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Farzan SF, Kamai E, Barahona DD, Van Horne Ornelas Y, Zuidema C, Wong M, Torres C, Bejarano E, Seto E, English P, Olmedo L, Johnston J. Cohort profile: The Assessing Imperial Valley Respiratory Health and the Environment (AIRE) study. Paediatr Perinat Epidemiol 2024; 38:359-369. [PMID: 38450855 PMCID: PMC11116055 DOI: 10.1111/ppe.13065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 02/13/2024] [Accepted: 02/20/2024] [Indexed: 03/08/2024]
Abstract
BACKGROUND The Children's Assessing Imperial Valley Respiratory Health and the Environment (AIRE) study is a prospective cohort study of environmental influences on respiratory health in a rural, southeastern region of California (CA), which aims to longitudinally examine the contribution of a drying saline lake to adverse health impacts in children. OBJECTIVES This cohort was established through a community-academic partnership with the goal of assessing the health effects of childhood exposures to wind-blown particulate matter (PM) and inform public health action. We hypothesize that local PM sources are related to poorer children's respiratory health. POPULATION Elementary school children in Imperial Valley, CA. DESIGN Prospective cohort study. METHODS Between 2017 and 2019, we collected baseline information on 731 children, then follow-up assessments yearly or twice-yearly since 2019. Data have been collected on children's respiratory health, demographics, household characteristics, physical activity and lifestyle, via questionnaires completed by parents or primary caregivers. In-person measurements, conducted since 2019, repeatedly assessed lung function, height, weight and blood pressure. Exposure to air pollutants has been assessed by multiple methods and individually assigned to participants using residential and school addresses. Health data will be linked to ambient and local sources of PM, during and preceding the study period to understand how spatiotemporal trends in these environmental exposures may relate to respiratory health. PRELIMINARY RESULTS Analyses of respiratory symptoms indicate a high prevalence of allergies, bronchitic symptoms and wheezing. Asthma diagnosis was reported in 24% of children at enrolment, which exceeds both CA state and US national prevalence estimates for children. CONCLUSIONS The Children's AIRE cohort, while focused on the health impacts of the drying Salton Sea and air quality in Imperial Valley, is poised to elucidate the growing threat of drying saline lakes and wind-blown dust sources to respiratory health worldwide, as sources of wind-blown dust emerge in our changing climate.
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Affiliation(s)
- Shohreh F. Farzan
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Elizabeth Kamai
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Dayane Duenas Barahona
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Yoshira Van Horne Ornelas
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Christopher Zuidema
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, USA
| | - Michelle Wong
- Tracking California, Public Health Institute, Oakland, CA, USA
| | | | | | - Edmund Seto
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, USA
| | - Paul English
- Tracking California, Public Health Institute, Oakland, CA, USA
| | | | - Jill Johnston
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Tsai YG, Chio CP, Yang KD, Lin CH, Yeh YP, Chang YJ, Chien JW, Wang SL, Huang SK, Chan CC. Long-term PM 2.5 exposure is associated with asthma prevalence and exhaled nitric oxide levels in children. Pediatr Res 2024:10.1038/s41390-023-02977-5. [PMID: 38263452 DOI: 10.1038/s41390-023-02977-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 10/19/2023] [Accepted: 11/26/2023] [Indexed: 01/25/2024]
Abstract
BACKGROUND Exhaled nitric oxide concentration (FENO) is a marker of airway inflammation. This study aimed to evaluate the association of air pollution exposure with FENO levels and asthma prevalence with respiratory symptoms in school children. METHODS We analyzed 4736 school children who reside in six townships near industrial areas in central Taiwan. We evaluated asthmatic symptoms, FENO, and conducted the environmental questionnaire. The personal exposure of PM2.5, NO, and SO2 was estimated using land-use regression models data on children's school and home addresses. RESULTS Annual exposure to PM2.5 was associated with increased odds of physician-diagnosed asthma (OR = 1.595), exercise-induced wheezing (OR = 1.726), itchy eyes (OR = 1.417), and current nasal problems (OR = 1.334) (P < 0.05). FENO levels in the absence of infection were positively correlated with age, previous wheezing, allergic rhinitis, atopic eczema, near the road, and for children with high exposure to PM2.5 (P < 0.05). An increase of 1 μg/m3 PM2.5 exposure was significantly associated with a 1.0% increase in FENO levels for children after adjusting for potential confounding variables, including exposures to NO and SO2. CONCLUSIONS Long-term exposures to PM2.5 posed a significant risk of asthma prevalence and airway inflammation in a community-based population of children. IMPACT Annual exposure to PM2.5 was associated with increased odds of physician-diagnosed asthma and nasal problems and itchy eyes. Long-term exposures to PM2.5 were significantly associated with FENO levels after adjusting for potential confounding variables. This is first study to assess the association between FENO levels and long-term air pollution exposures in children near coal-based power plants. An increase of 1 μg/m3 annual PM2.5 exposure was significantly associated with a 1.0% increase in FENO levels. Long-term exposures to PM2.5 posed a significant risk of asthma prevalence and airway inflammation in a community-based population of children.
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Affiliation(s)
- Yi-Giien Tsai
- Department of Pediatrics, Changhua Christian Children's Hospital, Changhua, Taiwan, ROC
- School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan, ROC
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan, ROC
| | - Chia-Pin Chio
- Department of Medical Research, Tungs' Taichung MetroHarbor Hospital, Taichung, Taiwan, ROC
- Institute of Environmental and Occupational Health Sciences, College of Public Health, National Taiwan University, Taipei, Taiwan, ROC
| | - Kuender D Yang
- Department of Pediatrics, Mackay Memorial Hospital, and Department of Microbiology & Immunology, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Ching-Hsiung Lin
- Division of Chest Medicine, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan, ROC
- Institute of Genomics and Bioinformatics, National Chung Hsing University, Taichung, Taiwan, ROC
- Ph.D. Program in Translational Medicine, National Chung Hsing University, Taichung, Taiwan, ROC
- Department of Recreation and Holistic Wellness, MingDao University, Changhua, Taiwan, ROC
| | - Yen-Po Yeh
- Changhua County Public Health Bureau, Changhua, Taiwan, ROC
| | - Yu-Jun Chang
- Epidemiology and Biostatistics Center, Changhua Christian Hospital, Changhua, Taiwan, ROC
| | - Jien-Wen Chien
- Department of Pediatrics, Changhua Christian Children's Hospital, Changhua, Taiwan, ROC
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan, ROC
| | - Shu-Li Wang
- National Institute of Environmental Health Sciences, National Health Research Institutes, 35 Keyan Rd, Zhunan, Miaoli County, Miaoli, Taiwan, ROC.
| | - Shau-Ku Huang
- National Institute of Environmental Health Sciences, National Health Research Institutes, 35 Keyan Rd, Zhunan, Miaoli County, Miaoli, Taiwan, ROC.
- Johns Hopkins Asthma and Allergy Center, School of Medicine, Johns Hopkins University, Baltimore, MD, USA.
| | - Chang-Chuan Chan
- Institute of Environmental and Occupational Health Sciences, College of Public Health, National Taiwan University, Taipei, Taiwan, ROC.
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Areal AT, Singh N, Zhao Q, Berdel D, Koletzko S, von Berg A, Gappa M, Heinrich J, Standl M, Abramson MJ, Schikowski T. The Influence of Short-Term Weather Parameters and Air Pollution on Adolescent Airway Inflammation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6827. [PMID: 37835097 PMCID: PMC10572171 DOI: 10.3390/ijerph20196827] [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: 07/11/2023] [Revised: 09/14/2023] [Accepted: 09/18/2023] [Indexed: 10/15/2023]
Abstract
Fraction of exhaled Nitric Oxide (FeNO) is a marker of airway inflammation. We examined the main effects and interactions of relative humidity (RH) and air pollution on adolescents' FeNO. Two thousand and forty-two participants from the 15-year follow-up of the German GINIplus and LISA birth cohorts were included. Daily meteorological (maximum [Tmax], minimum [Tmin] and mean [Tmean] temperatures and RH) and air pollution [Ozone (O3), nitrogen dioxide (NO2) and particulate matter < 2.5 µm (PM2.5)] were assessed. Linear models were fitted with Ln(FeNO) as the outcome. Increases in FeNO indicate an increase in lung inflammation. Increased FeNO was associated with an increase in temperature, PM2.5, O3 and NO2. A 5% increase in RH was associated with a decrease in FeNO. Interactions between RH and high (p = 0.007) and medium (p = 0.050) NO2 were associated with increases in FeNO; while interactions between RH and high (p = 0.042) and medium (p = 0.040) O3 were associated with decreases in FeNO. Adverse effects were present for male participants, participants with low SES, participants with chronic respiratory disease, and participants from Wesel. Short-term weather and air pollution have an effect on lung inflammation in German adolescents. Future research should focus on further assessing the short-term effect of multiple exposures on lung inflammation in adolescents.
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Affiliation(s)
- Ashtyn Tracey Areal
- IUF—Leibniz Research Institute for Environmental Medicine, 40225 Düsseldorf, Germany; (A.T.A.); (N.S.); (Q.Z.)
- Department of Epidemiology, Medical Research School, Heinrich-Heine-University, 40225 Düsseldorf, Germany
| | - Nidhi Singh
- IUF—Leibniz Research Institute for Environmental Medicine, 40225 Düsseldorf, Germany; (A.T.A.); (N.S.); (Q.Z.)
| | - Qi Zhao
- IUF—Leibniz Research Institute for Environmental Medicine, 40225 Düsseldorf, Germany; (A.T.A.); (N.S.); (Q.Z.)
- School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan 250100, China
| | - Dietrich Berdel
- Department of Pediatrics, Research Institute, Marien-Hospital Wesel, 46483 Wesel, Germany; (D.B.); (A.v.B.)
| | - Sibylle Koletzko
- Department of Pediatrics, Dr. von Hauner Children’s Hospital Munich, University Hospital, LMU Munich, 80539 Munich, Germany;
- Department of Pediatrics, Gastroenterology and Nutrition, School of Medicine Collegium Medicum, University of Warmia and Mazury, 10-082 Olsztyn, Poland
| | - Andrea von Berg
- Department of Pediatrics, Research Institute, Marien-Hospital Wesel, 46483 Wesel, Germany; (D.B.); (A.v.B.)
| | - Monika Gappa
- Department of Paediatrics, Evangelisches Krankenhaus, 40217 Düsseldorf, Germany;
| | - Joachim Heinrich
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, 80539 Munich, Germany;
- German Center for Lung Research (DZL), 35392 Gießen, Germany;
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC 3010, Australia
| | - Marie Standl
- German Center for Lung Research (DZL), 35392 Gießen, Germany;
- Institute of Epidemiology, Helmholtz Zentrum München—German Research Center for Environmental Health, 85764 Neuherberg, Germany
| | - Michael J. Abramson
- School of Public Health & Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia;
| | - Tamara Schikowski
- IUF—Leibniz Research Institute for Environmental Medicine, 40225 Düsseldorf, Germany; (A.T.A.); (N.S.); (Q.Z.)
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Tan DJ, Lodge CJ, Walters EH, Lowe AJ, Bui DS, Bowatte G, Kandane‐Rathnayake R, Aldakheel FM, Erbas B, Hamilton GS, Thomas PS, Hew M, Tang MLK, Abramson MJ, Perret JL, Dharmage SC. Biomarkers of asthma relapse and lung function decline in adults with spontaneous asthma remission: A population-based cohort study. Allergy 2023; 78:957-967. [PMID: 36301194 PMCID: PMC10953440 DOI: 10.1111/all.15566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 10/06/2022] [Accepted: 10/10/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND The extent to which biomarkers of asthma activity persist in spontaneous asthma remission and whether such markers are associated with future respiratory outcomes remained unclear. We investigated the association between sub-clinical inflammation in adults with spontaneous asthma remission and future asthma relapse and lung function decline. METHODS The Tasmanian Longitudinal Health Study is a population-based cohort (n = 8583). Biomarkers of systemic inflammation were measured on participants at age 45, and latent profile analysis was used to identify cytokine profiles. Bronchial hyperresponsiveness (BHR) and nitric oxide products in exhaled breath condensate (EBC NOx) were measured at age 50. Participants with spontaneous asthma remission at ages 45 (n = 466) and 50 (n = 318) were re-evaluated at age 53, and associations between baseline inflammatory biomarkers and subsequent asthma relapse and lung function decline were assessed. RESULTS We identified three cytokine profiles in adults with spontaneous asthma remission: average (34%), Th2-high (42%) and Th2-low (24%). Compared to the average profile, a Th2-high profile was associated with accelerated decline in post-BD FEV1 /FVC (MD -0.18% predicted per-year; 95% CI -0.33, -0.02), while a Th2-low profile was associated with accelerated decline in both post-BD FEV1 (-0.41%; -0.75, -0.06) and post-BD FVC (-0.31%; -0.62, 0.01). BHR and high TNF-α during spontaneous remission were associated with an increased risk of asthma relapse. In contrast, we found no evidence of association between EBC NOx and either asthma relapse or lung function decline. CONCLUSION BHR and serum inflammatory cytokines have prognostic value in adults with spontaneous asthma remission. At-risk individuals with BHR, Th2-high or Th2-low cytokine profiles may benefit from closer monitoring and on-going follow-up.
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Affiliation(s)
- Daniel J. Tan
- Allergy and Lung Health Unit, Centre for Epidemiology and BiostatisticsSchool of Population and Global Health, University of MelbourneMelbourneVictoriaAustralia
| | - Caroline J. Lodge
- Allergy and Lung Health Unit, Centre for Epidemiology and BiostatisticsSchool of Population and Global Health, University of MelbourneMelbourneVictoriaAustralia
| | - Eugene Haydn Walters
- Allergy and Lung Health Unit, Centre for Epidemiology and BiostatisticsSchool of Population and Global Health, University of MelbourneMelbourneVictoriaAustralia
- School of Medicine, University of TasmaniaHobartTasmaniaAustralia
| | - Adrian J. Lowe
- Allergy and Lung Health Unit, Centre for Epidemiology and BiostatisticsSchool of Population and Global Health, University of MelbourneMelbourneVictoriaAustralia
| | - Dinh S. Bui
- Allergy and Lung Health Unit, Centre for Epidemiology and BiostatisticsSchool of Population and Global Health, University of MelbourneMelbourneVictoriaAustralia
| | - Gayan Bowatte
- Allergy and Lung Health Unit, Centre for Epidemiology and BiostatisticsSchool of Population and Global Health, University of MelbourneMelbourneVictoriaAustralia
- Department of Basic Sciences, Faculty of Allied Health SciencesUniversity of PeradeniyaPeradeniyaSri Lanka
| | | | - Fahad M. Aldakheel
- Department of Clinical Laboratory Sciences, College of Applied Medical SciencesKing Saud UniversityRiyadhSaudi Arabia
| | - Bircan Erbas
- School of Psychology and Public HealthLa Trobe UniversityMelbourneVictoriaAustralia
- Violet Vines Marshman Centre for Rural Health ResearchLa Trobe UniversityBendigoVictoriaAustralia
| | - Garun S. Hamilton
- School of Clinical SciencesMonash UniversityMelbourneVictoriaAustralia
- Monash Lung, Sleep, Allergy and ImmunologyMonash HealthMelbourneVictoriaAustralia
| | - Paul S. Thomas
- Prince of Wales' Clinical School, Faculty of MedicineUniversity of New South WalesSydneyNew South WalesAustralia
| | - Mark Hew
- School of Public Health & Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
- The Alfred HospitalMelbourneVictoriaAustralia
| | - Mimi L. K. Tang
- Murdoch Children's Research InstituteMelbourneVictoriaAustralia
- Department of PaediatricsUniversity of MelbourneMelbourneVictoriaAustralia
| | - Michael J. Abramson
- School of Public Health & Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
| | - Jennifer L. Perret
- Allergy and Lung Health Unit, Centre for Epidemiology and BiostatisticsSchool of Population and Global Health, University of MelbourneMelbourneVictoriaAustralia
- Institute for Breathing and SleepMelbourneVictoriaAustralia
| | - Shyamali C. Dharmage
- Allergy and Lung Health Unit, Centre for Epidemiology and BiostatisticsSchool of Population and Global Health, University of MelbourneMelbourneVictoriaAustralia
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5
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Kress S, Kilanowski A, Wigmann C, Zhao Q, Zhao T, Abramson MJ, Gappa M, Standl M, Unfried K, Schikowski T. Airway inflammation in adolescents and elderly women: Chronic air pollution exposure and polygenic susceptibility. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 841:156655. [PMID: 35697214 DOI: 10.1016/j.scitotenv.2022.156655] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 06/01/2022] [Accepted: 06/08/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND AND AIM The fractional exhaled nitric oxide (FeNO) concentration in the exhaled breath is a biomarker for eosinophilic airway inflammation. We explored the interplay between chronic air pollution exposure and polygenic susceptibility to airway inflammation at different critical age stages. METHODS Adolescents (15 yr) enrolled in the GINIplus/LISA birth cohorts (n = 2434) and 220 elderly women (75 yr on average) enrolled in the SALIA cohort with FeNO measurements available were investigated. Environmental main effects of the mean of ESCAPE land-use regression air pollutant concentrations within a time window of 15 years and main effects of the polygenic risk scores (PRS) using internal weights from elastic net regression of genome-wide derived single nucleotide polymorphisms were investigated. Furthermore, we examined gene-environment interaction (GxE) effects on natural log-transformed FeNO levels by adjusted linear regression models. RESULTS While we observed no significant environmental and polygenic main effects on airway inflammation in either age group, we found robust harmful effects of chronic nitrogen dioxide (NO2) exposure in the GxE models for elderly women (16.2 % increase in FeNO, p-value = 0.027). Stratified analyses found GxE effects between the PRS and chronic NO2 exposure in never-smoker elderly women and in adolescents without any inflammatory respiratory conditions. CONCLUSIONS FeNO measurement is a useful biomarker to detect higher risk of NO2-induced eosinophilic airway inflammation in the elderly. There was limited evidence for GxE effects on airway inflammation in adolescents or the elderly. Further GxE studies in subpopulations should be conducted to investigate the assumption that susceptibility to airway inflammation differs between age stages.
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Affiliation(s)
- Sara Kress
- IUF - Leibniz Research Institute for Environmental Medicine, Auf'm Hennekamp 50, Düsseldorf 40225, Germany; Medical Research School Düsseldorf, Heinrich Heine University, Universitätsstraße 1, Düsseldorf 40225, Germany.
| | - Anna Kilanowski
- Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Ingolstädter Landstr. 1, Neuherberg 85764, Germany; Institute for Medical Information Processing, Biometry, and Epidemiology; Pettenkofer School of Public Health, LMU Munich, Geschwister-Scholl-Platz 1, Munich 80539, Germany; Division of Metabolic and Nutritional Medicine, Dr. von Hauner Children's Hospital, University of Munich Medical Center, Lindwurmstr. 4, Munich 80337, Germany.
| | - Claudia Wigmann
- IUF - Leibniz Research Institute for Environmental Medicine, Auf'm Hennekamp 50, Düsseldorf 40225, Germany.
| | - Qi Zhao
- IUF - Leibniz Research Institute for Environmental Medicine, Auf'm Hennekamp 50, Düsseldorf 40225, Germany; Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, 44 West Wenhua Road, Jinan City 250012, Shandong Province, China; School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, VIC 3004, Australia.
| | - Tianyu Zhao
- Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Ingolstädter Landstr. 1, Neuherberg 85764, Germany.
| | - Michael J Abramson
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, VIC 3004, Australia.
| | - Monika Gappa
- Department of Paediatrics, Evangelisches Krankenhaus, Kirchfeldstraße 40, Düsseldorf 40217, Germany.
| | - Marie Standl
- Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Ingolstädter Landstr. 1, Neuherberg 85764, Germany; German Center for Lung Research (DZL), Aulweg 130, Gießen 35392, Germany.
| | - Klaus Unfried
- IUF - Leibniz Research Institute for Environmental Medicine, Auf'm Hennekamp 50, Düsseldorf 40225, Germany.
| | - Tamara Schikowski
- IUF - Leibniz Research Institute for Environmental Medicine, Auf'm Hennekamp 50, Düsseldorf 40225, Germany.
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6
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Carraro S, Ferraro VA, Zanconato S. Impact of air pollution exposure on lung function and exhaled breath biomarkers in children and adolescents. J Breath Res 2022; 16. [PMID: 35947967 DOI: 10.1088/1752-7163/ac8895] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 08/10/2022] [Indexed: 11/12/2022]
Abstract
A growing number of scientific papers focus on the description and quantification of the detrimental effects of pollution exposure on human health. The respiratory system is one of the main targets of these effects and children are potentially a vulnerable population. Many studies analyzed the effects of short- and long-term exposure to air pollutants on children's respiratory function. Aim of the present narrative review is to summarize the results of the available cohort studies which investigated how children's lung function is affected by exposure to air pollution. In addition, an overview is provided on the association, in children, between pollution exposure and exhaled breath biomarkers, as possible indicators of the pathogenetic mechanisms involved in pollution-related lung damages. The identified cohort studies suggest that, beside the possible impact of recent exposure, early and lifetime exposure are the variables most consistently associated with a reduction in lung function parameters in both children and adolescents. As for the effect of air pollution exposure on exhaled breath biomarkers, the available studies show an association with increased exhaled nitric oxide, with increased concentrations of malondialdehyde and 8-isoprostane in exhaled breath condensate (EBC), and with EBC acidification. These studies, therefore, suggest lung inflammation and oxidative stress as possible pathogenetic mechanisms involved in pollution related lung damages. Taken together, the available data underscore the importance of the development and application of policies aimed at reducing air pollutant concentration, since the protection of children's lung function can have a beneficial impact on adults' respiratory health in the future.
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Affiliation(s)
- Silvia Carraro
- Women's and Children's Health Department, University of Padova, via Giustiniani 3, Padova, 35128, ITALY
| | - Valentina Agnese Ferraro
- Women's and Children's Health Department, University of Padova, via Giustiniani, 3, Padova, 35128, ITALY
| | - Stefania Zanconato
- Women's and Children's Health Department, University of Padova, via Giustiniani 3, Padova, 35128, ITALY
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Gamrad-Streubel L, Haase LM, Rudolph KK, Rühle K, Bachand AM, Crawford L, Mundt KA, Bünger J, Pallapies D, Taeger D, Casjens S, Molkenthin A, Neumann S, Giesen J, Neumann V, Brüning T, Birk T. Underground salt and potash workers exposed to nitrogen oxides and diesel exhaust: assessment of specific effect biomarkers. Int Arch Occup Environ Health 2022; 95:1817-1828. [PMID: 35583687 PMCID: PMC9630174 DOI: 10.1007/s00420-022-01876-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 04/22/2022] [Indexed: 01/08/2023]
Abstract
Purpose Occupational exposure limits (OEL) for nitrogen oxides (NO, NO2) and diesel exhaust (EC-DPM) were reassessed by the German authorities in 2016/2017. We performed a clinical cross-sectional study among salt and potash underground workers exposed to these substances at relatively high levels to examine possible indicators of acute effects on workers’ health. Methods We measured post- versus pre-shift differences in cardiovascular, inflammatory, immune, and respiratory effect biomarkers and assessed their associations with personal exposures measured during the same shift. We also compared post- versus pre-shift differences in biomarker levels between exposure groups defined based on work site and job type. Results None of the above-ground workers exceeded the OEL for NO2 and only 5% exceeded the OEL for EC-DPM exposure. Among underground workers, 33% of miners and 7% underground maintenance workers exceeded the OEL for NO2; the OEL for EC-DPM was exceeded by 56% of miners and 17% of maintenance workers. Some effect biomarkers (thrombocytes, neutrophils, MPO, TNF-α, IgE, FeNO) showed statistically significant differences between pre- versus post-shift measurements; however, there were no consistent associations between pre- and post-shift differences and exposure group or personal exposure measurements during the shift. Conclusions We did not find evidence of associations between workplace exposure to NO, NO2 or EC-DPM and clinically relevant indicators of acute cardiovascular, inflammatory and immune, or respiratory effects among salt and potash underground workers in Germany. Supplementary Information The online version contains supplementary material available at 10.1007/s00420-022-01876-2.
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Affiliation(s)
- Lisa Gamrad-Streubel
- Environment and Health, Ramboll Deutschland GmbH, City Tower-Limbecker Platz1, 45127, Essen, Germany.
| | - Lisa-Marie Haase
- Environment and Health, Ramboll Deutschland GmbH, City Tower-Limbecker Platz1, 45127, Essen, Germany
| | - Katharina K Rudolph
- Environment and Health, Ramboll Deutschland GmbH, City Tower-Limbecker Platz1, 45127, Essen, Germany
| | - Katrin Rühle
- Environment and Health, Ramboll Deutschland GmbH, City Tower-Limbecker Platz1, 45127, Essen, Germany
| | | | | | | | - Jürgen Bünger
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University Bochum (IPA), Bochum, Germany
| | - Dirk Pallapies
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University Bochum (IPA), Bochum, Germany
| | - Dirk Taeger
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University Bochum (IPA), Bochum, Germany
| | - Swaantje Casjens
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University Bochum (IPA), Bochum, Germany
| | - Anja Molkenthin
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University Bochum (IPA), Bochum, Germany
| | - Savo Neumann
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University Bochum (IPA), Bochum, Germany
| | - Jörg Giesen
- Institute for the Research On Hazardous Substances (IGF), Bochum, Germany
| | - Volker Neumann
- Institute for the Research On Hazardous Substances (IGF), Bochum, Germany
| | - Thomas Brüning
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University Bochum (IPA), Bochum, Germany
| | - Thomas Birk
- Environment and Health, Ramboll Deutschland GmbH, City Tower-Limbecker Platz1, 45127, Essen, Germany
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8
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Zhang Y, Eckel SP, Berhane K, Garcia E, Muchmore P, Molshatzki NBA, Rappaport EB, Linn WS, Habre R, Gilliland FD. Long-term exposures to air pollutants affect F eNO in children: a longitudinal study. Eur Respir J 2021; 58:13993003.00705-2021. [PMID: 34503981 DOI: 10.1183/13993003.00705-2021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 08/05/2021] [Indexed: 11/05/2022]
Affiliation(s)
- Yue Zhang
- Dept of Internal Medicine, University of Utah, Salt Lake City, UT, USA .,Dept of Family and Preventive Medicine, University of Utah, Salt Lake City, UT, USA.,Veteran Affairs Salt Lake City Health Care System, Salt Lake City, UT, USA
| | - Sandrah P Eckel
- Dept of Preventive Medicine, University of Southern California, Los Angeles, CA, USA
| | - Kiros Berhane
- Dept of Biostatistics, Columbia University, New York, NY, USA
| | - Erika Garcia
- Dept of Preventive Medicine, University of Southern California, Los Angeles, CA, USA
| | | | | | - Edward B Rappaport
- Dept of Preventive Medicine, University of Southern California, Los Angeles, CA, USA
| | - William S Linn
- Dept of Preventive Medicine, University of Southern California, Los Angeles, CA, USA
| | - Rima Habre
- Dept of Preventive Medicine, University of Southern California, Los Angeles, CA, USA
| | - Frank D Gilliland
- Dept of Preventive Medicine, University of Southern California, Los Angeles, CA, USA
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9
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Jung KH, Goodwin KE, Perzanowski MS, Chillrud SN, Perera FP, Miller RL, Lovinsky-Desir S. Personal Exposure to Black Carbon at School and Levels of Fractional Exhaled Nitric Oxide in New York City. ENVIRONMENTAL HEALTH PERSPECTIVES 2021; 129:97005. [PMID: 34495741 PMCID: PMC8425518 DOI: 10.1289/ehp8985] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 08/12/2021] [Accepted: 08/13/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Schools are often located near traffic sources, leading to high levels of exposure to traffic-related air pollutants, including black carbon (BC). Thus, the school environment could play in a significant role in the adverse respiratory health of children. OBJECTIVES Our objective was to determine associations between personal BC levels at school and airway inflammation [i.e., fractional exhaled nitric oxide (FeNO)] in school-age children. We hypothesized that higher school BC (SBC) would be associated with higher FeNO. METHODS Children 9-14 years of age in New York City (NYC) (n=114) wore BC monitors for two 24-h periods over a 6-d sampling period, repeated 6 months later. SBC was defined as the average personal BC concentrations measured during NYC school hours (i.e., 0830-1430 hours). FeNO was measured following each 24-h BC monitoring period. Multivariable linear regression in generalized estimating equation models were used to examine associations between SBC and FeNO. Results are presented as percentage difference (PD) in FeNO. RESULTS Personal BC at school was associated with higher FeNO (PD=7.47% higher FeNO per 1-μg/m3 BC (95% CI: 1.31, 13.9), p=0.02]. Compared with BC exposure during school, a smaller PD in FeNO was observed in association with BC exposure while commuting to and from school [PD=6.82% (95% CI: 0.70, 13.3), p=0.03]. Personal BC in non-school environments and residential BC were not associated with FeNO (p>0.05). A significant association between personal BC at school and FeNO was observed among children with seroatopy who did not have asthma [PD=21.5% (95% CI: 4.81, 40.9), p=0.01]. DISCUSSION Schools may be important sources of BC exposure that contribute to airway inflammation in school-age children. Our results provide rationale for interventions that target improved air quality in urban schools and classrooms. https://doi.org/10.1289/EHP8985.
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Affiliation(s)
- Kyung Hwa Jung
- Division of Pediatric Pulmonary, Department of Pediatrics, College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - Kathleen E. Goodwin
- Division of Pediatric Pulmonary, Department of Pediatrics, College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - Matthew S. Perzanowski
- Mailman School of Public Health, Department of Environmental Health Sciences, Columbia University, New York, New York, USA
| | - Steven N. Chillrud
- Lamont-Doherty Earth Observatory, Columbia University, New York, New York, USA
| | - Frederica P. Perera
- Mailman School of Public Health, Department of Environmental Health Sciences, Columbia University, New York, New York, USA
| | - Rachel L. Miller
- Division of Clinical Immunology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Stephanie Lovinsky-Desir
- Division of Pediatric Pulmonary, Department of Pediatrics, College of Physicians and Surgeons, Columbia University, New York, New York, USA
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10
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Singh N, Singh S. Interstitial Lung Diseases and Air Pollution: Narrative Review of Literature. Pulm Ther 2021; 7:89-100. [PMID: 33689161 PMCID: PMC7943709 DOI: 10.1007/s41030-021-00148-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 01/29/2021] [Indexed: 12/16/2022] Open
Abstract
Air pollution has been associated with respiratory diseases such as chronic obstructive pulmonary disease (COPD) and lung malignancies. The aim of this narrative review is to analyze the current data on the possible association between air pollution and interstitial lung disease (ILD). There are multiple studies showing the association of ILD with air pollution but the mechanism remains unclear. Although some of the environmental factors have been associated with idiopathic pulmonary fibrosis (IPF), hypersensitivity pneumonitis (HP), and pneumoconiosis, data about other ILDs are scarce and not well known. Air pollution as an etiology for ILD may act in multiple ways, leading to disease pathogenesis or exacerbation of underlying ILD. Clinical implications of this association are manifold; limiting the exposure to poor-quality air could possibly reduce the fall in lung functions and the risk of acute exacerbations of the underlying ILD. Air pollution is a major problem worldwide. Pollutants are vented out in the ambient air by sources like vehicular fume exhaust, factory pollution, combustion by burning of biomass fuels, and indoor pollution. The probable constituents responsible for respiratory diseases are particulate matter 2.5 and 10, nitrogen dioxide (NO2), and ozone present in polluted air. The role of these pollutants in pathogenesis of interstitial lung disease (ILD) is complex. The probable pathways include: oxidative stress, inflammation, and telomere shortening. ILD is a heterogeneous group of diseases, and the effect of pollution on various types is also varied. Air pollution has been associated with poor lung function and exacerbations in idiopathic pulmonary fibrosis (IPF), increased prevalence of hypersensitivity pneumonitis (HP), and presence of pulmonary fibrosis in healthy adults and children. The incidence rate of IPF has also been associated with pollutant levels such as NO2. Thus, patients with ILD should be cautious during bad-quality air days and they are advised to avoid outdoor activities and use facemasks during this period.
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Affiliation(s)
- Nishtha Singh
- Department of Respiratory Medicine, Asthma Bhawan, Jaipur, India
| | - Sheetu Singh
- Department of Chest and Tuberculosis, Institute of Respiratory Disease, SMS Medical College, Jaipur, India.
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11
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Carvalho-Oliveira R, Amato-Lourenço LF, Almeida PS, Garcia BBM, Vieira WKM, Santana A, Motta Godinho-Netto MC, Carretero ME, Nascimento Saldiva PH, Mauad T. Effects of long-standing exposure to heavy-duty diesel vehicle traffic on respiratory symptoms and airway inflammation in older adults. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2021; 268:115893. [PMID: 33126158 DOI: 10.1016/j.envpol.2020.115893] [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: 06/25/2020] [Revised: 10/06/2020] [Accepted: 10/15/2020] [Indexed: 06/11/2023]
Abstract
In the present study, we evaluated the effects of chronic exposure to traffic from a heavy-duty diesel-fueled vehicle area on respiratory symptoms and airway inflammation in a nonsmoking adult and elderly population. Respiratory symptoms were evaluated by the ISAAC questionnaire (International Study of Asthma and Allergies questionnaire), and airway inflammation was assessed by fractional exhaled nitric oxide (FeNO). Forty volunteers were selected from the 112 volunteers who completed the ISAAC questionnaire for the measurement of FeNO. The FeNO population comprised seven men (six aged ≥ 64 years old, four aged ≥ 75 years old) and 32 women (27 aged ≥ 64 years old, nine aged ≥ 75 years old). FeNO levels were tracked for six months, from November 2014 to June 2015. Results: Twenty-four percent of the volunteers reported having had wheezing in the chest in the last 12 months. However, only 2.7% of the volunteers reported doctor-diagnosed asthma. There was a positive association between FeNO and pollutants in most of the study months. An increase of 1 μg m-3 in NO2 was associated with a mean increase of 1.08 ppb in FeNO, and an increase of 1 μg m-3 in O3 was associated with a mean increase of 1.06 ppb in FeNO. The relative risk for NO2 ranged from 1.009 to 1.32 and that for O3 ranged from 1.014 to 1.020. Conclusion: The frequency of respiratory symptoms was much higher than the previously described levels of 6% in the Brazilian adult population. In summary, a high frequency of respiratory symptoms and high levels of FeNO were described in an underdiagnosed adult population living very close to a heavy-duty diesel-traffic area. Older elderly adults presented greater susceptibility to airway inflammation than younger adults.
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Affiliation(s)
- Regiani Carvalho-Oliveira
- Pathology Department, School of Medicine at Sao Paulo University (FMUSP), Brazil; National Institute for Integrated Analysis of Environmental Risk (INAIRA), Brazil.
| | | | - Pâmela S Almeida
- Pathology Department, School of Medicine at Sao Paulo University (FMUSP), Brazil; Instituto Federal de Educação, Ciência e Tecnologia de São Paulo (IFSP), Brazil
| | - Bianca B M Garcia
- Pathology Department, School of Medicine at Sao Paulo University (FMUSP), Brazil; Instituto Federal de Educação, Ciência e Tecnologia de São Paulo (IFSP), Brazil
| | - William K M Vieira
- Instituto Federal de Educação, Ciência e Tecnologia de São Paulo (IFSP), Brazil
| | - Ariane Santana
- Instituto Federal de Educação, Ciência e Tecnologia de São Paulo (IFSP), Brazil
| | | | - Maria E Carretero
- Pathology Department, School of Medicine at Sao Paulo University (FMUSP), Brazil
| | - Paulo H Nascimento Saldiva
- Pathology Department, School of Medicine at Sao Paulo University (FMUSP), Brazil; National Institute for Integrated Analysis of Environmental Risk (INAIRA), Brazil
| | - Thais Mauad
- Pathology Department, School of Medicine at Sao Paulo University (FMUSP), Brazil; National Institute for Integrated Analysis of Environmental Risk (INAIRA), Brazil
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12
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Assessing the Respiratory Effects of Air Pollution from Biomass Cookstoves on Pregnant Women in Rural India. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 18:ijerph18010183. [PMID: 33383756 PMCID: PMC7795669 DOI: 10.3390/ijerph18010183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 12/24/2020] [Accepted: 12/24/2020] [Indexed: 11/19/2022]
Abstract
Background: In India, biomass fuel is burned in many homes under inefficient conditions, leading to a complex milieu of particulate matter and environmental toxins known as household air pollution (HAP). Pregnant women are particularly vulnerable as they and their fetus may suffer from adverse consequences of HAP. Fractional exhaled nitric oxide (FeNO) is a noninvasive, underutilized tool that can serve as a surrogate for airway inflammation. We evaluated the prevalence of respiratory illness, using pulmonary questionnaires and FeNO measurements, among pregnant women in rural India who utilize biomass fuel as a source of energy within their home. Methods: We prospectively studied 60 pregnant women in their 1st and 2nd trimester residing in villages near Nagpur, Central India. We measured FeNO levels in parts per billion (ppb), St. George’s Respiratory Questionnaire (SGRQ-C) scores, and the Modified Medical Research Council (mMRC) Dyspnea Scale. We evaluated the difference in the outcome distributions between women using biomass fuels and those using liquefied petroleum gas (LPG) using two-tailed t-tests. Results: Sixty-five subjects (32 in Biomass households; 28 in LPG households; 5 unable to complete) were enrolled in the study. Age, education level, and second-hand smoke exposure were comparable between both groups. FeNO levels were higher in the Biomass vs. LPG group (25.4 ppb vs. 8.6 ppb; p-value = 0.001). There was a difference in mean composite SGRQ-C score (27.1 Biomass vs. 10.8 LPG; p-value < 0.001) including three subtotal scores for Symptoms (47.0 Biomass vs. 20.2 LPG; p-value< 0.001), Activity (36.4 Biomass vs. 16.5 LPG; p-value < 0.001) and Impact (15.9 Biomass vs. 5.2 LPG; p-value < 0.001). The mMRC Dyspnea Scale was higher in the Biomass vs. LPG group as well (2.9 vs. 0.5; p < 0.001). Conclusion: Increased FeNO levels and higher dyspnea scores in biomass-fuel-exposed subjects confirm the adverse respiratory effects of this exposure during pregnancy. More so, FeNO may be a useful, noninvasive biomarker of inflammation that can help better understand the physiologic effects of biomass smoke on pregnant women. In the future, larger studies are needed to characterize the utility of FeNO in a population exposed to HAP.
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Olaniyan T, Jeebhay M, Röösli M, Naidoo RN, Künzli N, de Hoogh K, Saucy A, Badpa M, Baatjies R, Parker B, Leaner J, Dalvie MA. The association between ambient NO 2 and PM 2.5 with the respiratory health of school children residing in informal settlements: A prospective cohort study. ENVIRONMENTAL RESEARCH 2020; 186:109606. [PMID: 32371276 DOI: 10.1016/j.envres.2020.109606] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 04/25/2020] [Accepted: 04/25/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND No previous epidemiological study has investigated the combined association of long-term ambient nitrogen dioxide (NO2) and particulate matter of diameter size-2.5 (PM2.5) exposure with asthma outcomes among schoolchildren in Africa. OBJECTIVES This study investigated the independent and co-pollutant association of long-term exposures to ambient air pollutants on asthma-associated outcomes in a cohort of schoolchildren in the Western Cape Province of South Africa. METHODS A total of 590 grade-4 schoolchildren residing in four informal settlements were studied. Spirometry and fractional exhaled nitric-oxide (FeNO) measurements were conducted, including a standardized questionnaire administered to caregivers at baseline and 12-months follow-up. Annual NO2 and PM2.5 levels were estimated for each child's home using land-use regression modelling. Single- and two-pollutant models were constructed to assess the independent and co-pollutant association of both air pollutants (NO2 and PM2.5) on new cases of asthma-associated outcomes adjusting-for host characteristics, indoor exposures and study area. RESULTS The annual average concentration of PM2.5 and NO2 were 10.01μg/m3 and 16.62μg/m3 respectively, across the four study areas, and were below the local Standards of 20μg/m3 and 40μg/m3, for both pollutants, respectively. In the two-pollutant-adjusted models, an interquartile range (IQR) increase of 14.2μg/m3 in NO2 was associated with an increased risk of new onset of ocular-nasal symptoms (adjusted odds ratio-aOR: 1.63, 95% CI: 1.01-2.60), wheezing (aOR: 3.57, 95% CI: 1.18-10.92), more than two or more asthma symptom score (aOR: 1.71, 95% CI: 1.02-2.86), and airway inflammation defined as FeNO > 35 ppb (aOR: 3.10, 95% CI: 1.10-8.71), independent of PM2.5 exposures. CONCLUSION This study provided evidence that ambient NO2 levels below local standards and international guidelines, independent of PM2.5 exposure, increases new cases of asthma-associated outcomes after 12-months.
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Affiliation(s)
- Toyib Olaniyan
- Centre for Environmental and Occupational Health Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
| | - Mohamed Jeebhay
- Centre for Environmental and Occupational Health Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa; Division of Occupational Medicine, University of Cape Town, Cape Town, South Africa.
| | - Martin Röösli
- Swiss Tropical and Public Health Institute, Socinstrasse 57, P.O. Box, 4002, Basel, Switzerland; University of Basel, Petersplatz 1, 4003, Basel, Switzerland.
| | | | - Nino Künzli
- Swiss Tropical and Public Health Institute, Socinstrasse 57, P.O. Box, 4002, Basel, Switzerland; University of Basel, Petersplatz 1, 4003, Basel, Switzerland.
| | - Kees de Hoogh
- Swiss Tropical and Public Health Institute, Socinstrasse 57, P.O. Box, 4002, Basel, Switzerland; University of Basel, Petersplatz 1, 4003, Basel, Switzerland.
| | - Apolline Saucy
- Swiss Tropical and Public Health Institute, Socinstrasse 57, P.O. Box, 4002, Basel, Switzerland; University of Basel, Petersplatz 1, 4003, Basel, Switzerland.
| | - Mahnaz Badpa
- Swiss Tropical and Public Health Institute, Socinstrasse 57, P.O. Box, 4002, Basel, Switzerland; University of Basel, Petersplatz 1, 4003, Basel, Switzerland.
| | - Roslynn Baatjies
- Centre for Environmental and Occupational Health Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa; Department of Environmental and Occupational Studies, Faculty of Applied Sciences, Cape Peninsula University of Technology, Cape Town, 7700, South Africa.
| | - Bhawoodien Parker
- Department of Environmental Affairs and Developmental Planning, Western Cape Government, Cape Town, South Africa.
| | - Joy Leaner
- Department of Environmental Affairs and Developmental Planning, Western Cape Government, Cape Town, South Africa.
| | - Mohamed Aqiel Dalvie
- Centre for Environmental and Occupational Health Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
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14
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Dimakopoulou K, Douros J, Samoli E, Karakatsani A, Rodopoulou S, Papakosta D, Grivas G, Tsilingiridis G, Mudway I, Moussiopoulos N, Katsouyanni K. Long-term exposure to ozone and children's respiratory health: Results from the RESPOZE study. ENVIRONMENTAL RESEARCH 2020; 182:109002. [PMID: 31855698 DOI: 10.1016/j.envres.2019.109002] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 12/02/2019] [Accepted: 12/03/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Although there is evidence on the effects of short-term ozone (O3) exposures on children's respiratory health, few studies have reported results on the effects of long-term exposures. We report the effects of long-term exposure to O3 on respiratory health outcomes in 10-11-year old children. METHODS We conducted a panel study in a sample of the general population of school children in two cities with high average O3 concentrations, Athens and Thessaloniki, Greece. All 186 participating students were followed up intensively for 5 weeks spreading across a school year. Data was collected through questionnaires, weekly personal O3 measurements, spirometry, FeNO and time-activity diaries. Long-term O3 exposure was assessed using fixed site measurements and modeling, calibrated for personal exposures. The associations between measured lung function parameters and lung function growth over the study period, as well as FeNO and the occurrence of symptoms with long-term O3 exposure were assessed through the application of multiple mixed effects 2-level regression models, adjusting for confounders and for short-term exposures. RESULTS A 10 μg/m3 increase in calibrated long-term O3exposure, using measurements from fixed site monitors was associated with lower FVC and FEV1 by 17 mL (95% Confidence Interval: 5-28) and 13 mL (3-21) respectively and small decreases in lung growth: 0.008% (0.002-0.014%) for FVC and 0.006% (0.000-0.012%) in FEV1 over the study period. No association was observed with PEF, FeNO or the occurrence of symptoms. A similar pattern was observed when the exposure estimates from the dispersion models were employed. CONCLUSIONS Our study provides evidence that long-term O3 exposure is associated with reduced lung volumes and growth.
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Affiliation(s)
- Konstantina Dimakopoulou
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Greece
| | - John Douros
- Laboratory of Heat Transfer and Environmental Engineering, Aristotle University of Thessaloniki, Greece
| | - Evangelia Samoli
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Greece
| | - Anna Karakatsani
- 2nd Pulmonary Department, ATTIKON University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Sophia Rodopoulou
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Greece
| | - Despina Papakosta
- Pulmonary Department, G. Papanikolaou Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Georgios Grivas
- Institute for Environmental Research and Sustainable Development, National Observatory of Athens, 15236, Athens, Greece
| | - George Tsilingiridis
- Laboratory of Heat Transfer and Environmental Engineering, Aristotle University of Thessaloniki, Greece
| | - Ian Mudway
- MRC Centre for Environment and Health, School of Population Health & Environmental Sciences, King's College London, UK
| | - Nicholas Moussiopoulos
- Laboratory of Heat Transfer and Environmental Engineering, Aristotle University of Thessaloniki, Greece
| | - Klea Katsouyanni
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Greece; MRC Centre for Environment and Health, School of Population Health & Environmental Sciences, King's College London, UK.
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15
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Meo SA, Iqbal M, Al-Masri A, Zia I, Afzal S. Fractional exhaled nitric oxide and respiratory complaints in Hajj pilgrims wearing a cotton towel or plain cotton ihram. J Int Med Res 2019; 48:300060519891009. [PMID: 31891277 PMCID: PMC7607530 DOI: 10.1177/0300060519891009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective Hajj is an important component of Islam. This study aimed to determine the
effect of wearing a cotton towel or plain cotton ihram on the onset of
respiratory symptoms and fractional exhaled nitric oxide (FeNO) levels in
Hajj pilgrims. Methods One hundred male nonsmoking subjects (age: 20–60 years) without a previous
clinical history of respiratory illnesses were included. Fifty subjects were
dressed in a cotton towel ihram and 50 wore a plain cotton ihram (control
group). Respiratory symptoms and FeNO levels were recorded on the day before
leaving for Hajj, when ihrams were removed, and when the pilgrims had
returned home. Results Pilgrims who wore cotton towel ihrams showed significantly higher rates of
respiratory symptoms, including being generally ill, coughing, a sore
throat, and a runny nose, than those who wore plain ihrams. FeNO levels also
tended to be higher in pilgrims who wore a cotton towel ihram compared with
those with a plain cotton ihram during and after Hajj. Conclusions Hajj pilgrims who wear cotton towel ihrams may have a risk of respiratory
symptoms, including a cough, sore throat, and runny nose. Therefore, a plain
cotton ihram is advisable while performing Hajj to minimize respiratory
illness.
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Affiliation(s)
- Sultan Ayoub Meo
- Department of Physiology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Muhammad Iqbal
- Department of Physiology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Abeer Al-Masri
- Department of Physiology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Inam Zia
- Department of Physiology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Sibtain Afzal
- Department of Immunology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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Chau-Etchepare F, Hoerger JL, Kuhn BT, Zeki AA, Haczku A, Louie S, Kenyon NJ, Davis CE, Schivo M. Viruses and non-allergen environmental triggers in asthma. J Investig Med 2019; 67:1029-1041. [PMID: 31352362 PMCID: PMC7428149 DOI: 10.1136/jim-2019-001000] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2019] [Indexed: 12/23/2022]
Abstract
Asthma is a complex inflammatory disease with many triggers. The best understood asthma inflammatory pathways involve signals characterized by peripheral eosinophilia and elevated immunoglobulin E levels (called T2-high or allergic asthma), though other asthma phenotypes exist (eg, T2-low or non-allergic asthma, eosinophilic or neutrophilic-predominant). Common triggers that lead to poor asthma control and exacerbations include respiratory viruses, aeroallergens, house dust, molds, and other organic and inorganic substances. Increasingly recognized non-allergen triggers include tobacco smoke, small particulate matter (eg, PM2.5), and volatile organic compounds. The interaction between respiratory viruses and non-allergen asthma triggers is not well understood, though it is likely a connection exists which may lead to asthma development and/or exacerbations. In this paper we describe common respiratory viruses and non-allergen triggers associated with asthma. In addition, we aim to show the possible interactions, and potential synergy, between viruses and non-allergen triggers. Finally, we introduce a new clinical approach that collects exhaled breath condensates to identify metabolomics associated with viruses and non-allergen triggers that may promote the early management of asthma symptoms.
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Affiliation(s)
- Florence Chau-Etchepare
- Pulmonary, Critical Care, and Sleep Medicine, University of California Davis, Sacramento, California, USA
| | - Joshua L Hoerger
- Internal Medicine, University of California Davis, Sacramento, California, USA
| | - Brooks T Kuhn
- Pulmonary, Critical Care, and Sleep Medicine, University of California Davis, Sacramento, California, USA
| | - Amir A Zeki
- Pulmonary, Critical Care, and Sleep Medicine, University of California Davis, Sacramento, California, USA
- Center for Comparative Respiratory Biology and Medicine, University of California Davis, Davis, California, USA
| | - Angela Haczku
- Pulmonary, Critical Care, and Sleep Medicine, University of California Davis, Sacramento, California, USA
- Center for Comparative Respiratory Biology and Medicine, University of California Davis, Davis, California, USA
| | - Samuel Louie
- Pulmonary, Critical Care, and Sleep Medicine, University of California Davis, Sacramento, California, USA
| | - Nicholas J Kenyon
- Pulmonary, Critical Care, and Sleep Medicine, University of California Davis, Sacramento, California, USA
- Center for Comparative Respiratory Biology and Medicine, University of California Davis, Davis, California, USA
| | - Cristina E Davis
- Mechanical and Aerospace Engineering, University of California Davis, Davis, California, USA
| | - Michael Schivo
- Pulmonary, Critical Care, and Sleep Medicine, University of California Davis, Sacramento, California, USA
- Center for Comparative Respiratory Biology and Medicine, University of California Davis, Davis, California, USA
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Rachel M, Biesiadecki M, Aebisher D, Galiniak S. Exhaled nitric oxide in pediatric patients with respiratory disease. J Breath Res 2019; 13:046007. [PMID: 31234165 DOI: 10.1088/1752-7163/ab2c3d] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Measurement of nitric oxide (NO) levels in exhaled air from the upper and lower airways is currently used as a non-invasive marker of inflammation in respiratory diseases. Assessment of NO exhaled from the lower air respiratory tract is considered to be a quick method for confirmation and control of asthma in patients as well as an estimation of treatment efficiency. The main aim of this study was to determine differences between levels of exhaled nitric oxide (fractional exhaled NO; FeNO) in patients with respiratory disease as measured by an electrochemical analyzer. Measurements were taken in 352 pediatric patients aged 4-17 with cystic fibrosis (CF) (n = 43), asthma (n = 69), allergic rhinitis (AR) (n = 70), asthma and AR (n = 128) and non-diseased children (n = 42) recruited from the Allergology Outpatient Department, Provincial Hospital No 2, Rzeszów. The second objective of this study was to assess any correlations between FeNO and clinical parameters of patients. The level of FeNO in patients with CF was normal when compared with control subjects (10.8 ± 2.9 versus 11.4 ± 6 ppb). We found significantly higher FeNO in patients with asthma (26.6 ± 15.3 ppb, p < 0.001), AR (18.4 ± 9.6 ppb, p < 0.01) as well as in patients with both asthma and AR (43.3 ± 31.1 ppb, p < 0.001) when compared to healthy children. Statistical analysis revealed a positive correlation between FeNO and age, height and weight of control subjects, and height in children with AR. FeNO was independent of sex, BMI, spirometry and blood results as well as the type of residence in control children and subjects with CF, asthma, AR and combined asthma and AR. In conclusion, we found normal levels of FeNO in children with CF and elevated levels in patients with asthma, AR and combined asthma and AR as compared to control subjects. Due to conflicting data, there is still a need for additional research, especially related to regarding factors that affect FeNO levels in respiratory disease.
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Affiliation(s)
- Marta Rachel
- Faculty of Medicine, University of Rzeszów, Warzywna 1, 35-315 Rzeszów, Poland. Allergology Outpatient Department, Provincial Hospital No 2, Lwowska 60, 35-301 Rzeszów, Poland
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Associations of Timing and Mode of Commuting with In-Transit Black Carbon Exposure and Airway Inflammation: A Pilot Study. Ann Am Thorac Soc 2019; 16:923-927. [PMID: 30958965 DOI: 10.1513/annalsats.201810-668rl] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
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19
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Guo H. Comparisons of combined oxidant capacity and redox-weighted oxidant capacity in their association with increasing levels of FeNO. CHEMOSPHERE 2018; 211:584-590. [PMID: 30096571 DOI: 10.1016/j.chemosphere.2018.07.191] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Revised: 07/04/2018] [Accepted: 07/31/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Some ozone (O3) and nitrogen dioxides (NO2) health effects studies use Ox (sum value) as a surrogate. However, little is known about how this related to Oxwt (weighted value). OBJECTIVE We investigated the effects of redox-weighted oxidant capacity (Oxwt) on fractional exhaled nitric oxide (FeNO), a biomarker of airway inflammation, in a set of chronic obstructive pulmonary disease (COPD) patients. We also compare combined oxidant capacity (Ox) and Oxwt in their associations with increasing levels of FeNO. METHODS We measured FeNO values in 600 participants who have COPD at Shanghai Pulmonary Hospital. Ox was calculated directly by the sum of O3 and NO2. The redox-weighted oxidant capacity was calculated by denoting Oxwt as the weighted average of redox potentials. We applied generalized additive models (GAM) to investigate the impacts of Ox and Oxwt on FeNO levels, respectively. We fitted the same models for the influence of O3 and NO2 individually and jointly on FeNO levels to compare the result of Ox and Oxwt. RESULTS Oxwt were significantly linked with FeNO levels. The impact was robustest in current day after exposure, and were closely linked with the adjustment of PM2.5. A 10 μg m-3 increase in average Oxwt concentrations was linked to 0.88 (95% CI: -1.46, 3.28) increase, whereas a 10 μg m-3 increase in average Ox concentration was linked to 0.62 (95% CI: -0.79, 2.07) increase in FeNO. In two-pollutant models, an increase of 10 μg m-3 in average O3 concentrations with adjustment of NO2 was associated with 0.57 (95% CI: -1.26, 2.01) increase in FeNO. The impact estimates of Ox and Oxwt were statistically significant among males, non-smoking and elders who age above 65 years old. CONCLUSIONS This analysis demonstrated that Oxwt is used as a better indicator of atmospheric oxidative capacity as a proxy of O3 and NO2 in further epidemiological studies.
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Affiliation(s)
- Huibin Guo
- Department of Environmental Science and Engineering, Fudan University, Shanghai 200438, China.
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Krall JR, Ladva CN, Russell AG, Golan R, Peng X, Shi G, Greenwald R, Raysoni AU, Waller LA, Sarnat JA. Source-specific pollution exposure and associations with pulmonary response in the Atlanta Commuters Exposure Studies. JOURNAL OF EXPOSURE SCIENCE & ENVIRONMENTAL EPIDEMIOLOGY 2018; 28:337-347. [PMID: 29298976 PMCID: PMC6013329 DOI: 10.1038/s41370-017-0016-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 11/15/2017] [Accepted: 11/21/2017] [Indexed: 05/19/2023]
Abstract
Concentrations of traffic-related air pollutants are frequently higher within commuting vehicles than in ambient air. Pollutants found within vehicles may include those generated by tailpipe exhaust, brake wear, and road dust sources, as well as pollutants from in-cabin sources. Source-specific pollution, compared to total pollution, may represent regulation targets that can better protect human health. We estimated source-specific pollution exposures and corresponding pulmonary response in a panel study of commuters. We used constrained positive matrix factorization to estimate source-specific pollution factors and, subsequently, mixed effects models to estimate associations between source-specific pollution and pulmonary response. We identified four pollution factors that we named: crustal, primary tailpipe traffic, non-tailpipe traffic, and secondary. Among asthmatic subjects (N = 48), interquartile range increases in crustal and secondary pollution were associated with changes in lung function of -1.33% (95% confidence interval (CI): -2.45, -0.22) and -2.19% (95% CI: -3.46, -0.92) relative to baseline, respectively. Among non-asthmatic subjects (N = 51), non-tailpipe pollution was associated with pulmonary response only at 2.5 h post-commute. We found no significant associations between pulmonary response and primary tailpipe pollution. Health effects associated with traffic-related pollution may vary by source, and therefore some traffic pollution sources may require targeted interventions to protect health.
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Affiliation(s)
- Jenna R Krall
- Department of Global and Community Health, College of Health and Human Services, George Mason University, 4400 University Drive MS 5B7, Fairfax, VA, 22030, USA.
| | | | - Armistead G Russell
- School of Civil and Environmental Engineering, Georgia Institute of Technology, Atlanta, USA
| | - Rachel Golan
- Department of Public Health, Ben-Gurion University of the Negev, Beersheba, Israel
| | - Xing Peng
- College of Environmental Science and Engineering, Nankai University, Nankai Qu, China
| | - Guoliang Shi
- College of Environmental Science and Engineering, Nankai University, Nankai Qu, China
| | - Roby Greenwald
- Department of Environmental Health, Georgia State University, Atlanta, USA
| | - Amit U Raysoni
- Department of Environmental Health, Emory University, Atlanta, USA
| | - Lance A Waller
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, USA
| | - Jeremy A Sarnat
- Department of Environmental Health, Emory University, Atlanta, USA
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Annesi-Maesano I, Dinh-Xuan AT. Is exhaled nitric oxide a marker of air pollution effect? Eur Respir J 2018; 47:1304-6. [PMID: 27132258 DOI: 10.1183/13993003.00521-2016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Accepted: 03/11/2016] [Indexed: 01/04/2023]
Affiliation(s)
- Isabella Annesi-Maesano
- Epidemiology of Allergic and Respiratory Diseases Dept (EPAR), Sorbonne Universités, UPMC Univ Paris 06, INSERM, Pierre Louis Institute of Epidemiology and Public Health (IPLESP UMRS 1136), Saint-Antoine Medical School, Paris, France
| | - Anh Tuan Dinh-Xuan
- Université Paris Descartes, Hôpital Cochin - Paris Centre, Assistance Publique Hôpitaux de Paris, Laboratoire de Physiologie Respiratoire, UPRES-EA 2511, Paris, France
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Zhou Y, Liu Y, Sun H, Ma J, Xiao L, Cao L, Li W, Wang B, Yuan J, Chen W. Associations of urinary polycyclic aromatic hydrocarbon metabolites with fractional exhaled nitric oxide and exhaled carbon monoxide: A cross-sectional study. THE SCIENCE OF THE TOTAL ENVIRONMENT 2018; 618:542-550. [PMID: 29149738 DOI: 10.1016/j.scitotenv.2017.10.294] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 10/26/2017] [Accepted: 10/28/2017] [Indexed: 06/07/2023]
Abstract
Exposure to Polycyclic aromatic hydrocarbons (PAHs) has been associated with inflammatory responses. Fractional exhaled nitric oxide (FeNO) and exhaled carbon monoxide (eCO) are both important inflammatory mediators especially in airways. However, few studies have investigated associations of PAH exposures with FeNO or eCO. Therefore, we aimed to quantify the associations of urinary PAH metabolites with FeNO and eCO levels, and investigate their potential effect modifiers by linear mixed models among 4133 participants from the Wuhan-Zhuhai cohort in China. We further performed stratified analyses to estimate effect modification. We found significant associations of increased urinary PAH metabolites with elevated eCO and FeNO. Among all participants, each 1% increase of 1-hydroxynaphthalene, 2-hydroxynaphthalene, 2-hydroxyfluorene, 4-hydroxyphenanthrene, 3-hydroxyphenanthrene, and total PAH metabolites was significantly associated with a 12.6% (95% confidence interval: 9.3%, 15.9%), 9.7% (6.5%, 12.9%), 7.5% (4.1%, 10.9%), 3.2% (0.2%, 6.2%), 2.7% (0.1%, 5.3%), and 6.5% (2.7%, 10.4%) increased eCO level, respectively; while each 1% increase of urinary 1-hydroxynaphthalene, 9-hydroxyphenanthrene, 3-hydroxyphenanthrene, and 2-hydroxyphenanthrene was associated with a -3.0% (-5.8%, -0.2%), 2.9% (0.3%, 5.6%), 3.2% (1.0%, 5.4%), and 4.5% (2.2%, 6.9%) change of FeNO level, respectively. Positive associations between certain urinary PAH metabolites and eCO were observed among both ever-smokers and non-smokers, and the associations were stronger among ever-smokers than that among non-smokers. Increased urinary PAH metabolites were associated with decreased FeNO among ever-smokers and elevated FeNO levels among non-smokers. Our findings suggest that PAH exposures may impair airway through inducing inflammatory response, especially among ever-smokers.
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Affiliation(s)
- Yun Zhou
- Department of Occupational & Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China; Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
| | - Yuewei Liu
- Hubei Provincial Key Laboratory for Applied Toxicology, Hubei Provincial Center for Disease Control and Prevention, Wuhan, Hubei 430079, China
| | - Huizhen Sun
- Department of Occupational & Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China; Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
| | - Jixuan Ma
- Department of Occupational & Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China; Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
| | - Lili Xiao
- Department of Occupational & Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China; Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
| | - Limin Cao
- Department of Occupational & Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China; Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
| | - Wei Li
- Department of Occupational & Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China; Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
| | - Bin Wang
- Department of Occupational & Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China; Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
| | - Jing Yuan
- Department of Occupational & Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China; Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
| | - Weihong Chen
- Department of Occupational & Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China; Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China.
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Zhang Y, Salam MT, Berhane K, Eckel SP, Rappaport EB, Linn WS, Habre R, Bastain TM, Gilliland FD. Genetic and epigenetic susceptibility of airway inflammation to PM 2.5 in school children: new insights from quantile regression. Environ Health 2017; 16:88. [PMID: 28821285 PMCID: PMC5563051 DOI: 10.1186/s12940-017-0285-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2017] [Accepted: 07/11/2017] [Indexed: 05/16/2023]
Abstract
BACKGROUND The fractional concentration of exhaled nitric oxide (FeNO) is a biomarker of airway inflammation that has proved to be useful in investigations of genetic and epigenetic airway susceptibility to ambient air pollutants. For example, susceptibility to airway inflammation from exposure to particulate matter with aerodynamic diameter < =2.5 μm (PM2.5) varies by haplotypes and promoter region methylation in inducible nitric oxide synthase (iNOS encoded by NOS2). We hypothesized that PM2.5 susceptibility associated with these epigenetic and genetic variants may be greater in children with high FeNO from inflamed airways. In this study, we investigated genetic and epigenetic susceptibility to airborne particulate matter by examining whether the joint effects of PM2.5, NOS2 haplotypes and iNOS promoter methylation significantly vary across the distribution of FeNO in school children. METHODS The study included 940 school children in the southern California Children's Health Study who provided concurrent buccal samples and FeNO measurements. We used quantile regression to examine susceptibility by estimating the quantile-specific joint effects of PM2.5, NOS2 haplotype and methylation on FeNO. RESULTS We discovered striking differences in susceptibility to PM2.5 in school children. The joint effects of short-term PM2.5 exposure, NOS2 haplotypes and methylation across the FeNO distribution were significantly larger in the upper tail of the FeNO distribution, with little association in its lower tail, especially among children with asthma and Hispanic white children. CONCLUSION School-aged children with higher FeNO have greater genetic and epigenetic susceptibility to PM2.5, highlighting the importance of investigating effects across the entire distribution of FeNO.
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Affiliation(s)
- Yue Zhang
- Division of Epidemiology, Department of Internal Medicine, University of Utah, 295 Chipeta Way, Salt Lake City, UT 84018 USA
- Department of Family and Preventive Medicine, University of Utah, Salt Lake City, UT USA
- Veteran Affairs Salt Lake City Health Care System, Salt Lake City, UT USA
| | - Muhammad T. Salam
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA USA
- Department of Psychiatry, Kern Medical, Bakersfield, CA USA
| | - Kiros Berhane
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA USA
| | - Sandrah P. Eckel
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA USA
| | - Edward B. Rappaport
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA USA
| | - William S. Linn
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA USA
| | - Rima Habre
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA USA
| | - Theresa M. Bastain
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA USA
| | - Frank D. Gilliland
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA USA
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Horváth I, Barnes PJ, Loukides S, Sterk PJ, Högman M, Olin AC, Amann A, Antus B, Baraldi E, Bikov A, Boots AW, Bos LD, Brinkman P, Bucca C, Carpagnano GE, Corradi M, Cristescu S, de Jongste JC, Dinh-Xuan AT, Dompeling E, Fens N, Fowler S, Hohlfeld JM, Holz O, Jöbsis Q, Van De Kant K, Knobel HH, Kostikas K, Lehtimäki L, Lundberg J, Montuschi P, Van Muylem A, Pennazza G, Reinhold P, Ricciardolo FLM, Rosias P, Santonico M, van der Schee MP, van Schooten FJ, Spanevello A, Tonia T, Vink TJ. A European Respiratory Society technical standard: exhaled biomarkers in lung disease. Eur Respir J 2017; 49:49/4/1600965. [PMID: 28446552 DOI: 10.1183/13993003.00965-2016] [Citation(s) in RCA: 369] [Impact Index Per Article: 52.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 01/09/2017] [Indexed: 12/19/2022]
Abstract
Breath tests cover the fraction of nitric oxide in expired gas (FeNO), volatile organic compounds (VOCs), variables in exhaled breath condensate (EBC) and other measurements. For EBC and for FeNO, official recommendations for standardised procedures are more than 10 years old and there is none for exhaled VOCs and particles. The aim of this document is to provide technical standards and recommendations for sample collection and analytic approaches and to highlight future research priorities in the field. For EBC and FeNO, new developments and advances in technology have been evaluated in the current document. This report is not intended to provide clinical guidance on disease diagnosis and management.Clinicians and researchers with expertise in exhaled biomarkers were invited to participate. Published studies regarding methodology of breath tests were selected, discussed and evaluated in a consensus-based manner by the Task Force members.Recommendations for standardisation of sampling, analysing and reporting of data and suggestions for research to cover gaps in the evidence have been created and summarised.Application of breath biomarker measurement in a standardised manner will provide comparable results, thereby facilitating the potential use of these biomarkers in clinical practice.
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Affiliation(s)
- Ildiko Horváth
- Dept of Pulmonology, National Korányi Institute of Pulmonology, Budapest, Hungary
| | - Peter J Barnes
- National Heart and Lung Institute, Imperial College London, Royal Brompton Hospital, London, UK
| | | | - Peter J Sterk
- Dept of Respiratory Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Marieann Högman
- Centre for Research & Development, Uppsala University/Gävleborg County Council, Gävle, Sweden
| | - Anna-Carin Olin
- Occupational and Environmental Medicine, Sahlgrenska Academy and University Hospital, Goteborg, Sweden
| | - Anton Amann
- Innsbruck Medical University, Innsbruck, Austria
| | - Balazs Antus
- Dept of Pathophysiology, National Korányi Institute of Pulmonology, Budapest, Hungary
| | | | - Andras Bikov
- Dept of Pulmonology, Semmelweis University, Budapest, Hungary
| | - Agnes W Boots
- Dept of Pharmacology and Toxicology, University of Maastricht, Maastricht, The Netherlands
| | - Lieuwe D Bos
- Intensive Care, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Paul Brinkman
- Dept of Respiratory Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Caterina Bucca
- Biomedical Sciences and Human Oncology, Universita' di Torino, Turin, Italy
| | | | | | - Simona Cristescu
- Dept of Molecular and Laser Physics, Institute for Molecules and Materials, Radboud University, Nijmegen, The Netherlands
| | - Johan C de Jongste
- Dept of Pediatrics/Respiratory Medicine, Erasmus MC-Sophia Childrens' Hospital, Rotterdam, The Netherlands
| | | | - Edward Dompeling
- Dept of Paediatrics/Family Medicine Research School CAPHRI, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Niki Fens
- Dept of Respiratory Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Stephen Fowler
- Respiratory Research Group, University of Manchester Wythenshawe Hospital, Manchester, UK
| | - Jens M Hohlfeld
- Clinical Airway Research, Fraunhofer Institute of Toxicology and Experimental Medicine (ITEM), Hannover, Germany.,Medizinische Hochschule Hannover, Hannover, Germany
| | - Olaf Holz
- Clinical Airway Research, Fraunhofer Institute of Toxicology and Experimental Medicine (ITEM), Hannover, Germany
| | - Quirijn Jöbsis
- Department of Paediatric Respiratory Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
| | - Kim Van De Kant
- Dept of Paediatrics/Family Medicine Research School CAPHRI, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Hugo H Knobel
- Philips Research, High Tech Campus 11, Eindhoven, The Netherlands
| | | | | | - Jon Lundberg
- Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Paolo Montuschi
- Pharmacology, Catholic University of the Sacred Heart, Rome, Italy
| | - Alain Van Muylem
- Hopital Erasme Cliniques Universitaires de Bruxelles, Bruxelles, Belgium
| | - Giorgio Pennazza
- Faculty of Engineering, University Campus Bio-Medico, Rome, Italy
| | - Petra Reinhold
- Institute of Molecular Pathogenesis, Friedrich Loeffler Institut, Jena, Germany
| | - Fabio L M Ricciardolo
- Clinic of Respiratory Disease, Dept of Clinical and Biological Sciences, University of Torino, Torino, Italy
| | - Philippe Rosias
- Dept of Paediatrics/Family Medicine Research School CAPHRI, Maastricht University Medical Centre, Maastricht, The Netherlands.,Dept of Pediatrics, Maasland Hospital, Sittard, The Netherlands
| | - Marco Santonico
- Faculty of Engineering, University Campus Bio-Medico, Rome, Italy
| | - Marc P van der Schee
- Dept of Respiratory Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | | | | | - Thomy Tonia
- European Respiratory Society, Lausanne, Switzerland
| | - Teunis J Vink
- Philips Research, High Tech Campus 11, Eindhoven, The Netherlands
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Hao Y, Zhang G, Han B, Xu X, Feng N, Li Y, Wang W, Kan H, Bai Z, Zhu Y, Au W, Xia ZL. Prospective evaluation of respiratory health benefits from reduced exposure to airborne particulate matter. INTERNATIONAL JOURNAL OF ENVIRONMENTAL HEALTH RESEARCH 2017; 27:126-135. [PMID: 28245677 DOI: 10.1080/09603123.2017.1292497] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
We aimed to investigate if short-term exposure to reduced particulate matter (PM) air pollution would affect respiratory function in healthy adults. We followed a cohort of 42 healthy participants from a community afflicted with severe PM air pollution to a substantially less polluted area for nine days. We measured daily airborne PM [with an aerodynamic diameter of less than 2.5 μm (PM2.5) and 10 μm (PM10)] and PM2.5 carbon component concentrations. Five repeated respiratory function measurements and fractional exhaled nitric oxide test were made for each participant. Associations between respiratory health and PM exposure were assessed using linear mixed models. Each 10 μg/m3 decrease in same-day PM2.5 was associated with small but consistent increase in the forced expiratory volume in 1 s (FEV1) (9.00 mL) and forced vital capacity (14.35 mL). Our observations indicate that respiratory health benefits can be achieved even after a short-term reduction of exposure to PM. Our results provide strong evidence for more rigorous air pollution controls for the health benefit of populations.
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Affiliation(s)
- Yanhui Hao
- a Department of Occupational and Environmental Health, School of Public Health , Fudan University , Shanghai , China
| | - Guanghui Zhang
- a Department of Occupational and Environmental Health, School of Public Health , Fudan University , Shanghai , China
| | - Bin Han
- b State Key Laboratory of Environmental Criteria and Risk Assessment , Chinese Research Academy of Environmental Sciences , Beijing , China
| | - Xiaowen Xu
- a Department of Occupational and Environmental Health, School of Public Health , Fudan University , Shanghai , China
| | - Nannan Feng
- a Department of Occupational and Environmental Health, School of Public Health , Fudan University , Shanghai , China
| | - Yong Li
- a Department of Occupational and Environmental Health, School of Public Health , Fudan University , Shanghai , China
| | - Wei Wang
- c Department of Epidemiology and Biostatistics , College of Public Health, University of South Florida , Tampa , FL , USA
| | - Haidong Kan
- a Department of Occupational and Environmental Health, School of Public Health , Fudan University , Shanghai , China
| | - Zhipeng Bai
- b State Key Laboratory of Environmental Criteria and Risk Assessment , Chinese Research Academy of Environmental Sciences , Beijing , China
| | - Yiliang Zhu
- c Department of Epidemiology and Biostatistics , College of Public Health, University of South Florida , Tampa , FL , USA
| | - William Au
- d Department of Environmental Toxicology , Preventive Medicine and MPH Education Center, Shantou University Medical College , Shantou , China
| | - Zhao-Lin Xia
- a Department of Occupational and Environmental Health, School of Public Health , Fudan University , Shanghai , China
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Comparison of the Fractional Exhaled Nitric Oxide Levels in Adolescents at Three Schools Located Three Different Distances from a Large Steel Mill. Can Respir J 2017; 2017:6231309. [PMID: 28265181 PMCID: PMC5317111 DOI: 10.1155/2017/6231309] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2016] [Revised: 12/04/2016] [Accepted: 12/27/2016] [Indexed: 11/17/2022] Open
Abstract
Objectives. Exposure to ambient metals and air pollutants in urban environments has been associated with impaired lung health and inflammation in the lungs. Fractional exhaled nitric oxide (FeNO) is a reliable marker of airway inflammation. In this study, we aimed to compare the FeNO levels of three schools that have different distances from iron and steel industry zone for assessing the effects of heavy metals and air pollution on their respiratory health. Methods. Pulmonary function test and FeNO measurements were evaluated in 387 adolescents in three schools which have different distance from plant. Results. FeNO levels were significantly higher in School I (n = 142; 18.89 ± 12.3 ppb) and School II (n = 131; 17.68 ± 7.7 ppb) than School III (n = 114; 4.28 ± 3.9 ppb). Increased FeNO concentration was related to the distance of iron and steel industry zone in young adults. Conclusion. The FeNO concentrations in school children were inversely proportional to the distance from the steel mill. There are needed some studies that can evaluate the safe distance and legislation must consider these findings.
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Outdoor Environment and Pediatric Asthma: An Update on the Evidence from North America. Can Respir J 2017; 2017:8921917. [PMID: 28239256 PMCID: PMC5292365 DOI: 10.1155/2017/8921917] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Revised: 11/09/2016] [Accepted: 12/20/2016] [Indexed: 01/19/2023] Open
Abstract
Introduction. The evidence about the association between asthma and outdoor environmental factors has been inadequate for certain allergens. Even less is known about how these associations vary across seasons and climate regions. We reviewed recent literature from North America for research related to outdoor environmental factors and pediatric asthma, with attention to spatial-temporal variations of these associations. Method. We included indexed literature between years 2010 and 2015 on outdoor environmental factors and pediatric asthma, by searching PubMed. Results. Our search resulted in 33 manuscripts. Studies about the link between pediatric asthma and traffic-related air pollutants (TRAP) consistently confirmed the correlation between TRAP and asthma. For general air pollution, the roles of PM2.5 and CO were consistent across studies. The link between asthma and O3 varied across seasons. Regional variation exists in the role of SO2. The impact of pollen was consistent across seasons, whereas the role of polycyclic aromatic hydrocarbon was less consistent. Discussion. Recent studies strengthened the evidence about the roles of PM2.5, TRAP, CO, and pollen in asthma, while the evidence for roles of PM10-2.5, PM10, O3, NO2, SO2, and polycyclic aromatic hydrocarbon in asthma was less consistent. Spatial-temporal details of the environment are needed in future studies of asthma and environment.
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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.
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Carlsen HK, Boman P, Björ B, Olin AC, Forsberg B. Coarse Fraction Particle Matter and Exhaled Nitric Oxide in Non-Asthmatic Children. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:ijerph13060621. [PMID: 27338437 PMCID: PMC4924078 DOI: 10.3390/ijerph13060621] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 06/08/2016] [Accepted: 06/15/2016] [Indexed: 12/17/2022]
Abstract
Coarse particle matter, PMcoarse, is associated with increased respiratory morbidity and mortality. The aim of this study was to investigate the association between short-term changes in PMcoarse and sub-clininal airway inflammation in children. Healthy children aged 11 years from two northern Swedish elementary schools underwent fraction of exhaled nitrogen oxide (FENO) measurements to determine levels of airway inflammation twice weekly during the study period from 11 April–6 June 2011. Daily exposure to PMcoarse, PM2.5, NO2, NOx, NO and O3 and birch pollen was estimated. Multiple linear regression was used. Personal covariates were included as fixed effects and subjects were included as a random effect. In total, 95 children participated in the study, and in all 493 FENO measurements were made. The mean level of PMcoarse was 16.1 μg/m3 (range 4.1–42.3), and that of O3 was 75.0 μg/m3 (range: 51.3–106.3). That of NO2 was 17.0 μg/m3 (range: 4.7–31.3), NOx was 82.1 μg/m3 (range: 13.3–165.3), and NO was 65 μg/m3 (range: 8.7–138.4) during the study period. In multi-pollutant models an interquartile range increase in 24 h PMcoarse was associated with increases in FENO by between 6.9 ppb (95% confidence interval 0.0–14) and 7.3 ppb (95% confidence interval 0.4–14.9). PMcoarse was associated with an increase in FENO, indicating sub-clinical airway inflammation in healthy children.
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Affiliation(s)
- Hanne Krage Carlsen
- Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, University of Umeå, Umeå 90187, Sweden.
- Section of Occupational and Environmental Medicine, Department of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg 40530, Sweden.
- Centre of Public Health, University of Iceland, Reykjavík 101, Iceland.
| | - Peter Boman
- Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, University of Umeå, Umeå 90187, Sweden.
| | - Bodil Björ
- Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, University of Umeå, Umeå 90187, Sweden.
| | - Anna-Carin Olin
- Section of Occupational and Environmental Medicine, Department of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg 40530, Sweden.
| | - Bertil Forsberg
- Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, University of Umeå, Umeå 90187, Sweden.
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Garcia-Marcos PW, Soriano-Pérez MJ, Perez-Fernández V, Valverde-Molina J. Exhaled nitric oxide in school children: Searching for the lost variability. Allergol Immunopathol (Madr) 2016; 44:206-13. [PMID: 26674385 DOI: 10.1016/j.aller.2015.06.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Accepted: 06/26/2015] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The factors - including asthma and rhinoconjunctivitis - which influence FeNO values in a general population of school children have been studied in order to know to what extent the variability of those values can be explained. METHODS FeNO was measured in a population of 240 school children aged 6-12 years by means of a Niox-Mino™ device in a standardised way. Parents filled in an ISAAC-validated questionnaire of symptoms and environmental factors. Diagnoses were checked against clinical records. Height and weight were measured. A multivariate regression analysis including all variables in the questionnaire was performed, which was followed by two Xi stepwise tests in order to build a predictive model which included the main variables influencing FeNO values. RESULTS Among the 240 children, 10 suffered from asthma, 16 from rhinoconjunctivitis and 15 from both conditions. FeNO values (GM±GSD) in children with rhinoconjunctivitis (19.61±1.20ppb), with asthma (18.62±1.32ppb), and with both conditions (17.62±1.19ppb) tended to be significantly higher than control children (11.42±1.04ppb), p=0.0016, p=0.08 and p=0.01, respectively. The different predictive models were able to explain only 20-27% of FeNO variability. CONCLUSIONS The proportion of FeNO inter-individual variability which can be explained by individual (including suffering from asthma or rhinoconjunctivitis), family, and environmental factors is very low (20-27%). This could have implications on the usefulness of FeNO as a diagnostic tool in asthma.
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Affiliation(s)
- P W Garcia-Marcos
- Department of General Pediatrics, Arrixaca University Children's Hospital, University of Murcia, Murcia, Spain.
| | - M J Soriano-Pérez
- Emergency Department, Los Arcos del Mar Menor University Hospital, San Javier, Murcia, Spain
| | - V Perez-Fernández
- Department of General Pediatrics, Arrixaca University Children's Hospital, University of Murcia, Murcia, Spain
| | - J Valverde-Molina
- Department of Pediatric Respiratory Medicine, Los Arcos del Mar Menor University Hospital, San Javier, Murcia, Spain
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Eckel SP, Zhang Z, Habre R, Rappaport EB, Linn WS, Berhane K, Zhang Y, Bastain TM, Gilliland FD. Traffic-related air pollution and alveolar nitric oxide in southern California children. Eur Respir J 2016; 47:1348-56. [PMID: 26797034 DOI: 10.1183/13993003.01176-2015] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 11/22/2015] [Indexed: 11/05/2022]
Abstract
Mechanisms for the adverse respiratory effects of traffic-related air pollution (TRAP) have yet to be established. We evaluated the acute effects of TRAP exposure on proximal and distal airway inflammation by relating indoor nitric oxide (NO), a marker of TRAP exposure in the indoor microenvironment, to airway and alveolar sources of exhaled nitric oxide (FeNO).FeNO was collected online at four flow rates in 1635 schoolchildren (aged 12-15 years) in southern California (USA) breathing NO-free air. Indoor NO was sampled hourly and linearly interpolated to the time of the FeNO test. Estimated parameters quantifying airway wall diffusivity (DawNO) and flux (J'awNO) and alveolar concentration (CANO) sources of FeNO were related to exposure using linear regression to adjust for potential confounders.We found that TRAP exposure indoors was associated with elevated alveolar NO. A 10 ppb higher indoor NO concentration at the time of the FeNO test was associated with 0.10 ppb higher average CANO (95% CI 0.04-0.16) (equivalent to a 7.1% increase from the mean), 4.0% higher J'awNO (95% CI -2.8-11.3) and 0.2% lower DawNO (95% CI -4.8-4.6).These findings are consistent with an airway response to TRAP exposure that was most marked in the distal airways.
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Affiliation(s)
- Sandrah P Eckel
- Dept of Preventive Medicine, University of Southern California, Los Angeles, CA, USA
| | - Zilu Zhang
- Dept of Preventive Medicine, University of Southern California, Los Angeles, CA, USA
| | - Rima Habre
- Dept of Preventive Medicine, University of Southern California, Los Angeles, CA, USA
| | - Edward B Rappaport
- Dept of Preventive Medicine, University of Southern California, Los Angeles, CA, USA
| | - William S Linn
- Dept of Preventive Medicine, University of Southern California, Los Angeles, CA, USA
| | - Kiros Berhane
- Dept of Preventive Medicine, University of Southern California, Los Angeles, CA, USA
| | - Yue Zhang
- Dept of Internal Medicine, University of Utah, Salt Lake City, UT, USA
| | - Theresa M Bastain
- Dept of Preventive Medicine, University of Southern California, Los Angeles, CA, USA
| | - Frank D Gilliland
- Dept of Preventive Medicine, University of Southern California, Los Angeles, CA, USA
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Community views about the health and exposure of children living near a coal ash storage site. J Community Health 2015; 40:357-63. [PMID: 25204532 DOI: 10.1007/s10900-014-9943-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Coal ash, a waste product generated from burning coal, is composed of small particles comprised of highly toxic elements. Coal ash particles contain heavy metals such as arsenic, lead, and mercury, as well as polyaromatic hydrocarbons and radioactive elements. Most coal ash is stored in landfills and ponds, often located in close proximity to low income communities. Currently, there are no federal regulations governing the storage and transport of coal ash; however the Environmental Protection Agency proposed a coal ash rule in 2010, which could designate coal ash as a hazardous waste. This is the first article to assess community impact from coal ash storage, by exploring parents' perceptions of their children's health and its relationship to chronic exposure to coal ash. This was a community-based study involving four neighborhoods adjacent to a large coal ash storage facility. Focus groups were conducted with community members and the transcripts were analyzed to identify themes regarding children's health, children's exposure to coal ash, and behaviors done to protect children from exposure. The majority of parents (85 %) reported that their children suffered from health conditions; specifically respiratory and emotional and behavioral disorders. Parents highlighted ways in which their children were exposed to coal ash, although many felt they were constantly exposed just by living in the area. Parents felt strongly that exposure to coal ash from the landfill is affecting the health and well-being of their children. Some parents attempted protective behaviors, but most parents felt helpless in reducing children's exposure.
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Zhang Y, Berhane K, Eckel SP, Salam MT, Linn WS, Rappaport EB, Bastain TM, Gilliland FD. Determinants of Children's Exhaled Nitric Oxide: New Insights from Quantile Regression. PLoS One 2015. [PMID: 26214692 PMCID: PMC4516246 DOI: 10.1371/journal.pone.0130505] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
While the fractional concentration of exhaled nitric oxide (FeNO) has proven useful in asthma research, its exact role in clinical care remains unclear, in part due to unexplained inter-subject heterogeneity. In this study, we assessed the hypothesis that the effects of determinants of the fractional concentration of exhaled nitric oxide (FeNO) vary with differing levels of FeNO. In a population-based cohort of 1542 school children aged 12–15 from the Southern California Children's Health Study, we used quantile regression to investigate if the relationships of asthma, socio-demographic and clinical covariates with FeNO vary across its distribution. Differences in FeNO between children with and without asthma increased steeply as FeNO increased (Estimated asthma effects (in ppb) at selected 20th, 50th and 80th percentiles of FeNO are 2.4, 6.3 and 22.2, respectively) but the difference was steeper with increasing FeNO in boys and in children with active rhinitis (p-values<0.01). Active rhinitis also showed significantly larger effects on FeNO at higher concentrations of FeNO (Estimated active rhinitis effects (in ppb) at selected 20th, 50th and 80th percentiles of FeNO are 2.1, 5.7 and 14.3, respectively). Boys and children of Asian descent had higher FeNO than girls and non-Hispanic whites; these differences were significantly larger in those with higher FeNO (p-values<0.01). In summary, application of quantile regression techniques provides new insights into the determinants of FeNO showing substantially varying effects in those with high versus low concentrations.
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Affiliation(s)
- Yue Zhang
- Department of Internal Medicine, University of Utah, Salt Lake City, Utah, United States of America
- Department of Family and Preventive Medicine, University of Utah, Salt Lake City, Utah, United States of America
- Veteran Affairs Salt Lake City Health Care System, Salt Lake City, Utah, United States of America
- * E-mail:
| | - Kiros Berhane
- Department of Preventive Medicine, University of Southern California, Los Angeles, California, United States of America
| | - Sandrah P. Eckel
- Department of Preventive Medicine, University of Southern California, Los Angeles, California, United States of America
| | - Muhammad T. Salam
- Department of Preventive Medicine, University of Southern California, Los Angeles, California, United States of America
- Department of Psychiatry, Kern Medical Center, Bakersfield, California, United States of America
| | - William S. Linn
- Department of Preventive Medicine, University of Southern California, Los Angeles, California, United States of America
| | - Edward B. Rappaport
- Department of Preventive Medicine, University of Southern California, Los Angeles, California, United States of America
| | - Theresa M. Bastain
- Department of Preventive Medicine, University of Southern California, Los Angeles, California, United States of America
| | - Frank D. Gilliland
- Department of Preventive Medicine, University of Southern California, Los Angeles, California, United States of America
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Kim HB, Eckel SP, Kim JH, Gilliland FD. Exhaled NO: Determinants and Clinical Application in Children With Allergic Airway Disease. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2015; 8:12-21. [PMID: 26540497 PMCID: PMC4695403 DOI: 10.4168/aair.2016.8.1.12] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 04/29/2015] [Indexed: 11/20/2022]
Abstract
Nitric oxide (NO) is endogenously released in the airways, and the fractional concentration of NO in exhaled breath (FeNO) is now recognized as a surrogate marker of eosinophilic airway inflammation that can be measured using a noninvasive technique suitable for young children. Although FeNO levels are affected by several factors, the most important clinical determinants of increased FeNO levels are atopy, asthma, and allergic rhinitis. In addition, air pollution is an environmental determinant of FeNO that may contribute to the high prevalence of allergic disease. In this review, we discuss the mechanism for airway NO production, methods for measuring FeNO, and determinants of FeNO in children, including host and environmental factors such as air pollution. We also discuss the clinical utility of FeNO in children with asthma and allergic rhinitis and further useful directions using FeNO measurement.
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Affiliation(s)
- Hyo Bin Kim
- Department of Pediatrics, Inje University Sanggye Paik Hospital, Seoul, Korea
| | - Sandrah P Eckel
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, California, USA
| | - Jeong Hee Kim
- Department of Pediatrics, Inha University School of Medicine, Incheon, Korea. .,Environmental Health Center for Allergic Rhinitis, Inha University Hospital, Ministry of Environment, Incheon, Korea
| | - Frank D Gilliland
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, California, USA.
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Johannson KA, Balmes JR, Collard HR. Air pollution exposure: a novel environmental risk factor for interstitial lung disease? Chest 2015; 147:1161-1167. [PMID: 25846532 PMCID: PMC4388120 DOI: 10.1378/chest.14-1299] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Accepted: 09/22/2014] [Indexed: 11/01/2022] Open
Abstract
Air pollution exposure is a well-established risk factor for several adverse respiratory outcomes, including airways diseases and lung cancer. Few studies have investigated the relationship between air pollution and interstitial lung disease (ILD) despite many forms of ILD arising from environmental exposures. There are potential mechanisms by which air pollution could cause, exacerbate, or accelerate the progression of certain forms of ILD via pulmonary and systemic inflammation as well as oxidative stress. This article will review the current epidemiologic and translational data supporting the plausibility of this relationship and propose a new conceptual framework for characterizing novel environmental risk factors for these forms of lung disease.
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Affiliation(s)
- Kerri A Johannson
- Department of Medicine, University of California, San Francisco, CA; Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - John R Balmes
- Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, Berkeley, CA
| | - Harold R Collard
- Department of Medicine, University of California, San Francisco, CA.
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Chen Z, Salam MT, Eckel SP, Breton CV, Gilliland FD. Chronic effects of air pollution on respiratory health in Southern California children: findings from the Southern California Children's Health Study. J Thorac Dis 2015; 7:46-58. [PMID: 25694817 DOI: 10.3978/j.issn.2072-1439.2014.12.20] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Accepted: 11/20/2014] [Indexed: 01/05/2023]
Abstract
Outdoor air pollution is one of the leading contributors to adverse respiratory health outcomes in urban areas around the world. Children are highly sensitive to the adverse effects of air pollution due to their rapidly growing lungs, incomplete immune and metabolic functions, patterns of ventilation and high levels of outdoor activity. The Children's Health Study (CHS) is a continuing series of longitudinal studies that first began in 1993 and has focused on demonstrating the chronic impacts of air pollution on respiratory illnesses from early childhood through adolescence. A large body of evidence from the CHS has documented that exposures to both regional ambient air and traffic-related pollutants are associated with increased asthma prevalence, new-onset asthma, risk of bronchitis and wheezing, deficits of lung function growth, and airway inflammation. These associations may be modulated by key genes involved in oxidative-nitrosative stress pathways via gene-environment interactions. Despite successful efforts to reduce pollution over the past 40 years, air pollution at the current levels still brings many challenges to public health. To further ameliorate adverse health effects attributable to air pollution, many more toxic pollutants may require regulation and control of motor vehicle emissions and other combustion sources may need to be strengthened. Individual interventions based on personal susceptibility may be needed to protect children's health while control measures are being implemented.
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Affiliation(s)
- Zhanghua Chen
- 1 Department of Preventive Medicine, Division of Environmental Health, 2 Department of Preventive Medicine, Division of Biostatistics, Keck School of Medicine, University of Southern California, Los Angeles, CA 90032, USA
| | - Muhammad T Salam
- 1 Department of Preventive Medicine, Division of Environmental Health, 2 Department of Preventive Medicine, Division of Biostatistics, Keck School of Medicine, University of Southern California, Los Angeles, CA 90032, USA
| | - Sandrah P Eckel
- 1 Department of Preventive Medicine, Division of Environmental Health, 2 Department of Preventive Medicine, Division of Biostatistics, Keck School of Medicine, University of Southern California, Los Angeles, CA 90032, USA
| | - Carrie V Breton
- 1 Department of Preventive Medicine, Division of Environmental Health, 2 Department of Preventive Medicine, Division of Biostatistics, Keck School of Medicine, University of Southern California, Los Angeles, CA 90032, USA
| | - Frank D Gilliland
- 1 Department of Preventive Medicine, Division of Environmental Health, 2 Department of Preventive Medicine, Division of Biostatistics, Keck School of Medicine, University of Southern California, Los Angeles, CA 90032, USA
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