1
|
Siegel J, Gill N, Ramanathan M, Patadia M. Unified Airway Disease. Otolaryngol Clin North Am 2023; 56:39-53. [DOI: 10.1016/j.otc.2022.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
|
2
|
Boudier A, Markevych I, Jacquemin B, Abramson MJ, Accordini S, Forsberg B, Fuertes E, Garcia-Aymerich J, Heinrich J, Johannessen A, Leynaert B, Pin I, Siroux V. Long-term air pollution exposure, greenspace and health-related quality of life in the ECRHS study. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 849:157693. [PMID: 35907524 DOI: 10.1016/j.scitotenv.2022.157693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 07/11/2022] [Accepted: 07/25/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Associations of long-term exposure to air pollution and greenspace with health-related quality of life (HRQOL) are poorly studied and few studies have accounted for asthma-rhinitis status. OBJECTIVE To assess the associations of air pollution and greenspace with HRQOL and whether asthma and/or rhinitis modify these associations. METHODS The study was based on the participants in the second (2000-2002, n = 6542) and third (2011-2013, n = 3686) waves of the European Community Respiratory Health Survey (ECRHS) including 19 centres. The mean follow-up time was 11.3 years. HRQOL was assessed by the SF-36 Physical and Mental Component Summary scores (PCS and MCS). NO2, PM2.5 and PM10 annual concentrations were estimated at the residential address from existing land-use regression models. Greenspace around the residential address was estimated by the (i) mean of the Normalized Difference Vegetation Index (NDVI) and by the (ii) presence of green spaces within a 300 m buffer. Associations of each exposure variable with PCS and MCS were assessed by mixed linear regression models, accounting for the multicentre design and repeated data, and adjusting for potential confounders. Analyses were stratified by asthma-rhinitis status. RESULTS The mean (SD) age of the ECRHS-II and III participants was 43 (7.1) and 54 (7.2) years, respectively, and 48 % were men. Higher NO2, PM2.5 and PM10 concentrations were associated with lower MCS (regression coefficients [95%CI] for one unit increase in the inter-quartile range of exposures were -0.69 [-1.23; -0.15], -1.79 [-2.88; -0.70], -1.80 [-2.98; -0.62] respectively). Higher NDVI and presence of forests were associated with higher MCS. No consistent associations were observed for PCS. Similar association patterns were observed regardless of asthma-rhinitis status. CONCLUSION European adults who resided at places with higher air pollution and lower greenspace were more likely to have lower mental component of HRQOL. Asthma or rhinitis status did not modify these associations.
Collapse
Affiliation(s)
- Anne Boudier
- Team of Environmental Epidemiology Applied to the Development and Respiratory Health, Institute for Advanced Biosciences, Inserm U 1209, CNRS UMR 5309, Université Grenoble Alpes, 38000 Grenoble, France; Pediatrics, CHU Grenoble-Alpes, Grenoble, France
| | - Iana Markevych
- Institute of Psychology, Jagiellonian University, Krakow, Poland
| | - Bénédicte Jacquemin
- Univ Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail), UMR_S 1085, F-35000 Rennes, France
| | - Michael J Abramson
- School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia
| | - Simone Accordini
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Bertil Forsberg
- Department of Public Health and Clinical Medicine, Umea University, Umea, Sweden
| | - Elaine Fuertes
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Judith Garcia-Aymerich
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Spain
| | - Joachim Heinrich
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Comprehensive Pneumology Center Munich (CPC-M), German Center for Lung Research (DZL), Germany
| | - Ane Johannessen
- Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | | | - Isabelle Pin
- Pediatrics, CHU Grenoble-Alpes, Grenoble, France
| | - Valérie Siroux
- Team of Environmental Epidemiology Applied to the Development and Respiratory Health, Institute for Advanced Biosciences, Inserm U 1209, CNRS UMR 5309, Université Grenoble Alpes, 38000 Grenoble, France.
| |
Collapse
|
3
|
Leland EM, Vohra V, Seal SM, Zhang Z, Ramanathan M. Environmental air pollution and chronic rhinosinusitis: A systematic review. Laryngoscope Investig Otolaryngol 2022; 7:349-360. [PMID: 35434330 PMCID: PMC9008184 DOI: 10.1002/lio2.774] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 02/25/2022] [Accepted: 03/01/2022] [Indexed: 11/07/2022] Open
Abstract
Objective Chronic rhinosinusitis (CRS) is a highly prevalent and burdensome disease. The pathophysiology is not fully elucidated, but environmental pollutants have been suggested to impact the inflammatory component of the disease process. This review aims to summarize the role of environmental pollution in CRS onset and disease severity. Methods A systematic review was performed following Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines. PubMed, EMBASE, Cochrane Library, Web of Science, and Scopus databases were queried in August 2021. Original articles reporting on air pollution exposure in CRS were included. Other forms of sinonasal disease were excluded. Results Literature search produced 11,983 articles, of which 10 met inclusion criteria. Outcomes evaluated included incidence/prevalence, disease severity, quality of life, and histopathologic/microbial changes. Air pollutant exposure was associated with higher odds of CRS, particularly with particulate matter (PM) exposure. Increasing air pollution exposure was also associated with worsened disease severity and detectable histopathologic changes. Impact on quality of life was less clear. Conclusion Air pollution (particularly PM) is correlated with CRS incidence/prevalence and disease severity, with evidence of histopathologic changes in CRS tissue samples. Further research is warranted to better understand the mechanisms by which air pollution components may cause CRS and type 2 inflammation. Level of Evidence 3a Recent evidence suggests a role for air pollution in the onset and severity of CRS, most notably with relation to PM2.5 exposure. This systematic review supports previous in vitro and in vivo models of pollution in CRS. This study further adds to the existing body of literature demonstrating the many negative health impacts of exposure to air pollution, including impacts on upper airway disease, lower airway disease, cardiac disease, and overall morbidity and mortality.
Collapse
Affiliation(s)
- Evelyn M. Leland
- Department of Otolaryngology‐Head and Neck Surgery Johns Hopkins University Baltimore Maryland USA
| | - Varun Vohra
- Department of Otolaryngology‐Head and Neck Surgery Johns Hopkins University Baltimore Maryland USA
| | - Stella M. Seal
- Welch Medical Library Johns Hopkins University School of Medicine Baltimore Maryland USA
| | - Zhenyu Zhang
- Department of Global Health School of Public Health, Peking University Beijing China
- Institute for Global Health and Development Peking University Beijing China
| | - Murugappan Ramanathan
- Department of Otolaryngology‐Head and Neck Surgery Johns Hopkins University Baltimore Maryland USA
| |
Collapse
|
4
|
Yang X, Shen S, Deng Y, Wang C, Zhang L. Air Pollution Exposure Affects Severity and Cellular Endotype of Chronic Rhinosinusitis With Nasal Polyps. Laryngoscope 2021; 132:2103-2110. [PMID: 34870326 DOI: 10.1002/lary.29974] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 11/16/2021] [Accepted: 11/24/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVES/HYPOTHESIS Air pollution has emerged as an important environmental risk factor for chronic rhinosinusitis (CRS) progression. This study assessed exposure to five types of air pollution (PM2.5/10 , SO2 , NO2 , CO, O3 ) and explored their effects on CRS with nasal polyps (CRSwNP) severity and endotype. STUDY DESIGN Retrospective cohort study. METHODS Air pollution data from monitoring sites in Beijing were obtained to assess individual air pollution exposure. Outcomes of CRSwNP (n = 282) including Lund-Mackay (L-M) score, Lund-Kennedy (L-K) score, visual analogue scale (VAS) score and nasal patency/airflow resistance and so on were measured to analyze correlations with air pollution and compare groups with different exposure types. Multivariable-adjusted binary logistic regression was used to determine potential air pollution risk factors of the endotype of eosinophilic CRSwNP (ECRSwNP). RESULTS Short-term exposures to PM2.5/10 , SO2 , CO, NO2 , and O3 were weak but significantly associated with increased L-M scores. Short-term exposures to PM10 , CO, and NO2 were correlated with increased VAS headache/facial pain scores. The L-M scores of the group of the highest PM2.5 (≥150 μg/m3 ) exposure were significantly higher than those of control group. For each increased unit of the average concentration of PM2.5 , there was a 1.047-fold (95% confidence interval, 1.005-1.091) increased risk of the endotype of ECRSwNP. CONCLUSIONS Air pollution exposure exacerbated CRSwNP severity and PM2.5 could be a risk factor for endotype of ECRSwNP, suggesting the role of air pollution in CRSwNP pathogenesis. LEVEL OF EVIDENCE 4 Laryngoscope, 2021.
Collapse
Affiliation(s)
- Xiaozhe Yang
- Research Unit of Diagnosis and Treatment of Chronic Nasal Diseases, Chinese Academy of Medical Sciences, Beijing, China.,Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China.,Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Shen Shen
- Research Unit of Diagnosis and Treatment of Chronic Nasal Diseases, Chinese Academy of Medical Sciences, Beijing, China.,Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China.,Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Yuzhoujia Deng
- Research Unit of Diagnosis and Treatment of Chronic Nasal Diseases, Chinese Academy of Medical Sciences, Beijing, China.,Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Chengshuo Wang
- Research Unit of Diagnosis and Treatment of Chronic Nasal Diseases, Chinese Academy of Medical Sciences, Beijing, China.,Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China.,Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Luo Zhang
- Research Unit of Diagnosis and Treatment of Chronic Nasal Diseases, Chinese Academy of Medical Sciences, Beijing, China.,Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China.,Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| |
Collapse
|
5
|
de Ferreyro Monticelli D, Santos JM, Goulart EV, Mill JG, Kumar P, Reis NC. A review on the role of dispersion and receptor models in asthma research. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2021; 287:117529. [PMID: 34186501 DOI: 10.1016/j.envpol.2021.117529] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 05/17/2021] [Accepted: 06/01/2021] [Indexed: 06/13/2023]
Abstract
There is substantial evidence that air pollution exposure is associated with asthma prevalence that affects millions of people worldwide. Air pollutant exposure can be determined using dispersion models and refined with receptor models. Dispersion models offer the advantage of giving spatially distributed outdoor pollutants concentration while the receptor models offer the source apportionment of specific chemical species. However, the use of dispersion and/or receptor models in asthma research requires a multidisciplinary approach, involving experts on air quality and respiratory diseases. Here, we provide a literature review on the role of dispersion and receptor models in air pollution and asthma research, their limitations, gaps and the way forward. We found that the methodologies used to incorporate atmospheric dispersion and receptor models in human health studies may vary considerably, and several of the studies overlook features such as indoor air pollution, model validation and subject pathway between indoor spaces. Studies also show contrasting results of relative risk or odds ratio for a health outcome, even using similar methodologies. Dispersion models are mostly used to estimate air pollution levels outside the subject's home, school or workplace; however, very few studies addressed the subject's routines or indoor/outdoor relationships. Conversely, receptor models are employed in regions where asthma incidence/prevalence is high or where a dispersion model has been previously used for this assessment. Road traffic (vehicle exhaust) and NOx are found to be the most targeted source and pollutant, respectively. Other key findings were the absence of a standard indicator, shortage of studies addressing VOC and UFP, and the shift toward chemical speciation of exposure.
Collapse
Affiliation(s)
- Davi de Ferreyro Monticelli
- Department of Environmental Engineering, Federal University of Espirito Santo (UFES), Vitória, Espirito Santo, Brazil
| | - Jane Meri Santos
- Department of Environmental Engineering, Federal University of Espirito Santo (UFES), Vitória, Espirito Santo, Brazil.
| | - Elisa Valentim Goulart
- Department of Environmental Engineering, Federal University of Espirito Santo (UFES), Vitória, Espirito Santo, Brazil
| | - José Geraldo Mill
- Department of Physiological Sciences, Federal University of Espirito Santo (UFES), Vitória, Espirito Santo, Brazil
| | - Prashant Kumar
- Global Centre for Clean Air Research (GCARE), Department of Civil and Environmental Engineering, Faculty of Engineering and Physical Sciences, University of Surrey, Guildford, GU2 7XH, United Kingdom
| | - Neyval Costa Reis
- Department of Environmental Engineering, Federal University of Espirito Santo (UFES), Vitória, Espirito Santo, Brazil
| |
Collapse
|
6
|
Velasquez N, Gardiner L, Cheng TZ, Moore JA, Boudreau RM, Presto AA, Lee SE. Relationship between socioeconomic status, exposure to airborne pollutants, and chronic rhinosinusitis disease severity. Int Forum Allergy Rhinol 2021; 12:172-180. [PMID: 34510788 DOI: 10.1002/alr.22884] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 07/01/2021] [Accepted: 07/23/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Air pollution directly interacts with airway mucosa, yet little is known about how pollutants affect upper airway inflammation. Studies have shown increased incidence of chronic rhinosinusitis (CRS), rhinitis, and asthma in areas with higher traffic pollution, and these neighborhoods are often associated with lower socioeconomic status (SES). The Area Deprivation Index (ADI) assesses neighborhood-level SES by zip code. The purpose of this study was to assess the relationship between SES and exposure to inhaled pollutants and CRS disease severity. METHODS CRS patients with and without nasal polyps (CRSwNP and CRSsNP, respectively) were identified (total patients = 234; CRSwNP patients = 138; CRSsNP patients = 96). Pollutant concentrations, including particulate matter 2.5 (PM2.5 ), black carbon (BC), and nitrogen dioxide (NO2 ), were measured at 70 sites within the defined countywide sites and used to estimate patient exposures. SES was measured by ADI state deciles. Disease severity metrics included the modified Lund-Mackay score (LMS), the need for systemic steroids, and functional endoscopic sinus surgery (FESS). Associations were analyzed and identified using linear, logistic, and Poisson multivariable regression. RESULTS The distribution of CRSsNP and CRSwNP patients across ADI state deciles was similar. ADI, however, was a predictor of exposure to airborne pollutants (PM2.5 , BC, and NO2 ) with a 1.39%, 2.39%, and 2.49% increase in PM2.5 , BC, and NO2 per increasing decile increment (p < 0.0001), respectively, which demonstrated a direct correlation between deprived neighborhoods and higher levels of exposure to PM2.5 , BC, and NO2 with an increase in pollutant levels per increase in ADI decile. Furthermore, ADI was a predictor for increased steroid treatment. CONCLUSION Lower SES predicted higher exposure to air pollution and increased disease severity in patients with CRS as demonstrated by the increased need for steroid treatment.
Collapse
Affiliation(s)
| | - Lauren Gardiner
- Department of Otolaryngology, University of Pittsburgh, Pittsburgh, PA
| | - Tracy Z Cheng
- Department of Otolaryngology, University of Pittsburgh, Pittsburgh, PA
| | - John A Moore
- Department of Otolaryngology, University of Pittsburgh, Pittsburgh, PA
| | - Robert M Boudreau
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA
| | - Albert A Presto
- Center for Atmospheric Particle Studies and Department of Mechanical Engineering, Carnegie Mellon University, Pittsburgh, PA
| | - Stella E Lee
- Department of Otolaryngology, University of Pittsburgh, Pittsburgh, PA
| |
Collapse
|
7
|
Ambient Air Pollution and Variation in Multiple Domains of Asthma Morbidity among Peruvian Children. Ann Am Thorac Soc 2020; 16:348-355. [PMID: 30365919 DOI: 10.1513/annalsats.201807-448oc] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
RATIONALE A large portion of asthma morbidity occurs in low- and middle-income countries, and Peru suffers particularly high asthma prevalence. Ambient air exposures are also high, and likely play a role. Most studies of environmental exposures focus on understanding contributors to health care utilization or mortality risk; however, less severe outcomes may still impact quality of life (QOL). OBJECTIVES To study the association between multiple pollutants and several asthma domains in Peruvian children. METHODS A total of 484 children aged 9-19 years with asthma were followed for 6-9 months, and evaluated for asthma control, asthma-related QOL, missed school days, and health care utilization. We used geographically distributed monitors to estimate air pollutant concentrations and multivariable generalized linear mixed models to model asthma outcomes as a function of pollutants. RESULTS A total of 67% of children had moderate to severe persistent asthma. In multipollutant models, higher particulate matter less than 2.5 μm in aerodynamic diameter (PM2.5), black carbon, and nitrogen dioxide concentrations were independently associated with worse asthma control. For each interquartile range increase in PM2.5 or nitrogen dioxide concentration, there was a 59% or 34% higher odds of uncontrolled asthma, respectively. If the proportion of PM2.5 that was black carbon increased, there were increased odds of uncontrolled asthma. Similarly, pollutants were independently associated with worse asthma-related QOL, and PM exposure was associated with increased risk of health care utilization. CONCLUSIONS Our study highlights the importance of pollutant exposures on multiple domains of asthma morbidity among Peruvian children, including not only acute exacerbations, but also on general asthma burden, such as worse asthma symptom control and QOL.
Collapse
|
8
|
Short-Term Fluctuations in Air Pollution and Asthma in Scania, Sweden. Is the Association Modified by Long-Term Concentrations? PLoS One 2016; 11:e0166614. [PMID: 27861543 PMCID: PMC5115756 DOI: 10.1371/journal.pone.0166614] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 11/01/2016] [Indexed: 11/19/2022] Open
Abstract
Background and aims Asthma is one of the most common respiratory diseases in the world. Research has shown that temporal increases in air pollution concentrations can aggravate asthma symptoms. The aim of this study was to assess whether individuals living in areas with higher air pollution concentrations responded differently to short-term temporal exposure to air pollution than those living in lower air pollution areas. Method The study was designed as a case-crossover study in Scania, Sweden. Outcome data was visits to primary health care clinics with asthma as the main complaint during the years 2007 to 2010. Nitrogen dioxide levels were obtained from 21 different air pollution monitoring stations. Short-term exposure was defined as the average concentration four days prior to the visit. Data was pooled for areas above and below a two-year average NO2 concentration of 10 μg/m3, dispersion modelled with an emission database. Results The short-term association between NO2 and asthma visits seemed stronger in areas with NO2 levels below 10 μg/m3, with an odds ratio (OR) of 1.15 (95% confidence interval (CI): 1.08–1.23) associated with a 10 μg/m3 increase in NO2 compared to areas above 10 μg/m3 NO2 levels, where corresponding OR of 1.09 (95% CI: 1.02–1.17). However, this difference was not statistically significant. (p = 0.13) Conclusions The study provided some evidence, although not statistically significant, that short-term associations between air pollution and asthma may depend on background air pollution levels. However, we cannot rule out that the association is due to other spatially dependent factors in Scania. The study should be reproduced in other study areas.
Collapse
|
9
|
Mogensen I, Alving K, Bjerg A, Borres MP, Hedlin G, Sommar J, Dahlén SE, Janson C, Malinovschi A. Simultaneously elevated exhaled nitric oxide and serum-eosinophil cationic protein relate to recent asthma events in asthmatics in a cross-sectional population-based study. Clin Exp Allergy 2016; 46:1540-1548. [PMID: 27513280 DOI: 10.1111/cea.12792] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 06/23/2016] [Accepted: 07/20/2016] [Indexed: 12/30/2022]
Abstract
BACKGROUND We have reported that increased fraction of exhaled nitric oxide (FeNO), a measure of TH2 -driven airway inflammation, and blood eosinophil count, a marker of systemic eosinophil inflammation, correlated with asthma attacks in a population-based study. OBJECTIVE To investigate the relation between simultaneously elevated FeNO and serum eosinophil cationic protein (S-ECP) levels and asthma events among asthmatics. METHODS Measurements of FeNO (elevated ≥ 25 ppb) and S-ECP (elevated ≥ 20 ng/mL) were performed in 339 adult asthmatics. Asthma events (attacks and symptoms) were self-reported. RESULTS Simultaneously normal S-ECP and FeNO levels were found in 48% of the subjects. Subjects with simultaneously elevated S-ECP and FeNO (13% of the population) had a higher prevalence of asthma attacks in the preceding 3 months than subjects with normal S-ECP and FeNO (51% vs. 25%, P = 0.001). This was not found for subjects with singly elevated S-ECP (P = 0.14) or FeNO (P = 0.34) levels. Elevated S-ECP and FeNO levels were independently associated with asthma attacks in the preceding 3 months after adjusting for potential confounders (OR (95% CI) 4.2 (2.0-8.8). CONCLUSIONS Simultaneously elevated FeNO and S-ECP levels were related to a higher likelihood of asthma attacks in the preceding 3 months. This indicates that there is a value in measuring both FeNO and systemic eosinophilic inflammation in patients with asthma to identify individuals at high risk of exacerbations. CLINICAL RELEVANCE FeNO and S-ECP are markers for inflammation in asthma, but are dependent on different inflammatory pathways and weakly correlated. Simultaneous measurements of both offer better risk characterization of adult asthmatics.
Collapse
Affiliation(s)
- I Mogensen
- Department of Medical Sciences: Lung-, Allergy- and Sleep Research, Uppsala University, Uppsala, Sweden
| | - K Alving
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - A Bjerg
- Department of Women's and Children's Health: Clinical Paediatrics, Karolinska Institute, Stockholm, Sweden
| | - M P Borres
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - G Hedlin
- Department of Women's and Children's Health: Clinical Paediatrics, Karolinska Institute, Stockholm, Sweden
| | - J Sommar
- Department of Public Health and Clinical Medicine: Occupational Medicine, Umeå University, Umeå, Sweden
| | - S-E Dahlén
- Experimental Asthma and Allergy Research Unit: Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
| | - C Janson
- Department of Medical Sciences: Lung-, Allergy- and Sleep Research, Uppsala University, Uppsala, Sweden
| | - A Malinovschi
- Department of Medical Sciences: Clinical Physiology, Uppsala University, Uppsala, Sweden
| |
Collapse
|
10
|
Sommar JN, Ek A, Middelveld R, Bjerg A, Dahlén SE, Janson C, Forsberg B. Quality of life in relation to the traffic pollution indicators NO2 and NOx: results from the Swedish GA(2)LEN survey. BMJ Open Respir Res 2014; 1:e000039. [PMID: 25478186 PMCID: PMC4212716 DOI: 10.1136/bmjresp-2014-000039] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Revised: 06/23/2014] [Accepted: 06/25/2014] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Asthma is a chronic disease that may affect daily activities and quality of life. Asthmatics have higher incidence of chronic rhinosinusitis (CRS) and asthma is associated with sinonasal inflammation and nasal symptoms, that all impair quality of life. Worsening of asthma has been found associated with levels of nitrogen dioxide as traffic indicator. AIMS The aim of the study was to evaluate the impact of traffic pollution indicated by nitrogen oxides (NO2 and NOx) on quality of life in asthmatic persons, individuals with CRS and controls. METHODS Within the Swedish Ga(2)len (Global Allergy and Asthma European Network), 605 asthmatics with and without CRS, 110 individuals with CRS only and 226 controls from four cities were surveyed. The mini Asthma Quality of life Questionnaire (mAQLQ) and the Euro Quality of Life (EQ-5D) health questionnaire were used. Air pollution concentrations at the home address were modelled using dispersion models. RESULTS Levels of NO2 (geometric mean 10.1 μg/m(3) (95% CI 9.80 to 10.5) and NOx (12.1 μg/m(3), 11.7 to 12.6) were similar among conditions (controls, asthmatics, individuals with CRS and asthmatics with CRS). The mAQLQ overall score was not found associated with levels of NO2 or NOx, with or without adjustments, and neither was scores within each of the four domains of mAQLQ: symptoms, activity limitations, emotional functions and effects of environmental stimuli. The mean EQ-5D index value, based on the five dimensions mobility, self-care, usual activities, pain/discomfort and anxiety depression, was also found unrelated to NO2 and NOx. CONCLUSIONS At moderate exposure levels traffic pollution appears not to affect quality of life.
Collapse
Affiliation(s)
- Johan Nilsson Sommar
- Occupational and Environmental Medicine, Department of Public Health and Clinical Medicine , Umeå University , Umeå , Sweden
| | - Alexandra Ek
- Experimental Asthma and Allergy Research Unit , Institute of Environmental Medicine, Karolinska Institutet , Stockholm , Sweden
| | - Roelinde Middelveld
- The Centre for Allergy Research, Karolinska Institutet , Stockholm , Sweden ; The Institute of Environmental Medicine, Karolinska Institutet , Stockholm , Sweden
| | - Anders Bjerg
- Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy , Krefting Research Centre, University of Gothenburg , Göteborg , Sweden
| | - Sven-Erik Dahlén
- Experimental Asthma and Allergy Research Unit , Institute of Environmental Medicine, Karolinska Institutet , Stockholm , Sweden
| | - Christer Janson
- Department of Medical Sciences: Respiratory Medicine and Allergology , Uppsala University , Uppsala , Sweden
| | - Bertil Forsberg
- Occupational and Environmental Medicine, Department of Public Health and Clinical Medicine , Umeå University , Umeå , Sweden
| |
Collapse
|