical Sciences Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Lisa Stillwell
- Renaissance Computing Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Alejandro Valencia
- Institute for the Environment, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Hao Xu
- Renaissance Computing Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - David B Peden
- North Carolina Translational and Clinical Sciences Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Division of Allergy & Immunology, Department of Pediatrics, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Center for Environmental Medicine, Asthma and Lung Biology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
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23
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Shoari N, Heydari S, Blangiardo M. School neighbourhood and compliance with WHO-recommended annual NO 2 guideline: A case study of Greater London. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 803:150038. [PMID: 34525726 DOI: 10.1016/j.scitotenv.2021.150038] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 08/10/2021] [Accepted: 08/26/2021] [Indexed: 06/13/2023]
Abstract
Despite several national and local policies towards cleaner air in England, many schools in London breach the WHO-recommended concentrations of air pollutants such as NO2 and PM2.5. This is while, previous studies highlight significant adverse health effects of air pollutants on children's health. In this paper we adopted a Bayesian spatial hierarchical model to investigate factors that affect the odds of schools exceeding the WHO-recommended concentration of NO2 (i.e., 40 μg/m3 annual mean) in Greater London (UK). We considered a host of variables including schools' characteristics as well as their neighbourhoods' attributes from household, socioeconomic, transport-related, land use, built and natural environment characteristics perspectives. The results indicated that transport-related factors including the number of traffic lights and bus stops in the immediate vicinity of schools, and borough-level bus fuel consumption are determinant factors that increase the likelihood of non-compliance with the WHO guideline. In contrast, distance from roads, river transport, and underground stations, vehicle speed (an indicator of traffic congestion), the proportion of borough-level green space, and the area of green space at schools reduce the likelihood of exceeding the WHO recommended concentration of NO2. We repeated our analysis under a hypothetical scenario in which the recommended concentration of NO2 is 35 μg/m3 - instead of 40 μg/m3. Our results underscore the importance of adopting clean fuel technologies on buses, installing green barriers, and reducing motorised traffic around schools in reducing exposure to NO2 concentrations in proximity to schools. Also, our findings highlight the presence of environmental inequalities in the Greater London area. This study would be useful for local authority decision making with the aim of improving air quality for school-aged children in urban settings.
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Affiliation(s)
- Niloofar Shoari
- MRC Centre for Environment & Health, Department of Epidemiology and Biostatistics, Imperial College London, London, UK.
| | - Shahram Heydari
- Department of Civil, Maritime, and Environmental Engineering, University of Southampton, UK
| | - Marta Blangiardo
- MRC Centre for Environment & Health, Department of Epidemiology and Biostatistics, Imperial College London, London, UK
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Lin TY, Lin HC, Liu YS, Lo YL, Wang CH, Chang PJ, Lo CY, Lin SM. Proximity to Heavy Traffic Roads and Patient Characteristics of Late of Onset Asthma in an Urban Asthma Center. Front Med (Lausanne) 2021; 8:783720. [PMID: 34977086 PMCID: PMC8716741 DOI: 10.3389/fmed.2021.783720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 11/15/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Traffic-related pollution is associated with the onset of asthma and the development of different phenotypes of asthma. Few studies have investigated the association between traffic proximity and late-onset of asthma (LOA) and early-onset asthma (EOA). This study was conducted to investigate the associations of LOA phenotypes with a function of the distance between residence and heavy traffic roads (HTRs).Methods: The study group consisted of 280 patients who were (LOA: 78.4%) recruited consecutively from a pay-for-performance asthma program to clarify the patient characteristics and proximity to HTRs within 1,000 m from their residences between EOA and LOA in three urban centers in Taiwan. The subsequent analysis focused on patients with LOA (n = 210) linking phenotypes and distance to HTRs.Results: Subjects with LOA tended to be older than those with EOA and had shorter asthma duration, poorer lung function, lower atopy, and less exposure to fumes or dust at home. Patients with LOA were more likely than those with EOA to live within 900 m of two or more HTRs (14.3 vs. 3.4%, p = 0.02). Among patients with LOA, minimum distance to an HTR was negatively associated with numbers of specific IgE as well as positively associated with the age of onset and body weight significantly. A higher proportion of patients with atopy (26.3 vs. 20.6%, p = 0.001. odds ratio [OR]: 2.82) and anxiety/depression (21.0 vs. 18.1%, p = 0.047. OR: 1.81) and a trend of lower proportion of patients with obese (5.7 vs. 12.4%, p = 0.075) were found to be living within 900 m from HTRs.Conclusions: Late-onset of asthma (LOA) tended to live in areas of higher HTR density compared to EOAs. Among patients with LOA living close to HTRs, the interaction between traffic-related pollution, allergy sensitization, and mood status were the factors associated with asthma onset early. Obesity may be the factor for later onset who live far from HTRs.
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Affiliation(s)
- Ting-Yu Lin
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Taipei, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Horng-Chyuan Lin
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Taipei, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yun-Sheng Liu
- BalDr Strategic Consulting (Hong Kong) Ltd., Taipei, Taiwan
| | - Yu-Lun Lo
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Taipei, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chun-Hua Wang
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Taipei, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Po-Jui Chang
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Taipei, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chun-Yu Lo
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Taipei, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Shu-Min Lin
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Taipei, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- *Correspondence: Shu-Min Lin
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Miller RL, Grayson MH, Strothman K. Advances in asthma: New understandings of asthma's natural history, risk factors, underlying mechanisms, and clinical management. J Allergy Clin Immunol 2021; 148:1430-1441. [PMID: 34655640 DOI: 10.1016/j.jaci.2021.10.001] [Citation(s) in RCA: 83] [Impact Index Per Article: 27.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 10/11/2021] [Accepted: 10/11/2021] [Indexed: 10/20/2022]
Abstract
The last 2 years yielded a proliferation of high-quality asthma research. These include new understandings of the incidence and natural history of asthma, findings on the effects of exposure to air pollution, allergens, and intake of acetaminophen, soy isoflavones, and polyunsaturated fatty acids, and exposure to microbial products. The past 2 years have benefited from great strides in determining potential mechanisms of asthma development and asthma exacerbations. These novel understandings led to identification and development of exciting new avenues for potential therapeutic intervention. Finally, there has been significant progress made in the development of tools to facilitate the diagnosis of asthma and measurement of airway physiology and in precision diagnostic approaches. Asthma guidelines were updated and new insights into the pharmacologic management of patients, including biologics, were reported. We review the most notable advances in the natural history of asthma, risk factors for the development of asthma, underlying mechanisms, diagnostic approaches, and treatments. Although greater knowledge of the mechanisms underlying responses and nonresponses to novel therapeutics and across asthma phenotypes would be beneficial, the progress over just the past 2 years has been immense and impactful.
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Affiliation(s)
- Rachel L Miller
- Division of Clinical Immunology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY.
| | - Mitchell H Grayson
- Division of Allergy and Immunology, Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio; Center for Clinical and Translational Research, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio
| | - Kasey Strothman
- Division of Allergy and Immunology, Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio
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Feasibility and acceptability of monitoring personal air pollution exposure with sensors for asthma self-management. Asthma Res Pract 2021; 7:13. [PMID: 34482835 PMCID: PMC8420032 DOI: 10.1186/s40733-021-00079-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Accepted: 08/08/2021] [Indexed: 11/18/2022] Open
Abstract
Background Exposure to fine particulate matter (PM2.5) increases the risk of asthma exacerbations, and thus, monitoring personal exposure to PM2.5 may aid in disease self-management. Low-cost, portable air pollution sensors offer a convenient way to measure personal pollution exposure directly and may improve personalized monitoring compared with traditional methods that rely on stationary monitoring stations. We aimed to understand whether adults with asthma would be willing to use personal sensors to monitor their exposure to air pollution and to assess the feasibility of using sensors to measure real-time PM2.5 exposure. Methods We conducted semi-structured interviews with 15 adults with asthma to understand their willingness to use a personal pollution sensor and their privacy preferences with regard to sensor data. Student research assistants used HabitatMap AirBeam devices to take PM2.5 measurements at 1-s intervals while walking in Philadelphia neighborhoods in May–August 2018. AirBeam PM2.5 measurements were compared to concurrent measurements taken by three nearby regulatory monitors. Results All interview participants stated that they would use a personal air pollution sensor, though the consensus was that devices should be small (watch- or palm-sized) and light. Patients were generally unconcerned about privacy or sharing their GPS location, with only two stating they would not share their GPS location under any circumstances. PM2.5 measurements were taken using AirBeam sensors on 34 walks that extended through five Philadelphia neighborhoods. The range of sensor PM2.5 measurements was 0.6–97.6 μg/mL (mean 6.8 μg/mL), compared to 0–22.6 μg/mL (mean 9.0 μg/mL) measured by nearby regulatory monitors. Compared to stationary measurements, which were only available as 1-h integrated averages at discrete monitoring sites, sensor measurements permitted characterization of fine-scale fluctuations in PM2.5 levels over time and space. Conclusions Patients were generally interested in using sensors to monitor their personal exposure to PM2.5 and willing to share personal sensor data with health care providers and researchers. Compared to traditional methods of personal exposure assessment, sensors captured personalized air quality information at higher spatiotemporal resolution. Improvements to currently available sensors, including more reliable Bluetooth connectivity, increased portability, and longer battery life would facilitate their use in a general patient population. Supplementary Information The online version contains supplementary material available at 10.1186/s40733-021-00079-9.
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Spatial Modeling of Asthma-Prone Areas Using Remote Sensing and Ensemble Machine Learning Algorithms. REMOTE SENSING 2021. [DOI: 10.3390/rs13163222] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
In this study, asthma-prone area modeling of Tehran, Iran was provided by employing three ensemble machine learning algorithms (Bootstrap aggregating (Bagging), Adaptive Boosting (AdaBoost), and Stacking). First, a spatial database was created with 872 locations of asthma patients and affecting factors (particulate matter (PM10 and PM2.5), ozone (O3), sulfur dioxide (SO2), carbon monoxide (CO), nitrogen dioxide (NO2), rainfall, wind speed, humidity, temperature, distance to street, traffic volume, and a normalized difference vegetation index (NDVI)). We created four factors using remote sensing (RS) imagery, including air pollution (O3, SO2, CO, and NO2), altitude, and NDVI. All criteria were prepared using a geographic information system (GIS). For modeling and validation, 70% and 30% of the data were used, respectively. The weight of evidence (WOE) model was used to assess the spatial relationship between the dependent and independent data. Finally, three ensemble algorithms were used to perform asthma-prone areas mapping. According to the Gini index, the most influential factors on asthma occurrence were distance to the street, NDVI, and traffic volume. The area under the curve (AUC) of receiver operating characteristic (ROC) values for the AdaBoost, Bagging, and Stacking algorithms was 0.849, 0.82, and 0.785, respectively. According to the findings, the AdaBoost algorithm outperforms the Bagging and Stacking algorithms in spatial modeling of asthma-prone areas.
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Huang W, Schinasi LH, Kenyon CC, Moore K, Melly S, Hubbard RA, Zhao Y, Diez Roux AV, Forrest CB, Maltenfort M, De Roos AJ. Effects of ambient air pollution on childhood asthma exacerbation in the Philadelphia metropolitan Region, 2011-2014. ENVIRONMENTAL RESEARCH 2021; 197:110955. [PMID: 33676951 DOI: 10.1016/j.envres.2021.110955] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 01/22/2021] [Accepted: 03/01/2021] [Indexed: 06/12/2023]
Abstract
Fine particulate matter (PM2.5) and ozone (O3) air pollutants are known risk factors for asthma exacerbation. We studied the association of these air pollutants with pediatric asthma exacerbation in the Philadelphia metropolitan region, and evaluated potential effect modification by children's characteristics (e.g., race/ethnicity, atopic conditions) and environmental factors (e.g., neighborhood tree canopy, meteorological factors, aeroallergens). We conducted a time-stratified case-crossover study of 54,632 pediatric (age ≤18 years) asthma exacerbation cases occurring from 2011 to 2014, identified through electronic health records (EHR) of the Children's Hospital of Philadelphia (CHOP) health system. We applied conditional logistic regression to estimate associations between air pollution and asthma exacerbation, using daily census-tract level pollutant concentrations estimated from the EPA Fused Air Quality Surface Using Downscaling (FAQSD) files. The associations were estimated within warm (Apr-Sep) and cold (Oct-Mar) months for unlagged exposure and for cumulative effects up to 5 days after exposure, with adjustment for temperature, relative humidity, and holidays. We found small increases in odds of asthma exacerbation with higher pollutant concentrations, with positive associations (OR, comparing concentrations of 75th to 25th percentile) observed for PM2.5 during both warm (1.03, 95% CI: 0.98-1.08) and cold months (1.05, 95% CI: 1.02-1.07), and for O3 during cold months (1.08, 95% CI: 1.02-1.14). The exposure-response relationship with PM2.5 during the cold months was essentially linear, whereas thresholds of effect were observed for the other associations at low-medium pollutant concentrations. Results were robust to multi-pollutant modeling and adjustment for additional covariates. We found no effect modification by most children's characteristics, while effect sizes were higher on days with detected tree and grass pollens during warm months. Our results suggest that even small decreases in pollutant concentrations could potentially reduce risk of childhood asthma exacerbation - an important finding, given the high burden of childhood asthma and known disparities in asthma control.
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Affiliation(s)
- Wanyu Huang
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA.
| | - Leah H Schinasi
- Department of Environmental and Occupational Health, Dornsife School of Public Health, Drexel University, PA, USA; Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Chén C Kenyon
- PolicyLab, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Kari Moore
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Steven Melly
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Rebecca A Hubbard
- Department of Biostatistics, Epidemiology & Informatics, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Yuzhe Zhao
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Ana V Diez Roux
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA; Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Christopher B Forrest
- The Applied Clinical Research Center, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Mitchell Maltenfort
- The Applied Clinical Research Center, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Anneclaire J De Roos
- Department of Environmental and Occupational Health, Dornsife School of Public Health, Drexel University, PA, USA; Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
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Vicens P, Heredia L, Bustamante E, Pérez Y, Domingo JL, Torrente M. Does living close to a petrochemical complex increase the adverse psychological effects of the COVID-19 lockdown? PLoS One 2021; 16:e0249058. [PMID: 33730077 PMCID: PMC7968890 DOI: 10.1371/journal.pone.0249058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 03/10/2021] [Indexed: 11/19/2022] Open
Abstract
The petrochemical industry has made the economic development of many local communities possible, increasing employment opportunities and generating a complex network of closely-related secondary industries. However, it is known that petrochemical industries emit air pollutants, which have been related to different negative effects on mental health. In addition, many people around the world are being exposed to highly stressful situations deriving from the COVID-19 pandemic and the lockdowns adopted by national and regional governments. The present study aims to analyse the possible differential effects on various psychological outcomes (stress, anxiety, depression and emotional regulation strategies) stemming from the COVID-19 pandemic and consequent lockdown experienced by individuals living near an important petrochemical complex and subjects living in other areas, nonexposed to the characteristic environmental pollutants emitted by these kinds of complex. The sample consisted of 1607 subjects who answered an ad hoc questionnaire on lockdown conditions, the Perceived Stress Scale (PSS), the Hospital Anxiety and Depression Scale (HADS), the Barratt Impulsivity Scale (BIS) and the Emotional Regulation Questionnaire (ERQ). The results indicate that people living closer to petrochemical complexes reported greater risk perception [K = 73.42, p < 0.001, with a medium size effect (η2 = 0.061)]. However, no significant relationship between psychological variables and proximity to the focus was detected when comparing people living near to or far away from a chemical/petrochemical complex. Regarding the adverse psychological effects of the first lockdown due to COVID-19 on the general population in Catalonia, we can conclude that the conditions included in this survey were mainly related to changes in the participants' impulsivity levels, with different total impulsivity scores being obtained if they had minors in their care (p<0.001), if they had lost their jobs, if they were working (p<0.001), if they were not telecommuting (p<0.001), if they went out to work (p<0.001) or if they established routines (p = 0.009). However, we can also be fairly certain that the economic effects are going to be worse than those initially detected in this study. More research will be necessary to corroborate our results.
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Affiliation(s)
- Paloma Vicens
- Department of Psychology, CRAMC (Research Center for Behavior Assessment), Universitat Rovira i Virgili, Tarragona, Spain
- Laboratory of Toxicology and Environmental Health, TECNATOX, School of Medicine, Universitat Rovira i Virgili, Reus, Spain
| | - Luis Heredia
- Department of Psychology, CRAMC (Research Center for Behavior Assessment), Universitat Rovira i Virgili, Tarragona, Spain
- Laboratory of Toxicology and Environmental Health, TECNATOX, School of Medicine, Universitat Rovira i Virgili, Reus, Spain
| | - Edgar Bustamante
- Department of Geography, GRATET, Universitat Rovira i Virgili, Vila-seca, Spain
| | - Yolanda Pérez
- Department of Geography, GRATET, Universitat Rovira i Virgili, Vila-seca, Spain
| | - José L. Domingo
- Laboratory of Toxicology and Environmental Health, TECNATOX, School of Medicine, Universitat Rovira i Virgili, Reus, Spain
| | - Margarita Torrente
- Department of Psychology, CRAMC (Research Center for Behavior Assessment), Universitat Rovira i Virgili, Tarragona, Spain
- Laboratory of Toxicology and Environmental Health, TECNATOX, School of Medicine, Universitat Rovira i Virgili, Reus, Spain
- * E-mail:
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Bonyadi Z, Arfaeinia H, Fouladvand M, Farjadfard S, Omidvar M, Ramavandi B. Impact of exposure to ambient air pollutants on the admission rate of hospitals for asthma disease in Shiraz, southern Iran. CHEMOSPHERE 2021; 262:128091. [PMID: 33182159 DOI: 10.1016/j.chemosphere.2020.128091] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 08/18/2020] [Accepted: 08/19/2020] [Indexed: 06/11/2023]
Abstract
Asthma is a common chronic respiratory disease in the world. Short-term exposure to ambient air pollutants is closely related to acute respiratory diseases and asthmatic symptoms. The purpose of this research was to estimate the correlation between exposure to three air pollutants (O3, NO2, and SO2) and hospital admission because of asthmatic disease (HAAD) in the city of Shiraz, southern Iran. The data were collected from the two real-time monitoring stations located in this city. The acquired information was used for developing predictive models by the AirQ software. The findings of this study were reported for two age groups (<15 and 15-64 years old). The highest levels of O3, NO2, and SO2 were obtained 187.33 μg/m3, 34.1 μg/m3, and 491.2 μg/m3 in 2016, respectively, and 227.75 μg/m3, 92.26 μg/m3, and 190.21 μg/m3, respectively, in 2017. Among the mentioned pollutants, the yearly average concentration of SO2 was 8.62 times more than the WHO guideline, during the studied times. The number of extra cases of HAAD for <15 years and 15-64 years caused by the air pollutants in Shiraz were estimated to be 273 and 36, respectively, in 2016, and 243 and 30 for 2017, respectively. The results of this work displayed that air pollutants have caused respiratory problems in Shiraz city. The AirQ model is a facile and potential tool for the prediction of asthma disease to reduce the health risk of atmospheric pollutants in the worldwide.
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Affiliation(s)
- Ziaeddin Bonyadi
- Department of Environmental Health Engineering, Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hossein Arfaeinia
- Department of Environmental Health Engineering, Faculty of Health and Nutrition, Bushehr University of Medical Sciences, Bushehr, Iran; Systems Environmental Health and Energy Research Center, The Persian Gulf Biomedical Sciences Research Institute, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Moradali Fouladvand
- The Persian Gulf Marine Biotechnology Research Center, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Sima Farjadfard
- Department of Environmental Engineering, Graduate School of the Environment and Energy, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Mohsen Omidvar
- Department of Occupational Health Engineering, Faculty of Health and Nutrition, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Bahman Ramavandi
- Department of Environmental Health Engineering, Faculty of Health and Nutrition, Bushehr University of Medical Sciences, Bushehr, Iran; Systems Environmental Health and Energy Research Center, The Persian Gulf Biomedical Sciences Research Institute, Bushehr University of Medical Sciences, Bushehr, Iran.
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Hopp RJ, Wilson MC, Pasha MA. Small Airway Disease in Pediatric Asthma: the Who, What, When, Where, Why, and How to Remediate. A Review and Commentary. Clin Rev Allergy Immunol 2020; 62:145-159. [PMID: 33241492 DOI: 10.1007/s12016-020-08818-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2020] [Indexed: 12/18/2022]
Abstract
Asthma affects all portions of the airways. Small airways, however, comprise a substantial component of the conducting lung air flow. In asthma, inflammatory processes can affect the whole respiratory tract, from central to peripheral/small airways. The emphasis in adult and pediatric respiratory disease clinics is to focus on large airway obstruction and reversibility. This information, although valuable, underemphasizes a large portion of the conduction airway of asthmatics. Standard descriptions of asthma management focus on a multiple medication approaches. We particularly focused on the management of asthma in the international guidelines for the Global Initiative for Asthma (GINA). Overall, however, minimal attention is placed on the small airway pool in asthma medical management. We took the opportunity to thoroughly review and present specific data from the adult asthma literature which supported the concept that small airway abnormalities may play a role in the pathogenesis and clinical expression of asthma. Based on the conclusions of the adult asthma literature, we here present a thorough review of the literature as it relates to small airway disease in children with asthma. We used, collectively, individual data sources of data to expand the information available from standard diagnostic techniques, especially spirometry, in the evaluation of small airway disease. As the pharmacological approaches to moderate to severe asthma are advancing rapidly into the realm of biologics, we sought to present potential pharmacological options for small airway dysfunction in pediatrics prior to biological modifier intervention.
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Affiliation(s)
- Russell J Hopp
- Department of Pediatrics, University of Nebraska Medical Center and Children's Hospital and Medical Center, Omaha, NE, 68114, USA.
| | - Mark C Wilson
- Department of Pediatrics, University of Nebraska Medical Center and Children's Hospital and Medical Center, Omaha, NE, 68114, USA
| | - M Asghar Pasha
- Division of Allergy and Immunology, Albany Medical College, 176 Washington Avenue Extension, Suite 102, Albany, NY, 12203, USA
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Residential proximity to major roads and fecundability in a preconception cohort. Environ Epidemiol 2020; 4:e112. [PMID: 33778352 PMCID: PMC7941774 DOI: 10.1097/ee9.0000000000000112] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 08/07/2020] [Indexed: 02/06/2023] Open
Abstract
Supplemental Digital Content is available in the text. Emerging evidence from animal and human studies indicates that exposure to traffic-related air pollution may adversely affect fertility.
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Mpairwe H, Nkurunungi G, Tumwesige P, Akurut H, Namutebi M, Nambuya I, Nnaluwooza M, Apule B, Onen C, Katongole T, Niwagaba E, Mukasa M, Webb EL, Elliott AM, Pearce N. Risk factors associated with rhinitis, allergic conjunctivitis and eczema among schoolchildren in Uganda. Clin Exp Allergy 2020; 51:108-119. [PMID: 33098716 PMCID: PMC7612100 DOI: 10.1111/cea.13769] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 08/31/2020] [Accepted: 10/19/2020] [Indexed: 01/19/2023]
Abstract
Background The prevalence of allergy-related diseases (ARDs), including rhinitis, allergic conjunctivitis and eczema, is on the increase globally. The causes of this increase are not well established. Objectives To investigate the risk factors associated with ARDs among schoolchildren in Uganda. Methods We conducted a secondary data analysis of a large asthma case–control study involving 1700 schoolchildren, 5–17 years, in urban Uganda. ARDs were defined according to the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire. Skin prick testing (SPT) was conducted using standard procedures and allergen-specific IgE (asIgE) using ImmunoCAP®. We employed inverse probability weighted analysis to generate estimated prevalence data and weighted odds ratios. Results The lifetime estimated weighted prevalence of reported rhinitis, allergic conjunctivitis and eczema was 43.3%, 39.5% and 13.5%; weighted prevalence in 12 months was 10.1%, 9.1% and 2.3%, respectively. There was overlap of ARDs, with 66.3% of 1193 schoolchildren who reported having ever an ARDs (including asthma) reporting two or more. Risk factors associated with reported rhinitis in the last 12 months were city residence at birth [adjusted odds ratio (95% confidence interval) 2.66 (1.42–4.99) compared to rural]; father’s [2.62 (1.79–3.83)] and mother’s history of allergic disease [2.12 (1.48–3.02)]; frequent de-worming in the last 12 months [2.01 (1.30–3.11), ≥2 versus none]; current high frequency of ‘trucks passing on the street near home’ [2.59 (1.48–4.52), ‘almost all the time’ versus rarely] and positive SPT [1.54 (1.09–2.18)] but not asIgE [1.38 (0.60–3.15)]. The same pattern of risk factors was observed for allergic conjunctivitis and eczema. Conclusion We found extensive multi-morbidity of, and overlap in the risk factors for, rhinitis, conjunctivitis and eczema—similar to asthma risk factors—among schoolchildren in urban Uganda. This suggests a similar underlying cause for all ARDs, associated with exposure to urban lifestyles and environment in Uganda.
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Affiliation(s)
- Harriet Mpairwe
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda.,London School of Hygiene and Tropical Medicine, London, UK
| | - Gyaviira Nkurunungi
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Pius Tumwesige
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Hellen Akurut
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Milly Namutebi
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Irene Nambuya
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Marble Nnaluwooza
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Barbara Apule
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Caroline Onen
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Tonny Katongole
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Emmanuel Niwagaba
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Mike Mukasa
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Emily L Webb
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda.,London School of Hygiene and Tropical Medicine, London, UK
| | - Alison M Elliott
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda.,London School of Hygiene and Tropical Medicine, London, UK
| | - Neil Pearce
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda.,London School of Hygiene and Tropical Medicine, London, UK
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He J, Ghorveh MG, Hurst JH, Tang M, Alhanti B, Lang JE, Goldstein BA. Evaluation of associations between asthma exacerbations and distance to roadways using geocoded electronic health records data. BMC Public Health 2020; 20:1626. [PMID: 33121457 PMCID: PMC7599107 DOI: 10.1186/s12889-020-09731-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 10/19/2020] [Indexed: 11/10/2022] Open
Abstract
Background Asthma exacerbations in children often require medications, urgent care, and hospitalization. Multiple environmental triggers have been associated with asthma exacerbations, including particulate matter 2.5 (PM2.5) and ozone, which are primarily generated by motor vehicle exhaust. There is mixed evidence as to whether proximity to highways increases risk of asthma exacerbations. Methods To evaluate the impact of highway proximity, we assessed the association between asthma exacerbations and the distance of child’s primary residence to two types of roadways in Durham County, North Carolina, accounting for other patient-level factors. We abstracted data from the Duke University Health System electronic health record (EHR), identifying 6208 children with asthma between 2014 and 2019. We geocoded each child’s distance to roadways (both 35 MPH+ and 55 MPH+). We classified asthma exacerbation severity into four tiers and fitted a recurrent event survival model to account for multiple exacerbations. Results There was a no observed effect of residential distance from 55+ MPH highway (Hazard Ratio: 0.98 (95% confidence interval: 0.94, 1.01)) and distance to 35+ MPH roadway (Hazard Ratio: 0.98 (95% confidence interval: 0.83, 1.15)) and any asthma exacerbation. Even those children living closest to highways (less 0.25 miles) had no increased risk of exacerbation. These results were consistent across different demographic strata. Conclusions While the results were non-significant, the characteristics of the study sample – namely farther distance to roadways and generally good ambient environmental pollution may contribute to the lack of effect. Compared to previous studies, which often relied on self-reported measures, we were able to obtain a more objective assessment of outcomes. Overall, this work highlights the opportunity to use EHR data to study environmental impacts on disease. Supplementary Information Supplementary information accompanies this paper at 10.1186/s12889-020-09731-0.
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Affiliation(s)
- Jingyi He
- Department of Biostatistics & Bioinformatics, Duke University, 2424 Erwin Road, Durham, NC, 27705, USA
| | | | - Jillian H Hurst
- Children's Health & Discovery Initiative, Duke University, Durham, NC, USA.,Department of Pediatrics, Duke University, Durham, USA
| | - Monica Tang
- Department of Medicine, University California, San Francisco, USA
| | | | - Jason E Lang
- Duke Clinical Research Institute, Durham, NC, USA.,Department of Pediatrics, Duke University, Durham, USA
| | - Benjamin A Goldstein
- Department of Biostatistics & Bioinformatics, Duke University, 2424 Erwin Road, Durham, NC, 27705, USA. .,Duke Clinical Research Institute, Durham, NC, USA. .,Children's Health & Discovery Initiative, Duke University, Durham, NC, USA. .,Department of Pediatrics, Duke University, Durham, USA.
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Rosser F, Han YY, Forno E, Acosta-Pérez E, Canino G, Celedón JC. Indoor endotoxin, proximity to a major roadway, and severe asthma exacerbations among children in Puerto Rico. Ann Allergy Asthma Immunol 2020; 125:658-664.e2. [PMID: 32911057 DOI: 10.1016/j.anai.2020.09.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 08/31/2020] [Accepted: 09/02/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Few studies have examined concurrent exposure to household endotoxin and traffic-related air pollution in relation to childhood asthma, yet both factors are associated with asthma outcomes. OBJECTIVE To examine whether proximity to a major roadway (a traffic-related air pollution proxy) modifies the estimated effects of indoor endotoxin on asthma outcomes in children. METHODS Cross-sectional study of 200 children with asthma (ages, 6-14 years) living in Puerto Rico. Residential distance to a major roadway was calculated as the distance from the participant's residential US census block centroid to the nearest major road. The outcomes of interest were severe asthma exacerbations, missed school days for asthma, atopy, lung function, and bronchodilator response (BDR). Logistic, linear, or negative binomial regression was used for the multivariable analysis. RESULTS In the multivariable analysis, there was an interaction between indoor endotoxin and residential distance to a roadway on severe asthma exacerbations (P = .02) and BDR (P = .07). In an analysis stratified by distance to a roadway, each log10-unit increase in endotoxin was associated with 4.21 times increased odds of severe asthma exacerbations among children living within 499 m (the lower 3 quartiles of residential distance) to a road (95% confidence interval, 1.5-12.0). Among subjects living further than 499 m away from a roadway, each log10-unit increase in endotoxin was associated with reduced odds of severe asthma exacerbations (odds ratio, 0.03; 95% confidence interval, 0.001-0.67). Similar but less substantial findings were observed for BDR. CONCLUSION Our findings suggest that residential proximity to a major road modifies the estimated effect of endotoxin on severe asthma exacerbations in children.
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Affiliation(s)
- Franziska Rosser
- Division of Pediatric Pulmonary Medicine, Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Yueh-Ying Han
- Division of Pediatric Pulmonary Medicine, Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Erick Forno
- Division of Pediatric Pulmonary Medicine, Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Edna Acosta-Pérez
- Department of Pediatrics, Behavioral Sciences Research Institute, University of Puerto Rico, San Juan, Puerto Rico
| | - Glorisa Canino
- Department of Pediatrics, Behavioral Sciences Research Institute, University of Puerto Rico, San Juan, Puerto Rico
| | - Juan C Celedón
- Division of Pediatric Pulmonary Medicine, Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pennsylvania.
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36
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Does traffic proximity at home and school influence asthma exacerbations? J Allergy Clin Immunol 2019; 145:100-102. [PMID: 31730877 DOI: 10.1016/j.jaci.2019.10.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 10/29/2019] [Indexed: 11/21/2022]
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