Impacts of air cleaners on indoor air quality in residences impacted by wood smoke

Portable Air Cleaner Usage and Particulate Matter Exposure Reduction in an Environmental Justice Community: A Pilot Study

Particulate matter (PM) exposure is associated with adverse health outcomes, including respiratory illness. A large fraction of exposure to airborne contaminants occurs in the home. This study, conducted over 5 months in a community with high asthma rates (Chelsea, MA, USA), investigated the use of portable air cleaners (PACs) to reduce indoor PM. Seven asthma-affected households participated, receiving a PAC (Austin Air Health Mate HEPA filter), a QuantAQ sensor to measure PM1, PM2.5, PM10 (µg/m3), and a HOBO plug-load data logger to track PAC usage. Results describe hourly and daily PM concentrations and PAC usage for each household. Hourly average PM concentrations decreased when PACs were turned on (vs. when they were turned off) across households during the study period: PM1 decreased by 0.46 µg/m3, PM2.5 decreased by 0.69 µg/m3, and PM10 decreased by 3.22 µg/m3. PAC usage varied for each household, including constant usage in one household and only usage at certain times of day in others. Higher filtration settings led to lower PM, with significant reductions in some, but not all, homes. Our findings highlight some difficulties in implementing household PAC interventions, yet also provide evidence to support household-level interventions to reduce PM and other indoor sources of air pollution. We also highlight academic-community partnerships as contributing to evidence-based solutions.

A systematic review and meta-analysis of field studies of portable air cleaners: Performance, user behavior, and by-product emissions

Indoor air quality is important for the health of building occupants, and public interest in controlling indoor airborne pathogens increased dramatically with the COVID-19 pandemic. Pollutant concentrations can be controlled locally using portable air cleaners (sometimes called air purifiers), which allow occupants to apply air cleaning technology to meet their needs in the location and times that they find appropriate. This paper provides a systematic review of scientific literature that describes field studies of the effectiveness of portable air cleaners. Over 500 papers were considered, and 148 were reviewed in detail, to extract 35 specific research results (e.g., particulate removal performance) or characteristics (e.g., type of building). These were aggregated to provide an overview of results and approaches to this type of research, and to provide meta-analyses of the results. The review includes: descriptions of the geographical location of the research; rate of publications over time; types of buildings and occupants in the field study; types of air cleaner technology being tested; pollutants being measured; resulting pollutant removal effectiveness; patterns of usage and potential barriers to usage by occupants; and the potential for by-product emissions in some air cleaner technologies. An example result is that 83 of the 148 papers measured reductions in fine particulates (PM2.5) and found a mean reduction of 49 % with standard deviation of 20 %. The aggregated results were approximately normally distributed, ranging from finding no significant reduction up to a maximum above 90 % reduction. Sixteen of the 148 papers considered gaseous pollutants, such as volatile organic compounds, nitrogen dioxide, and ozone; 36 papers considered biological pollutants, such as bacteria, viruses, pollen, fungi, etc. An important challenge, common to several studies, is that occupants run the air cleaners for shorter periods and on low airflow rate settings, because of concerns about noise, drafts, and electricity cost, which significantly reduces air cleaning effectiveness.

Asthma and landscape fire smoke: A Thoracic Society of Australia and New Zealand position statement

Landscape fires are increasing in frequency and severity globally. In Australia, extreme bushfires cause a large and increasing health and socioeconomic burden for communities and governments. People with asthma are particularly vulnerable to the effects of landscape fire smoke (LFS) exposure. Here, we present a position statement from the Thoracic Society of Australia and New Zealand. Within this statement we provide a review of the impact of LFS on adults and children with asthma, highlighting the greater impact of LFS on vulnerable groups, particularly older people, pregnant women and Aboriginal and Torres Strait Islander peoples. We also highlight the development of asthma on the background of risk factors (smoking, occupation and atopy). Within this document we present advice for asthma management, smoke mitigation strategies and access to air quality information, that should be implemented during periods of LFS. We promote clinician awareness, and the implementation of public health messaging and preparation, especially for people with asthma.

Systems toxicology of complex wood combustion aerosol reveals gaseous carbonyl compounds as critical constituents

Epidemiological studies identified air pollution as one of the prime causes for human morbidity and mortality, due to harmful effects mainly on the cardiovascular and respiratory systems. Damage to the lung leads to several severe diseases such as fibrosis, chronic obstructive pulmonary disease and cancer. Noxious environmental aerosols are comprised of a gas and particulate phase representing highly complex chemical mixtures composed of myriads of compounds. Although some critical pollutants, foremost particulate matter (PM), could be linked to adverse health effects, a comprehensive understanding of relevant biological mechanisms and detrimental aerosol constituents is still lacking. Here, we employed a systems toxicology approach focusing on wood combustion, an important source for air pollution, and demonstrate a key role of the gas phase, specifically carbonyls, in driving adverse effects. Transcriptional profiling and biochemical analysis of human lung cells exposed at the air-liquid-interface determined DNA damage and stress response, as well as perturbation of cellular metabolism, as major key events. Connectivity mapping revealed a high similarity of gene expression signatures induced by wood smoke and agents prompting DNA-protein crosslinks (DPCs). Indeed, various gaseous aldehydes were detected in wood smoke, which promote DPCs, initiate similar genomic responses and are responsible for DNA damage provoked by wood smoke. Hence, systems toxicology enables the discovery of critical constituents of complex mixtures i.e. aerosols and highlights the role of carbonyls on top of particulate matter as an important health hazard.

Reaction of HOCl with Wood Smoke Aerosol: Impacts on Indoor Air Quality and Outdoor Reactive Chlorine

High loadings of biomass burning (BB) aerosol particles from wildfire or residential heating sources can be present in both outdoor and indoor environments, where they deposit onto surfaces such as walls and furniture. These pollutants can interact with oxidants in both the aerosol and deposited forms. Hypochlorous acid (HOCl), a strong oxidant emitted during cleaning with chlorine-cleaning agents such as bleach, can attain mixing ratios of hundreds of ppbv indoors; moreover, lower mixing ratios are naturally present outdoors. Here, we report the heterogeneous reactivity of HOCl with wood smoke aerosol particles. After exposure to gas-phase HOCl, the particle chlorine content increased reaching chlorine-to-organic mass ratios of 0.07 with the chlorine covalently bound as organochlorine species, many of which are aromatic. Investigating individual potential BB components, we observed that unsaturated species such as coniferaldehyde and furfural react efficiently with HOCl. These observations indicate that organochlorine pollutants will form indoors when bleach cleaning a wildfire impacted space. The chlorine component of particles internally mixed with BB material and chloride initially increased, upon HOCl exposure, indicating that active chlorine recycling in the outdoor environment will be suppressed in the presence of BB emissions.

Exposure to fine particulate matter (PM2.5) from non-tobacco sources in homes within high-income countries: a systematic review

The health impacts associated with exposure to elevated concentrations of fine particulate matter (PM_2.5) are well recognised. There is a substantial number of studies characterising PM_2.5 concentrations outdoors, as well as in homes within low- and middle-income countries. In high-income countries (HICs), there is a sizeable literature on indoor PM_2.5 relating to smoking, but the evidence on exposure to PM_2.5 generated from non-tobacco sources in homes is sparse. This is especially relevant as people living in HICs spend the majority of their time at home, and in the northern hemisphere households often have low air exchange rates for energy efficiency. This review identified 49 studies that described indoor PM_2.5 concentrations generated from a variety of common household sources in real-life home settings in HICs. These included wood/solid fuel burning appliances, cooking, candles, incense, cleaning and humidifiers. The reported concentrations varied widely, both between sources and within groups of the same source. The burning of solid fuels was found to generate the highest indoor PM_2.5 concentrations. On occasion, other sources were also reported to be responsible for high PM_2.5 concentrations; however, this was only in a few select examples. This review also highlights the many inconsistencies in the ways data are collected and reported. The variable methods of measurement and reporting make comparison and interpretation of data difficult. There is a need for standardisation of methods and agreed contextual data to make household PM_2.5 data more useful in epidemiological studies and aid comparison of the impact of different interventions and policies.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s11869-022-01288-8.

A review of critical residential buildings parameters and activities when investigating indoor air quality and pollutants

Indoor air in residential dwellings can contain a variety of chemicals, sometimes present at concentrations or in combinations which can have a negative impact on human health. Indoor Air Quality (IAQ) surveys are often required to characterize human exposure or to investigate IAQ concerns and complaints. Such surveys should include sufficient contextual information to elucidate sources, pathways, and the magnitude of exposures. The aim of this review was to investigate and describe the parameters that affect IAQ in residential dwellings: building location, layout, and ventilation, finishing materials, occupant activities, and occupant demography. About 180 peer-reviewed articles, published from 01/2013 to 09/2021 (plus some important earlier publications), were reviewed. The importance of the building parameters largely depends on the study objectives and whether the focus is on a specific pollutant or to assess health risk. When considering classical pollutants such as particulate matter (PM) or volatile organic compounds (VOCs), the building parameters can have a significant impact on IAQ, and detailed information of these parameters needs to be reported in each study. Research gaps and suggestions for the future studies together with recommendation of where measurements should be done are also provided.

Efficacy of air filtration and education interventions on fine particulate matter among rural Native American homes heated with wood stoves: Results from the EldersAIR randomized trial

BACKGROUND

Native Americans living in rural areas often rely upon wood stoves for home heating that can lead to elevated indoor concentrations of fine particulate matter (PM2.5). Wood stove use is associated with adverse health outcomes, which can be a particular risk in vulnerable populations including older adults.

OBJECTIVES

We assessed the impact of portable air filtration units and educational approaches that incorporated elements of traditional knowledge on indoor and personal PM2.5 concentrations among rural, Native American elder households with wood stoves.

METHODS

EldersAIR was a three-arm, pre-post randomized trial among rural households from the Navajo Nation and Nez Perce Tribe in the United States. We measured personal and indoor PM2.5 concentrations over 2-day sampling periods on up to four occasions across two consecutive winter seasons in elder participant homes. We assessed education and air filtration intervention efficacy using linear mixed models.

RESULTS

Geometric mean indoor PM2.5 concentrations were 50.5 % lower (95 % confidence interval: -66.1, -27.8) in the air filtration arm versus placebo, with similar results for personal PM2.5. Indoor PM2.5 concentrations among education arm households were similar to placebo, although personal PM2.5 concentrations were 33.3 % lower for the education arm versus placebo (95 % confidence interval: -63.2, 21.1).

SIGNIFICANCE

The strong partnership between academic and community partners helped facilitate a culturally acceptable approach to a clinical trial intervention within the study communities. Portable air filtration units can reduce indoor PM2.5 that originates from indoor wood stoves, and this finding was supported in this study. The educational intervention component was meaningful to the communities, but did not substantially impact indoor PM2.5 relative to placebo. However, there is evidence that the educational interventions reduced indoor PM2.5 in some subsets of the study households. More study is required to determine ways to optimize educational interventions within Native American communities.

Pulmonary Benefits of Intervention with Air Cleaner among Schoolchildren in Beijing: A Randomized Double-Blind Crossover Study

We conducted a crossover study employing air cleaner intervention among 125 schoolchildren aged 9-12 years in a boarding school in Beijing, China. The PM concentrations were monitored, and 27 biomarkers were analyzed. We used the linear mixed-effects model to evaluate the association of intervention/time-weighted PM concentrations with biomarkers. The outcomes showed that air cleaner intervention was associated with FeNO, exhaled breath condensate (EBC) IL-1β, and IL-6, which decreased by 12.57%, 10.83%, and 4.33%, respectively. Similar results were observed in the associations with PMs. Lag 1 day PMs had the strongest relationship with biomarkers, and significant changes were observed in biomarkers such as FEV₁, FeNO, EBC 8-iso, and MCP-1. Boys showed higher percentage changes than girls, and the related biomarkers were FeNO, EBC 4-HNE, IL-1β, IL-6, and MCP-1. The results showed that biomarkers such as FeNO, EBC IL-6, MCP-1, and 4-HNE could sensitively reflect the early abnormal response of the respiratory system under short-term PM exposure among healthy schoolchildren and indicated that (1) air cleaners exert a protective effect on children's respiratory system. (2) PM had lag and cumulative effect, lag 1 day had the greatest effect. (3) The boys were more sensitive than the girls.

Efficacy of Air Filtration and Education Interventions on Indoor Fine Particulate Matter and Child Lower Respiratory Tract Infections among Rural U.S. Homes Heated with Wood Stoves: Results from the KidsAIR Randomized Trial

BACKGROUND

Millions of rural U.S. households are heated with wood stoves. Wood stove use can lead to high indoor concentrations of fine particulate matter [airborne particles ≤2.5μm in aerodynamic diameter (PM2.5)] and is associated with lower respiratory tract infection (LRTI) in children.

OBJECTIVES

We assessed the impact of low-cost educational and air filtration interventions on childhood LRTI and indoor PM2.5 in rural U.S. homes with wood stoves.

METHODS

The Kids Air Quality Interventions for Reducing Respiratory Infections (KidsAIR) study was a parallel three-arm (education, portable air filtration unit, control), post-only randomized trial in households from Alaska, Montana, and Navajo Nation (Arizona and New Mexico) with a wood stove and one or more children <5 years of age. We tracked LRTI cases for two consecutive winter seasons and measured indoor PM2.5 over a 6-d period during the first winter. We assessed results using two analytical frameworks: a) intervention efficacy on LRTI and PM2.5 (intent-to-treat), and b) association between PM2.5 and LRTI (exposure-response).

RESULTS

There were 61 LRTI cases from 14,636 child-weeks of follow-up among 461 children. In the intent-to-treat analysis, children in the education arm [odds ratio (OR)=0.98; 95% confidence interval (CI): 0.35, 2.72] and the filtration arm (OR=1.23; 95% CI: 0.46, 3.32) had similar odds of LRTI vs. control. Geometric mean PM2.5 concentrations were similar to control in the education arm (11.77% higher; 95% CI: -16.57, 49.72) and air filtration arm (6.96% lower; 95% CI: -30.50, 24.55). In the exposure-response analysis, odds of LRTI were 1.45 times higher (95% CI: 1.02, 2.05) per interquartile range (25 μg/m3) increase in mean indoor PM2.5.

DISCUSSION

We did not observe meaningful differences in LRTI or indoor PM2.5 in the air filtration or education arms compared with the control arm. Results from the exposure-response analysis provide further evidence that biomass air pollution adversely impacts childhood LRTI. Our results highlight the need for novel, effective intervention strategies in households heated with wood stoves. https://doi.org/10.1289/EHP9932.

A review on reducing indoor particulate matter concentrations from personal-level air filtration intervention under real-world exposure situations

Improving air quality in indoor environments where people live is of importance to protect human health. In this systematic review, we assessed the effectiveness of personal-level use of air filtration units in reducing indoor particulate matters (PM) concentrations under real-world situations following systematic review guidelines. A total of 54 articles were included in the review, in which 20 randomized controlled/crossover trials that reported the changes in indoor fine PM (PM_2.5 ) concentrations were quantitatively assessed in meta-analysis. Standardized mean differences (SMDs) were calculated for changes in indoor PM concentrations following air filtration interventions. Moderate-to-large reductions of 11%-82% in indoor PM_2.5  concentrations were observed with SMD of -1.19 (95% CI: -1.50, -0.88). The reductions in indoor PM concentrations varied by geographical locations, filtration technology employed, indoor environmental characteristics, and air pollution sources. Most studies were graded with low-to-moderate risk of bias; however, the overall certainty of evidence for indoor PM concentration reductions was graded at very low level. Considering the effectiveness of indoor air filtration under practical uses, socio-economic disparities across study populations, and costs of air filter replacement over time, our results highlight the importance of reducing air pollution exposure at the sources.

Effects of air purification of indoor PM2.5 on the cardiorespiratory biomarkers in young healthy adults

Ambient fine particulate matter (PM_2.5 ), as one of the predominant air pollutants, has achieved effective control in recent years in China. Whether the use of indoor air purifiers is still necessary needs further exploration. A randomized crossover trial was conducted in 54 healthy students in Beijing, China. Participants were randomized assigned to the use of real or sham high-efficiency particulate air filter (HEPA) for a week and changed the status after a washout period. Health measurements of cardiorespiratory biomarkers were performed at the end of each period. Linear mixed-effects models were used to evaluate the association between PM_2.5 exposure and cardiorespiratory biomarkers. Compared with sham air purification, average diastolic blood pressure (DBP), fractional exhaled nitric oxide (FeNO), and 8-isoprostane (8-isoPGF2α) levels decreased significantly in the real purification. The effects of indoor air purification on lung function indicators including forced expiratory volume in one second (FEV₁ ), peak expiratory flow (PEF), and forced expiratory flow between the 25th and 75th percentile of forced vital capacity (FEF_25%-75% ) were also significant. Our findings showed a protective effect of indoor HEPA air purifiers on cardiorespiratory health of young healthy adults reflected by the decreased blood pressure, respiratory inflammation, and systematic oxidative stress and improved lung function.

Portable air purification: Review of impacts on indoor air quality and health

A systematic literature review was carried out to examine the impact of portable air purifiers (PAPs) on indoor air quality (PM_2.5) and health, focussing on adults and children in indoor environments (homes, schools and offices). Analysed studies all showed reductions in PM_2.5 of between 22.6 and 92.0% with the use of PAPs when compared to the control. Associations with health impacts found included those on blood pressure, respiratory parameters and pregnancy outcomes. Changes in clinical biochemical markers were also identified. However, evidence for such associations was limited and inconsistent. Health benefits from a reduction in PM_2.5 would be expected as the cumulative body of scientific evidence from various cohort studies shows positive impacts of long-term reduction in PM_2.5 concentrations. The current evidence demonstrates that using a PAP results in short-term reductions in PM_2.5 in the indoor environment, which has the potential to offer health benefits.

Can Public Spaces Effectively Be Used as Cleaner Indoor Air Shelters during Extreme Smoke Events?

During extreme air pollution events, such as bushfires, public health agencies often recommend that vulnerable individuals visit a nearby public building with central air conditioning to reduce their exposure to smoke. However, there is limited evidence that these "cleaner indoor air shelters" reduce exposure or health risks. We quantified the impact of a "cleaner indoor air shelter" in a public library in Port Macquarie, NSW, Australia when concentrations of fine particulate matter (PM_2.5) were elevated during a local peat fire and nearby bushfires. Specifically, we evaluated the air quality improvements with central air conditioning only and with the use of portable high efficiency particulate air (HEPA) filter air cleaners. We measured PM_2.5 from August 2019 until February 2020 by deploying pairs of low-cost PM_2.5 sensors (i) inside the main library, (ii) in a smaller media room inside the library, (iii) outside the library, and (iv) co-located with regulatory monitors located in the town. We operated two HEPA cleaners in the media room from August until October 2019. We quantified the infiltration efficiency of outdoor PM_2.5 concentrations, defined as the fraction of the outdoor PM_2.5 concentration that penetrates indoors and remains suspended, as well as the additional effect of HEPA cleaners on PM_2.5 concentrations. The infiltration efficiency of outdoor PM_2.5 into the air-conditioned main library was 30%, meaning that compared to the PM_2.5 concentration outdoors, the concentrations of outdoor-generated PM_2.5 indoors were reduced by 70%. In the media room, when the HEPA cleaners were operating, PM_2.5 concentrations were reduced further with a PM_2.5 infiltration efficiency of 17%. A carefully selected air-conditioned public building could be used as a cleaner indoor air shelter during episodes of elevated smoke emissions. Further improvements in indoor air quality within the building can be achieved by operating appropriately sized HEPA cleaners.

Biomass burning-derived airborne particulate matter in Southeast Asia: A critical review

Smoke haze episodes, resulting from uncontrolled biomass burning (BB) including forest and peat fires, continue to occur in Southeast Asia (SEA), affecting air quality, atmospheric visibility, climate, ecosystems, hydrologic cycle and human health. The pollutant of major concern in smoke haze is airborne particulate matter (PM). A number of fundamental laboratory, field and modeling studies have been conducted in SEA from 2010 to 2020 to investigate potential environmental and health impacts of BB-induced PM. The goal of this review is to bring together the most recent developments in our understanding of various aspects of BB-derived PM based on 127 research articles published from 2010 to 2020, which have not been conveyed in previous reviews. Specifically, this paper discusses the physical, chemical, toxicological and radiative properties of BB-derived PM. It also provides insights into the environmental and health impacts of BB-derived PM, summarizes the approaches taken to do the source apportionment of PM during BB events and discusses the mitigation of exposure to BB-derived PM. Suggestions for future research priorities are outlined. Policies needed to prevent future BB events in the SEA region are highlighted.

Improving the Indoor Air Quality of Residential Buildings during Bushfire Smoke Events

Exposure to bushfire smoke is associated with acute and chronic health effects such as respiratory and cardiovascular disease. Residential buildings are important places of refuge from bushfire smoke, however the air quality within these locations can become heavily polluted by smoke infiltration. Consequently, some residential buildings may offer limited protection from exposure to poor air quality, especially during extended smoke events. This paper evaluates the impact of bushfire smoke on indoor air quality within residential buildings and proposes strategies and guidance to reduce indoor levels of particulates and other pollutants. The paper explores the different monitoring techniques used to measure air pollutants and assesses the influence of the building envelope, filtration technologies, and portable air cleaners used to improve indoor air quality. The evaluation found that bushfire smoke can substantially increase the levels of pollutants within residential buildings. Notably, some studies reported indoor levels of PM2.5 of approximately 500µg/m3 during bushfire smoke events. Many Australian homes are very leaky (i.e., >15 ACH) compared to those in countries such as the USA. Strategies such as improving the building envelope will help reduce smoke infiltration, however even in airtight homes pollutant levels will eventually increase over time. Therefore, the appropriate design, selection, and operation of household ventilation systems that include particle filtration will be critical to reduce indoor exposures during prolonged smoke events. Future studies of bushfire smoke intrusion in residences could also focus on filtration technologies that can remove gaseous pollutants.

Outstanding performance of ZnS/TiO2 for the urgent disposal of liquid mercury leakage indoors: Novel support effect, reaction mechanism and kinetics

Effectively weakening the bond strength of Zn-S in S-Zn-S on ZnS is of great significance to the improvement of its performance for the urgent disposal of liquid Hg⁰ leakage indoors. In this work, ZnS was loaded on three common supports (i.e., TiO₂, SiO₂, and Al₂O₃) to further improve its performance for capturing high concentrations of Hg⁰ indoors. After being loaded on TiO₂, the S-Zn-O bond was present on ZnS, and the bond strength of Zn-S in S-Zn-O was significantly weaker than that in S-Zn-S because Zn²⁺ preferred to O^2- than S^2-. Hence, physically adsorbed Hg⁰ was much easier to bond with S in S-Zn-O than that in S-Zn-S to form HgS. Therefore, TiO₂ showed a novel support effect on ZnS for Hg⁰ capture, and the Hg⁰ capture performance of ZnS/TiO₂ was greatly better than those of ZnS, ZnS/SiO₂, and ZnS/Al₂O₃. Moreover, the promotion mechanism of ZnO loading on Hg⁰ adsorption onto TiO₂-S was discovered after comparing the Hg⁰ adsorption kinetic parameters of TiO₂-S and ZnS/TiO₂. The promotion of ZnO loading was primarily related to the notable increase in the content of S^2- that can bond with physically adsorbed Hg⁰, which predominantly resulted from the strong interaction of ZnO/TiO₂ with H₂S.

Mitigation of indoor human exposure to airborne particles of outdoor origin in an urban environment during haze and non-haze periods

During the 2019 smoke haze episode in Singapore, elevated levels of fine particulate matter (PM_2.5) were observed, deteriorating both ambient and indoor air quality (IAQ). We investigated the mitigation of indoor human exposure to PM_2.5 of outdoor origin under diverse exposure scenarios with and without filtration of PM_2.5 during both hazy and non-hazy days. The key objective of our study was to make a comparative evaluation of the effectiveness of portable air cleaners (PACs) and air conditioning (AC) systems equipped with particle filters in improving IAQ and to assess related long-term carcinogenic and non-carcinogenic health risks. We conducted real-time measurements of PM_2.5, black carbon mass concentrations and particle number concentrations in both indoor and outdoor areas, quantified the relative concentrations of the water-soluble fraction of toxic trace elements in PM_2.5 for health risk assessment, and estimated the levels of thermal comfort. In addition, we calculated the total estimated cost of indoor air pollution control. Our findings suggest that indoor air cleaners are more effective at mitigating human exposure to airborne particles and reducing health risk with less consumption of electricity and better cost-effectiveness compared to AC. This information would be beneficial for public health interventions during major air pollution events.

Cardiopulmonary Impact of Particulate Air Pollution in High-Risk Populations: JACC State-of-the-Art Review

Fine particulate air pollution <2.5 μm in diameter (PM2.5) is a major environmental threat to global public health. Multiple national and international medical and governmental organizations have recognized PM2.5 as a risk factor for cardiopulmonary diseases. A growing body of evidence indicates that several personal-level approaches that reduce exposures to PM2.5 can lead to improvements in health endpoints. Novel and forward-thinking strategies including randomized clinical trials are important to validate key aspects (e.g., feasibility, efficacy, health benefits, risks, burden, costs) of the various protective interventions, in particular among real-world susceptible and vulnerable populations. This paper summarizes the discussions and conclusions from an expert workshop, Reducing the Cardiopulmonary Impact of Particulate Matter Air Pollution in High Risk Populations, held on May 29 to 30, 2019, and convened by the National Institutes of Health, the U.S. Environmental Protection Agency, and the U.S. Centers for Disease Control and Prevention.

Personal-Level Protective Actions Against Particulate Matter Air Pollution Exposure: A Scientific Statement From the American Heart Association

Since the publication of the last American Heart Association scientific statement on air pollution and cardiovascular disease in 2010, unequivocal evidence of the causal role of fine particulate matter air pollution (PM2.5, or particulate matter ≤2.5 μm in diameter) in cardiovascular disease has emerged. There is a compelling case to provide the public with practical personalized approaches to reduce the health effects of PM2.5. Such interventions would be applicable not only to individuals in heavily polluted countries, high-risk or susceptible individuals living in cleaner environments, and microenvironments with higher pollution exposures, but also to those traveling to locations with high levels of PM2.5. The overarching motivation for this document is to summarize the current evidence supporting personal-level strategies to prevent the adverse cardiovascular effects of PM2.5, guide the use of the most proven/viable approaches, obviate the use of ineffective measures, and avoid unwarranted interventions. The significance of this statement relates not only to the global importance of PM2.5, but also to its focus on the most tested interventions and viable approaches directed at particulate matter air pollution. The writing group sought to provide expert consensus opinions on personal-level measures recognizing the current uncertainty and limited evidence base for many interventions. In doing so, the writing group acknowledges that its intent is to assist other agencies charged with protecting public health, without minimizing the personal choice considerations of an individual who may decide to use these interventions in the face of ongoing air pollution exposure.

Effectiveness and Eco-Costs of Air Cleaners in Terms of Improving Fungal Air Pollution in Dwellings Located in Southern Poland—A Preliminary Study

Epidemiological evidence shows that air pollution is responsible for several million premature deaths per year. By virtue of being responsible for these deaths, economic evidence shows that air pollution also imposes a so-called economic cost to society of several trillion dollars per year. The diseases caused by biological air pollutants are of primary global concern for both social and economic reasons, and given that people may spend more than 90% of their time in enclosed spaces, the investigation into methods to remove indoor air pollutants is of paramount importance. One of the methods to improve indoor air quality (IAQ) is to use air cleaners (ACLs) with high-efficiency particulate air filters (HEPA) that remove biological indoor air pollutants from indoor environments. This work presents the results of a study of fungal aerosol samples collected during the summer season from inside two dwellings (DG1 and DG2) before and after starting the use of ACLs. The fungal aerosol samples collected from each of the six stages of the sampler were incubated on agar plates at 26 °C, and the colony forming units (CFU) were manually counted and statistically corrected. The concentration of living airborne fungi was expressed as the CFU in the volume of air (CFU·m−3). The average concentration of fungal aerosol decreased the most when the ACLs were active for 24 min. The reduction was from 474 CFU·m−3 to 306 CFU·m−3, and from 582 CFU·m−3 to 338 CFU·m−3 in DG1 and DG2, respectively. The use of ACLs was assessed by the life cycle assessment (LCA) methodology. This study highlights the benefits of controlling biological air pollutants in order to keep occupants of buildings happy and healthy.

How efficiently can HEPA purifiers remove priority fine and ultrafine particles from indoor air?

More than 1 million premature deaths in Asia annually are estimated to be associated with indoor air quality. HEPA (high-efficiency particulate air) filter air purifiers (APs) are widely used in urban Chinese residences by the growing middle class, as public awareness of air pollution increases. Currently, understanding of how particle size affects particle removal is inconsistent, and the rate at which different particle types are removed remains largely unknown. Therefore, this investigation aimed to determine the relationship between particle size and the removal efficiency of particles, and how efficiently ambient air is filtered compared to particle types which are typically used in standard tests (tobacco smoke, dust and pollen). Three of the most popular AP models in China were tested in China's largest indoor controlled chamber laboratory and the removal efficiencies of particles in the 18-514 nm range were identified. Each AP had a distinct profile of removal efficiency against particle size, but the three APs shared similarities in performance, with removal efficiency consistently lowest at 200-250 nm. This size fraction is important in an exposure context as these particles are abundant in ambient air in mega-cities, can penetrate through building shells effectively, remain airborne for long periods of time and can penetrate the deepest areas of the lungs. Ambient air particles were removed at a similar rate to test particles; this confirms that the Association of Home Appliance Manufacturers' (AHAM) standards are a suitable proxy for "real world" performance.

Control of wildfire-sourced PM2.5 in an office setting using a commercially available portable air cleaner

A steady increase in wildfire event severity and season length has led to greater potential for exposure to fine particulate matter associated with wildfire smoke. Research has found fine particulate matter to be correlated with a myriad of health ailments and thus effective strategies for controlling exposures are needed. In this study, a correction factor associated with wildfire-sourced fine particulate matter was established for a TSI SidePak AM520 by conducting sampling with a co-located MetOne BAM 1020. Portable air cleaner efficacy was assessed by simultaneously measuring PM_2.5 mass concentrations in two identical offices with the inclusion of a portable air cleaner in one. The relationship between indoor and outdoor PM_2.5 mass concentrations was assessed by comparing concentrations recorded in an office to those recorded at the nearest National Ambient Air Quality Standards monitoring station. Results revealed that a portable air cleaner reduced indoor fine particulate matter within an office by 73% and 92% during working and non-working hours, respectively, and that a strong significant correlation (ρ = .91, p = 0.00) existed between indoor and outdoor fine particulate matter mass concentration measurements. A direct relationship between indoor and outdoor PM_2.5 mass concentrations was observed during this study, suggesting that elevated fine particulate matter concentrations due to wildfire smoke could be a concern in the indoor work environment; however the current study determined that the use of a portable air cleaner can substantially decrease fine particulate matter concentrations even in an active office setting.

Characteristics of indoor and outdoor fine particles in heating period at urban, suburban, and rural sites in Harbin, China

Concurrent indoor-outdoor fine particulate matter (PM_2.5) measurements were conducted at urban, suburban, and rural sites in Harbin, a megacity in the northeast of China. Chemical constituents of indoor-outdoor PM_2.5 were determined. Infiltration factors (F_INF) of all sites were calculated according to the indoor to outdoor (I/O) ratios of PM_2.5 based on the regression analysis. Linear discriminant analysis (LDA) is applied to determine the indoor-outdoor relationship. Secondary organic carbon (SOC) was calculated on the basis of organic carbon to elemental carbon (OC/EC) ratios. The mean concentrations of indoor and outdoor PM_2.5 were 166.4 ± 32.5 μg/m³ and 228.4 ± 83.7 μg/m³, respectively, during the heating period. OC/EC and potassium ion to elemental carbon (K⁺/EC) ratios verified that biomass was an important source in Harbin especially for rural sites. The nitrate to sulfate (NO₃^-/SO₄^2-) ratio indicates the higher contribution of traffic emissions in urban sites. Cr was the only species that exceeded the guidelines of WHO 2002, which was mainly emitted from coal and oil combustion. SOC/OC and NO₃^-/SO₄^2- ratios, and ion-balanced acidity (the ratio of cation to anion, R_+/-) showed a large urban-rural and indoor-outdoor difference. The highest SOC/OC ratio was found at urban sites, up to 38.3% for indoors. SOC/OC ratios and R_+/- values of indoor environments were higher, which is attributed to the conducive condition of forming the secondary pollutants during the heating period. The results of LDA indicated that the distributions of the chemical components of PM_2.5 at three sites were statistically dissimilar. Graphical abstract.

Reduction of personal PM2.5 exposure via indoor air filtration systems in Detroit: an intervention study

The adverse health effects of fine particulate matter (PM < 2.5 μm in diameter [PM_2.5]) air pollution are well-documented. There is a growing body of evidence that high-efficiency particulate arrestance (HEPA) filtration can reduce indoor PM_2.5 concentrations and deliver some health benefits via the reduction of exposure to PM. However, few studies have tested the ability of portable air filtration systems to lower overall personal-level PM_2.5 exposures. The Reducing Air Pollution in Detroit Intervention Study (RAPIDS) was designed to evaluate cardiovascular health benefits and personal PM_2.5 exposure reductions via indoor portable air filtration systems among senior citizens in Detroit, Michigan. We evaluated the utility of two commercially available high-efficiency (HE: true-HEPA) and low-efficiency (LE: HEPA-type) indoor air filtration to reduce indoor PM_2.5 concentrations and personal PM_2.5 exposures for 40 participants in a double-blinded randomized crossover intervention. Each participant was subjected to three intervention scenarios: HE, LE, or no filter (control) of three consecutive days each, during which personal, indoor, and outdoor PM_2.5 concentrations were measured daily. For mean indoor PM_2.5 concentrations, we observed 60 and 52% reductions using HE and LE filters, respectively, relative to no filtration. Personal PM_2.5 exposures were reduced by 53 and 31% using HE and LE filters, respectively, when compared with the control scenario. To our knowledge, this is the first indoor air filtration intervention study to examine the effectiveness of both HE and LE filters in reducing personal PM_2.5 exposures.

Is remaining indoors an effective way of reducing exposure to fine particulate matter during biomass burning events?

Bushfires, prescribed burns, and residential wood burning are significant sources of fine particles (aerodynamic diameter <2.5 μm; PM_2.5) affecting the health and well-being of many communities. Despite the lack of evidence, a common public health recommendation is to remain indoors, assuming that the home provides a protective barrier against ambient PM_2.5. The study aimed to assess to what extent houses provide protection against peak concentrations of outdoor PM_2.5 and whether remaining indoors is an effective way of reducing exposure to PM_2.5. The effectiveness of this strategy was evaluated by conducting simultaneous week-long indoor and outdoor measurements of PM_2.5 at 21 residences in regional areas of Victoria, Australia. During smoke plume events, remaining indoors protected residents from peak outdoor PM_2.5 concentrations, but the level of protection was highly variable, ranging from 12% to 76%. Housing stock (e.g., age of the house) and ventilation (e.g., having windows/doors open or closed) played a significant role in the infiltration of outdoor PM_2.5 indoors. The results also showed that leaving windows and doors closed once the smoke plume abates trapped PM_2.5 indoors and increased indoor exposure to PM_2.5. Furthermore, for approximately 50% of households, indoor sources such as cooking activities, smoking, and burning candles or incense contributed significantly to indoor PM_2.5. Implications: Smoke from biomass burning sources can significantly impact on communities. Remaining indoors with windows and doors closed is a common recommendation by health authorities to minimize exposures to peak concentrations of fine particles during smoke plume events. Findings from this study have shown that the protection from fine particles in biomass burning smoke is highly variable among houses, with information on housing age and ventilation status providing an approximate assessment on the protection of a house. Leaving windows closed once a smoke plume abates traps particles indoors and increases exposures.

Wood Stove Pollution in the Developed World: A Case to Raise Awareness Among Pediatricians

Use of wood for residential heating is regaining popularity in developed countries. Currently, over 11 million US homes are heated with a wood stove. Although wood stoves reduce heating costs, wood smoke may adversely impact child health through the emission of gaseous and particulate air pollutants. Our purpose is to raise awareness of this environmental health issue among pediatricians. To summarize the state of the science, we performed a narrative review of articles published in PubMed and Web of Science. We identified 36 studies in developed countries that reported associations of household wood stove use and/or community wood smoke exposure with pediatric health outcomes. Studies primarily investigated respiratory outcomes, with no evaluation of cardiometabolic or neurocognitive health. Studies found community wood smoke exposure to be consistently associated with adverse pediatric respiratory health. Household wood stove use was less consistently associated with respiratory outcomes. However, studies of household wood stoves always relied on participant self-report of wood stove use, while studies of community wood smoke generally assessed air pollution exposure directly and more precisely in larger study populations. In most studies, important potential confounders, such as markers of socioeconomic status, were unaccounted for and may have biased results. We conclude that studies with improved exposure assessment, that measure and account for confounding, and that consider non-respiratory outcomes are needed. While awaiting additional data, pediatricians can refer patients to precautionary measures recommended by the US Environmental Protection Agency (EPA) to mitigate exposure. These include replacing old appliances with EPA-certified stoves, properly maintaining the stove, and using only dry, well-seasoned wood. In addition, several studies have shown mechanical air filters to effectively reduce wood stove pollution exposure in affected homes and communities.

Efficacy of interventions targeting household air pollution from residential wood stoves

Wood is commonly used for residential heating, but there are limited evidence-based interventions for reducing wood smoke exposures in the indoor environment. The Asthma Randomized Trial of Indoor Wood Smoke (ARTIS) study was designed to assess the efficacy of residential interventions to reduce indoor PM exposure from wood stoves. As part of a three-arm randomized placebo-controlled trial, two household-level interventions were evaluated: wood stove changeouts and air filtration units. Exposure outcomes included indoor measures such as continuous PM_2.5, particle counts, and carbon monoxide. Median indoor PM_2.5 concentration was 17.5 μg/m³ in wood-burning homes prior to interventions. No significant reductions in PM_2.5 concentrations were observed in the 40 homes receiving the placebo filter intervention. Sixteen homes received the wood stove changeout and showed no significant changes in PM_2.5 or particle counts. PM_2.5 concentrations were reduced by 68% in the filter intervention homes. Relative to placebo, air filtration unit homes had an overall PM_2.5 reduction of 63% (95% CI: 47-75%). Relative to the wood stove changeout, the filtration unit intervention was more efficacious and less expensive, yet compliance issues indicated a need for the evaluation of additional strategies for improving indoor air quality in homes using wood stoves.

Urban-rural differences in daily time-activity patterns, occupational activity and housing characteristics

BACKGROUND

There is evidence that rural residents experience a health disadvantage compared to urban residents, associated with a greater prevalence of health risk factors and socioeconomic differences. We examined differences between urban and rural Canadians using data from the Canadian Human Activity Pattern Survey (CHAPS) 2.

METHODS

Data were collected from 1460 respondents in two rural areas (Haldimand-Norfolk, Ontario and Annapolis Valley-Kings County, Nova Scotia) and 3551 respondents in five urban areas (Vancouver, Edmonton, Toronto, Montreal, and Halifax) using a 24-h recall diary and supplementary questionnaires administered using computer-assisted telephone interviews. We evaluated differences in time-activity patterns, occupational activity, and housing characteristics between rural and urban populations using multivariable linear and logistic regression models adjusted for design as well as demographic and socioeconomic covariates. Taylor linearization method and design-adjusted Wald tests were used to test statistical significance.

RESULTS

After adjustment for demographic and socioeconomic covariates, rural children, adults and seniors spent on average 0.7 (p < 0.05), 1.2 (p < 0.001), and 0.9 (p < 0.001) more hours outdoors per day respectively than urban counterparts. 23.1% (95% CI: 19.0-27.2%) of urban and 37.8% (95% CI: 31.2-44.4%) of rural employed populations reported working outdoors and the distributions of job skill level and industry differed significantly (p < 0.001) between urban and rural residents. In particular, 11.4% of rural residents vs. 4.9% of urban residents were employed in unskilled jobs, and 11.5% of rural residents vs. <0.5% of urban residents were employ in primary industry. Rural residents were also more likely than urban residents to report spending time near gas or diesel powered equipment other than vehicles (16.9% vs. 5.2%, p < 0.001), more likely to report wood as a heating fuel (9.8% vs. <0.1%; p < 0.001 for difference in distribution of heating fuels), less likely to have an air conditioner (43.0% vs. 57.2%, p < 0.001), and more likely to smoke (29.1% vs. 19.0 %, p < 0.001). Private wells were the main water source in rural areas (68.6%) in contrast to public water systems (97.6%) in urban areas (p < 0.001). Despite these differences, no differences in self-reported health status were observed between urban and rural residents.

CONCLUSIONS

We identified a number of differences between urban and rural residents, which provide evidence pertinent to the urban-rural health disparity.

The impacts of traffic-related and woodsmoke particulate matter on measures of cardiovascular health: a HEPA filter intervention study

BACKGROUND

Combustion-generated fine particulate matter (PM2.5) is associated with cardiovascular morbidity. Both traffic-related air pollution and residential wood combustion may be important, but few studies have compared their impacts.

OBJECTIVES

To assess and compare effects of traffic-related and woodsmoke PM2.5 on endothelial function and systemic inflammation (C reactive protein, interleukin-6 and band cells) among healthy adults in Vancouver, British Columbia, Canada, using high efficiency particulate air (HEPA) filtration to introduce indoor PM2.5 exposure gradients.

METHODS

We recruited 83 healthy adults from 44 homes in traffic-impacted or woodsmoke-impacted areas to participate in this randomised, single-blind cross-over intervention study. PM2.5 concentrations were measured during two consecutive 7-day periods, one with filtration and the other with 'placebo filtration'. Endothelial function and biomarkers of systematic inflammation were measured at the end of each 7-day period.

RESULTS

HEPA filtration was associated with a 40% decrease in indoor PM2.5 concentrations. There was no relationship between PM2.5 exposure and endothelial function. There was evidence of an association between indoor PM2.5 and C reactive protein among those in traffic-impacted locations (42.1% increase in C reactive protein per IQR increase in indoor PM2.5, 95% CI 1.2% to 99.5%), but not among those in woodsmoke-impacted locations. There were no associations with interleukin-6 or band cells.

CONCLUSIONS

Evidence of an association between C reactive protein and indoor PM2.5 among healthy adults in traffic-impacted areas is consistent with the hypothesis that traffic-related particles, even at relatively low concentrations, play an important role in the cardiovascular effects of the urban PM mixture.

TRIAL REGISTRATION NUMBER

http://www.clinicaltrials.gov (NCT01570062).

The impact of commonly used air filters in eliminating the exposure to secondhand smoke constituents

Exposure to secondhand tobacco smoke (SHS) also known as environmental tobacco smoke (ETS) has been well established scientifically as a human health hazard. Despite this and warnings from health agencies, concerns over the economic impact of smoke-free bans have limited political resolve to enact these regulations. Arguments against smoke-free bans include the contention that air filters can eliminate the health risks from SHS exposure. In this study, we assessed the effectiveness of air filters (MERV 4 and MERV 8) commonly used in homes and businesses in reducing the concentrations of total suspended particulates, fine particles and carbon monoxide from SHS as a measure of their potential to reduce the toxicity associated with SHS exposure. Our results demonstrate that these filters are not effective at reducing carbon monoxide levels or PM 2.5, which have been correlated with human health toxicity/disease. Thus, our findings, from a public health perspective, do not support the use of common air filters as a viable alternative to smoke-free bans.