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Wang S, Song R, Xu Z, Chen M, Di Tanna GL, Downey L, Jan S, Si L. The costs, health and economic impact of air pollution control strategies: a systematic review. Glob Health Res Policy 2024; 9:30. [PMID: 39164785 PMCID: PMC11337783 DOI: 10.1186/s41256-024-00373-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Accepted: 07/24/2024] [Indexed: 08/22/2024] Open
Abstract
BACKGROUND Air pollution poses a significant threat to global public health. While broad mitigation policies exist, an understanding of the economic consequences, both in terms of health benefits and mitigation costs, remains lacking. This study systematically reviewed the existing economic implications of air pollution control strategies worldwide. METHODS A predefined search strategy, without limitations on region or study design, was employed to search the PubMed, Scopus, Cochrane Library, Embase, Web of Science, and CEA registry databases for studies from their inception to November 2023 using keywords such as "cost-benefit analyses", "air pollution", and "particulate matter". Focus was placed on studies that specifically considered the health benefits of air pollution control strategies. The evidence was summarized by pollution control strategy and reported using principle economic evaluation measurements such as net benefits and benefit-cost ratios. RESULTS The search yielded 104 studies that met the inclusion criteria. A total of 75, 21, and 8 studies assessed the costs and benefits of outdoor, indoor, and mixed control strategies, respectively, of which 54, 15, and 3 reported that the benefits of the control strategy exceeded the mitigation costs. Source reduction (n = 42) and end-of-pipe treatments (n = 15) were the most commonly employed pollution control methodologies. The association between particulate matter (PM) and mortality was the most widely assessed exposure-effect relationship and had the largest health gains (n = 42). A total of 32 studies employed a broader benefits framework, examining the impacts of air pollution control strategies on the environment, ecology, and society. Of these, 31 studies reported partially or entirely positive economic evidence. However, despite overwhelming evidence in support of these strategies, the studies also highlighted some policy flaws concerning equity, optimization, and uncertainty characterization. CONCLUSIONS Nearly 70% of the reviewed studies reported that the economic benefits of implementing air pollution control strategies outweighed the relative costs. This was primarily due to the improved mortality and morbidity rates associated with lowering PM levels. In addition to health benefits, air pollution control strategies were also associated with other environmental and social benefits, strengthening the economic case for implementation. However, future air pollution control strategy designs will need to address some of the existing policy limitations.
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Affiliation(s)
- Siyuan Wang
- The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Rong Song
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, China
| | - Zhiwei Xu
- School of Medicine and Dentistry, Griffith University, Gold Coast, QLD, Australia
| | - Mingsheng Chen
- School of Health Policy and Management, Nanjing Medical University, Nanjing, China.
- Jiangsu Health Vocational College, Nanjing, China.
| | - Gian Luca Di Tanna
- Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Lugano, Switzerland
| | - Laura Downey
- The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Stephen Jan
- The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Lei Si
- School of Health Sciences, Western Sydney University, Campbelltown, NSW, Australia
- Translational Health Research Institute, Western Sydney University, Penrith, NSW, Australia
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Zachariah JP, Jone PN, Agbaje AO, Ryan HH, Trasande L, Perng W, Farzan SF. Environmental Exposures and Pediatric Cardiology: A Scientific Statement From the American Heart Association. Circulation 2024; 149:e1165-e1175. [PMID: 38618723 DOI: 10.1161/cir.0000000000001234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/16/2024]
Abstract
Environmental toxicants and pollutants are causes of adverse health consequences, including well-established associations between environmental exposures and cardiovascular diseases. Environmental degradation is widely prevalent and has a long latency period between exposure and health outcome, potentially placing a large number of individuals at risk of these health consequences. Emerging evidence suggests that environmental exposures in early life may be key risk factors for cardiovascular conditions across the life span. Children are a particularly sensitive population for the detrimental effects of environmental toxicants and pollutants given the long-term cumulative effects of early-life exposures on health outcomes, including congenital heart disease, acquired cardiac diseases, and accumulation of cardiovascular disease risk factors. This scientific statement highlights representative examples for each of these cardiovascular disease subtypes and their determinants, focusing specifically on the associations between climate change and congenital heart disease, airborne particulate matter and Kawasaki disease, blood lead levels and blood pressure, and endocrine-disrupting chemicals with cardiometabolic risk factors. Because children are particularly dependent on their caregivers to address their health concerns, this scientific statement highlights the need for clinicians, research scientists, and policymakers to focus more on the linkages of environmental exposures with cardiovascular conditions in children and adolescents.
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Ashcraft LE, Cabrera KI, Lane-Fall MB, South EC. Leveraging Implementation Science to Advance Environmental Justice Research and Achieve Health Equity through Neighborhood and Policy Interventions. Annu Rev Public Health 2024; 45:89-108. [PMID: 38166499 DOI: 10.1146/annurev-publhealth-060222-033003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2024]
Abstract
Environmental justice research is increasingly focused on community-engaged, participatory investigations that test interventions to improve health. Such research is primed for the use of implementation science-informed approaches to optimize the uptake and use of interventions proven to be effective. This review identifies synergies between implementation science and environmental justice with the goal of advancing both disciplines. Specifically, the article synthesizes the literature on neighborhood-, community-, and policy-level interventions in environmental health that address underlying structural determinants (e.g., structural racism) and social determinants of health. Opportunities to facilitate and scale the equitable implementation of evidence-based environmental health interventions are highlighted, using urban greening as an illustrative example. An environmental justice-focused version of the implementation science subway is provided, which highlights these principles: Remember and Reflect, Restore and Reclaim, and Reinvest. The review concludes with existing gaps and future directions to advance the science of implementation to promote environmental justice.
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Affiliation(s)
- Laura Ellen Ashcraft
- Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA
- Division of General Internal Medicine, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA;
| | - Keven I Cabrera
- Division of Emergency Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Urban Health Lab, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Meghan B Lane-Fall
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA;
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Penn Implementation Science Center (PISCE), University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Eugenia C South
- Urban Health Lab, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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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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5
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Fisher S, Mathers A, Austin Z. Development of a Self-Assessment Audit Instrument to Support Climate-Conscious Community Pharmacy Practice and Education. PHARMACY 2023; 11:158. [PMID: 37888503 PMCID: PMC10610274 DOI: 10.3390/pharmacy11050158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 09/11/2023] [Accepted: 09/27/2023] [Indexed: 10/28/2023] Open
Abstract
Climate breakdown continues to occur at an alarming pace, and the need for all citizens and professionals to respond has never been so urgent. Healthcare work contributes significantly to greenhouse gas (GHG) emissions, representing an opportunity and responsibility for pharmacists to engage in more climate-conscious practices. A key informant interview-based qualitative research method was undertaken to identify options and strategies for community pharmacists to contribute positively to achieving climate-related carbon footprint reduction goals. A total of 10 thought leaders in climate-conscious pharmacy practice were interviewed using a semi-structured protocol, and a constant comparative data analysis method was used to identify common themes and priorities. A self-assessment audit instrument (SAAI) was identified as a positive first step to build awareness, knowledge, skills, and confidence amongst community pharmacists regarding actionable climate-conscious community pharmacy practice. The SAAI supported both self-reflection and self-assessment, while signposting additional resources that could be accessed by pharmacists to continue their learning and professional development. Further work in this area is required if community pharmacy is to contribute positively to climate reduction targets locally and globally.
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Affiliation(s)
- Stella Fisher
- School of Pharmacy, The University of Nottingham, Nottingham NG7 2RD, UK;
| | - Annalise Mathers
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON M5S 3M2, Canada;
| | - Zubin Austin
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON M5S 3M2, Canada;
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Behinaein P, Hutchings H, Knapp T, Okereke IC. The growing impact of air quality on lung-related illness: a narrative review. J Thorac Dis 2023; 15:5055-5063. [PMID: 37868892 PMCID: PMC10586990 DOI: 10.21037/jtd-23-544] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 07/28/2023] [Indexed: 10/24/2023]
Abstract
Background and Objective Poor air quality can be harmful to human well-being. There are a variety of respiratory disorders associated with toxins present within the atmosphere, such as bronchitis and asthma, which eventually lead to heart or lung complications over time. Fine particles like particulate matter 2.5 (PM2.5) accumulate in the small airways of the lung. These irritants can cause epigenetic modifications in gene regulation, leading to changes responsible for both benign and malignant lung diseases. In this review we will discuss known associations between environmental factors and pulmonary complications, consider preventative measures and offer further areas for future investigation. This review presents a summary of the literature outlining the current work done on air quality and its effects on lung-related illnesses. We discuss regional differences in air quality and consider the causes, such as manufacturing, traffic density, increase in fuel usage and natural events. We further explore disparities based on geography, race, and other social determinants. Methods A comprehensive literature review was performed using keywords related to air quality, pollution and lung disease within the PubMed database as well as MEDLINE and Google Scholar. Key Content and Findings The Clean Air Act of 1970 marked an essential transition for air quality improvement. The legislation led to decreased emissions and control measures to address atmosphere contamination. Despite these actions, poor atmospheric conditions still persist today and have become an ongoing issue. These poor conditions affect individuals living in metropolitan areas more significantly than suburban or rural areas. Pollution from industrial operations and transportation vehicles have led to increased emission outputs recently. Climate change further aggravates air quality problems by raising pollutant and allergen concentrations. The detrimental consequences of poor air quality include increased incidence of disease processes like asthma, chronic obstructive pulmonary disease (COPD) and lung cancer. To keep up with the well-being of people globally, it is important that actions be taken to battle contamination in the climate so its impact on public health can be limited. Conclusions Poor air quality and recent worsening of industrial emissions have had a negative impact on lung-related illnesses. Future mitigation strategies should be taken to reduce pollution and treat diseases earlier in their course. Some of these strategies include more reliance on alternative energy sources, creation of mass transit systems and increased rates of recycling.
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Affiliation(s)
| | - Hollis Hutchings
- Department of Surgery, Henry Ford Health System, Detroit, MI, USA
| | - Thomas Knapp
- School of Medicine, University of Central Florida, Orlando, FL, USA
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Malamardi S, Lambert K, Siddaiah JB, Erbas B, Mahesh PA. Effects of Ambient Air Pollutants on Hospital Admissions among Children Due to Asthma and Wheezing-Associated Lower Respiratory Infections in Mysore, India: A Time Series Study. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1322. [PMID: 37628320 PMCID: PMC10453753 DOI: 10.3390/children10081322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 07/14/2023] [Accepted: 07/20/2023] [Indexed: 08/27/2023]
Abstract
Air pollutants are known to trigger asthma and wheezing-associated lower respiratory infections in children, but evidence regarding their effect on hospital admissions in India is limited. We conducted a time-series study over a period of five years to assess the role of ambient air pollutants in daily asthma-related hospital admissions in children in Mysore, India. Daily asthma and wheeze (associated with lower respiratory infections) admissions were modelled using a generalised additive model (GAM) to examine the non-linear effects and generalised linear models (GLM) for linear effects, if any. Models were adjusted by day of the week and lag days, with smooth terms for time, maximum temperature, and relative humidity, and they were stratified by sex and age group. Of the 362 children admitted, more than 50% were boys, and the mean age was 5.34 years (±4.66). The GAMs showed non-linear associations between NO2, PM2.5, and NH3. For example, a 10 µgm-3 (or 10%) increase in NO2 increased admissions by 2.42. These non-linear effects were more pronounced in boys. A linear effect was detected for PM10 with a relative risk (95% CI) of 1.028, 1.013, and 1.043 with admission. Further research is needed to explore whether these findings can be replicated in different cities in India. Air pollution needs to be controlled, and policies that focus on lower cut-off levels for vulnerable populations are necessary.
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Affiliation(s)
- Sowmya Malamardi
- Department of Public Health, School of Psychology & Public Health, College of Science Health and Engineering, La Trobe University, Melbourne, VIC 3083, Australia; (S.M.); (K.L.); (B.E.)
| | - Katrina Lambert
- Department of Public Health, School of Psychology & Public Health, College of Science Health and Engineering, La Trobe University, Melbourne, VIC 3083, Australia; (S.M.); (K.L.); (B.E.)
| | - Jayaraj Biligere Siddaiah
- Department of Respiratory Medicine, JSS Academy of Higher Education & Research (JSSAHER), JSS Medical College, Mysore 570015, Karnataka, India;
| | - Bircan Erbas
- Department of Public Health, School of Psychology & Public Health, College of Science Health and Engineering, La Trobe University, Melbourne, VIC 3083, Australia; (S.M.); (K.L.); (B.E.)
| | - Padukudru Anand Mahesh
- Department of Respiratory Medicine, JSS Academy of Higher Education & Research (JSSAHER), JSS Medical College, Mysore 570015, Karnataka, India;
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Chowdhury S, Pillarisetti A, Oberholzer A, Jetter J, Mitchell J, Cappuccilli E, Aamaas B, Aunan K, Pozzer A, Alexander D. A global review of the state of the evidence of household air pollution's contribution to ambient fine particulate matter and their related health impacts. ENVIRONMENT INTERNATIONAL 2023; 173:107835. [PMID: 36857905 PMCID: PMC10378453 DOI: 10.1016/j.envint.2023.107835] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 01/24/2023] [Accepted: 02/16/2023] [Indexed: 06/18/2023]
Abstract
Direct exposure to household fine particulate air pollution (HAP) associated with inefficient combustion of fuels (wood, charcoal, coal, crop residues, kerosene, etc.) for cooking, space-heating, and lighting is estimated to result in 2.3 (1.6-3.1) million premature yearly deaths globally. HAP emitted indoors escapes outdoors and is a leading source of outdoor ambient fine particulate air pollution (AAP) in low- and middle-income countries, often being a larger contributor than well-recognized sources including road transport, industry, coal-fired power plants, brick kilns, and construction dust. We review published scientific studies that model the contribution of HAP to AAP at global and major sub-regional scales. We describe strengths and limitations of the current state of knowledge on HAP's contribution to AAP and the related impact on public health and provide recommendations to improve these estimates. We find that HAP is a dominant source of ambient fine particulate matter (PM2.5) globally - regardless of variations in model types, configurations, and emission inventories used - that contributes approximately 20 % of total global PM2.5 exposure. There are large regional variations: in South Asia, HAP contributes ∼ 30 % of ambient PM2.5, while in high-income North America the fraction is ∼ 7 %. The median estimate indicates that the household contribution to ambient air pollution results in a substantial premature mortality burden globally of about 0.77(0.54-1) million excess deaths, in addition to the 2.3 (1.6-3.1) million deaths from direct HAP exposure. Coordinated global action is required to avert this burden.
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Affiliation(s)
| | | | | | - James Jetter
- United States Environmental Protection Agency, Washington, D.C., USA
| | - John Mitchell
- United States Environmental Protection Agency, Washington, D.C., USA
| | - Eva Cappuccilli
- United States Environmental Protection Agency, Washington, D.C., USA
| | - Borgar Aamaas
- CICERO Center for International Climate Research, Oslo, Norway
| | - Kristin Aunan
- CICERO Center for International Climate Research, Oslo, Norway
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Trasande L, Kassotis CD. The Pediatrician's Role in Protecting Children from Environmental Hazards. Pediatr Clin North Am 2023; 70:137-150. [PMID: 36402464 PMCID: PMC10591514 DOI: 10.1016/j.pcl.2022.09.003] [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] [Indexed: 11/18/2022]
Abstract
Children suffer disproportionately from disease and disability due to environmental hazards, for reasons rooted in their biology. The contribution is substantial and increasingly recognized, particularly due to ever-increasing awareness of endocrine disruption. Regulatory actions can be traced directly to reductions in toxic exposures, with tangible benefits to society. Deep flaws remain in the policy framework in industrialized countries, failing to offer sufficient protection, but are even more limited in industrializing nations where the majority of chemical production and use will occur by 2030. Evidence-based steps for reducing chemical exposures associated with adverse health outcomes exist and should be incorporated into anticipatory guidance.
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Affiliation(s)
- Leonardo Trasande
- Department of Pediatrics, Division of Environmental Pediatrics, NYU Grossman School of Medicine, New York, NY, USA; Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA; Department of Environmental Medicine, NYU Grossman School of Medicine, New York, NY, USA; NYU Wagner School of Public Service, New York, NY, USA; NYU School of Global Public Health, New York, NY, USA.
| | - Christopher D Kassotis
- Institute of Environmental Health Sciences and Department of Pharmacology, Wayne State University, Detroit, MI, USA
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Goldsborough E, Gopal M, McEvoy JW, Blumenthal RS, Jacobsen AP. Pollution and cardiovascular health: A contemporary review of morbidity and implications for planetary health. AMERICAN HEART JOURNAL PLUS : CARDIOLOGY RESEARCH AND PRACTICE 2023; 25:100231. [PMID: 38510496 PMCID: PMC10946040 DOI: 10.1016/j.ahjo.2022.100231] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 11/18/2022] [Indexed: 03/22/2024]
Abstract
Pollution is a leading cause of premature morbidity and mortality and an important risk factor for cardiovascular disease. Convincing data predict increased rates of cardiovascular morbidity and mortality with current and projected pollution burden trends. Multiple classes of pollutants - including criteria air pollutants, secondhand smoke, toxic steel pollutants, and manufactured chemical pollutants - are associated with varied cardiovascular disease risk profiles. To reduce the future risk of cardiovascular disease from anthropogenic pollution, mitigation strategies, both at the individual level and population level, must be thoughtfully and intentionally employed. The literature supporting individual level interventions to protect against cardiovascular disease is growing but lacks large clinical trials. Population level interventions are crucial to larger societal change and rely upon policy and governmental support. While these mitigation strategies can play a major role in maintaining the health of individuals, planetary health - the impact on human health because of anthropogenic perturbation of natural ecosystems - must also be acknowledged. Future research is needed to further delineate the planetary health implications of current and projected pollutant burden as well as the mitigation strategies employed to attenuate future pollutant burden.
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Affiliation(s)
| | - Medha Gopal
- Saint George's University School of Medicine, University Centre Grenada, West Indies, Grenada
| | - John William McEvoy
- National Institute for Prevention and Cardiovascular Health, National University of Ireland Galway, Galway, Ireland
| | - Roger S. Blumenthal
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Alan P. Jacobsen
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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11
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Ammons S, Aja H, Ghazarian AA, Lai GY, Ellison GL. Perception of worry of harm from air pollution: results from the Health Information National Trends Survey (HINTS). BMC Public Health 2022; 22:1254. [PMID: 35752789 PMCID: PMC9233822 DOI: 10.1186/s12889-022-13450-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 05/17/2022] [Indexed: 11/28/2022] Open
Abstract
Background Air pollution exposure has been associated with a multitude of diseases and poses a significant concern to public health. For targeted environmental risk communication and interventions to be effective, it is important to correctly identify characteristics associated with worry of harm from air pollution. Methods Using responses from 3,630 participants of the Health Information National Trends Survey 4 Cycle 2, we assessed worry of harm from exposure to indoor (IAP) and outdoor (OAP) air pollution separately. Multinomial logistic regression models were used to calculate odds ratios and 95% confidence intervals. Results Hispanics were more likely to worry about harm from IAP and OAP compared to non-Hispanic whites. Participants who lived in metropolitan counties were more likely to worry about harm from IAP and OAP compared to those who lived in rural counties. Finally, those who believed their chance of getting cancer was high were more likely to worry about harm from IAP and OAP compared to those who thought their likelihood of getting cancer was low. Conclusions Worry of harm from IAP and OAP varied across sociodemographic and cancer-related characteristics. Public health professionals should consider these characteristics when developing targeted environmental risk communication and interventions. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13450-z.
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Affiliation(s)
- Samantha Ammons
- Epidemiology and Genomics Research Program, Division of Cancer Control and Population Sciences, Department of Health and Human Services, National Cancer Institute, National Institutes of Health, MD, Bethesda, USA
| | - Hayley Aja
- Epidemiology and Genomics Research Program, Division of Cancer Control and Population Sciences, Department of Health and Human Services, National Cancer Institute, National Institutes of Health, MD, Bethesda, USA.,Extramural Research Branch, Extramural Research and Partnerships Division, Office of Science Advisor, Policy, and Engagement, U.S. Environmental Protection Agency, Washington, DC, USA
| | - Armen A Ghazarian
- Epidemiology and Genomics Research Program, Division of Cancer Control and Population Sciences, Department of Health and Human Services, National Cancer Institute, National Institutes of Health, MD, Bethesda, USA
| | - Gabriel Y Lai
- Epidemiology and Genomics Research Program, Division of Cancer Control and Population Sciences, Department of Health and Human Services, National Cancer Institute, National Institutes of Health, MD, Bethesda, USA
| | - Gary L Ellison
- Epidemiology and Genomics Research Program, Division of Cancer Control and Population Sciences, Department of Health and Human Services, National Cancer Institute, National Institutes of Health, MD, Bethesda, USA.
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Scott Downen R, Dong Q, Chorvinsky E, Li B, Tran N, Jackson JH, Pillai DK, Zaghloul M, Li Z. Personal NO 2 sensor demonstrates feasibility of in-home exposure measurements for pediatric asthma research and management. JOURNAL OF EXPOSURE SCIENCE & ENVIRONMENTAL EPIDEMIOLOGY 2022; 32:312-319. [PMID: 35110684 PMCID: PMC8930644 DOI: 10.1038/s41370-022-00413-0] [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: 02/24/2021] [Revised: 01/11/2022] [Accepted: 01/18/2022] [Indexed: 05/05/2023]
Abstract
BACKGROUND One of the most common pollutants in residences due to gas appliances, NO2 has been shown to increase the risk of asthma attacks after small increases in short term exposure. However, standard environmental sampling methods taken at the regional level overlook chronic intermittent exposure due to lack of temporal and spatial granularity. Further, the EPA and WHO do not currently provide exposure recommendations to at-risk populations. AIMS A pilot study with pediatric asthma patients was conducted to investigate potential deployment challenges as well as benefits of home-based NO2 sensors and, when combined with a subject's hospital records and self-reported symptoms, the richness of data available for larger-scale epidemiological studies. METHODS We developed a compact personal NO2 sensor with one minute temporal resolution and sensitivity down to 15 ppb to monitor exposure levels in the home. Patient hospital records were collected along with self-reported symptom diaries, and two example hypotheses were created to further demonstrate how data of this detail may enable study of the impact of NO2 in this sensitive population. RESULTS 17 patients (55%) had at least 1 h each day with average NO2 exposure >21 ppb. Frequency of acute NO2 exposure >21 ppb was higher in the group with gas stoves (U = 27, p ≤ 0.001), and showed a positive correlation (rs = 0.662, p = 0.037, 95% CI 0.36-0.84) with hospital admissions. SIGNIFICANCE Similar studies are needed to evaluate the true impact of NO2 in the home environment on at-risk populations, and to provide further data to regulatory bodies when developing updated recommendations.
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Affiliation(s)
- R Scott Downen
- Department of Biomedical Engineering, The George Washington University, Washington, DC, USA
| | - Quan Dong
- Department of Biomedical Engineering, The George Washington University, Washington, DC, USA
| | - Elizabeth Chorvinsky
- Department of Integrative Systems Biology, The George Washington University, Washington, DC, USA
| | - Baichen Li
- Department of Biomedical Engineering, The George Washington University, Washington, DC, USA
| | - Nam Tran
- Department of Biomedical Engineering, The George Washington University, Washington, DC, USA
| | - James Hunter Jackson
- Division of Pulmonary and Sleep Medicine, Children's National Hospital, Washington, DC, USA
| | - Dinesh K Pillai
- Department of Integrative Systems Biology, The George Washington University, Washington, DC, USA
- Division of Pulmonary and Sleep Medicine, Children's National Hospital, Washington, DC, USA
| | - Mona Zaghloul
- Department of Electrical and Computer Engineering, The George Washington University, Washington, DC, USA
| | - Zhenyu Li
- Department of Biomedical Engineering, The George Washington University, Washington, DC, USA.
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13
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Kuo CY, Chan CK, Huang JL, Wu CY, Phan DV, Lo HY, Chan CL. Decline in hospitalization for childhood asthma in different air pollution regions in Taiwan, 2001-2012. INTERNATIONAL JOURNAL OF ENVIRONMENTAL HEALTH RESEARCH 2022; 32:95-105. [PMID: 32073299 DOI: 10.1080/09603123.2020.1729964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Accepted: 02/11/2020] [Indexed: 06/10/2023]
Abstract
This study aimed to investigate the trends in childhood asthma hospitalization in regions with differing levels of air pollution in Taiwan, 2001-2012. Joinpoint regression was used to identify significant trend changes. The hospitalization rate varied according to gender, geographic region, and age. The incidence of childhood asthma hospitalization decreased from 127.99 to 76.67 (/100,000 population), with an average annual percentage change of around -4.1%; in the Yilan region, the average air pollution concentrations were 19.92 μg/m3, 39.47 μg/m3, 25.99 ppb, 2.19 ppb, and 11.23 ppb for PM2.5, PM10, O3, SO2, and NO2, respectively, which were lower than Taiwan's average values; however, the childhood asthma hospitalization rate was the highest (179.75/100,000 population). The national trend in childhood asthma hospitalization exhibited a significant decrease. The effects of air pollution on childhood asthma were greater in the higher-level air pollution regions, while less association was observed in the lower-level air pollution regions.
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Affiliation(s)
- Ching-Yen Kuo
- Department of Information Management, Yuan Ze University, Taoyuan City, Taiwan
- Department of Medical Administration, Ministry of Health and Welfare, Taoyuan General Hospital, Taoyuan City, Taiwan
| | - Chin-Kan Chan
- Department of Pediatrics, Ministry of Health and Welfare, Taoyuan General Hospital, Taoyuan City, Taiwan
- Department of Biotechnology, Ming Chuan University, Taoyuan City, Taiwan
| | - Jing-Long Huang
- Department of Pediatrics, Division of Allergy, Asthma and Rheumatology, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taipei, Taiwan
| | - Chiung-Yi Wu
- Institute of Public Health, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Dinh-Van Phan
- Department of Information Management, Yuan Ze University, Taoyuan City, Taiwan
- University of Economics, The University of Danang, Da Nang, Vietnam
- Teaching and Research Team for Business Intelligence, University of Economics, the University of Danang, Da Nang, Vietnam
| | - Huei Yu Lo
- Department of Rehabilitation, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan City, Taiwan
- Department of Chemistry, Chung Yuan Christian University, Taoyuan City, Taiwan
| | - Chien Lung Chan
- Department of Information Management, Yuan Ze University, Taoyuan City, Taiwan
- Innovation Center for Big Data and Digital Convergence, Yuan Ze University, Taoyuan City, Taiwan
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14
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Velasquez N, Gardiner L, Cheng TZ, Moore JA, Boudreau RM, Presto AA, Lee SE. Relationship between socioeconomic status, exposure to airborne pollutants, and chronic rhinosinusitis disease severity. Int Forum Allergy Rhinol 2021; 12:172-180. [PMID: 34510788 DOI: 10.1002/alr.22884] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 07/01/2021] [Accepted: 07/23/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Air pollution directly interacts with airway mucosa, yet little is known about how pollutants affect upper airway inflammation. Studies have shown increased incidence of chronic rhinosinusitis (CRS), rhinitis, and asthma in areas with higher traffic pollution, and these neighborhoods are often associated with lower socioeconomic status (SES). The Area Deprivation Index (ADI) assesses neighborhood-level SES by zip code. The purpose of this study was to assess the relationship between SES and exposure to inhaled pollutants and CRS disease severity. METHODS CRS patients with and without nasal polyps (CRSwNP and CRSsNP, respectively) were identified (total patients = 234; CRSwNP patients = 138; CRSsNP patients = 96). Pollutant concentrations, including particulate matter 2.5 (PM2.5 ), black carbon (BC), and nitrogen dioxide (NO2 ), were measured at 70 sites within the defined countywide sites and used to estimate patient exposures. SES was measured by ADI state deciles. Disease severity metrics included the modified Lund-Mackay score (LMS), the need for systemic steroids, and functional endoscopic sinus surgery (FESS). Associations were analyzed and identified using linear, logistic, and Poisson multivariable regression. RESULTS The distribution of CRSsNP and CRSwNP patients across ADI state deciles was similar. ADI, however, was a predictor of exposure to airborne pollutants (PM2.5 , BC, and NO2 ) with a 1.39%, 2.39%, and 2.49% increase in PM2.5 , BC, and NO2 per increasing decile increment (p < 0.0001), respectively, which demonstrated a direct correlation between deprived neighborhoods and higher levels of exposure to PM2.5 , BC, and NO2 with an increase in pollutant levels per increase in ADI decile. Furthermore, ADI was a predictor for increased steroid treatment. CONCLUSION Lower SES predicted higher exposure to air pollution and increased disease severity in patients with CRS as demonstrated by the increased need for steroid treatment.
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Affiliation(s)
| | - Lauren Gardiner
- Department of Otolaryngology, University of Pittsburgh, Pittsburgh, PA
| | - Tracy Z Cheng
- Department of Otolaryngology, University of Pittsburgh, Pittsburgh, PA
| | - John A Moore
- Department of Otolaryngology, University of Pittsburgh, Pittsburgh, PA
| | - Robert M Boudreau
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA
| | - Albert A Presto
- Center for Atmospheric Particle Studies and Department of Mechanical Engineering, Carnegie Mellon University, Pittsburgh, PA
| | - Stella E Lee
- Department of Otolaryngology, University of Pittsburgh, Pittsburgh, PA
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15
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Willis MD, Hill EL, Kile ML, Carozza S, Hystad P. Assessing the effectiveness of vehicle emission regulations on improving perinatal health: a population-based accountability study. Int J Epidemiol 2021; 49:1781-1791. [PMID: 33485273 DOI: 10.1093/ije/dyaa137] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/03/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Since the 1990s, extensive regulations to reduce traffic-related air pollution (TRAP) have been implemented, yet the effectiveness of these regulations has not been assessed with respect to improving infant health. In this study, we evaluate how infant health risks associated with maternal residences near highways during pregnancy have changed over time. METHODS We created a population-based retrospective birth cohort with geocoded residential addresses in Texan metropolitan areas from 1996 through 2009 (n = 2 259 411). We compared term birthweight (37-42 weeks of gestation) among maternal residences <300 m from a highway (high TRAP exposure) (n = 394 346) and 500-3500 m from a highway (comparison group) (n = 1 865 065). We implemented linear regressions to evaluate interactions between high TRAP exposure and birth year, adjusting for demographics, socioeconomic status and neighbourhood context. In addition, we used propensity score matching to further reduce residual confounding. RESULTS From 1996 to 2009, outdoor NO2 decreased by 51.3%, based on regulatory monitoring data in Texas. Among pregnant women who resided in the high TRAP zone during pregnancy, interaction terms between residential location and birth year show that birthweight increased by 1.1 g [95% confidence interval CI): 0.7, 1.5) in unadjusted models and 0.3 g (95% CI: 0.0, 0.6) in matched models. Time-stratified models also show decreasing impacts of living in high TRAP areas on birthweight when comparing infants born in 1996-97 with 2008-09. Sensitivity analyses with alternative exposure and control groups show consistent results. CONCLUSIONS Infant health risks associated with maternal residence near highways have reduced over time, paralleling regulatory measures to improve exhaust pipe emissions.
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Affiliation(s)
- Mary D Willis
- School of Biological and Population Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, USA
| | - Elaine L Hill
- Department of Public Health Sciences, School of Medicine and Dentistry, University of Rochester, Rochester, New York, NY, USA
| | - Molly L Kile
- School of Biological and Population Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, USA
| | - Susan Carozza
- School of Biological and Population Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, USA
| | - Perry Hystad
- School of Biological and Population Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, USA
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16
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Hsu SC, Chang JH, Lee CL, Huang WC, Hsu YP, Liu CT, Jean SS, Huang SK, Hsu CW. Differential time-lag effects of ambient PM 2.5 and PM 2.5-bound PAHs on asthma emergency department visits. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2020; 27:43117-43124. [PMID: 32729038 DOI: 10.1007/s11356-020-10243-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Accepted: 07/21/2020] [Indexed: 06/11/2023]
Abstract
Epidemiological studies have suggested the effects of ambient fine particles (PM2.5) on asthma, but the effects of specific components of PM2.5 on asthma remain to be explored. Here, we studied the effect of PM2.5-bound polycyclic aromatic hydrocarbons (PAHs) on asthma acute exacerbation. The data on daily counts of emergency room visits (ERVs) were obtained from Wan Fang Medical Center, Taipei, Taiwan, from 2012 to 2015. The daily concentrations of PM2.5 and pollutant gases were obtained from a local air quality monitoring station. The levels of PM2.5-bound PAH were estimated by an established grid-scale model. Relative risks for ERVs as the increase in the level of ambient pollutants were calculated by using a generalized additive model of Poisson regression. In the present study, we observed statistically significant positive associations between PM2.5 and asthma ERVs for all age groups. PM2.5-bound PAH was also associated with asthma ERVs for all age groups. In the adult subgroup analysis, there was a significant association between PM2.5-bound PAH and asthma ERVs at lags 1 and 2 (RR 1.289, 95% CI 1.050-1.582 and RR 1.242, 95% CI 1.039-1.485). The impacts of air pollution on the risk of pediatric asthma ERV were found to be significant for PM2.5 at lag day 0 (RR 1.310, 95% CI 1.069-1.606). Moreover, pediatric asthma ERVs were significantly associated with the levels of PM2.5-bound PAH at lag 1 and 2 days (RR 1.576, 95% CI 1.371-1.810 and RR 1.426, 95% CI 1.265-1.607). The study provides evidence that PM2.5-bound PAHs were associated with an increased risk of asthma attacks. Our data further suggested that traffic exhaust is a primary source of PM2.5-bound PAHs.
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Affiliation(s)
- Shih-Chang Hsu
- Emergency Department, Department of Emergency and Critical Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Department of Emergency Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Jer-Hwa Chang
- School of Respiratory Therapy, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Division of Pulmonary Medicine, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Chon-Lin Lee
- Department of Marine Environment and Engineering, National Sun Yat-sen University, Kaohsiung, Taiwan
- Department of Public Health, Kaohsiung Medical University, Kaohsiung, Taiwan
- Research Center for Environmental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Wen-Cheng Huang
- Emergency Department, Department of Emergency and Critical Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Department of Emergency Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yuan-Pin Hsu
- Emergency Department, Department of Emergency and Critical Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Department of Emergency Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chung-Te Liu
- Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Division of Nephrology, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Shio-Shin Jean
- Emergency Department, Department of Emergency and Critical Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Department of Emergency Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Shau-Ku Huang
- National Institute of Environmental Health Sciences, National Health Research Institutes, Miaoli County, Taiwan
- State Key Laboratory of Respiratory Disease for Allergy at Shenzhen University, Shenzhen Key Laboratory of Allergy & Immunology, Shenzhen University School of Medicine, Shenzhen, China
- Department of Respirology & Allergy, Third Affiliated Hospital of Shenzhen University, Shenzhen, 518020, China
- Johns Hopkins Asthma and Allergy Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Chin-Wang Hsu
- Emergency Department, Department of Emergency and Critical Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
- Department of Emergency Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
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17
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The Impact of Chronic Ambient Exposure to PM 2.5 and Ozone on Asthma Prevalence and COPD Mortality Rates in the Southeastern United States. ANNUAL REVIEW OF NURSING RESEARCH 2020; 38:15-34. [PMID: 32102953 DOI: 10.1891/0739-6686.38.15] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Respiratory diseases affect millions of people across the United States annually. Two of the most common respiratory diseases are chronic obstructive pulmonary disease (COPD) and asthma. Mortality rates due to COPD have increased by an estimated 30% between 1980 and 2014, with significant variances among geographic regions. Both acute and chronic ambient exposures to fine particulate matter (PM2.5) and ozone have been associated with exacerbations of respiratory diseases in numerous studies, and exposure to air pollutants are considered as the largest health risk factor globally. This study adds to the current literature by reporting the results of a time series analysis of the impact of PM2.5 and ozone on prevalence rates of asthma and mortality rates for COPD at regional and county levels across the southeastern United States for the years 2005-2014. While general reductions in levels of PM2.5 and ozone were demonstrated across all years, a distributed lag model showed continued strong associations between PM2.5 and prevalence of asthma and mortality due to COPD, even at relatively small increases in ambient exposure (<1 μg/m3) across the southeastern United States. The results of the study support the need for additional research that considers factors such as patient demographics, medical histories, and health disparities in combination with ambient exposures to known pollutants.
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Baek J, Kash BA, Xu X, Benden M, Roberts J, Carrillo G. Association between Ambient Air Pollution and Hospital Length of Stay among Children with Asthma in South Texas. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17113812. [PMID: 32471209 PMCID: PMC7312124 DOI: 10.3390/ijerph17113812] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 05/22/2020] [Accepted: 05/23/2020] [Indexed: 12/13/2022]
Abstract
Although hospital length of stay (LOS) has been identified as a proxy measure of healthcare expenditures in the United States, there are limited studies investigating the potentially important association between outdoor air pollution and LOS for pediatric asthma. This study aims to examine the effect of ambient air pollution on LOS among children with asthma in South Texas. It included retrospective data on 711 children aged 5–18 years old admitted for asthma to a pediatric tertiary care hospital in South Texas between 2010 and 2014. Air pollution data including particulate matter (PM2.5) and ozone were collected from the U.S. Centers for Disease Control and Prevention. The multivariate binomial logistic regression analyses were performed to determine the association between each air pollutant and LOS, controlling for confounders. The regression models showed the increased ozone level was significantly associated with prolonged LOS in the single- and two-pollutant models (p < 0.05). Furthermore, in the age-stratified models, PM2.5 was positively associated with LOS among children aged 5–11 years old (p < 0.05). In conclusion, this study revealed a concerning association between ambient air pollution and LOS for pediatric asthma in South Texas.
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Affiliation(s)
- Juha Baek
- Department of Environmental and Occupational Health, School of Public Health, Texas A&M University, College Station, TX 77843, USA; (J.B.); (M.B.)
- Center for Outcomes Research, Houston Methodist Research Institute, Houston, TX 77030, USA;
| | - Bita A. Kash
- Center for Outcomes Research, Houston Methodist Research Institute, Houston, TX 77030, USA;
- Center for Health and Nature, Houston Methodist Research Institute, Houston, TX 77030, USA
- Department of Health Policy and Management, School of Public Health, Texas A&M University, College Station, TX 77843, USA
| | - Xiaohui Xu
- Department of Epidemiology and Biostatistics, School of Public Health, Texas A&M University, College Station, TX 77843, USA;
| | - Mark Benden
- Department of Environmental and Occupational Health, School of Public Health, Texas A&M University, College Station, TX 77843, USA; (J.B.); (M.B.)
| | - Jon Roberts
- Department of Pediatric Pulmonology, Driscoll Children’s Hospital, Corpus Christi, TX 78411, USA;
| | - Genny Carrillo
- Department of Environmental and Occupational Health, School of Public Health, Texas A&M University, College Station, TX 77843, USA; (J.B.); (M.B.)
- Correspondence: ; Tel.: +1-979-436-0963
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19
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Schwarzbach HL, Mady LJ, Lee SE. What is the Role of Air Pollution in Chronic Rhinosinusitis? Immunol Allergy Clin North Am 2020; 40:215-222. [DOI: 10.1016/j.iac.2019.12.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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20
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Velasquez N, Moore JA, Boudreau RM, Mady LJ, Lee SE. Association of air pollutants, airborne occupational exposures, and chronic rhinosinusitis disease severity. Int Forum Allergy Rhinol 2019; 10:175-182. [PMID: 31661614 DOI: 10.1002/alr.22477] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Revised: 09/16/2019] [Accepted: 10/16/2019] [Indexed: 01/12/2023]
Abstract
BACKGROUND Previous work has shown that chronic rhinosinusitis (CRS) severity may be associated with particulate matter 2.5 (PM2.5 ) and black carbon (BC) in CRS patients without nasal polyps (CRSsNP). Data regarding occupational exposures, however, are lacking. We assessed the impact of PM2.5 , BC, as well as occupational airborne exposure on CRS disease severity. METHODS Patients with CRS with nasal polyps (CRSwNP), CRSsNP, and aspirin-exacerbated respiratory disease (AERD) were identified from an institutionwide database. Spatial modeling from 37 pollutant monitoring sites in Allegheny County was used to estimate exposures. Patient occupations using the 2010 Standard Occupation Classification (SOC10) and airborne occupation exposures to vapors, gases, dusts, fumes, fibers and mists (VGDFFiM) or diesel fumes were recorded. Disease severity was measured by modified Lund-Mackay score (LMS), systemic corticosteroid therapy, and incidence of functional endoscopic sinus surgery (FESS). RESULTS Two hundred thirty-four patients were included (CRSwNP, n = 113; CRSsNP, n = 96; AERD, n = 25). The prevalence of AERD among those with CRSwNP was 18%. Patients exposed to VGDFFiM or diesel fumes required higher steroid doses vs nonexposed patients (p = 0.015 and p = 0.03, respectively); patients with VGDFFiM levels >5% were more likely to undergo FESS vs nonexposed patients (p = 0.0378). There was no difference in PM2.5 and BC with regard to disease severity and FESS between CRSwNP, CRSsNP, and AERD patients. Steroid use was significantly higher in CRSwNP and AERD vs CRSsNP (p = 0.001). LMS was significantly higher in AERD as compared with CRSwNP and CRSsNP (p = 0.001). CONCLUSION Occupational airborne exposure to VGDFFiM correlated with increased prevalence of FESS and need for corticosteroids in CRS patients. There was no difference in PM2.5 and BC levels and disease severity outcome measures between CRS subtypes in this subset.
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Affiliation(s)
| | - John A Moore
- Department of Otolaryngology, University of Pittsburgh, Pittsburgh, PA
| | - Robert M Boudreau
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA
| | - Leila J Mady
- Department of Otolaryngology, University of Pittsburgh, Pittsburgh, PA
| | - Stella E Lee
- Department of Otolaryngology, University of Pittsburgh, Pittsburgh, PA
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Hölscher K, Frantzeskaki N, McPhearson T, Loorbach D. Tales of transforming cities: Transformative climate governance capacities in New York City, U.S. and Rotterdam, Netherlands. JOURNAL OF ENVIRONMENTAL MANAGEMENT 2019; 231:843-857. [PMID: 30419440 DOI: 10.1016/j.jenvman.2018.10.043] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 09/22/2018] [Accepted: 10/14/2018] [Indexed: 06/09/2023]
Abstract
Climate change actions in cities worldwide are driving deep changes in urban governance. We ask whether new capacities for transformative climate governance are emerging in two cities that have experimented with urban climate governance: Rotterdam, the Netherlands, and New York City (NYC), United States. Transformative climate governance creates the conditions for developing integrated and innovative climate mitigation and adaptation policies and interventions that respond to and shape urban transformation dynamics and contribute to sustainability and resilience. The comparison of capacities for transformative climate governance in Rotterdam and NYC offers insights into the emerging features of urban climate governance vis-à-vis existing urban governance regimes: how urban climate governance is driven and delivered, what new governance conditions emerge, and whether these conditions enable transformative climate governance. In both cities, an integrated, experimental and inclusive approach to climate governance is emerging, which crosses multiple policy sectors and domains (e.g. transport, energy, health, justice), involves a variety of actors and facilitates innovative solutions. Envisioning, long-term goal and knowledge integration, experimentation and tapping into coalitions for change help to provide the basis (including guiding principles, urgency, actor networks, innovative solutions) for transformative climate governance. However, these transformative approaches tend to be still subordinate to business-as-usual interests and policy and planning approaches, which favour isolated, incremental and short-term responses. The challenge for strengthening transformative climate governance will be to develop rigorous institutional and organisational conditions that decisively stipulate a prioritisation of climate change across scales and sectors, provide action mandates and enable wider coordination, collaboration and learning.
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Affiliation(s)
- Katharina Hölscher
- DRIFT, Erasmus University, Mandeville Building, 16th Floor (T16-36), Burgmeester Oudlaan 50, 3062 PA, Rotterdam, the Netherlands.
| | - Niki Frantzeskaki
- DRIFT, Erasmus University, Mandeville Building, 16th Floor (T16-36), Burgmeester Oudlaan 50, 3062 PA, Rotterdam, the Netherlands.
| | - Timon McPhearson
- Urban Systems Lab, The New School, 79 Fifth Avenue, 16th Floor, New York City, NY 10003, USA; Cary Institute of Ecosystem Studies, 2801 Sharon Turnpike, Millbrook, NY 12545, USA; Stockholm Resilience Centre, Stockholm University, Kräftriket, 104 05, Stockholm, Sweden.
| | - Derk Loorbach
- DRIFT, Erasmus University, Mandeville Building, 16th Floor (T16-36), Burgmeester Oudlaan 50, 3062 PA, Rotterdam, the Netherlands.
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22
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Kuo CY, Chan CK, Wu CY, Phan DV, Chan CL. The Short-Term Effects of Ambient Air Pollutants on Childhood Asthma Hospitalization in Taiwan: A National Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16020203. [PMID: 30642061 PMCID: PMC6351918 DOI: 10.3390/ijerph16020203] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 01/05/2019] [Accepted: 01/08/2019] [Indexed: 12/27/2022]
Abstract
This investigation determined the effects of air pollution on childhood asthma hospitalization in regions with differing air pollution levels in Taiwan over a long time period. Data of childhood hospital admissions for asthma in patients aged 0–18 years and air quality in eight regions for the period 2001–2012 in Taiwan were collected. Poisson generalized linear regression analysis was employed to identify the relative risks of hospitalization due to asthma in children associated with exposure to varying levels of air pollutants with a change in the interquartile range after adjusting for temperature and relative humidity. Particulate matter ≤2.5 μm (PM2.5), particulate matter ≤10 μm (PM10), ozone (O3), sulfur dioxide (SO2), and nitrogen dioxide (NO2), were positively associated with childhood asthma hospitalization, while O3 was negatively associated with childhood asthma hospitalization. SO2 was identified as the most significant risk factor. The relative risks for asthma hospitalization associated with air pollutants were higher among children aged 0–5 years than aged 6–18 years and were higher among males than females. The effects of air pollution on childhood asthma were greater in the higher-level air pollution regions, while no association was observed in the lower-level air pollution regions. These findings may prove important for policymakers involved in implementing policies to reduce air pollution.
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Affiliation(s)
- Ching-Yen Kuo
- Department of Information Management, Yuan Ze University, 135 Yuan-Tung Road, Jung-Li, Taoyuan 320, Taiwan.
- Department of Medical Administration, Taoyuan General Hospital, Ministry of Health and Welfare, 1492 Zhongshan Road, Taoyuan Dist., Taoyuan 330, Taiwan.
| | - Chin-Kan Chan
- Department of Pediatrics, Taoyuan General Hospital, Ministry of Health and Welfare, 1492 Zhongshan Road, Taoyuan Dist., Taoyuan 330, Taiwan.
- Department of Biotechnology, Ming Chuan University, 5 De Ming Road, Gui Shan Dist., Taoyuan 333, Taiwan.
| | - Chiung-Yi Wu
- Department of Information Management, Yuan Ze University, 135 Yuan-Tung Road, Jung-Li, Taoyuan 320, Taiwan.
| | - Dinh-Van Phan
- Department of Information Management, Yuan Ze University, 135 Yuan-Tung Road, Jung-Li, Taoyuan 320, Taiwan.
- Innovation Center for Big Data and Digital Convergence, Yuan Ze University, 135 Yuan-Tung Road, Jung-Li, Taoyuan 320, Taiwan.
- University of Economics, The University of Danang, 71 Ngu Hanh Son Street, Danang 550000, Vietnam.
| | - Chien-Lung Chan
- Department of Information Management, Yuan Ze University, 135 Yuan-Tung Road, Jung-Li, Taoyuan 320, Taiwan.
- Innovation Center for Big Data and Digital Convergence, Yuan Ze University, 135 Yuan-Tung Road, Jung-Li, Taoyuan 320, Taiwan.
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23
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Muttray A, Gosepath J, Schmall F, Brieger J, Mayer-Popken O, Melia M, Letzel S. An acute exposure to ozone impairs human olfactory functioning. ENVIRONMENTAL RESEARCH 2018; 167:42-50. [PMID: 30007872 DOI: 10.1016/j.envres.2018.07.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 06/11/2018] [Accepted: 07/03/2018] [Indexed: 06/08/2023]
Abstract
INTRODUCTION Ozone is a ubiquitous and irritant gas. We questioned whether an acute exposure to 0.2 ppm ozone impaired olfactory functioning. METHODS Healthy, normosmic subjects were exposed according to a parallel group design either to 0.2 ppm ozone (n = 15) or to sham (n = 13) in an exposure chamber for two hours. Possible irritating effects were assessed by questionnaire (range 0-5). The detection threshold of n-butanol was measured with the Sniffin' Sticks test before and after exposure. Olfactory thresholds were logarithmized and a two-way analysis of variance (ANOVA) with repeated measurements was carried out to test the effects of exposure (ozone vs. sham) and time (before vs. after exposure). Additionally, nasal secretions were taken at a preliminary examination and after exposure to determine interleukins 1ß and 8. RESULTS No irritating effects to the upper airways were observed. In the ozone group, the median score for cough increased from 0 to 2 at the end of exposure (sham group 0 and 0, respectively, p < 0.001). The ANOVA showed a main effect for ozone exposure (F (1, 26) = 27.6, p = 0.0002), indicating higher olfactory thresholds in the ozone group. Concentrations of interleukins in nasal secretions did not increase following ozone exposure. CONCLUSIONS This study shows a clear impairment of olfactory functioning following an acute exposure to 0.2 ppm ozone.
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Affiliation(s)
- Axel Muttray
- Institute of Occupational, Social and Environmental Medicine, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstraße 1, D-55131 Mainz, Germany.
| | - Jan Gosepath
- Department of Otolaryngology of the University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstraße 1, D-55131 Mainz, Germany
| | - Florian Schmall
- Institute of Occupational, Social and Environmental Medicine, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstraße 1, D-55131 Mainz, Germany; Department of Otolaryngology of the University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstraße 1, D-55131 Mainz, Germany
| | - Jürgen Brieger
- Department of Otolaryngology of the University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstraße 1, D-55131 Mainz, Germany
| | - Otfried Mayer-Popken
- Institute of Occupational, Social and Environmental Medicine, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstraße 1, D-55131 Mainz, Germany
| | - Michael Melia
- Institute of Occupational, Social and Environmental Medicine, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstraße 1, D-55131 Mainz, Germany
| | - Stephan Letzel
- Institute of Occupational, Social and Environmental Medicine, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstraße 1, D-55131 Mainz, Germany
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Cohen DA, Knopman DS. Existing Regulatory Approaches to Reducing Exposures to Chemical- and Product-Based Risk and Their Applicability to Diet-Related Chronic Disease. RISK ANALYSIS : AN OFFICIAL PUBLICATION OF THE SOCIETY FOR RISK ANALYSIS 2018; 38:2041-2054. [PMID: 29665622 DOI: 10.1111/risa.13002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 10/06/2017] [Accepted: 03/17/2018] [Indexed: 06/08/2023]
Abstract
We aimed to identify and categorize the types of policies that have been adopted to protect Americans from harmful exposures that could also be relevant for addressing diet-related chronic diseases. This article examines and categorizes the rationales behind government regulation. Our interest in the historical analysis is to inform judgments about how best to address newly emergent risks involving diet-related chronic disease within existing regulatory and information-based frameworks. We assessed exemplars of regulation with respect to harmful exposures from air, water, and food, as well as regulations that are intended to modify voluntary behaviors. Following the comparative analysis, we explored how exposures that lead to diet-related chronic diseases among the general population fit within models of regulation adopted for other comparable risks. We identified five rationales and five approaches that protect people from harmful exposures. Reasons for regulation include: protection from involuntary exposure to risk, high risk of death or chronic illness, ubiquity of risk, counteraction to limit compulsive behaviors, and promotion of population health. Regulatory approaches include: mandatory limits on use, mandatory limits on exposure, mandatory controls on quality, mandatory labeling, and voluntary guidance. In contrast to the use of mandates, the prevention of diet-related chronic diseases thus far has largely relied on information-only approaches and voluntary adoption of guidelines. There is ample precedent for mandatory regulatory approaches that could address harms related to exposure to unhealthy diets, but several barriers to action would need to be overcome.
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Abstract
: The Great London Smog of December 1952 lasted five days and killed up to 12,000 people. The smog developed primarily because of extensive burning of high-sulfur coal. The health effects were both immediate and long lasting, with a recent study revealing an increased likelihood of childhood asthma development in those exposed to the Great Smog while in utero or during their first year of life. Subsequent pollution legislation-including the U.S. Clean Air Act and its amendments-have demonstrably reduced air pollution and positively impacted health outcomes. With poor air quality events like the Great Smog continuing to occur today, nurses need to be aware of the impact such environmental disasters can have on human health.
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Kuo CY, Pan RH, Chan CK, Wu CY, Phan DV, Chan CL. Application of a Time-Stratified Case-Crossover Design to Explore the Effects of Air Pollution and Season on Childhood Asthma Hospitalization in Cities of Differing Urban Patterns: Big Data Analytics of Government Open Data. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15040647. [PMID: 29614737 PMCID: PMC5923689 DOI: 10.3390/ijerph15040647] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 03/27/2018] [Accepted: 03/28/2018] [Indexed: 11/16/2022]
Abstract
Few studies have assessed the lagged effects of levels of different urban city air pollutants and seasons on asthma hospitalization in children. This study used big data analysis to explore the effects of daily changes in air pollution and season on childhood asthma hospitalization from 2001 to 2010 in Taipei and Kaohsiung City, Taiwan. A time-stratified case-crossover study and conditional logistic regression analysis were employed to identify associations between the risk of hospitalization due to asthma in children and the levels of air pollutants (PM2.5, PM10, O₃, SO₂, and NO₂) in the days preceding hospitalization. During the study period, 2900 children in Taipei and 1337 in Kaohsiung aged ≤15 years were hospitalized due to asthma for the first time. The results indicated that the levels of air pollutants were significantly associated with the risk of asthma hospitalization in children, and seasonal effects were observed. High levels of air pollution in Kaohsiung had greater effects than in Taipei after adjusting for seasonal variation. The most important factor was O₃ in spring in Taipei. In children aged 0-6 years, asthma was associated with O₃ in Taipei and SO₂ in Kaohsiung, after controlling for the daily mean temperature and relative humidity.
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Affiliation(s)
- Ching-Yen Kuo
- Institute of Information Management, Yuan-Ze University, 135 Yuan-Tung Road, Jung-Li, Taoyuan 320, Taiwan.
- Department of Medical Administration, Taoyuan General Hospital, Ministry of Health and Welfare, 1492 Zhongshan Road, Taoyuan Dist., Taoyuan 330, Taiwan.
| | - Ren-Hao Pan
- Institute of Information Management, Yuan-Ze University, 135 Yuan-Tung Road, Jung-Li, Taoyuan 320, Taiwan.
| | - Chin-Kan Chan
- Department of Pediatrics, Taoyuan General Hospital, Ministry of Health and Welfare, 1492 Zhongshan Road, Taoyuan Dist., Taoyuan 330, Taiwan.
| | - Chiung-Yi Wu
- Institute of Information Management, Yuan-Ze University, 135 Yuan-Tung Road, Jung-Li, Taoyuan 320, Taiwan.
| | - Dinh-Van Phan
- Institute of Information Management, Yuan-Ze University, 135 Yuan-Tung Road, Jung-Li, Taoyuan 320, Taiwan.
- Innovation Center for Big Data and Digital Convergence, Yuan-Ze University, 135 Yuan-Tung Road, Jung-Li, Taoyuan 320, Taiwan.
- University of Economics, The University of Danang, , 71 Ngu Hanh Son Street, Danang 550000, Vietnam.
| | - Chien-Lung Chan
- Institute of Information Management, Yuan-Ze University, 135 Yuan-Tung Road, Jung-Li, Taoyuan 320, Taiwan.
- Innovation Center for Big Data and Digital Convergence, Yuan-Ze University, 135 Yuan-Tung Road, Jung-Li, Taoyuan 320, Taiwan.
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27
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Keet CA, Keller JP, Peng RD. Long-Term Coarse Particulate Matter Exposure Is Associated with Asthma among Children in Medicaid. Am J Respir Crit Care Med 2018; 197:737-746. [PMID: 29243937 PMCID: PMC5855070 DOI: 10.1164/rccm.201706-1267oc] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 11/21/2017] [Indexed: 01/12/2023] Open
Abstract
RATIONALE Short- and long-term fine particulate matter (particulate matter ≤2.5 μm in aerodynamic diameter [PM2.5]) pollution is associated with asthma development and morbidity, but there are few data on the effects of long-term exposure to coarse PM (PM10-2.5) on respiratory health. OBJECTIVES To understand the relationship between long-term fine and coarse PM exposure and asthma prevalence and morbidity among children. METHODS A semiparametric regression model that incorporated PM2.5 and PM10 monitor data and geographic characteristics was developed to predict 2-year average PM2.5 and PM10-2.5 exposure during the period 2009 to 2010 at the zip-code tabulation area level. Data from 7,810,025 children aged 5 to 20 years enrolled in Medicaid from 2009 to 2010 were used in a log-linear regression model with predicted PM levels to estimate the association between PM exposure and asthma prevalence and morbidity, adjusting for race/ethnicity, sex, age, area-level urbanicity, poverty, education, and unmeasured spatial confounding. MEASUREMENTS AND MAIN RESULTS Exposure to coarse PM was associated with increased asthma diagnosis prevalence (rate ratio [RR] for 1-μg/m3 increase in coarse PM level, 1.006; 95% confidence interval [CI], 1.001-1.011), hospitalizations (RR, 1.023; 95% CI, 1.003-1.042), and emergency department visits (RR, 1.017; 95% CI, 1.001-1.033) when adjusting for fine PM. Fine PM exposure was more strongly associated with increased asthma prevalence and morbidity than coarse PM. The estimates remained elevated across different levels of spatial confounding adjustment. CONCLUSIONS Among children enrolled in Medicaid, exposure to higher average coarse PM levels is associated with increased asthma prevalence and morbidity. These results suggest the need for direct monitoring of coarse PM and reconsideration of limits on long-term average coarse PM pollution levels.
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Affiliation(s)
- Corinne A. Keet
- Division of Pediatric Allergy and Immunology, Johns Hopkins University School of Medicine, Baltimore, Maryland; and
| | - Joshua P. Keller
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Roger D. Peng
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Environment and Human Health: The Challenge of Uncertainty in Risk Assessment. GEOSCIENCES 2018. [DOI: 10.3390/geosciences8010024] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Mady LJ, Schwarzbach HL, Moore JA, Boudreau RM, Kaffenberger TM, Willson TJ, Lee SE. The association of air pollutants and allergic and nonallergic rhinitis in chronic rhinosinusitis. Int Forum Allergy Rhinol 2017; 8:369-376. [DOI: 10.1002/alr.22060] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 10/23/2017] [Accepted: 11/16/2017] [Indexed: 02/05/2023]
Affiliation(s)
- Leila J. Mady
- Department of Otolaryngology; University of Pittsburgh; Pittsburgh PA
| | | | - John A. Moore
- Department of Otolaryngology; University of Pittsburgh; Pittsburgh PA
| | - Robert M. Boudreau
- Department of Epidemiology; University of Pittsburgh Graduate School of Public Health; Pittsburgh PA
| | | | - Thomas J. Willson
- Department of Otolaryngology; San Antonio Military Medical Center; Uniformed Services University of the Health Sciences; San Antonio TX
| | - Stella E. Lee
- Department of Otolaryngology; University of Pittsburgh; Pittsburgh PA
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Mady LJ, Schwarzbach HL, Moore JA, Boudreau RM, Tripathy S, Kinnee E, Dodson ZM, Willson TJ, Clougherty JE, Lee SE. Air pollutants may be environmental risk factors in chronic rhinosinusitis disease progression. Int Forum Allergy Rhinol 2017; 8:377-384. [PMID: 29210519 DOI: 10.1002/alr.22052] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 10/23/2017] [Accepted: 11/07/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Little is known about the role of environmental exposures in the pathophysiology of chronic rhinosinusitis (CRS). In this study, we measured the impact of air pollutants (particulate matter 2.5 [PM2.5 ] and black carbon [BC]) on CRS with nasal polyposis (CRSwNP) and CRS without nasal polyposis (CRSsNP). METHODS Spatial modeling from pollutant monitoring sites was used to estimate exposures surrounding residences for patients meeting inclusion criteria (total patients, n = 234; CRSsNP, n = 96; CRSwNP, n = 138). Disease severity outcome measures included modified Lund-Mackay score (LMS), systemic steroids, number of functional endoscopic sinus surgeries (FESS), and 22-item Sino-Nasal Outcome Test (SNOT-22) score. PM2.5 and BC exposures were correlated with outcome measures. RESULTS Mean PM2.5 and BC findings were not significantly different between CRSwNP and CRSsNP patients or patients with and without asthma. Among those with CRSsNP, PM2.5 was significantly associated with undergoing FESS. For each unit increase in PM2.5 , there was a 1.89-fold increased risk in the proportion of CRSsNP patients who required further surgery (p = 0.015). This association was not identified in CRSwNP patients (p = 0.445). BC was also significantly associated with SNOT-22 score in the CRSsNP group. For each 0.1-unit increase in BC, there was a 7.97-unit increase in SNOT-22 (p = 0.008). A similar, although not significant, increase in SNOT-22 was found with increasing BC in the CRSwNP group (p = 0.728). CONCLUSION Air pollutants correlate with CRS symptom severity that may be influenced by exposure levels, with a more pronounced impact on CRSsNP patients. This study is the first to demonstrate the possible role of inhalant pollutants in CRS phenotypes, addressing a critical knowledge gap in environmental risk factors for disease progression.
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Affiliation(s)
- Leila J Mady
- Department of Otolaryngology, University of Pittsburgh, Pittsburgh, PA
| | | | - John A Moore
- Department of Otolaryngology, University of Pittsburgh, Pittsburgh, PA
| | - Robert M Boudreau
- Graduate School of Public Health, Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA
| | | | | | | | - Thomas J Willson
- Uniformed Services University of the Health Sciences, Department of Otolaryngology, San Antonio Military Medical Center, San Antonio, TX
| | | | - Stella E Lee
- Department of Otolaryngology, University of Pittsburgh, Pittsburgh, PA
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31
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Environmental effects on immune responses in patients with atopy and asthma. J Allergy Clin Immunol 2014; 134:1001-8. [PMID: 25439226 DOI: 10.1016/j.jaci.2014.07.064] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Revised: 07/25/2014] [Accepted: 07/30/2014] [Indexed: 12/13/2022]
Abstract
Despite attempts and some successes to improve air quality over the decades, current US national trends suggest that exposure to outdoor and indoor air pollution remains a significant risk factor for both the development of asthma and the triggering of asthma symptoms. Emerging science also suggests that environmental exposures during the prenatal period and early childhood years increase the risk of asthma. Multiple mechanisms mediate this risk because a wide range of deleterious air pollutants contribute to the pathogenesis of asthma across a variety of complex asthma phenotypes. In this review we will consider the role of altered innate and adaptive immune responses, gene-environment interactions, epigenetic regulation, and possibly gene-environment-epigene interactions. Gaining a greater understanding of the mechanisms that underlie the effect of exposure to air pollution on asthma, allergies, and other airway diseases can identify targets for therapy. Such interventions will include pollutant source reduction among those most exposed and most vulnerable and novel pharmaceutical strategies to reduce asthma morbidity.
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