Air pollution and chronic obstructive pulmonary disease

Study on the impact of smart city construction on the health of the elderly population--A quasi-natural experiment in China

In the context of global aging, promoting the health of the elderly has become a critical issue. However, whether the development of smart cities can impact the health of older adults remains to be further validated. In this paper, based on panel data from the China Health and Retirement Longitudinal Study (CHARLS), a difference in difference model is used to empirically investigate whether smart city construction improves the health of older people in the region. The results show that smart city construction enhances the health of the elderly. Specifically, the construction achieved a significant improvement in the physical health of the elderly who did not live with their children. The health promotion effect of the smart city was more significant for the urban elderly than for the rural elderly. The elucidated mechanisms of influence suggest that smart cities bring about their effects through the promotion of urban leisure infrastructure, enhancement of medical service provision, advancement in urban environmental protection and stimulation of urban information and communication technology infrastructure development.

Impact of artisanal refining activities on bacterial diversity in a Niger Delta fallow land

Hydrocarbon pollution is a major ecological problem facing oil-producing countries, especially in the Niger Delta region of Nigeria. In this study, a site that had been previously polluted by artisanal refining activity was investigated using 16S rRNA Illumina high-throughput sequencing technology and bioinformatics tools. These were used to investigate the bacterial diversity in soil with varying degrees of contamination, determined with a gas chromatography-flame ionization detector (GC-FID). Soil samples were collected from a heavily polluted (HP), mildly polluted (MP), and unpolluted (control sample, CS) portion of the study site. DNA was extracted using the Zymo Research (ZR) Fungi/Bacteria DNA MiniPrep kit, followed by PCR amplification and agarose gel electrophoresis. The microbiome was characterized based on the V3 and V4 hypervariable regions of the 16S rRNA gene. QIIME (Quantitative Insights Into Microbial Ecology) 2 software was used to analyse the sequence data. The final data set covered 20,640 demultiplexed high-quality reads and a total of 160 filtered bacterial OTUs. Proteobacteria dominated samples HP and CS, while Actinobacteria dominated sample MP. Denitratisoma, Pseudorhodoplanes, and Spirilospora were the leading genera in samples HP, CS, and MP respectively. Diversity analysis indicated that CS [with 25.98 ppm of total petroleum hydrocarbon (TPH)] is more diverse than HP (with 490,630 ppm of TPH) and MP (with 5398 ppm of TPH). A functional prediction study revealed that six functional modules dominated the dataset, with metabolism covering up to 70%, and 11 metabolic pathways. This study demonstrates that a higher hydrocarbon concentration in soil adversely impacts microbial diversity, creating a narrow bacterial diversity dominated by hydrocarbon-degrading species, in addition to the obvious land and ecosystem degradation caused by artisanal refining activities. Overall, the artisanal refining business is significantly driving ecosystem services losses in the Niger Delta, which calls for urgent intervention, with focus on bioremediation.

Randomised controlled trial of a behavioural intervention to reduce exposure to PM2.5 in patients with COPD

BACKGROUND

Fine particulate matter (PM2.5) is a well-known risk factor for worse outcomes of chronic obstructive pulmonary disease (COPD). However, evidence-based guidance on effective personal behavioural strategies to minimise the effects of PM2.5 is limited. This study aimed to assess the effectiveness of a behavioural intervention in reducing PM2.5 exposure and improving clinical outcomes in patients with COPD.

MATERIALS AND METHODS

Participants were 1:1 randomised, and the intervention group received a behavioural intervention consisting of five activities, while the control group received usual care. The participants were followed up for 9 months. The primary outcomes were differences in the score of St. George's Respiratory Questionnaire for patients with COPD (SGRQ-C) and COPD assessment test (CAT) from baseline.

RESULTS

A total of 106 participants were enrolled and 102 completed the study. At the end of the study, the intervention group showed significant improvements in the primary outcomes compared to the control group, with a group difference of -5.9 in the reduction of total SGRQ-C (-3.4 vs. 2.5; p = 0.049) and -3.8 in the CAT score (-1.2 vs. 2.7; p = 0.001). Participants with good adherence to the intervention demonstrated a greater extent of improvement in CAT score and lower PM2.5 levels compared to those who had poor adherence or were in the control group. Regular checking of air quality forecasts was significantly associated with a reduction in CAT scores among all the intervention activities.

CONCLUSION

Individual-level behavioural interventions can be an effective strategy for mitigating the health hazards associated with PM2.5.

CLINICALTRIALS

gov Identifier: NCT04878367.

Airborne Particulate Matter Size and Chronic Obstructive Pulmonary Disease Exacerbations: A Prospective, Risk-Factor Analysis Comparing Global Initiative for Obstructive Lung Disease 3 and 4 Categories

Current research primarily emphasizes the generalized correlations between airborne pollution and respiratory diseases, seldom considering the differential impacts of particular particulate matter sizes on chronic obstructive pulmonary disease (COPD) exacerbations in distinct Global Initiative for Obstructive Lung Disease (GOLD) categories. This study hypothesizes a critical association between particulate matter sizes (PM 1.0, PM 2.5, and PM 10) and exacerbation frequency in COPD patients categorized under GOLD 3 and GOLD 4, with a potential augmenting role played by proximity to main roads and industrial areas. This research aspires to offer a nuanced perspective on the exacerbation patterns in these groups, setting the stage for targeted intervention strategies. Utilizing a prospective design, this study followed 79 patients divided into GOLD 3 (n = 47) and GOLD 4 (n = 32) categories. The participants were monitored for ten days for daily activity levels, symptoms, living conditions, and airborne particulate matter concentrations, with spirometric evaluations employed to measure lung function. Statistical analyses were used to identify potential risk factors and significant associations. The analysis revealed substantial disparities in airborne particulate matter sizes between the two groups. The mean PM 1.0 concentration was notably higher in GOLD 4 patients (26 µg/m3) compared to GOLD 3 patients (18 µg/m3). Similarly, elevated PM 2.5 levels were observed in the GOLD 4 category (35 µg/m3) in contrast to the GOLD 3 category (24 µg/m3). A vital finding was the increased frequency of exacerbations in individuals residing within 200 m of main roads compared to those living further away (OR = 2.5, 95% CI: 1.5-4.1). Additionally, patients residing in homes smaller than 50 square meters demonstrated a greater frequency of exacerbations. Spirometry results corroborated the exacerbated condition in GOLD 4 patients, indicating a significant decline in lung function parameters compared to the GOLD 3 group. This study substantiates a significant association between airborne particulate matter sizes and exacerbation frequencies in COPD patients, particularly accentuating the increased risk in GOLD 4 patients. Our findings underscore the pivotal role of environmental factors, including the size of living areas and proximity to main roads, in influencing COPD exacerbations. These results suggest the need for personalized healthcare strategies and interventions, which account for environmental risk factors and the distinctions between GOLD 3 and GOLD 4 categories of COPD patients.

The impact of the synergistic effect of SO2 and PM2.5/PM10 on obstructive lung disease in subtropical Taiwan

Background

Chronic Obstructive lung diseases (COPD) are complex conditions influenced by various environmental, lifestyle, and genetic factors. Ambient air pollution has been identified as a potential risk factor, causing 4.2 million deaths worldwide in 2016, accounting for 25% of all COPD-related deaths and 26% of all respiratory infection-related deaths. This study aims to evaluate the associations among chronic lung diseases, air pollution, and meteorological factors.

Methods

This cross-sectional study obtained data from the Taiwan Biobank and Taiwan Air Quality Monitoring Database. We defined obstructive lung disease as patients with FEV1/FVC < 70%. Descriptive analysis between spirometry groups was performed using one-way ANOVA and the chi-square or Fisher's exact test. A generalized additive model (GAM) was used to evaluate the relationship between SO2 and PM2.5/PM10 through equations and splines fitting.

Results

A total of 2,635 participants were enrolled. Regarding environmental factors, higher temperature, higher relative humidity, and lower rainfall were risk factors for obstructive lung disease. SO2 was positively correlated with PM10 and PM2.5, with correlation coefficients of 0.53 (p < 0.0001) and 0.52 (p < 0.0001), respectively. Additionally, SO2 modified the relative risk of obstructive impairment for both PM10 [β coefficient (β) = 0.01, p = 0.0052] and PM2.5 (β = 0.01, p = 0.0155). Further analysis per standard deviation (per SD) increase revealed that SO2 also modified the relationship for both PM10 (β = 0.11, p = 0.0052) and PM2.5 (β = 0.09, p = 0.0155). Our GAM analysis showed a quadratic pattern for SO2 (per SD) and PM10 (per SD) in model 1, and a quadratic pattern for SO2 (per SD) in model 2. Moreover, our findings confirmed synergistic effects among temperature, SO2 and PM2.5/PM10, as demonstrated by the significant associations of bivariate (SO2 vs. PM10, SO2 vs. PM2.5) thin-plate smoothing splines in models 1 and 2 with obstructive impairment (p < 0.0001).

Conclusion

Our study showed high temperature, humidity, and low rainfall increased the risk of obstructive lung disease. Synergistic effects were observed among temperature, SO2, and PM2.5/PM10. The impact of air pollutants on obstructive lung disease should consider these interactions.

L-Arginine, as an essential amino acid, is a potential substitute for treating COPD via regulation of ROS/NLRP3/NF-κB signaling pathway

BACKGROUNDS

Chronic obstructive pulmonary disease (COPD) is a frequent and common disease in clinical respiratory medicine and its mechanism is unclear. The purpose of this study was to find the new biomarkers of COPD and elucidate its role in the pathogenesis of COPD. Analysis of metabolites in plasma of COPD patients were performed by ultra-high performance liquid chromatography (UPLC) and quadrupole time-of-flight mass spectrometry (TOF-MS). The differential metabolites were analyzed and identified by multivariate analysis between COPD patients and healthy people. The role and mechanisms of the differential biomarkers in COPD were verified with COPD rats, arginosuccinate synthetase 1 (ASS-l) KO mice and bronchial epithelial cells (BECs). Meanwhile, whether the differential biomarkers can be the potential treatment targets for COPD was also investigated. 85 differentials metabolites were identified between COPD patients and healthy people by metabonomic.

RESULTS

L-Arginine (LA) was the most obvious differential metabolite among the 85 metabolites. Compare with healthy people, the level of LA was markedly decreased in serum of COPD patients. It was found that LA had protective effects on COPD with in vivo and in vitro experiments. Silencing Ass-1, which regulates LA metabolism, and α-methy-DL-aspartic (NHLA), an Ass-1 inhibitor, canceled the protective effect of LA on COPD. The mechanism of LA in COPD was related to the inhibition of ROS/NLRP3/NF-κB signaling pathway. It was also found that exogenous LA significantly improved COPD via regulation of ROS/NLRP3/NF-κB signaling pathway. L-Arginine (LA) as a key metabolic marker is identified in COPD patients and has a protective effect on COPD via regulation of ROS/NLRP3/NF-κB signaling pathway.

CONCLUSION

LA may be a novel target for the treatment of COPD and also a potential substitute for treating COPD.

Air pollution and COPD: GOLD 2023 committee report

Exposure to air pollution is a major contributor to the pathogenesis of COPD worldwide. Indeed, most recent estimates suggest that 50% of the total attributable risk of COPD may be related to air pollution. In response, the Global Initiative for Chronic Obstructive Lung Disease (GOLD) Scientific Committee performed a comprehensive review on this topic, qualitatively synthesised the evidence to date and proffered recommendations to mitigate the risk. The review found that both gaseous and particulate components of air pollution are likely contributors to COPD. There are no absolutely safe levels of ambient air pollution and the relationship between air pollution levels and respiratory events is supra-linear. Wildfires and extreme weather events such as heat waves, which are becoming more common owing to climate change, are major threats to COPD patients and acutely increase their risk of morbidity and mortality. Exposure to air pollution also impairs lung growth in children and as such may lead to developmental COPD. GOLD recommends strong public health policies around the world to reduce ambient air pollution and for implementation of public warning systems and advisories, including where possible the use of personalised apps, to alert patients when ambient air pollution levels exceed acceptable minimal thresholds. When household particulate content exceeds acceptable thresholds, patients should consider using air cleaners and filters where feasible. Air pollution is a major health threat to patients living with COPD and actions are urgently required to reduce the morbidity and mortality related to poor air quality around the world.

Health risk assessment for particulate matter: application of AirQ+ model in the northern Caribbean region of Colombia

Air pollution is considered the world's most important environmental and public health risk. The annual exposure for particulate matter (PM) in the northern Caribbean region of Colombia between 2011 and 2019 was determined using PM records from 25 monitoring stations located within the area. The impact of exposure to particulate matter was assessed through the updated Global Burden of Disease health risk functions using the AirQ+ model for mortality attributable to acute lower respiratory disease (in children ≤ 4 years); mortality in adults aged > 18 years old attributable to chronic obstructive pulmonary disease, ischaemic heart disease, lung cancer, and stroke; and all-cause post-neonatal infant mortality. The proportions of the prevalence of bronchitis in children and the incidence of chronic bronchitis in adults attributable to PM exposure were also estimated for the population at risk. Weather Research and Forecasting-California PUFF (WRF-CALPUFF) modeling systems were used to estimate the spatiotemporal trends and calculate mortality relative risk due to prolonged PM_2.5 exposure. Proportions of mortality attributable to long-term exposure to PM_2.5 were estimated to be around 11.6% of ALRI deaths in children ≤ 4 years of age, 16.1% for COPD, and 26.6% for IHD in adults. For LC and stroke, annual proportions attributable to PM exposure were estimated to be 9.1% and 18.9%, respectively. An estimated 738 deaths per year are directly attributed to particulate matter pollution. The highest number of deaths per year is recorded in the adult population over 18 years old with a mean of 401 events. The mean risk in terms of the prevalence of bronchitis attributable to air pollution in children was determined to be 109 per 100,000 inhabitants per year. The maximum RR values for mortality (up 1.95%) from long-term PM_2.5 exposure were predicted to correspond to regions downwind to the industrial zone.

Supplementary information

The online version contains supplementary material available at 10.1007/s11869-023-01304-5.

Chronic Obstructive Pulmonary Disease Prevalence and Associated Risk Factors in Adults Aged 40 Years and Older in Southeast China: A Cross-Sectional Study During 2019-2020

Purpose

Chronic obstructive pulmonary disease (COPD) is one of many major public health problems in China, and its prevalence and associated risk factors in the southeast of China need to be determined to facilitate disease control and prevention.

Methods

A multistage stratified cluster sampling method was used to select 5486 participants aged ≥ 40 years from nine COPD monitoring districts in Fujian Province during 2019–2020. Participants were interviewed using a laptop-based questionnaire and underwent pulmonary function tests. COPD was diagnosed according to the 2019 Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria.

Results

Final analysis was conducted using data from 4999 participants with qualified post-bronchodilator results. The prevalence of COPD was 11.6% (95% confidence interval [CI]: 10.5–12.7). Risk factors for COPD in the logistic regression model were being male (odds ratio [OR] = 2.83, 95% CI: 2.01–3.98), > 70 years old (OR = 16.16, 95% CI: 8.14–32.08), having a low body mass index (BMI) (OR = 1.81, 95% CI: 1.13–2.89), parental history of respiratory disease (OR = 1.78, 95% CI: 1.50–2.10), being a current (OR = 2.82, 95% CI: 1.83–4.36) or former (OR = 2.47, 95% CI: 1.45–4.19) smoker, and indoor exposure to biomass (OR = 1.28, 95% CI: 1.05–1.58).

Conclusion

The estimated prevalence of COPD in southeast China is high. COPD was strongly associated with sex, aging, a low BMI, parental history of respiratory diseases, smoking, and indoor exposure to biomass in adults aged ≥ 40 years. The government should urgently implement comprehensive measures to reduce the risk factors for COPD.

Particle characterization and quantification of organic and inorganic compounds from Chinese and Iranian aerosol filter samples using scanning laser desorption/ionization mass spectrometry

Besides their influence on climate and cloud formation, many organic and inorganic substances in aerosol particles pose a risk to human health. Namely, polycyclic aromatic hydrocarbons (PAH) and heavy metals are suspected to be carcinogenic or acutely toxic. The detection and quantification of such compounds is difficult if only small amounts of particulate matter (PM) are available. In addition, filter samples are often complex and time-consuming to prepare for chromatographic measurements and elemental analysis. Here, we present a method based on high-resolution atmospheric pressure laser desorption ionization mass spectrometry imaging (AP-LDI-MSI) and statistical analysis which allows the analysis and characterization of very small sample quantities (< 30 µg) without any sample preparation. The power and simplicity of the method is demonstrated by two filter samples from heavily polluted mega cities. The samples were collected in Tehran (Iran) and Hangzhou (China) in February 2018. In the course of the measurement, more than 3200 sum formulae were assigned, which allowed a statistical evaluation of colocalized substances within the particles on the filter samples. This resulted in a classification of the different particle types on the filters. Finally, both megacities could be distinguished based on characteristic compounds. In the samples from Tehran, the number of sulphur-containing organic compounds was up to 6 times as high as the samples from Hangzhou, possibly due to the increasing efforts of the Chinese government to reduce sulphur emissions in recent years. Additionally, quantification of 13 PAH species was carried out via standard addition. Especially, the samples from Tehran showed elevated concentrations of PAHs, which in the case of higher-molecular-weight species (> m/z 228) were mostly more than twice as high as in Hangzhou. Both cities showed high levels of heavy metals and potentially harmful organic compounds, although their share of total particulate matter was significantly higher in the samples from Tehran. The pre-treatment of the samples was reduced to a minimum with this method, and only small amounts of particles were required to obtain a comprehensive picture for a specific filter sample. The described method provides faster and better control of air pollution in heavily polluted megacities.

Beyond the COPD-tobacco binomium: New opportunities for the prevention and early treatment of the disease

Chronic obstructive pulmonary disease (COPD) has been traditionally understood as a self-inflicted disease cause by tobacco smoking occurring in individuals older than 50-60 years. This traditional paradigm has changed over the last decade because new scientific evidence showed that there are many genetic (G) and environmental (E) factors associated with reduced lung function, that vary, accumulate, and interact over time (T), even before birth (G×E×T). This new perspective opens novel windows of opportunity for the prevention, early diagnosis, and personalized treatment of COPD. This review presents the evidence that supports this proposal, as well as its practical implications, with particular emphasis on the need that clinical histories in patients with suspected COPD should investigate early life events and that spirometry should be used much more widely as a global health marker.

Short-Term Air Pollution Exposure and Risk of Acute Exacerbation of Chronic Obstructive Pulmonary Disease in Korea: A National Time-Stratified Case-Crossover Study

We investigated the association between short-term exposure to air pollution and the risk of acute exacerbation of chronic obstructive pulmonary disease (AE-COPD) in seven metropolitan cities in Korea. We used national health insurance claims data to identify AE-COPD cases in 2015. We estimated short-term exposure to particulate matter (PM) with a diameter of ≤2.5 μm (PM_2.5), PM with diameters of ≤10 μm (PM₁₀), sulfur dioxide (SO₂), nitrogen dioxide (NO₂), carbon monoxide (CO), and ozone (O₃) obtained from the Ministry of Environment. We conducted a time-stratified, case-crossover study to evaluate the effect of short-term exposure to air pollution on hospital visits for AE-COPD, using a conditional logistic regression model. The risk of hospital visits for AE-COPD was significantly associated with interquartile range increases in PM₁₀ in a cumulative lag model (lag 0–2, 0.35%, 95% confidence interval (CI) 0.06–0.65%; lag 0–3, 0.39%, 95% CI 0.01–0.77%). The associations were higher among patients who were men, aged 40–64 years, with low household income, and with a history of asthma. However, other air pollutants were not significantly associated with the risk of hospital visits for AE-COPD. Short-term exposure to air pollution, especially PM₁₀, increases the risk of hospital visits for AE-COPD.

Association Between Air Pollutants and Acute Exacerbation of Chronic Obstructive Pulmonary Disease: A Time Stratified Case-Crossover Design With a Distributed Lag Nonlinear Model

Acute exacerbation of chronic obstruction pulmonary disease (AECOPD) as a respiratory disease, is considered to be related to air pollution by more and more studies. However, the evidence on how air pollution affect the incidence of AECOPD and whether there are population differences is still insufficient. Therefore, we select PM10, PM2.5, SO2, NO2, CO, and O3 as representatives combined with daily AECOPD admission data from 1 January 2015 to 26 June 2016 in the rural areas of Qingyang, northwestern China to explore the associations of air pollution with AECOPD. Based on a time-stratified case-crossover design, we constructed a distributed lag nonlinear model to qualify the single and cumulative lagged effects of air pollution on AECOPD. Stratified related risks by sex and age were also reported. The cumulative exposure-response curves were approximately linear for PM2.5, "V"-shaped for PM10, "U"-shaped for NO2 and inverted-"V" for SO2, CO and O3. Exposure to high-PM2.5 (42 μg/m3), high-PM10 (91 μg/m3), high-SO2 (58 μg/m3), low-NO2 (12 μg/m3), and high-CO (1.55 mg/m3) increased the risk of AECOPD. Females aged 15-64 were more susceptible under extreme concentrations of PM2.5, SO2, CO, and low-PM10 than other subgroups. In addition, adults aged 15-64 were more sensitive to extreme concentrations of NO2 compared with the elderly ≥65 years old, while the latter were more sensitive to high-PM10. High-SO2, high-NO2, and extreme concentrations of PM2.5 had the greatest effects on the day of exposure, while low-SO2 and low-CO had lagged effects on AECOPD. Precautionary measures should be taken with a focus on vulnerable subgroups, to control hospitalization for AECOPD associated with air pollutants.

Early Diagnosis and Real-Time Monitoring of Regional Lung Function Changes to Prevent Chronic Obstructive Pulmonary Disease Progression to Severe Emphysema

First- and second-hand exposure to smoke or air pollutants is the primary cause of chronic obstructive pulmonary disease (COPD) pathogenesis, where genetic and age-related factors predispose the subject to the initiation and progression of obstructive lung disease. Briefly, airway inflammation, specifically bronchitis, initiates the lung disease, leading to difficulty in breathing (dyspnea) and coughing as initial symptoms, followed by air trapping and inhibition of the flow of air into the lungs due to damage to the alveoli (emphysema). In addition, mucus obstruction and impaired lung clearance mechanisms lead to recurring acute exacerbations causing progressive decline in lung function, eventually requiring lung transplant and other lifesaving interventions to prevent mortality. It is noteworthy that COPD is much more common in the population than currently diagnosed, as only 16 million adult Americans were reported to be diagnosed with COPD as of 2018, although an additional 14 million American adults were estimated to be suffering from COPD but undiagnosed by the current standard of care (SOC) diagnostic, namely the spirometry-based pulmonary function test (PFT). Thus, the main issue driving the adverse disease outcome and significant mortality for COPD is lack of timely diagnosis in the early stages of the disease. The current treatment regime for COPD emphysema is most effective when implemented early, on COPD onset, where alleviating symptoms and exacerbations with timely intervention(s) can prevent steep lung function decline(s) and disease progression to severe emphysema. Therefore, the key to efficiently combatting COPD relies on early detection. Thus, it is important to detect early regional pulmonary function and structural changes to monitor modest disease progression for implementing timely interventions and effectively eliminating emphysema progression. Currently, COPD diagnosis involves using techniques such as COPD screening questionnaires, PFT, arterial blood gas analysis, and/or lung imaging, but these modalities are limited in their capability for early diagnosis and real-time disease monitoring of regional lung function changes. Hence, promising emerging techniques, such as X-ray phase contrast, photoacoustic tomography, ultrasound computed tomography, electrical impedance tomography, the forced oscillation technique, and the impulse oscillometry system powered by robust artificial intelligence and machine learning analysis capability are emerging as novel solutions for early detection and real time monitoring of COPD progression for timely intervention. We discuss here the scope, risks, and limitations of current SOC and emerging COPD diagnostics, with perspective on novel diagnostics providing real time regional lung function monitoring, and predicting exacerbation and/or disease onset for prognosis-based timely intervention(s) to limit COPD–emphysema progression.

Effects of exposure to ambient air pollution on pulmonary function impairment in South Korea: Korea National Health and Nutritional Examination Survey

OBJECTIVES

This study aimed to investigate the association between pulmonary function and air pollution using 2007–2017 data from the Korea National Health and Nutrition Examination Survey, a nationwide cross-sectional representative survey.

METHODS

A total of 27,378 participants that had sampling weights from a complex sample survey were included in this study. Using the data for forced expiratory volume in 1 second and forced vital capacity, the participants with pulmonary function impairment were classified according to the criteria of restrictive lung disease and chronic obstructive pulmonary disease (COPD). Exposure to ambient air pollution was estimated using the Community Multiscale Air Quality model. Multivariate linear and logistic regression analyses with complex samples were used to determine the associations between pulmonary function and air pollution after adjusting for covariates.

RESULTS

In total, 13.2% of the participants aged >40 years had COPD, and 10.7% were classified as being in the restrictive lung disease group. According to the multivariate logistic regression model, the odds ratios for the fourth quartiles of particulate matter less than 10 μm in diameter (PM₁₀), particulate matter less than 2.5 μm in diameter (PM_2.5) and carbon monoxide (CO) with a 2-year lag period were 1.203 (95% confidence interval [CI], 1.036 to 1.396), 1.283 (95% CI, 1.101 to1.495), and 1.292 (95% CI, 1.110 to 1.504), respectively, using the restrictive lung disease group as an event after adjusting for covariates in the complex sample.

CONCLUSIONS

Long-term exposure to PM₁₀, PM_2.5, and CO was significantly associated with pulmonary function, especially restrictive lung disease.

Is PM2.5 associated with emergency department visits for mechanical ventilation in acute exacerbation of chronic obstructive pulmonary disease?

BACKGROUND

Patients with chronic obstructive pulmonary disease (COPD) can have recurrent exacerbations and acute respiratory failure (ARF) triggered by particulate matter with a diameter of ≤2.5 μm (PM_2.5). To prevent ventilator shortages, this study investigated the short-term association between PM_2.5 concentration and emergency department visits (EDVs) among patients with acute exacerbation of COPD (AECOPD) requiring mechanical ventilation (MV).

METHODS

We conducted a time-series study to predict the PM_2.5 concentration and number of ventilators needed. Daily counts of EDVs among AECOPD patients requiring ventilation from 2015 to 2019 were obtained from a hospital. Generalized linear models extending Poisson regression were used to explore the association of AECOPD with PM_2.5 after controlling for the time trend, seasonal variations, and meteorological variables.

RESULTS

Eight hundred seventy-five AECOPD patients receiving MV were recorded, of whom 734 received noninvasive ventilation and 141 received invasive ventilatory support. EDVs for AECOPD patients with ARF significantly increased by 3.5% (95% confidence interval [CI]: 2.51%-4.42%) per 10 μg m^-3 increase in PM_2.5 concentration. Among seasons, PM_2.5 concentration had the strongest effect on AECOPD patients with ARF in spring (<24.5 °C), with a 1.64% (95% CI: -0.56% to 3.83%) increase in admissions per 10 μg m^-3 increase in same-day PM_2.5 concentration. The interquartile range increase of 20 μg m^-3 between winter and spring was associated with an average EDV increase of 48.66%.

CONCLUSION

This is the first study to predict the number of ventilators required by calculating quantitative estimates of the short-term effects of PM_2.5 on EDVs for AECOPD patients with ARF. Adverse effects of PM_2.5 on AECOPD patients requiring MV are evident, especially in the spring. Establishing protective standards and reducing the PM_2.5 concentration to below various thresholds are urgently needed.

Factors influencing protective behaviours during haze episodes in Singapore: A population-based study

INTRODUCTION

Haze is a recurrent problem in Southeast Asia. Exposure to haze is linked to ophthalmic, respiratory and cardiovascular diseases, and mortality. In this study, we investigated the role of demographic factors, knowledge and perceived risk in influencing protective behaviours during the 2013 haze in Singapore.

METHODS

We evaluated 696 adults in a cross-sectional study. Participants were sampled via a 2-stage simple random sampling without replacement from a large residential district in Singapore in 2015. The questionnaire measured the participant's knowledge, perceived risk and behaviours during the Southeast Asian haze crisis in 2013. Reliability and validity of the questionnaire were assessed using comparative fit index (≥0.96) and root mean square error of approximation (≤0.05). We performed structural equation modelling to examine the relationship between the hypothesised factors and protective behaviours.

RESULTS

More than 95% of the individuals engaged in at least 1 form of protective behaviour. Knowledge was strongly associated with protective behaviours via direct effect (β=0.45, 95% CI 0.19-0.69, P<0.001) and indirect effect through perceived risk (β=0.18, 95% CI 0.07-0.31, P=0.002). Perceived risk was associated with protective behaviours (β=0.28, 95% CI:0.11-0.44, P=0.002). A lower household income and ethnic minority were associated with protective behaviours. A lower education level and smokers were associated with lower knowledge of haze. A higher education and ethnic minority were associated with a lower perceived risk. Wearing of N95 masks was associated with other haze-related protective behaviours (β=0.24, 95% CI 0.08-0.37, P=0.001).

CONCLUSION

Knowledge was associated with protective behaviours, suggesting the importance of public education. Efforts should target those of lower education level and smokers. The wearing of N95 masks correlates with uptake of other protective behaviours.

Exposure to air pollutants and risk of congenital anomalies: A systematic review and metaanalysis

BACKGROUND

Congenital malformations are considered as one of the significant causes of preterm as well as neonatal morbidity and mortality. Literature suggests the association of diverse congenital deformities with maternal exposure to air pollutants. However, the evidence is still inconclusive on the manifestation of these during pregnancy. Thus, systematic review was done on the available epidemiological studies studying the effect of air pollutants on congenital malformations. Furthermore, the meta-analysis was conducted for several combinations of air pollutants and congenital defects.

METHODS

Twenty six epidemiological studies were extracted from the databases and examined for association of risk of congenital defects with air pollutant concentrations. Metaanalysis was done if the risk estimates of the same anomaly and pollutant group were reported in at least three studies.

RESULTS

Each study reported a statistically significant increased risk of congenital malformation with some air pollutant, amid the several tested combinations. Our meta-analysis reported that nitrogen dioxide and PM_2.5 were associated with the risk of pulmonary valve stenosis with OR = 1.74 and OR = 1.42 respectively. The risk of developing tetralogy of Fallot (TOF) was observed to be associated with PM_2.5 with OR = 1.52_. SO₂ exposure was related to a high risk of the ventricular septal defect (VSD) with OR = 1.15 and orofacial defects (OR = 1.27).

CONCLUSION

It is evidenced that ambient air pollutants have some effect on congenital malformations. Standard case definitions, improved methods of exposure, and better control of confounders will improve future research in this area.

Maternal exposure to ambient levels of sulfur dioxide and risk of neural tube defects in 14 cities in Liaoning province, China: a population-based case-control study

Epidemiological studies on the association of sulfur dioxide (SO₂) with neural tube defects (NTDs) are lacking. The purpose of this study was to assess the aforementioned association through a population-based case-control study. This study involved 1457 NTDs cases and 7950 randomly selected healthy infants born in 14 cities in Liaoning province between 2010 and 2015. Ambient SO₂ levels were acquired from 75 monitoring stations. The exposure assessment was based on the mean concentration of all stations in mother's residential city. We used logistic regression models to assess the associations. In multivariable models adjusted for the confounding variables selected based on the 10 percent change-in-estimate method, we found that maternal SO₂ exposure was positively associated with an increased risk of NTDs during the first month after conception (per 10 μg/m³ increase: adjusted odds ratio [aOR] = 1.02, 95% confidence interval [CI]: 1.00-1.04; highest versus lowest quartile: aOR = 2.55, 95% CI: 1.97-3.31) and the second month after conception (per 10 μg/m³ increase: aOR = 1.02, 95% CI: 1.00-1.04; highest versus lowest quartile: aOR=2.31, 95% CI: 1.77-3.00). For other exposure windows, positive associations also emerged in high- versus low-exposure analyses, except for the third month before conception; however, we could not further confirm significant findings from the continuous exposure analyses. Our study provides a new evidence that SO₂ exposure may increase the risk of NTDs.

Ambient air quality and the risk for Chronic Obstructive Pulmonary Disease among Metro Manila Development Authority traffic enforcers in Metro Manila: An exploratory study

Background

Air pollution and poor ambient air quality are significantly related to multiple health risks. One associated disease is chronic obstructive pulmonary disease (COPD), a preventable disease with several contributing factors and one of the leading causes of morbidity/mortality locally and globally. A potentially high-risk population are traffic enforcers who are constantly exposed to air pollution. In the Philippines, the MMDA has the widest coverage in traffic management. The study determined the risk of COPD among Metro Manila Development Authority (MMDA) traffic enforcers in relation to ambient air quality level, as well as identified other factors that increase the risk of developing COPD.

Methods

Fifty-two MMDA traffic enforcers deployed in PM_2.5 air quality sensor areas in Metro Manila from 2016 to 2018 were recruited through stratified sampling. The International Primary Airways Guidelines (IPAG) questionnaire was utilized to measure risk of COPD. Respiratory health and working history were obtained through questionnaires. Department of environment and natural resources provided PM_2.5 ambient air quality data which aided in the construction of the Exposure-Month Index. Ordinal logistic regression was used to examine the association of PM_2.5 together with the relevant factors and the risk of COPD.

Results

We found statistically significant associations between PM_2.5 and COPD among high risk category [odds risk (OR): 1.24, 95% confidence interval (CI): 1.07-1.44]. Age (Moderate, OR: 1.16, 95% CI: 0.98-1.38 and High, OR: 10.06, 95% CI: 4.02-25.17) and chest pain (Moderate, OR: 68.65, 95% CI: 1.71-2.75 × 10³) were potential risk factors, whereas body mass index (BMI) (OR: 0.05, 95% CI: 0.01-0.53) exhibited protective effect.

Conclusions

Exposure to PM_2.5 was associated with an increased risk of COPD among high-risk category MMDA traffic enforcers. Age and chest pain were potential risk factors to risk of COPD, whereas BMI exhibited a potential protective effect. Results of this study can be used for clinical management of high-risk populations, such that of MMDA traffic enforcers.

Profile of patients undergoing speech-language therapy in a physical and rehabilitation medicine hospital service

ABSTRACT Purpose: to analyze the profile and risk factors of patients attended by speech therapists in a hospital service of physical and rehabilitation medicine (P&RM) of the public health system. Methods: a retrospective cohort study was carried out. The variables were summarized using frequencies, proportions, and measures of central tendency. Relative risks (RR) were estimated, using the incidence ratio (IC:95%) and the bilateral Fisher's exact test. A level of significance was considered p <0.05. Results: 23,365 speech therapy activities distributed in 8,416 sessions were carried out between September 2016 to September 2018, with patients admitted to a P&RM service. The activities focused people over 60 years in the areas of swallowing (28.6%) and cognition (11.7%). Age equal to or greater than 60 years was identified as a risk factor for admission, due to cerebrovascular disease of 1.36 (95% CI: 1.24-1.49; p = 0.001), and belonging to section B of the National Health Fund (FONASA), 1.37 (95% CI: 1.29-1.46, p = 0.001). The RR for respiratory pathology was greater in the winter period: 1.63 (95% CI: 1.50-1.76; p = 0.001). Conclusion: elderly and low-income people are more likely to need speech therapy rehabilitation in the context of P&RM service.

Factors Affecting Community Pharmacist's Knowledge About Chronic Obstructive Pulmonary Disease (COPD) Management in China: A Cross-Sectional Survey Study

Purpose

Chronic obstructive pulmonary disease (COPD) has become a significant risk factor that threatens public health. Many studies have confirmed that the professional services for COPD patients by community pharmacists can improve comprehensive benefits. However, there's less research investigating the factors affecting community pharmacists' knowledge about COPD management. Therefore, this study aimed to investigate the knowledge of COPD among community pharmacists in China and analyze the factors affecting community pharmacist's knowledge about COPD management.

Methods

This study employed a face-to-face, self-administered questionnaire survey targeting community pharmacists from three cities (Nanjing, Zhuhai, Qingyang) in China. Descriptive statistics, t-test and one-way ANOVA were used for data analysis.

Results

Out of the 794 pharmacists surveyed, 177 (22.3%) were completed and valid. The majority (91.0%) of participants had a positive attitude they were responsible for assisting patients to control the disease progression. Among 12 knowledge-related survey questions, only 34 (19.2%) pharmacists answered more than half of them correctly, showing that overall knowledge level of participants was generally low. The overall knowledge level was significantly (P < 0.05) associated with higher academic education, on-the-job training, and pharmacies selling drugs for treating COPD. Regarding medical knowledge, participants got higher accuracy rates at some questions as the symptoms of COPD and identifying the main causative factors but were weak in disease characteristics and guidelines for disease diagnosis. As for medication, participants had a certain understanding of different drugs for COPD and their adverse reactions. For non-drug treatment, participants could not entirely choose the best non-drug treatment for patients, while most of them recognize the importance of pulmonary rehabilitation.

Conclusion

This research indicated that community pharmacists in China lacked sufficient knowledge about COPD management. It is necessary to improve university education, strengthen on-the-job training, adjust the social insurance system, and develop service guidelines for licensed pharmacists to support their professional services for COPD patients.

Mapping IPF helps identify geographic regions at higher risk for disease development and potential triggers

BACKGROUND AND OBJECTIVE

The relationship between IPF development and environmental factors has not been completely elucidated. Analysing geographic regions of idiopathic pulmonary fibrosis (IPF) cases could help identify those areas with higher aggregation and investigate potential triggers. We hypothesize that cross-analysing location of IPF cases and areas of consistently high air pollution concentration could lead to recognition of environmental risk factors for IPF development.

METHODS

This retrospective study analysed epidemiological and clinical data from 503 patients registered in the Observatory IPF.cat from January 2017 to June 2019. Incident and prevalent IPF cases from the Catalan region of Spain were graphed based on their postal address. We generated maps of the most relevant air pollutant PM2.5 from the last 10 years using data from the CALIOPE air quality forecast system and observational data.

RESULTS

In 2018, the prevalence of IPF differed across provinces; from 8.1 cases per 100 000 habitants in Barcelona to 2.0 cases per 100 000 in Girona. The ratio of IPF was higher in some areas. Mapping PM2.5 levels illustrated that certain areas with more industry, traffic and shipping maintained markedly higher PM2.5 concentrations. Most of these locations correlated with higher aggregation of IPF cases. Compared with other risk factors, PM2.5 exposure was the most frequent.

CONCLUSION

In this retrospective study, prevalence of IPF is higher in areas of elevated PM2.5 concentration. Prospective studies with targeted pollution mapping need to be done in specific geographies to compile a broader profile of environmental factors involved in the development of pulmonary fibrosis.

Environmental Awareness for Patients with COPD Undergoing Pulmonary Rehabilitation: Is It of Added Value?

Chronic obstructive pulmonary disease (COPD) is impacted by exposure to environmental contaminants. Improving health literacy on this topic might help to optimize health outcomes. We aimed to design and deliver a health-education session about the impact of environmental contaminants on respiratory symptoms and explore participants' perceptions on such session. Patients with COPD were recruited from a pulmonary rehabilitation (PR) program. Two focus groups were first conducted to explore knowledge amongst the group. Then, the session was designed and delivered, and three focus groups were conducted to obtain feedback from participants. Data were analyzed thematically by two independent researchers. Thirty-one patients (71 ± 8 years old, FEV1 = 47.6 ± 16.8% predicted; 74.2% male) were included. Prior to the session, participants recognized the importance of this topic and described avoidance strategies to deal with symptom triggering due to air pollution. After the session, participants had their knowledge validated, kept some avoidance strategies, but also adapted some "unavoidable" activities of daily living. Patients with COPD value education on this topic, and PR offers a friendly environment to discuss prevention and management strategies. Contents of the session are provided to help deliver these sessions. Future studies could investigate the effectiveness of this intervention on self-management and exacerbations of COPD.

Hardware Prototype for Wrist-Worn Simultaneous Monitoring of Environmental, Behavioral, and Physiological Parameters

We designed a low-cost wrist-worn prototype for simultaneously measuring environmental, behavioral, and physiological domains of influencing factors in healthcare. Our prototype continuously monitors ambient elements (sound level, toxic gases, ultraviolet radiation, air pressure, temperature, and humidity), personal activity (motion tracking and body positioning using gyroscope, magnetometer, and accelerometer), and vital signs (skin temperature and heart rate). An innovative three-dimensional hardware, based on the multi-physical-layer approach is introduced. Using board-to-board connectors, several physical hardware layers are stacked on top of each other. All of these layers consist of integrated and/or add-on sensors to measure certain domain (environmental, behavioral, or physiological). The prototype includes centralized data processing, transmission, and visualization. Bi-directional communication is based on Bluetooth Low Energy (BLE) and can connect to smartphones as well as smart cars and smart homes for data analytic and adverse-event alerts. This study aims to develop a prototype for simultaneous monitoring of the all three areas for monitoring of workplaces and chronic obstructive pulmonary disease (COPD) patients with a concentration on technical development and validation rather than clinical investigation. We have implemented 6 prototypes which have been tested by 5 volunteers. We have asked the subjects to test the prototype in a daily routine in both indoor (workplaces and laboratories) and outdoor. We have not imposed any specific conditions for the tests. All presented data in this work are from the same prototype. Eleven sensors measure fifteen parameters from three domains. The prototype delivers the resolutions of 0.1 part per million (PPM) for air quality parameters, 1 dB, 1 index, and 1 °C for sound pressure level, UV, and skin temperature, respectively. The battery operates for 12.5 h under the maximum sampling rates of sensors without recharging. The final expense does not exceed 133€. We validated all layers and tested the entire device with a 75 min recording. The results show the appropriate functionalities of the prototype for further development and investigations.

Ambient Gaseous Pollutants in an Urban Area in South Africa: Levels and Potential Human Health Risk

Urban air pollution from gaseous pollutants is a growing public health problem in many countries including South Africa. Examining the levels, trends and health risk of exposure to ambient gaseous pollutants will assist in understanding the effectiveness of existing control measures and plan for suitable management strategies. This study determined the concentration levels and non-cancer risk of CO, SO2, NO2, and O3 at an industrial area in Pretoria West, South Africa. We utilised a set of secondary data for CO, NO2, SO2, and O3 that was obtained from a monitoring station. Analysis of the hourly monitored data was done. Their non-cancer risk (HQ) was determined using the human health risk assessment model for different age categories. The annual levels of NO2 (39.442 µg/m3), SO2 (22.464 µg/m3), CO (722.003 µg/m3) and the 8-hour concentration of CO (649.902 µg/m3) and O3 (33.556 µg/m3) did not exceed the South African National Ambient Air Quality Standards for each pollutant. The HQ for each pollutant across exposed groups (except children) was less than 1. This indicates that the recorded levels could not pose non-cancer risk to susceptible individuals.

Ambient air pollution and its influence on human health and welfare: an overview

Human health is closely related to his environment. The influence of exposure to air pollutants on human health and well-being has been an interesting subject and gained much volume of research over the last 50 years. In general, polluted air is considered one of the major factors leading to many diseases such as cardiovascular and respiratory disease and lung cancer for the people. Besides, air pollution adversely affects the animals and deteriorates the plant environment. The overarching objective of this review is to explore the previous researches regarding the causes and sources of air pollution, how to control it and its detrimental effects on human health. The definition of air pollution and its sources were introduced extensively. Major air pollutants and their noxious effects were detailed. Detrimental impacts of air pollution on human health and well-being were also presented.

MOFs-carbon hybrid nanocomposites in environmental protection applications

The demand for green engineering environmentally friendly nanomaterials had made carbon nanotube a suitable material to keep metal-organic frameworks (MOFs) in the application of wastewater treatment and air pollution monitoring systems. This review summarizes many of the recent research accomplishments in the synthesis of MOFs and MOFs-carbon hybrid nanocomposites for various applications such as wastewater treatment and removal of hazardous gases (CO, SO₂, H₂S and NH₃) with emphasis on MOF/CNTs composites. This review focuses on the efficient removal of pollutants from the environment using adsorption techniques. Another important application of MOFs composite discussed in this review is sensor materials for environmental pollution.

PM2.5 exposure induces age-dependent hepatic lipid metabolism disorder in female mice

Particulate matter exposure has been described to elevate the risk of lung and cardiovascular diseases. An increasing number of recent studies have indicated positive correlations between PM_2.5 (the fraction of airborne particles with an aerodynamic diameter less than 2.5 μm) exposure and the risk of liver diseases. However, research on the effects of PM_2.5 exposure on liver fat synthesis, secretion, and clearance mechanisms under normal diet conditions is limited, and whether these effects are age-dependent is largely unknown. Female C57BL/6 mice at different ages (4 weeks (4 w), 4 months (4 m), and 10 months (10 m)) were treated with 3 mg/kg body weight of PM_2.5 every other day for 4 weeks. Subsequently, the ultrastructural changes of liver, the expression of genes involved in oxidative damage and lipid metabolism in the liver were examined. Observation of hepatic ultrastructure showed more and larger lipid droplets in the livers of 4-week-old and 10-month-old mice exposed to PM_2.5. Further analysis showed that PM_2.5 exposure increased the expression of genes related to lipid synthesis, but decreased the expression of genes involved in lipid transport and catabolism in the livers of 10-month-old mice. Our findings suggest that exposure to PM_2.5 disrupts the normal metabolism of liver lipids and induces lipid accumulation in the liver of female mice in an age-dependent manner, with older mice being more susceptible to PM_2.5.

Protein Network Analysis Identifies Changes in the Level of Proteins Involved in Platelet Degranulation, Proteolysis and Cholesterol Metabolism Pathways in AECOPD Patients

Chronic obstructive pulmonary disease (COPD) is characterised by a progressive pulmonary and systemic inflammation. Acute exacerbations of COPD (AECOPD) are associated with acute inflammation and infection, increase in the rates of morbidity and mortality. Previous proteomic studies have focussed on identifying proteins involved in COPD pathogenesis in samples collected from the lung (e.g. lung tissue biopsies, bronchoalveolar lavage and sputum) but not from blood of patients who experienced AECOPD. In this study, plasma was analysed by two independent quantitative proteomics techniques; isobaric tag for relative and absolute quantitation (iTRAQ) and multiple reaction monitoring (MRM) to identify differential expression of circulating proteins in patients with stable COPD (sCOPD) and AECOPD. Firstly, iTRAQ performed on pooled plasma samples from AECOPD, sCOPD, and healthy non-smoking controls (HC) revealed 15 differentially expressed proteins between the 3 groups. MRM subsequently performed on a separate cohort of AECOPD, sCOPD, and HC patients confirmed 9 proteins to be differentially expressed by AECOPD compared to HC (Afamin, alpha-1-antichymotrypsin, Apolipoprotein E, Beta-2-glycoprotein 1, Complement component C9, Fibronectin, Immunoglobulin lambda like polypeptide 5, Inter-alpha-trypsin inhibitor heavy chain H3, Leucine rich alpha-2-glycoprotein 1). Network analysis demonstrates that most of these proteins are involved in proteolysis regulation, platelet degranulation and cholesterol metabolism. In conclusion, several potential plasma biomarkers for AECOPD were identified in this study. Further validation studies of these proteins may elucidate their roles in the development of AECOPD.

Impact of High-Density Urban Built Environment on Chronic Obstructive Pulmonary Disease: A Case Study of Jing'an District, Shanghai

Respiratory health is a focus of interdisciplinary studies involving urban planning and public health. Studies have noted that urban built environments have impacts on respiratory health by influencing air quality and human behavior such as physical activity. The aim of this paper was to explore the impact of urban built environments on respiratory health, taking chronic obstructive pulmonary disease (COPD) as one of the typical respiratory diseases for study. A cross-sectional study was conducted including all cases (N = 1511) of death from COPD in the high-density Jing'an district of Shanghai from 2001 to 2010. Proxy variables were selected to measure modifiable features of urban built environments within this typical high-density district in Shanghai. A geographically weighted regression (GWR) model was used to explore the effects of the built environment on the mortality of COPD and the geographical variation in the effects. This study found that land use mix, building width-height ratio, frontal area density, and arterial road density were significantly correlated to the mortality of COPD in high-density urban area. By identifying built environment elements adjustable by urban planning and public policy, this study proposes corresponding environmental intervention for respiratory health.

A Preliminary Attempt at the Identification and Financial Estimation of the Negative Health Effects of Urban and Industrial Air Pollution Based on the Agglomeration of Gdańsk

This article marks the first attempt on Polish and European scale to identify the relationship between urban and industrial air pollution and the health conditions of urban populations, while also estimating the financial burden of incidence rates among urban populations for diseases selected in the course of this study as having a causal relation with such incidence. This paper presents the findings of a pilot study based on general regression models, intended to explore air pollutants with a statistically relevant impact on the incidence of selected diseases within the Agglomeration of Gdańsk in the years 2010–2018. In discussing the city’s industrial functions, the study takes into consideration the existence within its limits of a large port that services thousands of ships every year, contributing substantially to the volume of emissions (mainly NOx and PM) to the air. The causes considered include the impact of air pollution, seasonality, land- and sea-based emissions, as well as their mutual interactions. All of the factors and their interactions have a significant impact (p ≤ 0.05) on the incidence of selected diseases in the long term (9 years). The source data were obtained from the Polish National Health Fund (NFZ), the Agency for Regional Monitoring of Atmosphere in the Agglomeration of Gdańsk (ARMAAG), the Chief Inspectorate of Environmental Protection (GIOŚ), and the Port of Gdańsk Harbourmaster. The study used 60 variables representing the diseases, classified into 19 groups. The resulting findings were used to formulate a methodology for estimating the financial burden of the negative health effects of air pollution for the agglomeration, and will be utilized as a reference point for further research in selected regions of Poland.

Estimation of hospital admission respiratory disease cases attributed to exposure to SO2 and NO2 in two different sectors of Egypt

Air Q_2.2.3 was used to predicted hospital admissions respiratory disease cases due to SO₂ and NO₂ exposure in two sectors of Egypt during December 2015 to November 2016. Levels were 19, 22 µg/m³ at Ain Sokhna sector and 92, 78 µg/m³ at Shoubra El-Khaima sector for SO₂ and NO₂, respectively. These levels were less than the Egyptian Permissible limits (125 µg/m³ in urban and 150 µg/m³ in industrial for SO₂, 150 µg/m³ in urban and industrial for NO₂). Results showed that relative risks were 1.0330 (1.0246 - 1.0414) and 1.0229 (1.0171 - 1.0287) at Ain Sokhna sector while they were 1.0261 (1.0195 - 1.0327) and 1.0226 (1.0169 - 1.0283) at Shoubra El-Khaima sector for SO₂ and NO₂, respectively. The highest cases of HARD were found in Shoubra El-Khaima sector; 311 cases at 120 - 129 µg/m3 of SO₂ and 234 cases at 120 - 129 µg/m³ of NO₂. While, in Ain Sokhna, HARD were 18 cases at 50 - 59 µg/m³ of SO₂ and 15 cases at 60 - 69 µg/m³ of NO2. The excess cases found in Shoubra El-Khaima sector as compared to those in Ain Sokhna sector, may be attributed to the higher density of population and industries in Shoubra El-Khaima sector.

The hospitalization attributable burden of acute exacerbations of chronic obstructive pulmonary disease due to ambient air pollution in Shijiazhuang, China

Few studies have investigated the acute exacerbations of chronic obstructive pulmonary disease (AECOPD)-associated attributable burden under exposure to high levels of air pollution among Asians. Data on hospitalization for AECOPD, air pollution and meteorological factors from 1 January 2013 to 31 December 2016 were collected in Shijiazhuang, China. We used a Poisson generalized linear regression model combined with a distributed lag nonlinear model (DLNM) to evaluate the relative cumulative risk for a lag of 0-7 days and examined the potential effect modifications by age and sex via stratification analyses, controlling for long-term trends, seasonal patterns, meteorological factors, and other possible confounders. Then, we computed hospitalization percentages attributable to air pollutants. The AECOPD-associated relative cumulative risks for PM_2.5, PM₁₀, NO₂, SO₂, and CO for a lag of 0-7 days were significantly positively correlated with hospitalization. The associations were stronger in females and retired patients. The NO₂ Cum RR of AECOPD admission was the greatest. A 10μg/m³ increase in daily NO₂ concentration was associated with 6.7% and 5.7% increases in COPD hospitalizations in the retired and female groups, respectively. The results showed that 13%, 9.4%, 1.7%, 9.7%, and 8.8% of AECOPD hospitalizations were attributable to exposure to PM_2.5, PM₁₀, SO₂, NO₂, and CO, respectively. If the air pollutant concentration was reduced to the 24-h average grade II levels of NAAQS of China, the AECOPD attributable percentage for PM_2.5 and PM₁₀ would decrease by 80%. The air pollutants PM_2.5, PM₁₀, SO₂, NO₂, and CO were significantly relevant to AECOPD-associated hospitalization. The associations differed by individual characteristics. The retired and female populations were highly vulnerable.

Effects of air pollution on acute exacerbation of chronic obstructive pulmonary disease: a descriptive retrospective study (pol-AECOPD)

Purpose

Acute exacerbation of COPD (AECOPD) is among the most frequent causes for hospital admission, causing morbidity and mortality. Infection is the most frequent cause, and studies on pollution have shown higher hospital admission and mortality with inconsistent results. The objective was to identify if there is a change in levels of particulate matter (PM) during the days leading up to the symptom onset.

Patients and methods

A retrospective study was carried out on medical records of patients with AECOPD from a University Hospital. PM values of the consultation day, onset symptoms, and up to three previous days were recorded. Moreover, clinical presentation, laboratory findings, treatments, and hospital outcomes were recorded.

Results

A total of 250 medical records were included, mean age of 77 years, hospital stay mean of 6.7 days, 26.8% with no previous exposure was identified, coexistence with asthma was 5%, Obstructive Sleep Apnea Syndrome 15%, Pulmonary Hypertension 34%, antibiotic use 62%, ICU admission of 14% with non-invasive mechanical ventilation of 68%, and in-patient mortality of 2.4%. PM 2.5 of 48 hrs before onset symptoms median was 20.1 μg/m³ versus 15 and 16.5 for the day of symptoms and 3 days prior to onset symptoms (p<0.001). PM 10 of 46.65 μg/m³, versus 39 and 35.6, respectively (p<0.001). Expectoration OR 4.74; Purulence OR 6.58; Pleuritic pain OR 3.62; Antibiotic use OR 2.87, and corticoids use OR 2.62, all with p<0.05.

Conclusions

Patients with AECOPD have a higher median of particulate matter 48 hrs prior to symptomatic onset, as well as greater use of antibiotics and corticosteroids.

Analyze and Identify Peiminine Target EGFR Improve Lung Function and Alleviate Pulmonary Fibrosis to Prevent Exacerbation of Chronic Obstructive Pulmonary Disease by Phosphoproteomics Analysis

Chronic obstructive pulmonary disease (COPD) has been a major public health problem and is still a formidable challenge for clinicians. It is urgent to find new compounds for minimizing the risk of disease progression and exacerbation especially in the early phase of COPD. A traditional Chinese medicine (TCM) formula, Chuan Bei Pi Pa dropping pills (CBPP), was tested in this study to investigate its potential mechanisms in preventing the exacerbation of COPD. Phosphoproteomics analysis for a smog stimulated early stage COPD mice model was employed to detect the underlying molecular mechanisms of CBPP. In addition, protein–protein interaction (PPI) and bioinformatics analyses were included to analyze the key proteins and predict the key bioactive compounds. The results indicated that peiminine (PEI) target epidermal growth factor receptor (EGFR) prevented the exacerbation of COPD by inhibiting the EGFR signaling pathway, and ursolic acid (UA) can alleviate inflammation disorders via inhibition of CASP3 on mitogen-activated protein kinase (MAPK) signaling pathway. After in vivo and in vitro evaluations, we revealed that PEI from CBPP, as a lead compound, can improve lung function and alleviate pulmonary fibrosis by acting on the EGFR and MLC2 signaling pathways. Furthermore, the approach described here is an effective way to analyze and identify the bioactive ingredients from a mixture by functional proteomics analysis.

Does air pollution really impact the onset of spontaneous pneumothorax? A French case-crossover study

RATIONALE

A link is established between air pollution and respiratory diseases. Very few studies evaluated this link with primary spontaneous pneumothorax (PSP). Contrasted results, low statistical power and methodological limits of these studies brought us to evaluate in a more thorough way this link.

OBJECTIVES

(1) to estimate the relation between PSP and air pollutants namely nitrogen dioxide (NO₂₎, ozone (O₃₎ and particulate matter with a diameter ≤ 10 μm (PM₁₀); (2) to investigate a time lag effect between these pollutants and occurrence of PSP.

METHODS

This study has a case-crossover design. Subjects aged ≥18 years admitted from 1st June 2009 to 31st May 2013, in 14 Emergency Departments centers on the French territory. Were excluded: patients with traumatic, secondary, recurrent or history of previous pneumothorax. NO₂, O₃ and PM₁₀ data were collected hourly in monitoring stations. Three exposure assessments were retained: quantitative values, fast increase concentration of air pollutants and peak of pollution. These assessments were calculated for the entire exposure period and for each of the four days of all case and control periods.

RESULTS

948 subjects included. Whatever the pollutant considered, no differences were observed between case and control periods, regardless of whether the quantitative values of air pollutants exposure (p > 0.09), fast increase concentration (p > 0.46) and peak of pollution (p > 0.20).

CONCLUSIONS

We failed to show a relation between PSP and short-term air pollution exposure to low levels of NO₂ and PM₁₀. An association between O₃ exposure and PSP cannot be ruled out. An impact at higher exposure level, and/or a potentiating effect of different meteorological factors remain to be demonstrated.

The etiologic origins for chronic obstructive pulmonary disease

COPD, characterized by long-term poorly irreversible airway limitation and persistent respiratory symptoms, has resulted in enormous challenges to human health worldwide, with increasing rates of prevalence, death, and disability. Although its origin was thought to be in the interactions of genetic with environmental factors, the effects of environmental factors on the disease during different life stages remain little known. Without clear mechanisms and radical cure for it, early screening and prevention of COPD seem to be important. In this review, we will discuss the etiologic origins for poor lung function and COPD caused by specific adverse effects during corresponding life stages, as well as try to find new insights and potential prevention strategies for this disease.

Analysis of environmental risk factors for chronic obstructive pulmonary disease exacerbation: A case-crossover study (2004-2013)

Purpose

We aim to assess if air pollution levels and climatological factors are associated with hospital admissions for exacerbation of chronic obstructive pulmonary disease (COPD) in Spain from 2004 to 2013.

Methods

We conducted a retrospective study. Information on pollution level and climatological factors were obtained from the Spanish Meteorological Agency and hospitalizations from the Spanish hospital discharge database. A case-crossover design was used to identify factors associated with hospitalizations and in hospital mortality. Postal codes were used to assign climatic and pollutant factors to each patient.

Results

We detected 162,338 hospital admissions for COPD exacerbation. When seasonal effects were evaluated we observed that hospital admissions and mortality were more frequent in autumn and winter. In addition, we found significant associations of temperature, humidity, ozone (O₃), carbon monoxide (CO), particulate matter up to 10 μm in size (PM₁₀) and nitrogen dioxide (NO₂) with hospital admissions. Lower temperatures at admission with COPD exacerbation versus 1, 1.5, 2 and 3 weeks prior to hospital admission for COPD exacerbation, were associated with a higher probability of dying in the hospital. Other environmental factors that were related to in-hospital mortality were NO₂, O₃, PM₁₀ and CO.

Conclusions

Epidemiology of hospital admissions by COPD exacerbation was negatively affected by colder climatological factors (seasonality and absolute temperature) and short-term exposure to major air pollution (NO₂, O₃, CO and PM₁₀).

Iran in transition

Being the second-largest country in the Middle East, Iran has a long history of civilisation during which several dynasties have been overthrown and established and health-related structures have been reorganised. Iran has had the replacement of traditional practices with modern medical treatments, emergence of multiple pioneer scientists and physicians with great contributions to the advancement of science, environmental and ecological changes in addition to large-scale natural disasters, epidemics of multiple communicable diseases, and the shift towards non-communicable diseases in recent decades. Given the lessons learnt from political instabilities in the past centuries and the approaches undertaken to overcome health challenges at the time, Iran has emerged as it is today. Iran is now a country with a population exceeding 80 million, mainly inhabiting urban regions, and has an increasing burden of non-communicable diseases, including cardiovascular diseases, hypertension, diabetes, malignancies, mental disorders, substance abuse, and road injuries.

Factors associated with chronic obstructive pulmonary disease exacerbation, based on big data analysis

Preventing exacerbation in chronic obstructive pulmonary disease (COPD) patients is crucial, but requires identification of the exacerbating factors. To date, no integrated analysis of patient-derived and external factors has been reported. To identify factors associated with COPD exacerbation, we collected data, including smoking status, lung function, and COPD assessment test scores, from 594 COPD patients in the Korean COPD subgroup study (KOCOSS), and merged these data with patients' Korean Health Insurance Review and Assessment Service data for 2007-2012. We also collected primary weather variables, including levels of particulate matter <10 microns in diameter, daily minimum ambient temperature, as well as respiratory virus activities, and the logs of web queries on COPD-related issues. We then assessed the associations between these patient-derived and external factors and COPD exacerbations. Univariate analysis showed that patient factors, air pollution, various types of viruses, temperature, and the number of COPD-related web queries were associated with COPD exacerbation. Multivariate analysis revealed that the number of exacerbations in the preceding year, female sex, COPD grade, and influenza virus detection rate, and lowest temperature showed significant association with exacerbation. Our findings may help COPD patients predict when exacerbations are likely, and provide intervention as early as possible.

Association of Ambient Air Pollution with Increased Liver Enzymes in Korean Adults

An association between exposure to air pollution and liver enzymes in certain areas or older people has been reported in the literature; however, it cannot be generalized to the general population. We investigated the association between air pollution, liver enzyme levels, and alcohol consumption using nationwide data of South Korean adults. Air pollutants included particulate matter with an aerodynamic diameter ≤10 µm (PM₁₀), nitrogen dioxide (NO₂), sulfur dioxide (SO₂), and carbon monoxide (CO). Liver enzymes included alanine aminotransferase (ALT) and aspartate aminotransferase (AST). Exposure to air pollutants were significantly associated with elevation of log ALT and log AST, especially increases from 0.0073 IU/L (95% confidence interval (CI) = 0.0042, 0.0104) to 0.0251 IU/L (95% CI = 0.0132, 0.0371) per interquartile range (IQR) increase of each pollutant (all pollutants: p < 0.001). Association of the liver enzymes with PM₁₀ (β (95% CI) = 0.0285 IU/L (0.0201, 0.0368) for log ALT; β (95% CI) = 0.0139 IU/L (0.0079, 0.0198) for log AST) and CO (β (95% CI) = 0.0247 IU/L (0.0182, 0.0311) for log ALT; β (95% CI) = 0.0164 IU/L (0.0118, 0.0210) for log AST) were only significant among drinkers. Our findings suggest that chronic exposure to PM₁₀ and CO is a risk factor for liver enzymes increases among the general adult population who admitted to drinking alcohol.

Alzheimer and depressive cognitive-like behaviors in male and female rats: A new method for exposure to ambient air pollution

In the previous studies regarding the effects of exposure to ambient air pollution on biological markers and/or behavior of animals, the gaseous pollutants are not separated from the particulate matter (PM). Hence the synergetic effect of gaseous pollutants and PM was not considered. In this regard, current study was aimed to devolve a new method for separation of PM from gaseous pollutants. Also, the effect of exposure to fine particulate matter (PM_2.5) on the Alzheimer and depressive cognitive-like behaviors in rats after 3 and 6 months were investigated. Three chambers were designed including exposure group 1 (PM_2.5 plus gaseous pollutants alone), exposure group 2 (gaseous pollutants alone) and control group (clean air). Exposure time was 5 h per day (9.00 a.m.-2.00 p.m.) for 4 days per week. The concentration of PM_2.5 and gaseous pollutants (O₃, NO₂, and SO₂) were monitored in the exposure hours, continuously. Concentration of PM_2.5 by beta attenuation method and concentration of O₃, NO₂, and SO₂ by UV fluorescence was monitored. Also, the concentration of metals including Al, Cr, Mn, Pb, Cd, Ni, Fe, and Cu and 16-polycyclic aromatic hydrocarbons (PAHs) bound PM_2.5 by inductively coupled plasma mass spectrometry (ICP-MS) and gas chromatography-mass spectrometry (GC-MS) were analyzed, respectively. Cognitive-like behavior related to Alzheimer and depressive behaviors were determined by Y maze and Force swimming. The concentration of PM_2.5 in the 3 and 6 months exposure was higher than WHO guideline, significantly (p-value <0.05). The concentration of O₃, NO₂ and SO₂ in the 3 and 6 months exposure was lower than WHO guideline, significantly (p-value <0.05). The order of metals in the PM_2.5 according to mean concentration Al > Ca > Cu > Cd > Na > Fe > Cr > Ni > Mn > Pb. Also, the sum concentration of 16-PAHs in the PM_2.5 in the 3 and 6 months exposure was 45.7 ± 37.15 ng/m³ and 30.04 ± 25.27 ng/m³, respectively. Exposure to PM_2.5 cannot significantly increase Alzheimer and depressive cognitive-like behaviors in the rats. Also, a significant difference between male and female in Alzheimer and depressive cognitive-like behaviors not observed. •A new method for separation of PM_2.5 from other PM in the ambient air by ECO-PM sampler was presented.•A new method for separation of PM_2.5 from gaseous pollutants in the ambient air by HEPA filter and active carbon was presented.•Tow exposure groups including exposure 1: PM_2.5 plus gaseous pollutants and exposure 2: gaseous pollutants only were designed for increased accuracy of the in-vivo study.•Exposure to PM_2.5 cannot cause significant increased Alzheimer and depressive cognitive-like behaviors in the rats.

COPD Patients as Vulnerable Subpopulation for Exposure to Ambient Air Pollution

PURPOSE OF REVIEW

The prevalence of chronic obstructive pulmonary disease (COPD) is increasing worldwide with no known cure and an increasing number of triggers that exacerbate symptoms and speed up progression. This review aims to summarize the evidence for COPD patients being more vulnerable to air pollution exposure assessed as acute effects.

RECENT FINDINGS

Several recent systematic reviews show consistently increased risks for COPD mortality and COPD hospital admission, ranging between 2 and 3% with increasing PM_2.5 or PM₁₀. Similar adverse impacts were shown for NO_2. Also_, adverse health effects among COPD patients were also found for other gaseous pollutants such as ozone and SO₂; most of these studies could not be included in the meta-analysis we reviewed. Data from ten panel studies of COPD patients reported a small but statistically significant decline of FEV1 [- 3.38 mL (95% CI - 6.39 to - 0.37)] per increment of 10 μg/m³ PM₁₀, supporting an impact on respiratory health with increasing PM₁₀ exposure. The combined information from systematic reviews and more recent findings lead us to conclude that COPD patients are more vulnerable to ambient air pollution than healthier people.

Impact of Heart Disease Risk Factors, Respiratory Illness, Mastery, and Quality of Life on the Health Status of Individuals Living Near a Major Railyard in Southern California

The potential health risks for communities that surround railyards have largely been understudied. Mastery and quality of life (QoL) have been associated with self-reported health status in the general population, but few studies have explored this variable among highly vulnerable low-income groups exposed to harmful air pollutants. This study investigates the relationship between self-reported health status and correlates of Heart Disease Risk Factors (HDRF) and Respiratory Illness (RI) with mastery and QoL acting as potential protective buffers. This cross-sectional study of 684 residents residing near a Southern California railyard attempts to address this limitation. Results from three separate hierarchal linear regressions showed that those who reported being diagnosed with at least one type of HDRF and/or RI reported lower perceived health status. For those that lived further from the railyard, mastery and QoL predicted modest increases in perceived health status. Results suggest that mastery and QoL may be helpful as tools in developing interventions but should not solely be used to assess risk and health outcomes as perceived health status may not measure actual health status.

Winter Is Coming: A Socio-Environmental Monitoring and Spatiotemporal Modelling Approach for Better Understanding a Respiratory Disease

Chronic Obstructive Pulmonary Disease is a progressive lung disease affecting the respiratory function of every sixth New Zealander and over 300 million people worldwide. In this paper, we explored how the combination of social, demographical and environmental conditions (represented by increased winter air pollution) affected hospital admissions due to COPD in an urban area of Christchurch (NZ). We juxtaposed the hospitalisation data with dynamic air pollution data and census data to investigate the spatiotemporal patterns of hospital admissions. Spatial analysis identified high-risk health hot spots both overall and season specific, exhibiting higher rates in winter months not solely due to air pollution, but rather as a result of its combination with other factors that initiate deterioration of breathing, increasing impairments and lead to the hospitalisation of COPD patients. From this we found that socioeconomic deprivation and air pollution, followed by the age and ethnicity structure contribute the most to the increased winter hospital admissions. This research shows the continued importance of including both individual (composition) and area level (composition) factors when examining and analysing disease patterns.

Characterization and Triggers of Dyspnea in Patients with Chronic Obstructive Pulmonary Disease or Chronic Heart Failure: Effects of Weather and Environment

BACKGROUND AND OBJECTIVES

Dyspnea is one of the most disturbing symptoms for patients with chronic obstructive pulmonary disease (COPD) or heart failure (HF). This study investigated dyspnea triggers and factors associated with worsening dyspnea in patients with COPD or HF.

METHODS

COPD support group members and HF patients with reduced ejection fraction (HFrEF) and no airway obstruction answered a questionnaire describing different weather conditions (rising/falling air pressure, sunny, foggy, rainy, windy, snowy, hazy, high ozone levels, and airborne pollen) and environmental circumstances (cooking, grilling, perfumes, cigarette smoke, gasoline odor, and flower scents) and were asked to estimate the occurrence and severity of dyspnea under these conditions using predefined scales.

RESULTS

230 patients with COPD and 90 with HFrEF (left ventricular ejection fraction 34 ± 10%, Tiffeneau index > 70%) were analyzed. COPD patients reported dyspnea more often than HF patients in almost all weather and environmental conditions (p = 0.004 to p < 0.001), with the exception of outdoor floral scents and cigarette smoke. Severe to very severe dyspnea was reported more in COPD versus HF in all weather and environmental conditions except sunny weather (p = 0.01 to p < 0.001). COPD was associated with more severe dyspnea than HF in all conditions (all p < 0.001).

CONCLUSIONS

Dyspnea was triggered by a variety of weather and other environmental triggers in patients with COPD and occurred more often than in HF patients under the same conditions. Foggy weather and exposure to perfumes were associated with severe dyspnea in the majority of COPD patients, but only a minority of HF patients.

Frequency of heavy vehicle traffic and association with DNA methylation at age 18 years in a subset of the Isle of Wight birth cohort

Assessment of changes in DNA methylation (DNA-m) has the potential to identify adverse environmental exposures. To examine DNA-m among a subset of participants (n = 369) in the Isle of Wight birth cohort who reported variable near resident traffic frequencies. We used self-reported frequencies of heavy vehicles passing by the homes of study subjects as a proxy measure for TRAP, which were: never, seldom, 10 per day, 1-9 per hour and >10 per hour. Methylation of cytosine-phosphate-guanine (CpG) dinucleotide sequences in the DNA was assessed from blood samples collected at age 18 years (n = 369) in the F1 generation. We conducted an epigenome wide association study to examine CpGs related to the frequency of heavy vehicles passing by subjects' homes, and employed multiple linear regression models to assess potential associations. We repeated some of these analysis in the F2 generation (n = 140). Thirty-five CpG sites were associated with heavy vehicular traffic. After adjusting for confounders, we found 23 CpGs that were more methylated, and 11 CpGs that were less methylated with increasing heavy vehicular traffic frequency among all subjects. In the F2 generation, 2 of 31 CpGs were associated with traffic frequencies and the direction of the effect was the same as in the F1 subset while differential methylation of 7 of 31 CpG sites correlated with gene expression. Our findings reveal differences in DNA-m in participants who reported higher heavy vehicular traffic frequencies when compared to participants who reported lower frequencies.