Cough and environmental air pollution in China

Preserved Ratio Impaired Spirometry (PRISm): A Global Epidemiological Overview, Radiographic Characteristics, Comorbid Associations, and Differentiation from Chronic Obstructive Pulmonary Disease

Preserved Ratio Impaired Spirometry (PRISm) manifests notable epidemiological disparities across the globe, with its prevalence and influential factors showcasing pronounced diversities among various geographical territories and demographics. The prevalence of PRISm fluctuates considerably among regions such as Latin America, the United States, and Asian nations, potentially correlating with a myriad of determinants, including socioeconomic status, environmental factors, and lifestyle modalities. Concurrently, the link between PRISm and health risks and other disorders, especially its distinction and interrelation with chronic obstructive pulmonary disease (COPD), has become a pivotal subject of scientific enquiry. Radiographic anomalies, such as perturbations in the pulmonary parenchyma and structural alterations, are posited as salient characteristics of PRISm. Furthermore, PRISm unveils intricate associations with multiple comorbidities, inclusive of hypertension and type 2 diabetes, thereby amplifying the intricacy in comprehending and managing this condition. In this review, we aim to holistically elucidate the epidemiological peculiarities of PRISm, its potential aetiological contributors, its nexus with COPD, and its association with radiographic aberrations and other comorbidities. An integrative understanding of these dimensions will provide pivotal insights for the formulation of more precise and personalised preventative and therapeutic strategies.

Drivers of respiratory health care demand in Acre state, Brazilian Amazon: a cross-sectional study

Background

The scarce knowledge about the drivers of demand for respiratory health care in the Brazilian Amazon, where the gap of human and physical health care resources is wide, is expanded with two surveys conducted in the west of the region, in Acre state. Potential drivers, informed by a review of twelve recent papers, were classified into seven categories capturing the individual, household, community and macroeconomic dimensions.

Methods

Quantitative field surveys were conducted in 2017 and 2019 based on coupled conglomerate-quota randomization sampling. Adults responded about their own health or their children’s health. The probability of seeking physician care for the latest episode of respiratory illness or dry cough was analysed with multiple nonlinear regressions, having as covariates the potential predictors informed by the literature.

Results

The propensity to seek health care and to purchase medication was larger for children. Influenza-like illness (Despite the exact diagnostic stated by respondents being “influenza”, a virus detection test (such as the PCR test) is not commonly applied, as informed by the Acre state public health service. In consistency, the term “influenza-like illness” is used.) was the most frequently diagnosed disease, followed by pneumonia, suggesting that a health care-seeking rate below 40% may perpetuate health impairment and local contagion. Illnesses’ severity, including the pain experienced, was the main predictor, revealing that subjective perception was more influential than objective individual and household characteristics.

Conclusions

The results suggest that subjective underestimation of respiratory illnesses’ consequences for oneself and for local society could prevent health care from being sought. This is in line with some previous studies but departs from those emphasizing the role of objective factors. Social consequences, of, for instance, a macroeconomic nature, need to be highlighted based on studies detecting long-run relationships among health care demand, health and economic performance at the national level. Depending on the intensity of the trade-off between the costs imposed on the health system by increased demand and on the economy by the reduced productivity of the ill, policy could be adopted to change subjective perceptions of illnesses with nudges and educational and informational interventions.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-14171-z.

Cough hypersensitivity and chronic cough

Chronic cough is globally prevalent across all age groups. This disorder is challenging to treat because many pulmonary and extrapulmonary conditions can present with chronic cough, and cough can also be present without any identifiable underlying cause or be refractory to therapies that improve associated conditions. Most patients with chronic cough have cough hypersensitivity, which is characterized by increased neural responsivity to a range of stimuli that affect the airways and lungs, and other tissues innervated by common nerve supplies. Cough hypersensitivity presents as excessive coughing often in response to relatively innocuous stimuli, causing significant psychophysical morbidity and affecting patients' quality of life. Understanding of the mechanisms that contribute to cough hypersensitivity and excessive coughing in different patient populations and across the lifespan is advancing and has contributed to the development of new therapies for chronic cough in adults. Owing to differences in the pathology, the organs involved and individual patient factors, treatment of chronic cough is progressing towards a personalized approach, and, in the future, novel ways to endotype patients with cough may prove valuable in management.

Evaluation of the rate, pattern and appropriateness of antibiotic prescription in a cohort of pilgrims suffering from upper respiratory tract infection during the 2018 Hajj season

Hajj is associated with an increased risk of the transmission of infectious diseases including upper respiratory tract infections (URTIs). It can be a focal point for the emergence, persistence and dissemination of antimicrobial-resistant (AMR) bacteria. The overuse of antibiotics during Hajj can promote the development of antimicrobial resistance. Little information is known regarding the true appropriateness of prescribing antibiotics for treating URTIs during Hajj. Here we studied the rate, patterns and appropriateness of antibiotic prescription among a cohort of pilgrims who were treated for URTIs during the 2018 Hajj season. Adult pilgrims who sought medical services for URTIs [presenting with coryza, runny nose, nasal irritation, nasal congestion, cough, sore throat, headache or fever (even if subjective)] within the Holy sites were enrolled in this study and consented to provide swabs and medical information. A total of 121 pilgrims were enrolled, with the majority (60.3 %) originating from North African Arab countries. Most were male (89.3 %) with a median age of 45 years. Bacterial infections were detected in 7.3 % (n=9) of the URTI cases. The identified bacteria included Haemophilus influenzae (n=6, all resistant to ampicillin), Streptococcus pneumoniae (n=2), Staphylococcus aureus (n=1, resistant to oxacillin) and Moraxella catarrhalis (n=1, resistant to ampicillin and trimethoprim/sulfamethoxazole). The antibiotic prescription rate was 52.1%, most of which was amoxicillin (81 %). The data demonstrated that the proportion of appropriate practices in treating bacterial URTIs in this cohort was 45.5 %. This study highlights the need for implementing laboratory identification of the aetiological agents and related AMR profiles when treating URTIs in Hajj, rather than relying on clinical assessment alone.

Association of long-term exposure to ambient air pollution with the number of tuberculosis cases notified: a time-series study in Hong Kong

To analyze the association of long-term exposure to air pollution and its attributable risks with the number of tuberculosis (TB) cases notified, a quasi-Poisson regression model combined with a distributed lag nonlinear model (DLNM) was constructed using monthly data on air pollution and TB cases notified in Hong Kong from 1999 to 2018. Nonlinear relationships between PM₁₀, PM_2.5, and CO and TB cases notified were identified. The concentrations of PM₁₀, PM_2.5, and CO corresponding to the minimum numbers of TB cases notified (the minimum TB notification concentrations, MTNCs) were 58.3 μg/m³, 41.7 μg/m³, and 0.1 mg/m³, respectively. Compared with the MTNCs, the overall cumulative numbers of TB cases notified increased by 76.93% (95% CI: 13.08%, 176.83%), 88.81% (95% CI: 26.09%, 182.71%), and 233.43% (95% CI: 13.56%, 879.03%) for the 95th percentiles of PM₁₀ and PM_2.5 and for the 97.5th percentiles of CO, respectively. The TB notification rate attributed to concentration ranges above the 97.5th percentile of PM₁₀, PM_2.5, and CO was 3.38% (95% empirical confidence intervals [eCI]: 0.93%, 5.61%), 4.73% (95% eCI: 1.87%, 7.15%), and 3.34% (95% eCI: 0.29%, 5.83%), respectively. Long-term exposure to high concentrations of air pollution in Hong Kong may be associated with increases in the number of TB cases notified for this area.

Broilers' head behavior as an early warning index of production and lung health under ammonia exposure

This study investigated the effects of ammonia exposure (0, 15, 25, and 35 ppm) on head behavior, production performance and lung tissue morphology of broilers, and the relationship between head behavior, production performance, and lung tissue injury. In this experiment, a total of 264 AA commercial male broilers (21 d old) were assigned to 4 treatment groups with 6 replicates of 11 chickens for a 21-day trial period, the frequency of head-scratching and head-shaking behavior at the initial stage (2, 24, and 72 h) of ammonia exposure were recorded, and the production performance indices and the lung pathological changes after 21 d of ammonia exposure were observed. The correlation analysis was established between head behavior and production performance indices. Results showed that head-scratching behavior increased under 15 ppm ammonia for 72 h, head-shaking behavior increased when exposure to 15 ppm ammonia for 2, 24, and 72 h, and lung tissue was injured when exposure to 15 ppm ammonia for 21 d. However, exposure to 15 ppm ammonia did not influence growth performance. Compared with the control group, exposure to 25 ppm decreased the ADG and exposure to 35 ppm decreased the ADG, ADFI, and F/G. Furthermore, the increase in head-shaking frequency after 2 h and 24 h ammonia exposure was significantly associated with production performance and lung tissue injury after 21 d ammonia exposure. In conclusion, the head-shaking behavior at the initial stage of ammonia exposure can reflect the degree of harm of the later production performance and lung tissue health.

Nrf2 mitigates prolonged PM2.5 exposure-triggered liver inflammation by positively regulating SIKE activity: Protection by Juglanin

Air pollution containing particulate matter (PM) less than 2.5 μm (PM2.5) plays an essential role in regulating hepatic disease. However, its molecular mechanism is not yet clear, lacking effective therapeutic strategies. In this study, we attempted to investigate the effects and mechanisms of PM2.5 exposure on hepatic injury by the in vitro and in vivo experiments. At first, we found that PM2.5 incubation led to a significant reduction of nuclear factor erythroid-derived 2-related factor 2 (Nrf2), along with markedly reduced expression of different anti-oxidants. Notably, suppressor of IKKε (SIKE), known as a negative regulator of the interferon pathway, was decreased in PM2.5-incubated cells, accompanied with increased activation of TANK-binding kinase 1 (TBK1) and nuclear factor-κB (NF-κB). The in vitro studies showed that Nrf2 positively regulated SIKE expression under the conditions with or without PM2.5. After PM2.5 treatment, Nrf2 knockdown further accelerated SIEK decrease and TBK1/NF-κB activation, and opposite results were observed in cells with Nrf2 over-expression. Subsequently, the gene loss- and gain-function analysis demonstrated that SIKE deficiency further aggravated inflammation and TBK1/NF-κB activation caused by PM2.5, which could be abrogated by SIKE over-expression. Importantly, SIKE-alleviated inflammation was mainly dependent on TBK1 activation. The in vivo studies confirmed that SIKE- and Nrf2-knockout mice showed significantly accelerated hepatic injury after long-term PM2.5 exposure through reducing inflammatory response and oxidative stress. Juglanin (Jug), mainly isolated from Polygonum aviculare, exhibits anti-inflammatory and anti-oxidant effects. We found that Jug could increase Nrf2 activation, and then up-regulated SIKE in cells and liver tissues, mitigating PM2.5-induced liver injury. Together, all these data demonstrated that Nrf2 might positively meditate SIKE to inhibit inflammatory and oxidative damage, ameliorating PM2.5-induced liver injury. Jug could be considered as an effective therapeutic strategy against this disease by improving Nrf2/SIKE signaling pathway.

Associations between air pollution and outpatient visits for allergic rhinitis in Xinxiang, China

Several epidemiological studies have investigated the adverse health effects of air pollution, but studies reporting its effects on allergic rhinitis (AR) are limited, especially in developing countries having the most severe pollution. Limited studies have been conducted in China, but their results were inconsistent. So, we conducted a time-series study to evaluate the acute effect of six air pollutants (fine particulate matter [PM_2.5], particulate matter with diameter less than 10 μm [PM₁₀], sulfur dioxide [SO₂], nitrogen dioxide [NO₂], ozone [O₃], and carbon monoxide [CO]) on hospital outpatient visits for AR in Xinxiang, China from January 1, 2015, to December 31, 2018. An over-dispersed Poisson generalized additive model adjusting for weather conditions, long-term trends, and day of the week was used. In total, 14,965 AR outpatient records were collected during the study period. Results found that each 10 μg/m³ increase in PM_2.5, PM₁₀, SO₂, NO₂, O₃, and CO corresponded to 0.70% (95% confidence interval 0.00-1.41%), 0.79% (0.35-1.23%), 3.43% (1.47-5.39%), 4.54% (3.01-6.08%), 0.97% (- 0.11-2.05%), and 0.07% (0.02-0.12%) increments in AR outpatients on the current day, respectively. In the stratification analyses, statistically stronger associations were observed with PM_2.5, PM₁₀, SO₂, NO₂, and CO for AR outpatients < 15 years of age than in those 15-65 and ≥ 65 years of age, whereas the opposite result was found with O₃. Associations between PM₁₀, SO₂, NO₂, O₃, and AR outpatients were higher in the warm season than those in the cool season. This study suggests that exposure to PM_2.5, PM₁₀, SO₂, NO₂, and CO was associated with increased AR risk and children younger than 15 years might be more vulnerable.

The association of PM2.5 with airway innate antimicrobial activities of salivary agglutinin and surfactant protein D

Fine particulate matter ≤2.5 μm (PM_2.5) is a prominent global public health risk factor that can cause respiratory infection by downregulating the amounts of antimicrobial proteins and peptides (AMPs). Both salivary agglutinin (SAG) and surfactant protein D (SPD) are important AMPs in respiratory mucosal fluid, providing protection against airway pathogen invasion and infection by inducing microbial aggregation and enhancing pathogen clearance. However, the relationship between PM_2.5 and these AMPs is unclear. To better understand the relationship between PM_2.5 and airway innate immune defenses, we review the respiratory antimicrobial activities of SAG and SPD, as well as the adverse effects of PM_2.5 on airway innate antimicrobial defense. We speculate there exists a dual effect between PM_2.5 and respiratory antimicrobial activity, which means that PM_2.5 suppresses respiratory antimicrobial activity through downregulating airway AMPs, while airway AMPs accelerate PM_2.5 clearance by inducing PM_2.5 microbial aggregation. We propose further research on the relationship between PM_2.5 and these AMPs.

Short-term effect of relatively low level air pollution on outpatient visit in Shennongjia, China

BACKGROUND

Many cities in China are currently experiencing severe air pollution due to modernization. Previous studies investigating the effects of air pollutants exposure were particularly conducted in severe air polluted area and studies in low pollution areas were sparse.

METHODS

To quantitatively assess the short-term effects of ambient air pollutants (PM_2.5, PM₁₀, SO₂, NO₂, CO and O₃) on outpatient visits in low pollution area, we conducted a time-series analysis from Jan 1, 2015 to Dec 31, 2016 in Shennongjia, China. Generalized additive model (GAM) was used to evaluate the influence of PM_2.5 on daily hospital outpatient visits with different lag structures. We also conducted stratified analysis to explore the association between PM_2.5 concentration and outpatient visits in different seasons.

RESULTS

In the present study, per IQR increment of PM_2.5, PM₁₀, NO₂, CO and O₃ were related with 1.92% (0.76%-3.09%), 1.92% (0.77%-3.07%), 2.74% (95% CI: 1.65%-3.83%), 1.89% (95% CI: 0.68%-3.10%) and 2.30% (95% CI: 0.65%-3.95%) increase on respiratory outpatient visits. Significant associations were found between PM_2.5, PM₁₀, NO₂ and respiratory outpatient visits at lag0:1, lag0:2 days. The effects of PM_2.5 were more evident in the cool season than in the warm season.

CONCLUSIONS

Our study showed that short-term exposures to PM_2.5, PM₁₀, NO₂, CO and O₃ were related with increased risk of outpatient visits of respiratory diseases, and highlighted the adverse effect of air pollutants exposure, especially PM_2.5 exposure in cool season on health in low pollution area.

A Machine Hearing System for Robust Cough Detection Based on a High-Level Representation of Band-Specific Audio Features

Cough is a protective reflex conveying information on the state of the respiratory system. Cough assessment has been limited so far to subjective measurement tools or uncomfortable (i.e., non-wearable) cough monitors. This limits the potential of real-time cough monitoring to improve respiratory care.

OBJECTIVE

This paper presents a machine hearing system for audio-based robust cough segmentation that can be easily deployed in mobile scenarios.

METHODS

Cough detection is performed in two steps. First, a short-term spectral feature set is separately computed in five predefined frequency bands: [0, 0.5), [0.5, 1), [1, 1.5), [1.5, 2), and [2, 5.5125] kHz. Feature selection and combination are then applied to make the short-term feature set robust enough in different noisy scenarios. Second, high-level data representation is achieved by computing the mean and standard deviation of short-term descriptors in 300 ms long-term frames. Finally, cough detection is carried out using a support vector machine trained with data from different noisy scenarios. The system is evaluated using a patient signal database which emulates three real-life scenarios in terms of noise content.

RESULTS

The system achieves 92.71% sensitivity, 88.58% specificity, and 90.69% Area Under Receiver Operating Charcteristic (ROC) curve (AUC), outperforming state-of-the-art methods.

CONCLUSION

Our research outcome paves the way to create a device for cough monitoring in real-life situations.

SIGNIFICANCE

Our proposal is aligned with a more comfortable and less disruptive patient monitoring, with benefits for patients (allows self-monitoring of cough symptoms), practitioners (e.g., assessment of treatments or better clinical understanding of cough patterns), and national health systems (by reducing hospitalizations).

Factors associated with parent-reported wheeze and cough in children living in an industrial area of Gauteng, South Africa

We examined the factors associated with mother-reported wheeze and dry cough in children living in Tembisa, a residential and industrial community in South Africa. A cross-sectional sample of parents reported wheezing and dry cough in children (aged 1 to 26 months) by completing the standardised International Study of Asthma and Allergies in Childhood questionnaire with additional questions concerning tobacco use, income, living conditions, and mothers' educational level. Data were analysed using chi-square, univariate, and multivariable logistic regressions. Of the 493 children who participated, 81 (16.4%) had wheeze ever and 186 (37.7%) had dry cough ever. We observed that children had a higher probability of wheezing if mothers had lived in the area for longer periods (aOR 1.05; 95% CI 1.01-1.08). Children who had trucks passing on their streets frequently were more likely to have had dry cough ever compared to those with no trucks passing on their streets (aOR 3.88; 95% CI 2.29-6.57). In Tembisa, dry cough in a child was associated with the frequency of trucks passing in front of the child's home. Children were also more likely have wheeze if their mothers had been living in the community for longer times.

Mixed strategy to allocate resources with air pollution treatment in China: based on the analytic network process and large-group decision-making method

The resource allocation of air pollution treatment in China is a complex problem, since many alternatives are available and many criteria influence mutually. A number of stakeholders participate in this issue holding different opinions because of the benefits they value. So a method is needed, based on the analytic network process (ANP) and large-group decision-making (LGDM), to rank the alternatives considering interdependent criteria and stakeholders' opinions. In this method, the criteria related to air pollution treatment are examined by experts. Then, the network structure of the problem is constructed based on the relationships between the criteria. Further, every participant in each group provide comparison matrices by judging the importance between criteria according to dominance, regarding a certain criteria (or goal), and the geometric average comparison matrix of each group is obtained. The decision weight of each group is derived by combining the subjective weight and the objective weight, in which the subjective weight is provided by organizers, while the objective weight is determined by considering the consensus levels of groups. The final comparison matrices are obtained by the geometric average of comparison matrices and the decision weights. Next, the resource allocation is made according to the priorities of the alternatives using the super decision software. Finally, an example is given to illustrate the use of the proposed method.

Melatonin Attenuates Chronic Cough Mediated by Oxidative Stress via Transient Receptor Potential Melastatin-2 in Guinea Pigs Exposed to Particulate Matter 2.5

The aim of this study was to investigate the effects of melatonin on oxidative stress, the expression of transient receptor potential melastatin-2 (TRPM2) in guinea pig brains, and the influence of melatonin on oxidative stress in lungs and airway inflammation induced by particulate matter 2.5 (PM2.5). A particle suspension (0.1 g/ml) was nasally administered to the guinea pigs to prepare a PM2.5 exposure model. Cough frequency and cough incubation period were determined through RM6240B biological signal collection and disposal system. Oxidative stress markers, including malondialdehyde (MDA), total antioxidant capacity (T-AOC), total superoxide dismutase (T-SOD), and glutathione peroxidase (GSH-Px), in the medulla oblongata were examined through spectrophotometer. Reactive oxygen species (ROS) were detected in the hypoglossal nucleus, cuneate nucleus, Botzinger complex, dorsal vagal complex, and airway through dihydroethidium fluorescence. Hematoxylin-eosin (HE) staining and substance P expression via immunohistochemistry revealed the inflammatory levels in the airway. TRPM2 was observed in the medulla oblongata through immunofluorescence and Western blot. The ultrastructure of the blood-brain barrier and neuronal mitochondria was determined by using a transmission electron microscope. Our study suggests that melatonin treatment decreased PM2.5-induced oxidative stress level in the brains and lungs and relieved airway inflammation and chronic cough. TRPM2 might participate in oxidative stress in the cough center by regulating cough.

The Association between Ambient Air Pollution and Allergic Rhinitis: Further Epidemiological Evidence from Changchun, Northeastern China

With the continuous rapid urbanization process over the last three decades, outdoors air pollution has become a progressively more serious public health hazard in China. To investigate the possible associations, lag effects and seasonal differences of urban air quality on respiratory health (allergic rhinitis) in Changchun, a city in Northeastern China, we carried out a time-series analysis of the incidents of allergic rhinitis (AR) from 2013 to 2015. Environmental monitoring showed that PM_2.5 and PM₁₀ were the major air pollutants in Changchun, followed by SO₂, NO₂ and O₃. The results also demonstrated that the daily concentrations of air pollutants had obvious seasonal differences. PM₁₀ had higher daily mean concentrations in spring (May, dust storms), autumn (October, straw burning) and winter (November to April, coal burning). The mean daily number of outpatient AR visits in the warm season was higher than in the cold season. The prevalence of allergic rhinitis was significantly associated with PM_2.5, PM₁₀, SO₂ and NO₂, and the increased mobility was 10.2% (95% CI, 5.5%–15.1%), 4.9% (95% CI, 0.8%–9.2%), 8.5% (95% CI, −1.8%–19.8%) and 11.1% (95% CI, 5.8%–16.5%) for exposure to each 1-Standard Deviation (1-SD) increase of pollutant, respectively. Weakly or no significant associations were observed for CO and O₃. As for lag effects, the highest Relative Risks (RRs) of AR from SO₂, NO₂, PM₁₀ and PM_2.5 were on the same day, and the highest RR from CO was on day 4 (L4). The results also indicated that the concentration of air pollutants might contribute to the development of AR. To summarize, this study provides further evidence of the significant association between ambient particulate pollutants (PM_2.5 and PM₁₀, which are usually present in high concentrations) and the prevalence of respiratory effects (allergic rhinitis) in the city of Changchun, located in Northeastern China. Environmental control and public health strategies should be enforced to address this increasingly challenging problem.

One Health in China

As a result of rapid economic growth over the previous three decades, China has become the second largest economy worldwide since 2010. However, as a developing country with the largest population, this rapid economic growth primarily based on excessive consumption and waste of resources. Thus, China has been facing particularly severe ecological and environmental problems in speeding up industrialization and urbanization. The impact of the health risk factors is complex and difficult to accurately predict. Therefore, it is critical to investigate potential threats in the context of the human-animal-environment interface to protect human and animal health. The "One Health" concept recognizes that human health is connected to animal and environmental health. This review primarily discusses specific health problems in China, particularly zoonoses, and explains the origin and development of the One Health approach, as well as the importance of a holistic approach in China.