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Dimala CA, Kadia BM. A systematic review and meta-analysis on the association between ambient air pollution and pulmonary tuberculosis. Sci Rep 2022; 12:11282. [PMID: 35788679 PMCID: PMC9253106 DOI: 10.1038/s41598-022-15443-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 06/23/2022] [Indexed: 11/25/2022] Open
Abstract
There is inconclusive evidence on the association between ambient air pollution and pulmonary tuberculosis (PTB) incidence, tuberculosis-related hospital admission and mortality. This review aimed to assess the extent to which selected air pollutants are associated to PTB incidence, hospital admissions and mortality. This was a systematic review of studies published in English from January 1st, 1946, through May 31st, 2022, that quantitatively assessed the association between PM2.5, PM10, NO2, SO2, CO, O3 and the incidence of, hospital admission or death from PTB. Medline, Embase, Scopus and The Cochrane Library were searched. Extracted data from eligible studies were analysed using STATA software. Random-effect meta-analysis was used to derive pooled adjusted risk and odds ratios. A total of 24 studies (10 time-series, 5 ecologic, 5 cohort, 2 case–control, 1 case cross-over, 1 cross-sectional) mainly from Asian countries were eligible and involved a total of 437,255 tuberculosis cases. For every 10 μg/m3 increment in air pollutant concentration, there was a significant association between exposure to PM2.5 (pooled aRR = 1.12, 95% CI: 1.06–1.19, p < 0.001, N = 6); PM10 (pooled aRR = 1.06, 95% CI: 1.01–1.12, p = 0.022, N = 8); SO2 (pooled aRR = 1.08, 95% CI: 1.04–1.12, p < 0.001, N = 9); and the incidence of PTB. There was no association between exposure to CO (pooled aRR = 1.04, 95% CI: 0.98–1.11, p = 0.211, N = 4); NO2 (pooled aRR = 1.08, 95% CI: 0.99–1.17, p = 0.057, N = 7); O3 (pooled aRR = 1.00, 95% CI: 0.99–1.02, p = 0.910, N = 6) and the incidence of PTB. There was no association between the investigated air pollutants and mortality or hospital admissions due to PTB. Overall quality of evidence was graded as low (GRADE approach). Exposure to PM2.5, PM10 and SO2 air pollutants was found to be associated with an increased incidence of PTB, while exposure to CO, NO2 and O3 was not. There was no observed association between exposure to these air pollutants and hospital admission or mortality due to PTB. The quality of the evidence generated, however, remains low. Addressing the tuberculosis epidemic by 2030 as per the 4th Sustainable Development Goal may require a more rigorous exploration of this association.
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Affiliation(s)
- Christian Akem Dimala
- Health and Human Development (2HD) Research Network, Douala, Cameroon.,Department of Medicine, Reading Hospital, Tower Health System, West Reading, PA, USA
| | - Benjamin Momo Kadia
- Health Education and Research Organisation (HERO) Cameroon, Buea, Cameroon. .,Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK.
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2
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Patial S, Saini Y. Lung macrophages: current understanding of their roles in Ozone-induced lung diseases. Crit Rev Toxicol 2020; 50:310-323. [PMID: 32458707 DOI: 10.1080/10408444.2020.1762537] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Through the National Ambient Air Quality Standards (NAAQS), the Clean Air Act of the United States outlines acceptable levels of six different air pollutants considered harmful to humans and the environment. Included in this list is ozone (O3), a highly reactive oxidant gas, respiratory health hazard, and common environmental air pollutant at ground level. The respiratory health effects due to O3 exposure are often associated with molecular and cellular perturbations in the respiratory tract. Periodic review of NAAQS requires comprehensive scientific evaluation of the public health effects of these pollutants, which is formulated through integrated science assessment (ISA) of the most policy-relevant scientific literature. This review focuses on the protective and pathogenic effects of macrophages in the O3-exposed respiratory tract, with emphasis on mouse model-based toxicological studies. Critical findings from 39 studies containing the words O3, macrophage, mice, and lung within the full text were assessed. While some of these studies highlight the presence of disease-relevant pathogenic macrophages in the airspaces, others emphasize a protective role for macrophages in O3-induced lung diseases. Moreover, a comprehensive list of currently known macrophage-specific roles in O3-induced lung diseases is included in this review and the significant knowledge gaps that still exist in the field are outlined. In conclusion, there is a vital need in this field for additional policy-relevant scientific information, including mechanistic studies to further define the role of macrophages in response to O3.
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Affiliation(s)
- Sonika Patial
- Department of Comparative Biomedical Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, LA, USA
| | - Yogesh Saini
- Department of Comparative Biomedical Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, LA, USA
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3
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Loughner CP, Follette-Cook MB, Duncan BN, Hains J, Pickering KE, Moy J, Tzortziou M. The benefits of lower ozone due to air pollution emission reductions (2002-2011) in the Eastern United States during extreme heat. JOURNAL OF THE AIR & WASTE MANAGEMENT ASSOCIATION (1995) 2020; 70:193-205. [PMID: 31769734 DOI: 10.1080/10962247.2019.1694089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 08/27/2019] [Accepted: 10/21/2019] [Indexed: 06/10/2023]
Abstract
Using the Community Multiscale Air Quality (CMAQ) model and the Benefits Mapping and Analysis Program - Community Edition (BenMAP-CE) tool, we estimate the benefits of anthropogenic emission reductions between 2002 and 2011 in the Eastern United States (US) with respect to surface ozone concentrations and ozone-related health and economic impacts, during a month of extreme heat, July 2011. Based on CMAQ simulations using emissions appropriate for 2002 and 2011, we estimate that emission reductions since 2002 likely prevented 10- 15 ozone exceedance days (using the 2011 maximum 8-hr average ozone standard of 75 ppbv) throughout the Ohio River Valley and 5- 10 ozone exceedance days throughout the Washington, DC - Baltimore, MD metropolitan area during this extremely hot month. CMAQ results were fed into the BenMAP-CE tool to determine the health and health-related economic benefits of anthropogenic emission reductions between 2002 and 2011. We estimate that the concomitant health benefits from the ozone reductions were significant for this anomalous month: 160-800 mortalities (95% confidence interval (CI): 70-1,010) were avoided in July 2011 in the Eastern U.S, saving an estimated $1.3-$6.6 billion (CI: $174 million-$15.5 billion). Additionally, we estimate that emission reductions resulted in 950 (CI: 90-2,350) less hospital admissions from respiratory symptoms, 370 (CI: 180-580) less hospital admissions for pneumonia, 570 (CI: 0-1650) less Emergency Room (ER) visits from asthma symptoms, 922,020 (CI: 469,960-1,370,050) less minor restricted activity days (MRADs), and 430,240 (CI: -280,350-963,190) less symptoms of asthma exacerbation during July 2011.Implications: We estimate the benefits of air pollution emission reductions on surface ozone concentrations and ozone-related impacts on human health and the economy between 2002 and 2011 during an extremely hot month, July 2011, in the eastern United States (US) using the CMAQ and BenMAP-CE models. Results suggest that, during July 2011, emission reductions prevented 10-15 ozone exceedance days in the Ohio River Valley and 5-10 ozone exceedance days in the Mid Atlantic; saved 160-800 lives in the Eastern US, saving $1.3 - $6.5 billion; and resulted in 950 less hospital admissions for respiratory symptoms, 370 less hospital admissions for pneumonia, 570 less Emergency Room visits for asthma symptoms, 922,020 less minor restricted activity days, and 430,240 less symptoms of asthma exacerbation.
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Affiliation(s)
- Christopher P Loughner
- Cooperative Institute for Satellite Earth System Studies (CISESS)/Earth System Science Interdisciplinary Center (ESSIC), University of Maryland, College Park, MD, USA
- Atmospheric Sciences Modeling Division, Air Resources Laboratory, NOAA Air Resources Laboratory, College Park, MD, USA
| | - Melanie B Follette-Cook
- Atmospheric Chemistry and Dynamics Laboratory, NASA Goddard Space Flight Center, Greenbelt, MD, USA
- Goddard Earth Science Technology and Research, Morgan State University, Baltimore, MD, USA
| | - Bryan N Duncan
- Atmospheric Chemistry and Dynamics Laboratory, NASA Goddard Space Flight Center, Greenbelt, MD, USA
| | - Jennifer Hains
- Family Home Visiting, Minnesota Department of Health, St. Paul, MN, USA
| | - Kenneth E Pickering
- Atmospheric Chemistry and Dynamics Laboratory, NASA Goddard Space Flight Center, Greenbelt, MD, USA
- Department of Atmospheric and Oceanic Science, University of Maryland, College Park, MD, USA
| | - Justin Moy
- Department of Neurosciences, University of Maryland Medical System, Baltimore, MD, USA
| | - Maria Tzortziou
- Earth and Atmospheric Sciences, City College of New York, New York, NY, USA
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Hagemeyer AN, Sears CG, Zierold KM. Respiratory Health in Adults Residing Near a Coal-Burning Power Plant with Coal Ash Storage Facilities: A Cross-Sectional Epidemiological Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16193642. [PMID: 31569347 PMCID: PMC6801683 DOI: 10.3390/ijerph16193642] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 09/24/2019] [Accepted: 09/26/2019] [Indexed: 11/16/2022]
Abstract
Coal ash, the byproduct of burning coal made up of small particles, including heavy metals and radioactive elements, is discarded in open-air landfills where it can be emitted into the air, contributing to air pollution in the surrounding community. Few regulations exist regarding the storage, disposal, and transport of coal ash. There is limited research on the health impacts of coal ash exposure on communities. The purpose of this study was to examine the prevalence of respiratory symptoms among adults exposed to coal ash and non-exposed adults. A cross-sectional epidemiological study was conducted among two populations: one exposed to coal ash and one not exposed to coal ash. Perception of health (p-Value < 0.0001), cough (Adjusted Odds Ratio (AOR) = 5.30, 95% Confidence Intervals (CI) = 2.60-11), shortness of breath (AOR = 2.59, 95% CI = 1.56-4.31), hoarseness (AOR = 4.02, 95% CI = 2.45-6.60), respiratory infections (AOR = 1.82, 95% CI = 1.14-2.89), and mean overall respiratory health score (p-Value < 0.0001) were all statistically significantly greater in exposed adults (N = 231) when compared to non-exposed adults (N = 170). Adults residing near the coal ash facility were more likely to report respiratory symptoms than the non-exposed population. More research on the health impact of coal ash and storage regulations needs to be conducted.
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Affiliation(s)
- Abby N Hagemeyer
- Department of Epidemiology and Population Health, University of Louisville, Louisville, KY 40292, USA
| | - Clara G Sears
- Department of Epidemiology, Brown University, Providence, RI 02912, USA
| | - Kristina M Zierold
- Department of Environmental Health Sciences, School of Public Health, University of Alabama at Birmingham, Birmingham, AL 35294, USA.
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Abel DW, Holloway T, Harkey M, Meier P, Ahl D, Limaye VS, Patz JA. Air-quality-related health impacts from climate change and from adaptation of cooling demand for buildings in the eastern United States: An interdisciplinary modeling study. PLoS Med 2018; 15:e1002599. [PMID: 29969461 PMCID: PMC6029751 DOI: 10.1371/journal.pmed.1002599] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 05/30/2018] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Climate change negatively impacts human health through heat stress and exposure to worsened air pollution, amongst other pathways. Indoor use of air conditioning can be an effective strategy to reduce heat exposure. However, increased air conditioning use increases emissions of air pollutants from power plants, in turn worsening air quality and human health impacts. We used an interdisciplinary linked model system to quantify the impacts of heat-driven adaptation through building cooling demand on air-quality-related health outcomes in a representative mid-century climate scenario. METHODS AND FINDINGS We used a modeling system that included downscaling historical and future climate data with the Weather Research and Forecasting (WRF) model, simulating building electricity demand using the Regional Building Energy Simulation System (RBESS), simulating power sector production and emissions using MyPower, simulating ambient air quality using the Community Multiscale Air Quality (CMAQ) model, and calculating the incidence of adverse health outcomes using the Environmental Benefits Mapping and Analysis Program (BenMAP). We performed simulations for a representative present-day climate scenario and 2 representative mid-century climate scenarios, with and without exacerbated power sector emissions from adaptation in building energy use. We find that by mid-century, climate change alone can increase fine particulate matter (PM2.5) concentrations by 58.6% (2.50 μg/m3) and ozone (O3) by 14.9% (8.06 parts per billion by volume [ppbv]) for the month of July. A larger change is found when comparing the present day to the combined impact of climate change and increased building energy use, where PM2.5 increases 61.1% (2.60 μg/m3) and O3 increases 15.9% (8.64 ppbv). Therefore, 3.8% of the total increase in PM2.5 and 6.7% of the total increase in O3 is attributable to adaptive behavior (extra air conditioning use). Health impacts assessment finds that for a mid-century climate change scenario (with adaptation), annual PM2.5-related adult mortality increases by 13,547 deaths (14 concentration-response functions with mean incidence range of 1,320 to 26,481, approximately US$126 billion cost) and annual O3-related adult mortality increases by 3,514 deaths (3 functions with mean incidence range of 2,175 to 4,920, approximately US$32.5 billion cost), calculated as a 3-month summer estimate based on July modeling. Air conditioning adaptation accounts for 654 (range of 87 to 1,245) of the PM2.5-related deaths (approximately US$6 billion cost, a 4.8% increase above climate change impacts alone) and 315 (range of 198 to 438) of the O3-related deaths (approximately US$3 billion cost, an 8.7% increase above climate change impacts alone). Limitations of this study include modeling only a single month, based on 1 model-year of future climate simulations. As a result, we do not project the future, but rather describe the potential damages from interactions arising between climate, energy use, and air quality. CONCLUSIONS This study examines the contribution of future air-pollution-related health damages that are caused by the power sector through heat-driven air conditioning adaptation in buildings. Results show that without intervention, approximately 5%-9% of exacerbated air-pollution-related mortality will be due to increases in power sector emissions from heat-driven building electricity demand. This analysis highlights the need for cleaner energy sources, energy efficiency, and energy conservation to meet our growing dependence on building cooling systems and simultaneously mitigate climate change.
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Affiliation(s)
- David W. Abel
- Center for Sustainability and the Global Environment (SAGE), Nelson Institute for Environmental Studies, University of Wisconsin–Madison, Madison, Wisconsin, United States of America
| | - Tracey Holloway
- Center for Sustainability and the Global Environment (SAGE), Nelson Institute for Environmental Studies, University of Wisconsin–Madison, Madison, Wisconsin, United States of America
- Department of Atmospheric and Oceanic Sciences, University of Wisconsin–Madison, Madison, Wisconsin, United States of America
| | - Monica Harkey
- Center for Sustainability and the Global Environment (SAGE), Nelson Institute for Environmental Studies, University of Wisconsin–Madison, Madison, Wisconsin, United States of America
| | - Paul Meier
- Wisconsin Energy Institute (WEI), University of Wisconsin–Madison, Madison, Wisconsin, United States of America
- Great Lakes Bioenergy Research Center (GLBRC), University of Wisconsin–Madison, Madison, Wisconsin, United States of America
- Meier Engineering Research LLC, Stoughton, Wisconsin, United States of America
| | - Doug Ahl
- Seventhwave, Madison, Wisconsin, United States of America
| | - Vijay S. Limaye
- Center for Sustainability and the Global Environment (SAGE), Nelson Institute for Environmental Studies, University of Wisconsin–Madison, Madison, Wisconsin, United States of America
- Global Health Institute, University of Wisconsin–Madison, Madison, Wisconsin, United States of America
| | - Jonathan A. Patz
- Center for Sustainability and the Global Environment (SAGE), Nelson Institute for Environmental Studies, University of Wisconsin–Madison, Madison, Wisconsin, United States of America
- Global Health Institute, University of Wisconsin–Madison, Madison, Wisconsin, United States of America
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6
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Khaniabadi YO, Daryanoosh M, Sicard P, Takdastan A, Hopke PK, Esmaeili S, De Marco A, Rashidi R. Chronic obstructive pulmonary diseases related to outdoor PM 10, O 3, SO 2, and NO 2 in a heavily polluted megacity of Iran. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2018; 25:17726-17734. [PMID: 29671231 DOI: 10.1007/s11356-018-1902-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 03/27/2018] [Indexed: 05/22/2023]
Abstract
This study was conducted to quantify, by an approach proposed by the World Health Organization (WHO), the daily hospital admissions for chronic obstructive pulmonary disease (COPD) related to exposure to particulate matter (PM10) and oxidants such as ozone (O3), sulfur dioxide (SO2), and nitrogen dioxide (NO2) in a heavily polluted city in Iran. For the health impact assessment, in terms of COPD, the current published relative risk (RR) and baseline incidence (BI) values, suggested by the WHO, and the 1-h O3 concentrations and daily PM10, NO2, and SO2 concentrations were compiled. The results showed that 5.9, 4.1, 1.2, and 1.9% of the COPD daily hospitalizations in 2011 and 6.6, 1.9, 2.3, and 2.1% in 2012 were attributed to PM10, O3, SO2, and NO2 concentrations exceeding 10 μg/m3, respectively. This study indicates that air quality and the high air pollutant levels have an effect on COPD morbidity. Air pollution is associated with visits to emergency services and hospital admissions. A lower relative risk can be achieved if some stringent control strategies for reducing air pollutants or emission precursors are implemented.
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Affiliation(s)
- Yusef Omidi Khaniabadi
- Department of Environmental Health, Health Care System of Karoon, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mohammad Daryanoosh
- Department of Environmental Health, Health Center of Hendijan, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | | | - Afshin Takdastan
- Environmental Technologies Research Center (ETRC), Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Department of Environmental Health Engineering, School of Public Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Philip K Hopke
- Center for Air Resources Engineering and Science, Clarkson University, Potsdam, NY, 13699, USA
- Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, NY, 14619, USA
| | - Shirin Esmaeili
- Department of Environmental Health Engineering, School of Public Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Alessandra De Marco
- Department of Territorial and Production Systems Sustainability, ENEA, Rome, Italy
| | - Rajab Rashidi
- Nutrition Health Research Center, Department of Occupational Health Engineering, School of Health and Nutrition, Lorestan University of Medical Sciences, Khorramabad, Iran.
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Abstract
The rate of global warming has accelerated over the past 50 years. Increasing surface temperature is melting glaciers and raising the sea level. More flooding, droughts, hurricanes, and heat waves are being reported. Accelerated changes in climate are already affecting human health, in part by altering the epidemiology of climate-sensitive pathogens. In particular, climate change may alter the incidence and severity of respiratory infections by affecting vectors and host immune responses. Certain respiratory infections, such as avian influenza and coccidioidomycosis, are occurring in locations previously unaffected, apparently because of global warming. Young children and older adults appear to be particularly vulnerable to rapid fluctuations in ambient temperature. For example, an increase in the incidence in childhood pneumonia in Australia has been associated with sharp temperature drops from one day to the next. Extreme weather events, such as heat waves, floods, major storms, drought, and wildfires, are also believed to change the incidence of respiratory infections. An outbreak of aspergillosis among Japanese survivors of the 2011 tsunami is one such well-documented example. Changes in temperature, precipitation, relative humidity, and air pollution influence viral activity and transmission. For example, in early 2000, an outbreak of Hantavirus respiratory disease was linked to a local increase in the rodent population, which in turn was attributed to a two- to threefold increase in rainfall before the outbreak. Climate-sensitive respiratory pathogens present challenges to respiratory health that may be far greater in the foreseeable future.
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Spatial variation of pneumonia hospitalization risk in Twin Cities metro area, Minnesota. Epidemiol Infect 2017; 145:3274-3283. [PMID: 29039282 DOI: 10.1017/s0950268817002291] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Fine resolution spatial variability in pneumonia hospitalization may identify correlates with socioeconomic, demographic and environmental factors. We performed a retrospective study within the Fairview Health System network of Minnesota. Patients 2 months of age and older hospitalized with pneumonia between 2011 and 2015 were geocoded to their census block group, and pneumonia hospitalization risk was analyzed in relation to socioeconomic, demographic and environmental factors. Spatial analyses were performed using Esri's ArcGIS software, and multivariate Poisson regression was used. Hospital encounters of 17 840 patients were included in the analysis. Multivariate Poisson regression identified several significant associations, including a 40% increased risk of pneumonia hospitalization among census block groups with large, compared with small, populations of ⩾65 years, a 56% increased risk among census block groups in the bottom (first) quartile of median household income compared to the top (fourth) quartile, a 44% higher risk in the fourth quartile of average nitrogen dioxide emissions compared with the first quartile, and a 47% higher risk in the fourth quartile of average annual solar insolation compared to the first quartile. After adjusting for income, moving from the first to the second quartile of the race/ethnic diversity index resulted in a 21% significantly increased risk of pneumonia hospitalization. In conclusion, the risk of pneumonia hospitalization at the census-block level is associated with age, income, race/ethnic diversity index, air quality, and solar insolation, and varies by region-specific factors. Identifying correlates using fine spatial analysis provides opportunities for targeted prevention and control.
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Williams LJ, Chen L, Zosky GR. The respiratory health effects of geogenic (earth derived) PM10. Inhal Toxicol 2017; 29:342-355. [DOI: 10.1080/08958378.2017.1367054] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Lewis J. Williams
- School of Medicine, Faculty of Health, University of Tasmania, Hobart, Australia
| | - Ling Chen
- School of Medicine, Faculty of Health, University of Tasmania, Hobart, Australia
| | - Graeme R. Zosky
- School of Medicine, Faculty of Health, University of Tasmania, Hobart, Australia
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Saygın M, Gonca T, Öztürk Ö, Has M, Çalışkan S, Has ZG, Akkaya A. To Investigate the Effects of Air Pollution (PM10 and SO 2) on the Respiratory Diseases Asthma and Chronic Obstructive Pulmonary Disease. Turk Thorac J 2017; 18:33-39. [PMID: 29404157 DOI: 10.5152/turkthoracj.2017.16016] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 02/03/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Effects of air pollution parameters of sulfur dioxide (SO2) and particulate matter (PM10) values on the respiratory system were investigated. MATERIAL AND METHODS Data of SO2 and PM10 were obtained daily for air pollution and classified into two groups: Group I (2006-2007), coal burning years and Group II (2008-2009), natural gas+ coal burning. Groups I and II were divided into two subgroups according to the months of combustion as combustible (November-April) and noncombustible (May-October). The number of patients with asthma and chronic obstructive pulmonary disorder (COPD) was recorded between 2006 and 2009. RESULTS There was no statistically significant difference between Groups I and II for PM10 and SO2 (p>0.05). Within the years, the values of SO2 and PM10 were statistically different between the groups defined by month (p<0.01). The number of patients in the combustible and noncombustible subgroups were found to be different for every 4 years, and the numbers of patients with COPD or asthma were not changed through the years. There was a strong correlation between PM10 and COPD (r=0.59, p<0.01) and a weak correlation between PM10 and asthma (r=0.25, p>0.05). A correlation was found between SO2 and COPD (p<0.01) but not between SO2 and asthma (p>0.05). The number of visits for COPD and asthma was statistically different between combustible and noncombustible subgroups (X2:58.61, p=0.000; X2:34.55, p=0.000, respectively). The r2 values for SO2 and PM10 for COPD patients were 17% and 24%, respectively, in contrast to 8% and 5%, respectivley for asthma patients. CONCLUSION Air pollution is known to increase respiratory disease occurrences. With decrease in the usage of solid fuel, air pollution could be reduced and may be effective in preventing respiratory diseases.
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Affiliation(s)
- Mustafa Saygın
- Department of Physiology, Süleyman Demirel University School of Medicine, Isparta, Turkey
| | - Taner Gonca
- Clinic of Chest Diseases, Isparta State Hospital, Isparta, Turkey
| | - Önder Öztürk
- Department of Chest Diseases, Süleyman Demirel University School of Medicine, Isparta, Turkey
| | - Mehmet Has
- Clinic of Chest Diseases, Şanlıurfa Training and Research Hospital, Şanlıurfa, Turkey
| | - Sadettin Çalışkan
- Department of Physiology, Pamukkale University School of Medicine, Denizli, Turkey
| | | | - Ahmet Akkaya
- Department of Chest Diseases, Süleyman Demirel University School of Medicine, Isparta, Turkey
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Saari RK, Thompson TM, Selin NE. Human Health and Economic Impacts of Ozone Reductions by Income Group. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2017; 51:1953-1961. [PMID: 28075579 DOI: 10.1021/acs.est.6b04708] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Low-income households may be disproportionately affected by ozone pollution and ozone policy. We quantify how three factors affect the relative benefits of ozone policies with household income: (1) unequal ozone reductions; (2) policy delay; and (3) economic valuation methods. We model ozone concentrations under baseline and policy conditions across the full continental United States to estimate the distribution of ozone-related health impacts across nine income groups. We enhance an economic model to include these impacts across household income categories, and present its first application to evaluate the benefits of ozone reductions for low-income households. We find that mortality incidence rates decrease with increasing income. Modeled ozone levels yield a median of 11 deaths per 100 000 people in 2005. Proposed policy reduces these rates by 13%. Ozone reductions are highest among low-income households, which increases their relative welfare gains by up to 4% and decreases them for the rich by up to 8%. The median value of reductions in 2015 is either $30 billion (in 2006 U.S. dollars) or $1 billion if reduced mortality risks are valued with willingness-to-pay or as income from increased life expectancy. Ozone reductions were relatively twice as beneficial for the lowest- compared to the highest-income households. The valuation approach affected benefits more than a policy delay or differential ozone reductions with income.
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Affiliation(s)
| | - Tammy M Thompson
- CSU Cooperative Institute for Research in the Atmosphere , 1375 Campus Delivery, Fort Collins, Colorado 80523, United States
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12
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Khaniabadi YO, Hopke PK, Goudarzi G, Daryanoosh SM, Jourvand M, Basiri H. Cardiopulmonary mortality and COPD attributed to ambient ozone. ENVIRONMENTAL RESEARCH 2017; 152:336-341. [PMID: 27842286 DOI: 10.1016/j.envres.2016.10.008] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 10/08/2016] [Accepted: 10/12/2016] [Indexed: 06/06/2023]
Abstract
Tropospheric ozone is the second most important atmospheric pollutant after particulate matter with respect to its impact on human health and is increasing of its concentrations globally. The main objective of this study was to assess of health effects attributable to ground-level ozone (O3) in Kermanshah, Iran using one-hour O3 concentrations measured between March 2014 and March 2015. The AirQ program was applied for estimation of the numbers of cardiovascular mortality (CM), respiratory mortality (RM), and hospital admissions for chronic obstructive pulmonary disease (HA-COPD) using relative risk (RR) and baseline incidence (BI) as defined by the World Health Organization (WHO). The largest percentage of person-days for different O3 concentrations was in the concentration range of 30-39µg/m3. The health modeling results suggested that ~2% (95% CI: 0-2.9%) of cardiovascular mortality, 5.9% (95% CI: 2.3-9.4) of respiratory mortality, and 4.1% (CI: 2.5-6.1%) of the HA-COPD were attributed to O3 concentrations higher than 10µg/m3. For each 10µg/m3 increase in O3 concentration, the risk of cardiovascular mortality, respiratory mortality, and HA-COPD increased by 0.40%, 1.25%, and 0.86%, respectively. Furthermore, 88.8% of health effects occurred on days with O3 level less than 100µg/m3. Thus, action is needed to reduce the emissions of O3 precursors especially transport and energy production in Kermanshah.
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Affiliation(s)
- Yusef Omidi Khaniabadi
- Health Care System of Karoon, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Philip K Hopke
- Center for Air Resources Engineering and Science, Clarkson University, Potsdam, NY 13699, USA
| | - Gholamreza Goudarzi
- Air Pollution and Respiratory Diseases Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran; Environmental Technologies Research Center (ETRC), Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Seyed Mohammad Daryanoosh
- Department of Environmental Health Engineering, School of Health, Lorestan University of Medical Sciences, Khorramabad, Iran.
| | - Mehdi Jourvand
- Department of Environmental Health Engineering, School of Health, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Hassan Basiri
- Department of Environmental Health Engineering, School of Health, Lorestan University of Medical Sciences, Khorramabad, Iran
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Abstract
Changes in atmosphere and temperature are affecting multiple environmental indicators from extreme heat events to global air quality. Workers will be uniquely affected by climate change, and the occupational impacts of major shifts in atmospheric and weather conditions need greater attention. Climate change-related exposures most likely to differentially affect workers in the USA and globally include heat, ozone, polycyclic aromatic hydrocarbons, other chemicals, pathogenic microorganisms, vector-borne diseases, violence, and wildfires. Epidemiologic evidence documents a U-, J-, or V-shaped relationship between temperature and mortality. Whereas heat-related morbidity and mortality risks are most evident in agriculture, many other outdoor occupational sectors are also at risk, including construction, transportation, landscaping, firefighting, and other emergency response operations. The toxicity of chemicals change under hyperthermic conditions, particularly for pesticides and ozone. Combined with climate-related changes in chemical transport and distribution, these interactions represent unique health risks specifically to workers. Links between heat and interpersonal conflict including violence require attention because they pose threats to the safety of emergency medicine, peacekeeping and humanitarian relief, and public safety professionals. Recommendations for anticipating how US workers will be most susceptible to climate change include formal monitoring systems for agricultural workers; modeling scenarios focusing on occupational impacts of extreme climate events including floods, wildfires, and chemical spills; and national research agenda setting focusing on control and mitigation of occupational susceptibility to climate change.
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Li J, Sun S, Tang R, Qiu H, Huang Q, Mason TG, Tian L. Major air pollutants and risk of COPD exacerbations: a systematic review and meta-analysis. Int J Chron Obstruct Pulmon Dis 2016; 11:3079-3091. [PMID: 28003742 PMCID: PMC5161337 DOI: 10.2147/copd.s122282] [Citation(s) in RCA: 152] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Short-term exposure to major air pollutants (O3, CO, NO2, SO2, PM10, and PM2.5) has been associated with respiratory risk. However, evidence on the risk of chronic obstructive pulmonary disease (COPD) exacerbations is still limited. The present study aimed at evaluating the associations between short-term exposure to major air pollutants and the risk of COPD exacerbations. Methods After a systematic search up until March 30, 2016, in both English and Chinese electronic databases such as PubMed, EMBASE, and CNKI, the pooled relative risks and 95% confidence intervals were estimated by using the random-effects model. In addition, the population-attributable fractions (PAFs) were also calculated, and a subgroup analysis was conducted. Heterogeneity was assessed by I2. Results In total, 59 studies were included. In the single-pollutant model, the risks of COPD were calculated by each 10 μg/m3 increase in pollutant concentrations, with the exception of CO (100 μg/m3). There was a significant association between short-term exposure and COPD exacerbation risk for all the gaseous and particulate pollutants. The associations were strongest at lag0 and lag3 for gaseous and particulate air pollutants, respectively. The subgroup analysis not only further confirmed the overall adverse effects but also reduced the heterogeneities obviously. When 100% exposure was assumed, PAFs ranged from 0.60% to 4.31%, depending on the pollutants. The adverse health effects of SO2 and NO2 exposure were more significant in low-/middle-income countries than in high-income countries: SO2, relative risk: 1.012 (95% confidence interval: 1.001, 1.023); and NO2, relative risk: 1.019 (95% confidence interval: 1.014, 1.024). Conclusion Short-term exposure to air pollutants increases the burden of risk of COPD acute exacerbations significantly. Controlling ambient air pollution would provide benefits to COPD patients.
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Affiliation(s)
- Jinhui Li
- Shenzhen Institute of Research and Innovation, Nanshan, The University of Hong Kong, Shenzhen, People's Republic of China; School of Public Health, The University of Hong Kong, Pok Fu Lam, Hong Kong Special Administrative Region
| | - Shengzhi Sun
- Shenzhen Institute of Research and Innovation, Nanshan, The University of Hong Kong, Shenzhen, People's Republic of China; School of Public Health, The University of Hong Kong, Pok Fu Lam, Hong Kong Special Administrative Region
| | - Robert Tang
- Shenzhen Institute of Research and Innovation, Nanshan, The University of Hong Kong, Shenzhen, People's Republic of China; School of Public Health, The University of Hong Kong, Pok Fu Lam, Hong Kong Special Administrative Region
| | - Hong Qiu
- School of Public Health, The University of Hong Kong, Pok Fu Lam, Hong Kong Special Administrative Region
| | - Qingyuan Huang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Minhang, Shanghai, People's Republic of China
| | - Tonya G Mason
- School of Public Health, The University of Hong Kong, Pok Fu Lam, Hong Kong Special Administrative Region
| | - Linwei Tian
- Shenzhen Institute of Research and Innovation, Nanshan, The University of Hong Kong, Shenzhen, People's Republic of China; School of Public Health, The University of Hong Kong, Pok Fu Lam, Hong Kong Special Administrative Region
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Na HH, Nam SH, Lee GY, Jang YS, Yoon DY, Bae GT. Theoretical Studies of the Structures and Electronic Properties of Cu mSiO m+1Clusters (m = 0 - 7). JOURNAL OF THE KOREAN CHEMICAL SOCIETY-DAEHAN HWAHAK HOE JEE 2016. [DOI: 10.5012/jkcs.2016.60.4.239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Liu Y, Yan S, Poh K, Liu S, Iyioriobhe E, Sterling DA. Impact of air quality guidelines on COPD sufferers. Int J Chron Obstruct Pulmon Dis 2016; 11:839-72. [PMID: 27143874 PMCID: PMC4846081 DOI: 10.2147/copd.s49378] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Background COPD is one of the leading causes of morbidity and mortality in both high- and low-income countries and a major public health burden worldwide. While cigarette smoking remains the main cause of COPD, outdoor and indoor air pollution are important risk factors to its etiology. Although studies over the last 30 years helped reduce the values, it is not very clear if the current air quality guidelines are adequately protective for COPD sufferers. Objective This systematic review was to summarize the up-to-date literature on the impact of air pollution on the COPD sufferers. Methods PubMed and Google Scholar were utilized to search for articles related to our study’s focus. Search terms included “COPD exacerbation”, “air pollution”, “air quality guidelines”, “air quality standards”, “COPD morbidity and mortality”, “chronic bronchitis”, and “air pollution control” separately and in combination. We focused on articles from 1990 to 2015. We also used articles prior to 1990 if they contained relevant information. We focused on articles written in English or with an English abstract. We also used the articles in the reference lists of the identified articles. Results Both short-term and long-term exposures to outdoor air pollution around the world are associated with the mortality and morbidity of COPD sufferers even at levels below the current air quality guidelines. Biomass cooking in low-income countries was clearly associated with COPD morbidity in adult nonsmoking females. Conclusion There is a need to continue to improve the air quality guidelines. A range of intervention measures could be selected at different levels based on countries’ socioeconomic conditions to reduce the air pollution exposure and COPD burden.
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Affiliation(s)
- Youcheng Liu
- Department of Environmental and Occupational Health Sciences, School of Public Health, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Shuang Yan
- Department of Endocrinology and Metabolism, Fourth Affiliated Hospital, Harbin Medical University, Harbin, Heilongjiang Province, People's Republic of China
| | - Karen Poh
- Department of Environmental and Occupational Health Sciences, School of Public Health, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Suyang Liu
- Epidemiology, Human Genetics & Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Emanehi Iyioriobhe
- Department of Environmental and Occupational Health Sciences, School of Public Health, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - David A Sterling
- Department of Environmental and Occupational Health Sciences, School of Public Health, University of North Texas Health Science Center, Fort Worth, TX, USA
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Ghanbari Ghozikali M, Heibati B, Naddafi K, Kloog I, Oliveri Conti G, Polosa R, Ferrante M. Evaluation of Chronic Obstructive Pulmonary Disease (COPD) attributed to atmospheric O3, NO2, and SO2 using Air Q Model (2011-2012 year). ENVIRONMENTAL RESEARCH 2016; 144:99-105. [PMID: 26599588 DOI: 10.1016/j.envres.2015.10.030] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 09/29/2015] [Accepted: 10/28/2015] [Indexed: 05/28/2023]
Abstract
Chronic obstructive pulmonary disease (COPD) is an important disease worldwide characterized by chronically poor airflow. The economic burden of COPD on any society can be enormous if not managed. We applied the approach proposed by the World Health Organization (WHO) using the AirQ2.2.3 software developed by the WHO European Center for Environment and Health on air pollutants in Tabriz (Iran) (2011-2012 year). A 1h average of concentrations of ozone (O3), daily average concentrations of nitrogen dioxide (NO2) and sulfur dioxide (SO2) were used to assess human exposure and health effect in terms of attributable proportion of the health outcome and annual number of excess cases of Hospital Admissions for COPD (HA COPD). The results of this study showed that 2% (95% CI: 0.8-3.1%) of HA COPD were attributed to O3 concentrations over 10 μg/m(3). In addition, 0.7 % (95% CI: 0.1-1.8%) and 0.5% (95% CI: 0-1%) of HA COPD were attributed to NO2 and SO2 concentrations over 10 μg/m(3) respectively. In this study, we have shown that O3, NO2 and SO2 have a significant impact on COPD hospitalization. Given these results the policy decisions are needed in order to reduce the chronic pulmonary diseases caused by air pollution and furthermore better quantification studies are recommended.
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Affiliation(s)
- Mohammad Ghanbari Ghozikali
- Tabriz Health Services Management Research Center, Department of Environmental Health Engineering, East Azerbaijan Province Health Center, Tabriz University of Medical Sciences, Tabriz, Iran; Department of Environmental Health Engineering, School of Public Health and Center for Air Pollution Research (CAPR), Institute for Environmental Research (IER), Tehran University of Medical Sciences, Tehran, Iran
| | - Behzad Heibati
- Department of Occupational Health Engineering, Faculty of Health and Health Sciences Research Center, Student Research Committee, Mazandaran University of Medical Sciences, Sari, Iran
| | - Kazem Naddafi
- Department of Environmental Health Engineering, School of Public Health and Center for Air Pollution Research (CAPR), Institute for Environmental Research (IER), Tehran University of Medical Sciences, Tehran, Iran
| | - Itai Kloog
- Department of Environmental Health, Harvard University, 665 Huntington Avenue, Landmark Center Room 415, Boston, MA 0211, United States
| | - Gea Oliveri Conti
- Environmental and Food Hygiene Laboratories (LIAA), Department of Medical, Surgical Sciences and Advanced Technologies "G.F. Ingrassia", Hygiene and Public Health, University of Catania, Via S. Sofia 87, 95123 Catania, Italy.
| | - Riccardo Polosa
- Department of Internal and Emergency Medicine, Teaching Hospital-Policlinico-V. Emanuele II, University of Catania, Catania 95123, Italy
| | - Margherita Ferrante
- Environmental and Food Hygiene Laboratories (LIAA), Department of Medical, Surgical Sciences and Advanced Technologies "G.F. Ingrassia", Hygiene and Public Health, University of Catania, Via S. Sofia 87, 95123 Catania, Italy
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Jary H, Mallewa J, Nyirenda M, Faragher B, Heyderman R, Peterson I, Gordon S, Mortimer K. Study protocol: the effects of air pollution exposure and chronic respiratory disease on pneumonia risk in urban Malawian adults--the Acute Infection of the Respiratory Tract Study (The AIR Study). BMC Pulm Med 2015; 15:96. [PMID: 26286032 PMCID: PMC4545771 DOI: 10.1186/s12890-015-0090-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Accepted: 08/04/2015] [Indexed: 11/11/2022] Open
Abstract
Background Pneumonia is the 2nd leading cause of years of life lost worldwide and is a common cause of adult admissions to hospital in sub-Saharan Africa. Risk factors for adult pneumonia are well characterised in developed countries, but are less well described in sub-Saharan Africa where HIV is a major contributing factor. Exposure to indoor and outdoor air pollution is high, and tobacco smoking prevalence is increasing in sub-Saharan Africa, yet the contribution of these factors to the burden of chronic respiratory diseases in sub-Saharan Africa remains poorly understood. Furthermore, the extent to which the presence of chronic respiratory diseases and exposure to air pollution contribute to the burden of pneumonia is not known. Design The Acute Infection of the Respiratory Tract Study (The AIR Study) is a case–control study to identify preventable risk factors for adult pneumonia in the city of Blantyre, Malawi. Cases will be adults admitted with pneumonia, recruited from Queen Elizabeth Central Hospital, the largest teaching hospital in Malawi. Controls will be adults without pneumonia, recruited from the community. The AIR Study will recruit subjects and analyse data within strata defined by positive and negative HIV infection status. All participants will undergo thorough assessment for a range of potential preventable risk factors, with an emphasis on exposure to air pollution and the presence of chronic respiratory diseases. This will include collection of questionnaire data, clinical samples (blood, urine, sputum and breath samples), lung function data and air pollution monitoring in their home. Multivariate analysis will be used to identify the important risk factors contributing to the pneumonia burden in this setting. Identification of preventable risk factors will justify research into the effectiveness of targeted interventions to address this burden in the future. Discussion The AIR Study is the first study of radiologically confirmed pneumonia in which air pollution exposure measurements have been undertaken in this setting, and will contribute important new information about exposure to air pollution in urban SSA. Through identification of preventable risk factors, the AIR Study aims to facilitate future research and implementation of targeted interventions to reduce the high burden of pneumonia in SSA.
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Affiliation(s)
- Hannah Jary
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, University of Malawi College of Medicine, Blantyre, Malawi. .,Liverpool School of Tropical Medicine, Liverpool, UK.
| | - Jane Mallewa
- College of Medicine, University of Malawi, Blantyre, Malawi.
| | - Mulinda Nyirenda
- Queen Elizabeth Central Hospital, Ministry of Health, Blantyre, Malawi.
| | | | - Robert Heyderman
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, University of Malawi College of Medicine, Blantyre, Malawi.
| | - Ingrid Peterson
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, University of Malawi College of Medicine, Blantyre, Malawi.
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Abstract
Although the air quality in Western countries has continued to improve over the past decades, rapid economic growth in developing countries has left air quality in many cities notoriously poor. The World Health Organization estimates that urban outdoor air pollution is estimated to cause 1.3 million deaths worldwide per year. The primary health concerns of outdoor air pollution come from particulate matter less than 2.5 μm (PM2.5) and ozone (O3). Short-term exposure to PM2.5 increases cardiopulmonary morbidity and mortality. Long-term exposure to PM2.5 has been linked to adverse perinatal outcomes and lung cancer. Excessive O3 exposure is known to increase respiratory morbidity. Patients with chronic cardiopulmonary diseases are more susceptible to the adverse effects of air pollution. Counseling these patients about air pollution and the associated risks should be part of the regular management plans in clinical practice.
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Blount RJ, Djawe K, Daly KR, Jarlsberg LG, Fong S, Balmes J, Miller RF, Walzer PD, Huang L. Ambient air pollution associated with suppressed serologic responses to Pneumocystis jirovecii in a prospective cohort of HIV-infected patients with Pneumocystis pneumonia. PLoS One 2013; 8:e80795. [PMID: 24236202 PMCID: PMC3827464 DOI: 10.1371/journal.pone.0080795] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Accepted: 10/07/2013] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Ambient air pollution (AAP) may be associated with increased risk for Pneumocystis pneumonia (PCP). The mechanisms underlying this association remain uncertain. OBJECTIVES To determine if real-life exposures to AAP are associated with suppressed IgM antibody responses to P. jirovecii in HIV-infected (HIV+) patients with active PCP, and to determine if AAP, mediated by suppressed serologic responses to Pneumocystis, is associated with adverse clinical outcomes. METHODS We conducted a prospective cohort study in HIV+ patients residing in San Francisco and admitted to San Francisco General Hospital with microscopically confirmed PCP. Our AAP predictors were ambient air concentrations of particulate matter of < 10 µm in diameter (PM10) and < 2.5 µm in diameter (PM2.5), nitrogen dioxide (NO2), ozone (O3), and sulfur dioxide (SO2) measured immediately prior to hospital admission and 2 weeks prior to admission. Our primary outcomes were the IgM serologic responses to four recombinant P. jirovecii major surface glycoprotein (Msg) constructs: MsgC1, MsgC3, MsgC8, and MsgC9. RESULTS Elevated PM10 and NO2 exposures immediately prior to and two weeks prior to hospital admission were associated with decreased IgM antibody responses to P. jirovecii Msg. For exposures immediately prior to admission, every 10 µg/m(3) increase in PM10 was associated with a 25 to 35% decrease in IgM responses to Msg (statistically significant for all the Msg constructs), and every 10 ppb increase in NO2 was associated with a 19-45% decrease in IgM responses to Msg (statistically significant for MsgC8 and MsgC9). Similar findings were seen with exposures two weeks prior to admission, but for fewer of the Msg constructs. CONCLUSIONS Real life exposures to PM10 and NO2 were associated with suppressed IgM responses to P. jirovecii Msg in HIV+ patients admitted with PCP, suggesting a mechanism of immunotoxicity by which AAP increases host susceptibility to pulmonary infection.
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Affiliation(s)
- Robert J. Blount
- Division of Pulmonary and Critical Care Medicine, San Francisco General Hospital, University of California San Francisco, San Francisco, California, United States of America
- * E-mail:
| | - Kpandja Djawe
- Department of Internal Medicine, Division of Infectious Diseases, University of Cincinnati, Cincinnati, Ohio, United States of America
- Department of Environmental Health, Division of Epidemiology and Biostatistics, University of Cincinnati, Cincinnati, Ohio, United States of America
| | - Kieran R. Daly
- Department of Internal Medicine, Division of Infectious Diseases, University of Cincinnati, Cincinnati, Ohio, United States of America
- Veterans Administration Medical Center, Cincinnati, Ohio, United States of America
| | - Leah G. Jarlsberg
- Division of Pulmonary and Critical Care Medicine, San Francisco General Hospital, University of California San Francisco, San Francisco, California, United States of America
| | - Serena Fong
- HIV/AIDS Division, San Francisco General Hospital, University of California San Francisco, San Francisco, California, United States of America
| | - John Balmes
- Division of Pulmonary and Critical Care Medicine, San Francisco General Hospital, University of California San Francisco, San Francisco, California, United States of America
- School of Public Health, University of California Berkeley, Berkeley, California, United States of America
| | - Robert F. Miller
- Research Department of Infection and Population Health, Institute of Epidemiology and Healthcare, University College London, London, United Kingdom
- Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Peter D. Walzer
- Department of Internal Medicine, Division of Infectious Diseases, University of Cincinnati, Cincinnati, Ohio, United States of America
- Department of Environmental Health, Division of Epidemiology and Biostatistics, University of Cincinnati, Cincinnati, Ohio, United States of America
- Veterans Administration Medical Center, Cincinnati, Ohio, United States of America
| | - Laurence Huang
- Division of Pulmonary and Critical Care Medicine, San Francisco General Hospital, University of California San Francisco, San Francisco, California, United States of America
- HIV/AIDS Division, San Francisco General Hospital, University of California San Francisco, San Francisco, California, United States of America
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The influence of Nrf2 on cardiac responses to environmental stressors. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2013; 2013:901239. [PMID: 23738044 PMCID: PMC3655674 DOI: 10.1155/2013/901239] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Accepted: 03/26/2013] [Indexed: 01/01/2023]
Abstract
Nrf2 protects the lung from adverse responses to oxidants, including 100% oxygen (hyperoxia) and airborne pollutants like particulate matter (PM) exposure, but the role of Nrf2 on heart rate (HR) and heart rate variability (HRV) responses is not known. We hypothesized that genetic disruption of Nrf2 would exacerbate murine HR and HRV responses to severe hyperoxia or moderate PM exposures. Nrf2−/− and Nrf2+/+ mice were instrumented for continuous ECG recording to calculate HR and HRV (low frequency (LF), high frequency (HF), and total power (TP)). Mice were then either exposed to hyperoxia for up to 72 hrs or aspirated with ultrafine PM (UF-PM). Compared to respective controls, UF-PM induced significantly greater effects on HR (P < 0.001) and HF HRV (P < 0.001) in Nrf2−/− mice compared to Nrf2+/+ mice. Nrf2−/− mice tolerated hyperoxia significantly less than Nrf2+/+ mice (~22 hrs; P < 0.001). Reductions in HR, LF, HF, and TP HRV were also significantly greater in Nrf2−/− compared to Nrf2+/+ mice (P < 0.01). Results demonstrate that Nrf2 deletion increases susceptibility to change in HR and HRV responses to environmental stressors and suggest potential therapeutic strategies to prevent cardiovascular alterations.
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Cengiz MA, Terzi Y. Comparing models of the effect of air pollutants on hospital admissions and symptoms for chronic obstructive pulmonary disease. Cent Eur J Public Health 2013; 20:282-6. [PMID: 23441395 DOI: 10.21101/cejph.a3757] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
There is an increasing interest in the use of hospital admission for Chronic obstructive pulmonary disease (COPD) in studies of short-term exposure effects attributed to air pollutants. However, little is known about the effect of air pollutants on COPD symptoms. This study was undertaken to determine whether there was an association between air pollutant levels and both hospital admissions and symptoms for COPD. For model comparison, we present Generalized Linear Model, Generalized Additive Model and a general approach for Bayesian inference via Markov chain Monte Carlo in generalized additive model. Furthermore, for comparing the predictive accuracy, Artificial Neural Networks (ANN) approach is given.
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Affiliation(s)
- Mehmet Ali Cengiz
- Department of Statistics, University of Ondokuz Mayis, Samsun, Turkey.
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Simon H, Baker KR, Akhtar F, Napelenok SL, Possiel N, Wells B, Timin B. A direct sensitivity approach to predict hourly ozone resulting from compliance with the National Ambient Air Quality Standard. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2013; 47:2304-2313. [PMID: 23256562 DOI: 10.1021/es303674e] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
In setting primary ambient air quality standards, the EPA's responsibility under the law is to establish standards that protect public health. As part of the current review of the ozone National Ambient Air Quality Standard (NAAQS), the US EPA evaluated the health exposure and risks associated with ambient ozone pollution using a statistical approach to adjust recent air quality to simulate just meeting the current standard level, without specifying emission control strategies. One drawback of this purely statistical concentration rollback approach is that it does not take into account spatial and temporal heterogeneity of ozone response to emissions changes. The application of the higher-order decoupled direct method (HDDM) in the community multiscale air quality (CMAQ) model is discussed here to provide an example of a methodology that could incorporate this variability into the risk assessment analyses. Because this approach includes a full representation of the chemical production and physical transport of ozone in the atmosphere, it does not require assumed background concentrations, which have been applied to constrain estimates from past statistical techniques. The CMAQ-HDDM adjustment approach is extended to measured ozone concentrations by determining typical sensitivities at each monitor location and hour of the day based on a linear relationship between first-order sensitivities and hourly ozone values. This approach is demonstrated by modeling ozone responses for monitor locations in Detroit and Charlotte to domain-wide reductions in anthropogenic NOx and VOCs emissions. As seen in previous studies, ozone response calculated using HDDM compared well to brute-force emissions changes up to approximately a 50% reduction in emissions. A new stepwise approach is developed here to apply this method to emissions reductions beyond 50% allowing for the simulation of more stringent reductions in ozone concentrations. Compared to previous rollback methods, this application of modeled sensitivities to ambient ozone concentrations provides a more realistic spatial response of ozone concentrations at monitors inside and outside the urban core and at hours of both high and low ozone concentrations.
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Affiliation(s)
- Heather Simon
- Office of Air Quality Planning and Standards, US EPA , RTP, North Carolina 27711, United States
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Larcombe AN, Foong RE, Boylen CE, Zosky GR. Acute diesel exhaust particle exposure increases viral titre and inflammation associated with existing influenza infection, but does not exacerbate deficits in lung function. Influenza Other Respir Viruses 2012; 7:701-9. [PMID: 22994877 PMCID: PMC5781203 DOI: 10.1111/irv.12012] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Please cite this paper as: Larcombe et al. (2012) Acute diesel exhaust particle exposure increases viral titre and inflammation associated with existing influenza infection, but does not exacerbate deficits in lung function. Influenza and Other Respiratory Viruses DOI:10.1111/irv.12012. Background Exposure to diesel exhaust particles (DEP) is thought to exacerbate many pre‐existing respiratory diseases, including asthma, bronchitis and chronic obstructive pulmonary disease, however, there is a paucity of data on whether DEP exacerbates illness due to respiratory viral infection. Objectives To assess the physiological consequences of an acute DEP exposure during the peak of influenza‐induced illness. Methods We exposed adult female BALB/c mice to 100 μg DEP (or control) 3·75 days after infection with 104·5 plaque forming units of influenza A/Mem71 (or control). Six hours, 24 hours and 7 days after DEP exposure we measured thoracic gas volume and lung function at functional residual capacity. Bronchoalveolar lavage fluid was taken for analyses of cellular inflammation and cytokines, and whole lungs were taken for measurement of viral titre. Results Influenza infection resulted in significantly increased inflammation, cytokine influx and impairment to lung function. DEP exposure alone resulted in less inflammation and cytokine influx, and no impairment to lung function. Mice infected with influenza and exposed to DEP had higher viral titres and neutrophilia compared with infected mice, yet they did not have more impaired lung mechanics than mice infected with influenza alone. Conclusions A single dose of DEP is not sufficient to physiologically exacerbate pre‐existing respiratory disease caused by influenza infection in mice.
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Affiliation(s)
- Alexander N Larcombe
- Division of Clinical Sciences, Telethon Institute for Child Health Research, Centre for Child Health Research, University of Western Australia, West Perth, WA, Australia.
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Dukić V, Hayden M, Hopson T, Monaghan A, Adams Forgor A, Akweongo P, Hodgson A, Wiedinmyer C, Yoksas T, Pandya R, Thomson MC, Trzaska S. The Role of Weather in Meningitis Outbreaks in Navrongo, Ghana: A Generalized Additive Modeling Approach. JOURNAL OF AGRICULTURAL, BIOLOGICAL, AND ENVIRONMENTAL STATISTICS 2012; 17:442-460. [PMID: 38179552 PMCID: PMC10766424 DOI: 10.1007/s13253-012-0095-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Bacterial (meningococcal) meningitis is a devastating infectious disease with outbreaks occurring annually during the dry season in locations within the 'Meningitis Belt', a region in sub-Saharan Africa stretching from Ethiopia to Senegal. Meningococcal meningitis occurs from December to May in the Sahel with large epidemics every 5-10 years and attack rates of up to 1000 infections per 100,000 people. High temperatures coupled with low humidity may favor the conversion of carriage to disease as the meningococcal bacteria in the nose and throat are better able to cross the mucosal membranes into the blood stream. Similarly, respiratory diseases such as influenza and pneumonia might weaken the immune defenses and add to the mucosa damage. Although the transmission dynamics are poorly understood, outbreaks regularly end with the onset of the rainy season and may begin anew with the following dry season. In this paper, we employ a generalized additive modeling approach to assess the association between number of reported meningitis cases and a set of weather variables (relative humidity, rain, wind, sunshine, maximum and minimum temperature). The association is adjusted for air quality (dust, carbon monoxide), as well as varying degrees of unobserved time-varying confounding processes that co-vary with both the disease incidence and weather. We present the analysis of monthly reported meningitis counts in Navrongo, Ghana, from 1998-2008.
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Affiliation(s)
- Vanja Dukić
- Department of Applied Mathematics, University of Colorado, Boulder, CO, USA
| | - Mary Hayden
- National Center for Atmospheric Research, Boulder, CO, USA
| | - Tom Hopson
- National Center for Atmospheric Research, Boulder, CO, USA
| | | | | | | | | | | | - Tom Yoksas
- University Corporation for Atmospheric Research, Boulder, CO, USA
| | - Raj Pandya
- University Corporation for Atmospheric Research, Boulder, CO, USA
| | - Madeleine C Thomson
- The International Research Institute, Columbia University, New York City, NY, USA
| | - Sylwia Trzaska
- The International Research Institute, Columbia University, New York City, NY, USA
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Kang JH, Keller JJ, Chen CS, Lin HC. Asian Dust Storm Events are Associated With an Acute Increase in Pneumonia Hospitalization. Ann Epidemiol 2012; 22:257-63. [DOI: 10.1016/j.annepidem.2012.02.008] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2011] [Revised: 01/11/2012] [Accepted: 02/03/2012] [Indexed: 11/28/2022]
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Boylen CE, Sly PD, Zosky GR, Larcombe AN. Physiological and inflammatory responses in an anthropomorphically relevant model of acute diesel exhaust particle exposure are sex and dose-dependent. Inhal Toxicol 2012; 23:906-17. [PMID: 22122304 DOI: 10.3109/08958378.2011.625454] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONTEXT Diesel exhaust particles (DEP) are an important contributor to suspended particulate matter (PM) in urban areas. While epidemiological evidence exists for a sex-influenced dose-response relationship between acute PM exposure and respiratory health, similar data are lacking for DEP. Further, experimental evidence showing deleterious effects on respiratory health due to acute DEP exposure is sparse. OBJECTIVE To establish and characterize a mouse model of acute DEP exposure, comparing male and female mice and assessing the kinetics of the elemental carbon content of alveolar macrophages (AMs) to relate our model to human exposure. MATERIALS AND METHODS Adult BALB/c mice were intranasally inoculated with 0 (control), 10, 30 or 100 µg DEP in saline. Bronchoalveolar lavage cellular inflammation and cytokine levels were assessed 3, 6, 12, 24, 48 and 168 hours post exposure. Elemental carbon uptake by AMs was additionally assessed at 336 and 672 hours post DEP exposure. Thoracic gas volume and lung mechanics were measured 6 and 24 hours post exposure. RESULTS DEP resulted in dose-dependent cellular inflammation and cytokine production in both sexes. Males and females responded differently with females having more severe and prolonged neutrophilia, monocyte chemoattractant protein-1 and developing greater abnormalities in lung function. The sexual dimorphism in response was not related to the capacity of AMs to phagocytise DEP. CONCLUSIONS Our mouse model of acute diesel exhaust particle exposure shows a dose dependency and sexual dimorphism in response. Quantification of elemental carbon in AMs allows for comparison of the results of our study with human studies.
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Affiliation(s)
- Catherine E Boylen
- Division of Clinical Sciences, Telethon Institute for Child Health Research, Centre for Child Health Research, University of Western Australia, West Perth, WA, Australia
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Abstract
With the rapid economic development occurring in the last decade in many countries of Asia, the level of air pollution has increased from both industrial and motor vehicle emissions. Compared with Europe and North America, the potential health effects of this increasing air pollution in Asia remain largely unmeasured. Recent data published by the Health Effects Institute from some major cities in India and China reveal that a 10 µg/m(3) increase in PM(10) was associated with an increase in mortality of 0.6% in daily all-natural cause mortality, with higher risks being found at extremes of high temperatures and in the lowest economically advantaged population. Other Asian studies have confirmed the link between hospital admissions for the worsening of COPD and the increase in asthma prevalence to levels of outdoor air pollutants. Although potential health effects appear to be similar to already-published Western data, it is important that further studies be carried out in Asia that will inform the public and the authorities of the necessity to curb levels of outdoor air pollutants to acceptable levels.
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Affiliation(s)
- Kian Fan Chung
- National Heart and Lung Institute, Imperial College, and NIHR Biomedical Research Unit, Royal Brompton Hospital, London, UK.
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Amiot N, Tillon J, Viacroze C, Aouine H, Muir JF. Répercussions des fluctuations de la pollution atmosphérique chez les patients atteints de bronchopneumopathie chronique obstructive. REVUE FRANCAISE D ALLERGOLOGIE 2012. [DOI: 10.1016/j.reval.2010.10.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Grabow ML, Spak SN, Holloway T, Stone B, Mednick AC, Patz JA. Air quality and exercise-related health benefits from reduced car travel in the midwestern United States. ENVIRONMENTAL HEALTH PERSPECTIVES 2012; 120:68-76. [PMID: 22049372 PMCID: PMC3261937 DOI: 10.1289/ehp.1103440] [Citation(s) in RCA: 105] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2011] [Accepted: 10/05/2011] [Indexed: 05/04/2023]
Abstract
BACKGROUND Automobile exhaust contains precursors to ozone and fine particulate matter (PM ≤ 2.5 µm in aerodynamic diameter; PM2.5), posing health risks. Dependency on car commuting also reduces physical fitness opportunities. OBJECTIVE In this study we sought to quantify benefits from reducing automobile usage for short urban and suburban trips. METHODS We simulated census-tract level changes in hourly pollutant concentrations from the elimination of automobile round trips ≤ 8 km in 11 metropolitan areas in the upper midwestern United States using the Community Multiscale Air Quality (CMAQ) model. Next, we estimated annual changes in health outcomes and monetary costs expected from pollution changes using the U.S. Environmental Protection Agency Benefits Mapping Analysis Program (BenMAP). In addition, we used the World Health Organization Health Economic Assessment Tool (HEAT) to calculate benefits of increased physical activity if 50% of short trips were made by bicycle. RESULTS We estimate that, by eliminating these short automobile trips, annual average urban PM2.5 would decline by 0.1 µg/m3 and that summer ozone (O3) would increase slightly in cities but decline regionally, resulting in net health benefits of $4.94 billion/year [95% confidence interval (CI): $0.2 billion, $13.5 billion), with 25% of PM2.5 and most O3 benefits to populations outside metropolitan areas. Across the study region of approximately 31.3 million people and 37,000 total square miles, mortality would decline by approximately 1,295 deaths/year (95% CI: 912, 1,636) because of improved air quality and increased exercise. Making 50% of short trips by bicycle would yield savings of approximately $3.8 billion/year from avoided mortality and reduced health care costs (95% CI: $2.7 billion, $5.0 billion]. We estimate that the combined benefits of improved air quality and physical fitness would exceed $8 billion/year. CONCLUSION Our findings suggest that significant health and economic benefits are possible if bicycling replaces short car trips. Less dependence on automobiles in urban areas would also improve health in downwind rural settings.
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Affiliation(s)
- Maggie L Grabow
- Nelson Institute, Sustainability and the Global Environment, University of Wisconsin-Madison, 1710 University Ave., Madison, WI 53726, USA.
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Abstract
Epidemiological and toxicological research continues to support a link between urban air pollution and an increased incidence and/or severity of airway disease. Detrimental effects of ozone (O(3)), nitrogen dioxide (NO(2)) and particulate matter (PM), as well as traffic-related pollution as a whole, on respiratory symptoms and function are well documented. Not only do we have strong epidemiological evidence of a relationship between air pollution and exacerbation of asthma and respiratory morbidity and mortality in patients with chronic obstructive pulmonary disease (COPD), but recent studies, particularly in urban areas, have suggested a role for pollutants in the development of both asthma and COPD. Similarly, while prevalence and severity of atopic conditions appear to be more common in urban compared with rural communities, evidence is emerging that traffic-related pollutants may contribute to the development of allergy. Furthermore, numerous epidemiological and experimental studies suggest an association between exposure to NO(2) , O(3) , PM and combustion products of biomass fuels and an increased susceptibility to and morbidity from respiratory infection. Given the considerable contribution that traffic emissions make to urban air pollution researchers have sought to characterize the relative toxicity of traffic-related PM pollutants. Recent advances in mechanisms implicated in the association of air pollutants and airway disease include epigenetic alteration of genes by combustion-related pollutants and how polymorphisms in genes involved in antioxidant pathways and airway inflammation can modify responses to air pollution exposures. Other interesting epidemiological observations related to increased host susceptibility include a possible link between chronic PM exposure during childhood and vulnerability to COPD in adulthood, and that infants subjected to higher prenatal levels of air pollution may be at greater risk of developing respiratory conditions. While the characterization of pollutant components and sources promise to guide pollution control strategies, the identification of susceptible subpopulations will be necessary if targeted therapy/prevention of pollution-induced respiratory diseases is to be developed.
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Affiliation(s)
- F J Kelly
- MRC-HPA Centre for Environment and Health, King's College, London, 150 Stamford Street, London SE1 9NH, UK.
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Ji M, Cohan DS, Bell ML. Meta-analysis of the Association between Short-Term Exposure to Ambient Ozone and Respiratory Hospital Admissions. ENVIRONMENTAL RESEARCH LETTERS : ERL [WEB SITE] 2011; 6:024006. [PMID: 21779304 PMCID: PMC3138529 DOI: 10.1088/1748-9326/6/2/024006] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
Ozone is associated with health impacts including respiratory outcomes; however, results differ across studies. Meta-analysis is an increasingly important approach to synthesizing evidence across studies. We conducted meta-analysis of short-term ozone exposure and respiratory hospitalizations to evaluate variation across studies and explore some of the challenges in meta-analysis. We identified 136 estimates from 96 studies and investigated how estimates differed by age, ozone metric, season, lag, region, disease category, and hospitalization type. Overall results indicate associations between ozone and various types of respiratory hospitalizations; however, study characteristics affected risk estimates. Estimates were similar, but higher, for the elderly compared to all ages and for previous day exposure compared to same day exposure. Comparison across studies was hindered by variation in definitions of disease categories, as some (e.g., asthma) were identified through ≥3 different sets of ICD codes. Although not all analyses exhibited evidence of publication bias, adjustment for publication bias generally lowered overall estimates. Emergency hospitalizations for total respiratory disease increased 4.47% (95% interval 2.48, 6.50%) per 10ppb 24-hr ozone among the elderly without adjustment for publication bias and 2.97% (1.05, 4.94%) with adjustment. Comparison of multi-city study results and meta-analysis based on single-city studies further suggested publication bias.
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Affiliation(s)
- Meng Ji
- School of Forestry and Environmental Studies, School of Public Health, Yale University, New Haven, CT, U.S.A
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Balakrishna S, Saravia J, Thevenot P, Ahlert T, Lominiki S, Dellinger B, Cormier SA. Environmentally persistent free radicals induce airway hyperresponsiveness in neonatal rat lungs. Part Fibre Toxicol 2011; 8:11. [PMID: 21388553 PMCID: PMC3061909 DOI: 10.1186/1743-8977-8-11] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2010] [Accepted: 03/09/2011] [Indexed: 11/18/2022] Open
Abstract
Background Increased asthma risk/exacerbation in children and infants is associated with exposure to elevated levels of ultrafine particulate matter (PM). The presence of a newly realized class of pollutants, environmentally persistent free radicals (EPFRs), in PM from combustion sources suggests a potentially unrecognized risk factor for the development and/or exacerbation of asthma. Methods Neonatal rats (7-days of age) were exposed to EPFR-containing combustion generated ultrafine particles (CGUFP), non-EPFR containing CGUFP, or air for 20 minutes per day for one week. Pulmonary function was assessed in exposed rats and age matched controls. Lavage fluid was isolated and assayed for cellularity and cytokines and in vivo indicators of oxidative stress. Pulmonary histopathology and characterization of differential protein expression in lung homogenates was also performed. Results Neonates exposed to EPFR-containing CGUFP developed significant pulmonary inflammation, and airway hyperreactivity. This correlated with increased levels of oxidative stress in the lungs. Using differential two-dimensional electrophoresis, we identified 16 differentially expressed proteins between control and CGUFP exposed groups. In the rats exposed to EPFR-containing CGUFP; peroxiredoxin-6, cofilin1, and annexin A8 were upregulated. Conclusions Exposure of neonates to EPFR-containing CGUFP induced pulmonary oxidative stress and lung dysfunction. This correlated with alterations in the expression of various proteins associated with the response to oxidative stress and the regulation of glucocorticoid receptor translocation in T lymphocytes.
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Affiliation(s)
- Shrilatha Balakrishna
- Department of Pharmacology and Experimental Therapeutics, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
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Bennett CM, Dharmage SC, Matheson M, Gras JL, Markos J, Mészáros D, Hopper J, Walters EH, Abramson MJ. Ambient wood smoke exposure and respiratory symptoms in Tasmania, Australia. THE SCIENCE OF THE TOTAL ENVIRONMENT 2010; 409:294-299. [PMID: 21071067 DOI: 10.1016/j.scitotenv.2010.10.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2010] [Revised: 10/01/2010] [Accepted: 10/01/2010] [Indexed: 05/30/2023]
Abstract
Wood smoke exposure has been associated with adverse respiratory health outcomes, with much of the current research focused on wood smoke from domestic heating and cooking. This study examined the association between respiratory symptoms and outdoor wood smoke in Launceston, Tasmania, where ~30% of homes use wood burners for domestic heating. This ecological study examined data from participants of the 2004 Tasmanian Longitudinal Health Study postal survey and compared the prevalence of respiratory symptoms in Launceston (n=601) with that in Hobart (n=1071), a larger Tasmanian city with much less wood smoke. Multivariate logistic regression models were used to investigate the associations of interest while adjusting for gender, atopy, history of allergic disease and current smoking status. There were no significant differences in symptom prevalence between Launceston and Hobart. Two subgroup analyses, which examined participants with pre-existing chronic respiratory disease, and those who reported actively using a wood burner in their home, also did not find significant differences. Any impact of wood smoke on non-specific respiratory symptoms might have been overshadowed by other important determinants of respiratory health, such as vehicle exhaust and tobacco smoking, or were too small to have been detected. However, the lack of detectable differences in symptom prevalence might also reflect the success of regulatory action by local governments to reduce wood smoke emissions in Launceston. The results of other epidemiological studies support an association between ambient wood smoke exposure and adverse respiratory health. Further investigations of wood smoke exposure in Australian settings are needed to investigate the lack of significant associations found in this study, especially studies of indoor air quality and health impacts in children and elderly populations.
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Affiliation(s)
- C M Bennett
- National Centre for Epidemiology and Population Health, The Australian National University, Canberra, Australian Capital Territory 0200, Australia
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Maniar-Hew K, Postlethwait EM, Fanucchi MV, Ballinger CA, Evans MJ, Harkema JR, Carey SA, McDonald RJ, Bartolucci AA, Miller LA. Postnatal episodic ozone results in persistent attenuation of pulmonary and peripheral blood responses to LPS challenge. Am J Physiol Lung Cell Mol Physiol 2010; 300:L462-71. [PMID: 21131396 DOI: 10.1152/ajplung.00254.2010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Early life is a dynamic period of growth for the lung and immune system. We hypothesized that ambient ozone exposure during postnatal development can affect the innate immune response to other environmental challenges in a persistent fashion. To test this hypothesis, we exposed infant rhesus macaque monkeys to a regimen of 11 ozone cycles between 30 days and 6 mo of age; each cycle consisted of ozone for 5 days (0.5 parts per million at 8 h/day) followed by 9 days of filtered air. Animals were subsequently housed in filtered air conditions and challenged with a single dose of inhaled LPS at 1 yr of age. After completion of the ozone exposure regimen at 6 mo of age, total peripheral blood leukocyte and polymorphonuclear leukocyte (PMN) numbers were reduced, whereas eosinophil counts increased. In lavage, total cell numbers at 6 mo were not affected by ozone, however, there was a significant reduction in lymphocytes and increased eosinophils. Following an additional 6 mo of filtered air housing, only monocytes were increased in blood and lavage in previously exposed animals. In response to LPS challenge, animals with a prior history of ozone showed an attenuated peripheral blood and lavage PMN response compared with controls. In vitro stimulation of peripheral blood mononuclear cells with LPS resulted in reduced secretion of IL-6 and IL-8 protein in association with prior ozone exposure. Collectively, our findings suggest that ozone exposure during infancy can result in a persistent effect on both pulmonary and systemic innate immune responses later in life.
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Affiliation(s)
- Kinjal Maniar-Hew
- California National Primate Research Center, Univ. of California, Davis, 95616, USA
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Amiot N, Tillon J, Viacroze C, Aouine H, Muir JF. Répercussions des fluctuations de la pollution atmosphérique chez les patients atteints de bronchopneumopathie chronique obstructive. Rev Mal Respir 2010; 27:907-12. [DOI: 10.1016/j.rmr.2010.04.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2009] [Accepted: 01/14/2010] [Indexed: 10/19/2022]
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Pulmonary responses to printer toner particles in mice after intratracheal instillation. Toxicol Lett 2010; 199:288-300. [PMID: 20883754 DOI: 10.1016/j.toxlet.2010.09.011] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2010] [Revised: 09/15/2010] [Accepted: 09/18/2010] [Indexed: 12/19/2022]
Abstract
The release of ultrafine particles from office equipment is currently receiving great concerns due to its potential threat to human health when inhaled. Printer toner is one of the largest consumables in daily office work, and the particles released from printers and photocopiers may pose damage to respiratory system. In this study, we found the particles can be released into the surrounding environment during the printing process and the concentrations of PM(2.5) and PM(10) particles increased obviously. To evaluate the time-course pulmonary responses caused by toner particles, the toner suspension was instilled into the lungs of the male mice through intratracheally instillation every other day for four times and the pulmonary responses of the lung were monitored at days 9, 28, 56 and 84. Indeed, mice treated with toner particles displayed a slower body weight growth rate during the recovery phase. The total cell number in bronchoalveolar lavage fluids (BALF) of toner-exposed groups was much higher than the saline-treated groups. The total protein, lactate dehydrogenase and acid phosphatase in BALF exhibited significant changes (p<0.05 or p<0.01) at different time points. The nitric oxide synthase, interleukin 1-beta, and interleukin 6 in the lung tissue of the toner-exposed groups also exhibited significant changes (p<0.05 or p<0.01). The pathological examination showed that toner particles can adhere to the alveolar septal walls, then enter into the alveoli and cause pulmonary lesion. During the experimental period, particles phagocytosed by alveolar macrophages (AMs) led to an increase of both AMs number and apoptosis. The pulmonary stress still remained over time even with a clearance period for 12 weeks. These results indicate that exposure to toner particles can inhibit the normal growth of the mice and induce significant inflammatory responses and lesion in the lung tissues. The health and safety effects from working indoors in offices with fumes and particles released from photocopiers and printers need to be paid more attention.
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Cheng MF, Tsai SS, Chiu HF, Sung FC, Wu TN, Yang CY. Air pollution and hospital admissions for pneumonia: are there potentially sensitive groups? Inhal Toxicol 2010; 21:1092-8. [PMID: 19852550 DOI: 10.3109/08958370902744855] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Recent studies have shown that air pollution is a risk factor for hospitalization for pneumonia. However, there is limited evidence to suggest what subpopulations are at greater risk from air pollution. This study was undertaken to examine the modifying effect of specific secondary diagnosis (including hypertension, diabetes, asthma, and upper respiratory infections) on the relationship between hospital admissions for pneumonia and ambient air pollutants. Hospital admissions for pneumonia and ambient air pollution data for Kaohsiung were obtained for the period 1996-2006. The relative risk of hospital admission was estimated using a case-crossover approach. We found that an interquartile range (IQR) increase in PM(10), NO(2), and CO on warm days was associated with a 28% (95% confidence interval [CI], 11-48%), 40% (95% CI, 20-63%), and 31% (95% CI, 19-45%), respectively, increase in admissions for pneumonia with upper respiratory infections (URI), but only 23% (95% CI, 18-28%), 30% (95% CI, 25-36%), and 24% (95% CI, 21-28%), respectively, increase for persons without URI. An IQR increase in PM(10), SO(2), and CO on cool days was associated with a 70% (95% CI, 50-92%), 30% (95% CI, 15-47%), and 64% (95% CI, 47-83%), respectively, increase in admissions in persons with URI, and an increase of 64% (95% CI, 57-70%), 18% (95% CI, 14-22%), and 55% (95% CI, 50-60%), respectively, in admissions in persons without URI. Our findings provide evidence that patients with comorbid URI may increase the risk of hospital admissions for pneumonia, in relation to air pollutant levels.
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Affiliation(s)
- Ming-Fen Cheng
- Institute of Occupational Safety and Health, Kaohsiung Medical University, Kaohsiung, Taiwan
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White ANJ, Ng V, Spain CV, Johnson CC, Kinlin LM, Fisman DN. Let the sun shine in: effects of ultraviolet radiation on invasive pneumococcal disease risk in Philadelphia, Pennsylvania. BMC Infect Dis 2009; 9:196. [PMID: 19961583 PMCID: PMC2797517 DOI: 10.1186/1471-2334-9-196] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2008] [Accepted: 12/04/2009] [Indexed: 11/20/2022] Open
Abstract
Background Streptococcus pneumoniae is a common cause of community acquired pneumonia and bacteremia. Excess wintertime mortality related to pneumonia has been noted for over a century, but the seasonality of invasive pneumococcal disease (IPD) has been described relatively recently and is poorly understood. Improved understanding of environmental influence on disease seasonality has taken on new urgency due to global climate change. Methods We evaluated 602 cases of IPD reported in Philadelphia County, Pennsylvania, from 2002 to 2007. Poisson regression models incorporating seasonal smoothers were used to identify associations between weekly weather patterns and case counts. Associations between acute (day-to-day) environmental fluctuations and IPD occurrence were evaluated using a case-crossover approach. Effect modification across age and sex strata was explored, and meta-regression models were created using stratum-specific estimates for effect. Results IPD incidence was greatest in the wintertime, and spectral decomposition revealed a peak at 51.0 weeks, consistent with annual periodicity. After adjustment for seasonality, yearly increases in reporting, and temperature, weekly incidence was found to be associated with clear-sky UV index (IRR per unit increase in index: 0.70 [95% CI 0.54-0.91]). The effect of UV index was highest among young strata and decreased with age. At shorter time scales, only an association with increases in ambient sulphur oxides was linked to disease risk (OR for highest tertile of exposure 0.75, 95% CI 0.60 to 0.93). Conclusion We confirmed the wintertime predominance of IPD in a major urban center. The major predictor of IPD in Philadelphia is extended periods of low UV radiation, which may explain observed wintertime seasonality. The mechanism of action of diminished light exposure on disease occurrence may be due to direct effects on pathogen survival or host immune function via altered 1,25-(OH)2-vitamin-D metabolism. These findings may suggest less diminution in future IPD risk with climate change than would be expected if wintertime seasonality was driven by temperature.
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Affiliation(s)
- Alexander N J White
- Child Health Evaluative Sciences, Research Institute of the Hospital for Sick Children, 123 Edward Street, Toronto M4V 1X6, Canada.
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Neupane B, Jerrett M, Burnett RT, Marrie T, Arain A, Loeb M. Long-term exposure to ambient air pollution and risk of hospitalization with community-acquired pneumonia in older adults. Am J Respir Crit Care Med 2009; 181:47-53. [PMID: 19797763 DOI: 10.1164/rccm.200901-0160oc] [Citation(s) in RCA: 140] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Little is known about the long-term effects of air pollution on pneumonia hospitalization in the elderly. OBJECTIVES To assess the effect of long-term exposure to ambient nitrogen dioxide, sulfur dioxide, and fine particulate matter with diameter equal to or smaller than 2.5 microm (PM(2.5)) on hospitalization for community-acquired pneumonia in older adults. METHODS We used a population-based case-control study in Hamilton, Ontario, Canada. We enrolled 345 hospitalized patients aged 65 years or more for community-acquired pneumonia and 494 control participants, aged 65 years and more, randomly selected from the same community as cases from July 2003 to April 2005. Health data were collected by personal interview. Annual average levels of nitrogen dioxide, sulfur dioxide, and PM(2.5) before the study period were estimated at the residential addresses of participants by inverse distance weighting, bicubic splined and land use regression methods and merged with participants' health data. MEASUREMENTS AND MAIN RESULTS Long-term exposure to higher levels of nitrogen dioxide and PM(2.5) was significantly associated with hospitalization for community-acquired pneumonia (odds ratio [OR], 2.30; 95% confidence interval [CI], 1.25 to 4.21; P = 0.007 and OR, 2.26; 95% CI, 1.20 to 4.24; P = 0.012, respectively, over the 5th-95th percentile range increase of exposure). Sulfur dioxide did not appear to have any association (OR, 0.97; 95% CI, 0.59 to 1.61; P = 0.918). Results were somewhat sensitive to the choice of methods used to estimate air pollutant levels at residential addresses, although all risks from nitrogen dioxide and PM(2.5) exposure were positive and generally significant. CONCLUSIONS In older adults, exposure to ambient nitrogen dioxide and PM(2.5) was associated with hospitalization for community-acquired pneumonia.
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Affiliation(s)
- Binod Neupane
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
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Duc H, Jalaludin B, Morgan G. ASSOCIATIONS BETWEEN AIR POLLUTION AND HOSPITAL VISITS FOR CARDIOVASCULAR DISEASES IN THE ELDERLY IN SYDNEY USING BAYESIAN STATISTICAL METHODS. AUST NZ J STAT 2009. [DOI: 10.1111/j.1467-842x.2009.00545.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Milutinović S, Nikić D, Stosić L, Stanković A, Bogdanović D. Short-term association between air pollution and emergency room admissions for chronic obstructive pulmonary disease in Nis, Serbia. Cent Eur J Public Health 2009; 17:8-13. [PMID: 19418713 DOI: 10.21101/cejph.a3508] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The present study assesses the short-term association between black smoke (BS) and sulphur dioxide (SO2) levels in urban air and the daily number of emergency room admissions for chronic obstructive pulmonary disease (COPD) in Nis, Serbia. Generalised linear models extending Poisson regression were fitted controlling for time trend, seasonal variations, days of the week, temperature, relative humidity, air pressure, precipitation, rainfall, snowfall, overcast, and wind velocity. The emergency room admissions for all ages for COPD were significantly associated with previous-day level of BS and lag 0-2 (1,60% and 2,26% increase per 10 microg/m3, respectively). After controlling for SO2, single lagged (lag 1 and lag 2) as well as mean lagged values of BS (up to lag 0-3) were significantly associated with COPD emergencies. No effect was found for SO2, even after controlling for black smoke. The present findings support the conclusion that current levels of ambient BS may have an effect on the respiratory health of susceptible persons.
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Valavanidis A, Loridas S, Vlahogianni T, Fiotakis K. Influence of ozone on traffic-related particulate matter on the generation of hydroxyl radicals through a heterogeneous synergistic effect. JOURNAL OF HAZARDOUS MATERIALS 2009; 162:886-892. [PMID: 18602214 DOI: 10.1016/j.jhazmat.2008.05.124] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2008] [Revised: 05/21/2008] [Accepted: 05/22/2008] [Indexed: 05/26/2023]
Abstract
Epidemiologic studies suggest that ozone (O(3)) and airborne particulate matter (PM) can interact causing acute respiratory inflammation and other respiratory diseases. Recent studies investigated the hypothesis that the effects of air pollution caused by O(3) and PM are larger than the effect of these two pollutants individually. We investigated the hypothesis that ozone and traffic-related PM (PM(10) and PM(2.5), diesel and gasoline exhaust particles) interact synergistically to produce increasing amounts of highly reactive hydroxyl radicals (HO) in a heterogeneous aqueous mixture at physiological pH. Electron paramagnetic resonance (EPR) and spin trapping were used for the measurements. Results showed that HO radicals are generated by the catalytic action of PM surface area with ozone and that EPR peak intensities are two to three times higher compared to PM samples without ozone. Incubation of the nucleoside 2'-deoxyguanosine (dG) in aqueous mixtures of ozone and PM at pH 7.4 resulted in the hydroxylation at C(8) position of dG. The formation of 8-hydroxy-2'-deoxyguanosine (8-OHdG) showed a 2-2.5-fold increase over control (PM without O(3)). These results suggest that PM and O(3) act synergistically generating a sustained production of reactive HO radicals. Partitioning of O(3) into the particle phase depends on the concentration, hygroscopicity and particle size.
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Affiliation(s)
- Athanasios Valavanidis
- Department of Chemistry, University of Athens, University Campus Zografou, 15784 Athens, Greece.
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Chiu HF, Cheng MH, Yang CY. Air Pollution and Hospital Admissions for Pneumonia in a Subtropical City: Taipei, Taiwan. Inhal Toxicol 2009; 21:32-7. [DOI: 10.1080/08958370802441198] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Chiu HF, Tiao MM, Ho SC, Kuo HW, Wu TN, Yang CY. Effects of Asian dust storm events on hospital admissions for chronic obstructive pulmonary disease in Taipei, Taiwan. Inhal Toxicol 2008; 20:777-81. [PMID: 18645716 DOI: 10.1080/08958370802005308] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
In spring, windblown dust storms originating in the deserts of Mongolia and China make their way to Taipei city. These occurrences are known as Asian dust storm (ADS) events. These ADS events lead to enhanced PM(10) levels over that contributed by the usual local sources. The objective of this study was to assess the possible associations of PM(10) with hospital admissions for chronic obstructive pulmonary disease (COPD) in Taipei, Taiwan, during the period 1996-2001. We identified 54 dust storm episodes that were classified as index days. Daily COPD admissions on the index days were compared with admissions on the comparison days. We selected 2 comparison days for each index day, 7 days before the index days and 7 days after the index days. The effects of dust storms on hospital admissions for COPD were prominent 3 days after the event (relative risk = 1.057; 95% confidence interval = 0.982-1.138). However, the association was not statistically significant. There may not have been enough power to detect associations resulting from the inadequate sample size of COPD admissions on ADS events days. However, It seems worthwhile to pay more attention to the ADS events and health in the future.
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Affiliation(s)
- Hui-Fen Chiu
- Institute of Pharmacology, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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Hall JV, Brajer V, Lurmann FW. Measuring the gains from improved air quality in the San Joaquin Valley. JOURNAL OF ENVIRONMENTAL MANAGEMENT 2008; 88:1003-15. [PMID: 17590260 DOI: 10.1016/j.jenvman.2007.05.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2006] [Revised: 02/02/2007] [Accepted: 05/05/2007] [Indexed: 05/16/2023]
Abstract
Many regions worldwide are experiencing rapid urbanization, and often along with growth in the local economy and population comes worsening air quality. Such regions typically find that addressing the additional challenge of polluted air is difficult. This paper reports the results of an assessment of the present health and related economic costs of poor air quality in the San Joaquin Valley of California. Further, it suggests how such assessments can support strategies to pursue pollution reductions that offer the largest near-term gains, by rigorously modeling the associations between pollution levels, demographic groups, and recognized adverse health effects.
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Affiliation(s)
- Jane V Hall
- Department of Economics, California State University, 800 N. State College Blvd., Fullerton, CA 92834, USA.
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Cheng MF, Ho SC, Chiu HF, Wu TN, Chen PS, Yang CY. Consequences of exposure to Asian dust storm events on daily pneumonia hospital admissions in Taipei, Taiwan. JOURNAL OF TOXICOLOGY AND ENVIRONMENTAL HEALTH. PART A 2008; 71:1295-9. [PMID: 18686199 DOI: 10.1080/15287390802114808] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
In spring, windblown dust storms originating in the deserts of Mongolia and China travel to Taipei city. These occurrences are known as Asian dust storm (ADS) events. The objective of this study was to assess the possible associations of constituents of ADS with hospital pneumonia admissions of residents in Taipei, Taiwan, during the period 1996-2001. Fifty-four dust storm episodes were identified and were classified as index days. Daily pneumonia admissions on the index days were compared with admissions on comparison days. Two comparison days for each index day, 7 d before the index days and 7 d after the index days, were selected. The study results indicated a statistically significant association between ADS events and daily pneumonia admissions 1 d after the event. It is worthwhile to pay more attention to ADS events and health in the future based on the findings in this investigation.
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Affiliation(s)
- Ming-Fen Cheng
- Institute of Occupational Safety and Health, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan
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Domínguez-Cherit G, Posadas-Calleja JG, Borunda D. Chronic Obstructive Pulmonary Disease. Crit Care Med 2008. [DOI: 10.1016/b978-032304841-5.50042-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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