Indoor nitrous acid and respiratory symptoms and lung function in adults

Hourly effect of atmospheric reactive nitrogen species on the onset of acute ischemic stroke: Insight from the Shanghai Stroke Service System Database

Acute ischemic stroke (AIS) is one of the most predominant causes of mortality and disability in China. Significant uncertainties in stroke diagnosis and time of onset have resulted in inconsistent evidence on the association between ambient air pollution and the risk of AIS. The present study aimed to evaluate the impact of air pollution on AIS onset based on high time-resolution air pollution data and a stroke-specific registry across the past five years. Hourly concentrations of PM2.5, PM10, O3, SO2, CO, NO2 and nitrous acid (HONO) were monitored from 2017 to 2021, with which a distributed lag non-linear model and conditional logistic regression models coupled with a time-stratified case-crossover design were applied to 106,623 AIS cases recorded in the Shanghai Stroke Service (4S) database during the study period. Results from the conditional logistic regression models indicate that acute exposure to PM2.5, PM10, SO2, NO2 and HONO was found to be associated with AIS onset, respectively. The corresponding cumulative excessive risks of AIS onset were 0.8 %, 1 %, 2.4 %, 2.1 % and 1.8 % for each interquartile range increase in the respective concentration. The longest lag-effect (up to 13 h) was observed for reactive nitrogen species (RNS), such as NO2 and HONO, which remained robust in two-pollutant models. Similar important role of RNS in AIS onset were confirmed by the distributed lag non-linear model. By demonstrating the transient effect of ambient air pollution on AIS, especially the relationships between RNS and AIS for the first time, our study provides stringent evidence for future mitigation strategies for pollution emission and public health.

A review of indoor nitrous acid (HONO) pollution: Measurement techniques, pollution characteristics, sources, and sinks

Indoor air quality is of major concern for human health and well-being. Nitrous acid (HONO) is an emerging indoor pollutant, and its indoor mixing ratios are usually higher than outdoor levels, ranging from a few to tens of parts per billion (ppb). HONO exhibits adverse effects to human health due to its respiratory toxicity and mutagenicity. Additionally, HONO can easily undergo photodissociation by ultraviolet light to produce hydroxyl radicals (OH•), which in turn trigger a series of further photochemical oxidation reactions of primary or secondary pollutants. The accumulation of indoor HONO can be attributed to both direct emissions from combustion sources, such as cooking, and secondary formation resulting from enhanced heterogeneous reactions of NOx on indoor surfaces. During the day, the primary sink of indoor HONO is photolysis to OH• and NO. Moreover, adsorption and/or reaction on indoor surfaces, and diffusion to the outside atmosphere contribute to HONO loss both during the day and at night. The level of indoor HONO is also affected by human occupancy, which can influence household factors such as temperature, humidity, light irradiation, and indoor surfaces. This comprehensive review article summarized the research progress on indoor HONO pollution based on indoor air measurements, laboratory studies, and model simulations. The environmental and health effects were highlighted, measurement techniques were summarized, pollution levels, sources and sinks, and household influencing factors were discussed, and the prospects in the future were proposed.

Effects of air pollutants and temperature on the number of asthma outpatient visits in Hohhot, China

Although numerous studies have linked asthma to air temperature and pollution, few studies have examined their interactive effects on asthma outpatient visits. This study investigated how air pollutants and their interactions with temperature affect asthma outpatient visits in a city in northern Chinaduring the time period 2018 - 2020 . . As the results, 24,163 asthma outpatients were recorded, a 10-μg/m3 increase in PM10, PM2.5, SO2, and NO2 concentrations was associated with significant increases in visits of 3.47% (95% CI: 2.35%-4.60%), 0.83% (95% CI: 0.36%-1.30%), 3.17% (95% CI: 1.47%-4.90%), and 8.90% (95% CI: 6.09%-11.79%), respectively. The effect was stronger in females than males, and stronger in the elderly (≥65 years) than among the young. The interaction between low temperatures and high air pollution levels significantly increased the number of asthma outpatient visits. This study emphasizesthe importance of reducing air pollution in order to lessen the effects of cold.

Monitoring indoor air quality using smart integrated gas sensor module (IGSM) for improving health in COPD patients

Technology advancement, industrialisation, and globalisation have been significant reasons for air pollution outdoors and indoors. It may surprise us that we spend about 80% of our time indoors breathing toxic, stale, polluted air, making us sluggish and fretful. In contrast to outdoor air, indoor air does not recycle consistently. It traps and builds pollutants from wood and coal stoves, furniture and building materials, paints and solvents, cigarette smoke, and cleaning supplies. The prolonged exposure to these hidden pollutants can prompt respiratory disorders such as lung disease, pneumonitis, asthma, pulmonary hypertension, and chronic obstructive pulmonary disease (COPD). It is enduring and is not curable, which has been a threat to humanity for ages. COPD's major cause is airborne particulate matter and other toxic compounds emitted from indoor and outdoor sources. Outdoor air pollution can be controlled only by acquiring changes in the vast population, wherein for indoor, every individual may create a major impact on improving air purity, thereby promoting health. The proposed design model for monitoring indoor air quality was tested in a normal and stimulating environment where we live. Parameters tested included temperature, humidity, amount of PM2.5, and the concentration of CO, CO₂, and NH₃. These parameters were monitored for five to 6 h per day for 8 days. Results indicate that the total air quality lies in the moderate range. Further study will be helpful to utilise this module as an effective Indoor air quality (IAQ) monitoring system. HIGHLIGHTS: • A simple, effective, inexpensive integrated gas sensor module (IGSM) has been proposed in this study to monitor the indoor air quality index (IAQI). • Indoor air quality was tested in a normal and stimulating environment for 8 days. • The integrated gas sensor module (IGSM) was composed of sensors in series, and the outputs for the respective parameter were measured easily. • Among the parameters tested, CO and PM2.5 lie in the moderate range, while other pollutants within the normal range reveal that the tested air quality is moderate.

Gas-Phase Nitrous Acid (HONO) Is Controlled by Surface Interactions of Adsorbed Nitrite (NO2-) on Common Indoor Material Surfaces

Nitrous acid (HONO) is a household pollutant exhibiting adverse health effects and a major source of indoor OH radicals under a variety of lighting conditions. The present study focuses on gas-phase HONO and condensed-phase nitrite and nitrate formation on indoor surface thin films following heterogeneous hydrolysis of NO₂, in the presence and absence of light, and nitrate (NO₃^-) photochemistry. These thin films are composed of common building materials including zeolite, kaolinite, painted walls, and cement. Gas-phase HONO is measured using an incoherent broadband cavity-enhanced ultraviolet absorption spectrometer (IBBCEAS), whereby condensed-phase products, adsorbed nitrite and nitrate, are quantified using ion chromatography. All of the surface materials used in this study can store nitrogen oxides as nitrate, but only thin films of zeolite and cement can act as condensed-phase nitrite reservoirs. For both the photo-enhanced heterogeneous hydrolysis of NO₂ and nitrate photochemistry, the amount of HONO produced depends on the material surface. For zeolite and cement, little HONO is produced, whereas HONO is the major product from kaolinite and painted wall surfaces. An important result of this study is that surface interactions of adsorbed nitrite are key to HONO formation, and the stronger the interaction of nitrite with the surface, the less gas-phase HONO produced.

Nitrous acid (HONO) emission factors for diesel vehicles determined using a chassis dynamometer

Vehicle exhaust gases are important sources of nitrous acid (HONO). In this study, HONO in diesel vehicle exhaust was measured by incoherent broadband cavity-enhanced absorption spectroscopy using a chassis dynamometer system. The mean HONO concentrations in exhaust gases emitted by passenger cars and light-duty trucks were high when the after treatment devices were not fully working during the warming up period. The HONO/NOx ratio is a good index of HONO formation. The HONO/NOx ratios were 9.7 × 10^-3-18.1 × 10^-3, and were higher than what we found in a previous study. The estimated HONO emission factors were 7.71-64.70 mg (kg fuel)^-1, and were lower than were found in previous studies. The results indicated that the frequency particulate matter is removed from a diesel particle filter affects the HONO concentration in the emitted gases and the HONO emission factor.

Association of subjective health symptoms with indoor air quality in European office buildings: The OFFICAIR project

The aim of this study was to explore the association between the building-related occupants' reported health symptoms and the indoor pollutant concentrations in a sample of 148 office rooms, within the framework of the European OFFICAIR research project. A large field campaign was performed in 37 office buildings among eight countries, which included (a) 5-day air sampling of volatile organic compounds (VOCs), aldehydes, ozone, and NO₂ (b) collection of information from 1299 participants regarding their personal characteristics and health perception at workplace using online questionnaires. Stepwise and multilevel logistic regressions were applied to investigate associations between health symptoms and pollutant concentrations considering personal characteristics as confounders. Occupants of offices with higher pollutant concentrations were more likely to report health symptoms. Among the studied VOCs, xylenes were associated with general (such as headache and tiredness) and skin symptoms, ethylbenzene with eye irritation and respiratory symptoms, a-pinene with respiratory and heart symptoms, d-limonene with general symptoms, and styrene with skin symptoms. Among aldehydes, formaldehyde was associated with respiratory and general symptoms, acrolein with respiratory symptoms, propionaldehyde with respiratory, general, and heart symptoms, and hexanal with general SBS. Ozone was associated with almost all symptom groups.

Cooking, Bleach Cleaning, and Air Conditioning Strongly Impact Levels of HONO in a House

The relative importance of common activities on indoor nitrous acid (HONO) mixing ratios was explored during high time resolution, month-long measurements by chemical ionization mass spectrometry in a previously unoccupied house. Indoor HONO varied from 0.2 to 84.0 ppb (mean: 5.5 ppb; median 3.8 ppb), an order of magnitude higher than simultaneously measured outdoor values, indicating important indoor sources. They agree well with simultaneous measurements of HONO by Laser-Photofragmentation/Laser-Induced Fluorescence. Before any combustion activities, the mixing ratio of 3.0 ± 0.3 ppb is indicative of secondary sources such as multiphase formation from NO₂. Cooking (with propane gas), especially the use of an oven, led to significant enhancements up to 84 ppb, with elevated mixing ratios persisting for a few days due to slow desorption from indoor surface reservoirs. Floor bleach cleaning led to prolonged, substantial decreases of up to 71-90% due to reactive processes. Air conditioning modulated HONO mixing ratios driven by condensation to wet surfaces in the AC unit. Enhanced ventilation also significantly lowered mixing ratios. Other conditions including human occupancy, ozone addition, and cleaning with terpene, natural product, and vinegar cleaners had a much smaller influence on HONO background levels measured following these activities.

Lowest observed adverse effect level of pulmonary pathological alterations due to nitrous acid exposure in guinea pigs

BACKGROUND

We previously demonstrated that continuous exposure to nitrous acid gas (HONO) for 4 weeks, at a concentration of 3.6 parts per million (ppm), induced pulmonary emphysema-like alterations in guinea pigs. In addition, we found that HONO affected asthma symptoms, based on the measurement of respiratory function in rats exposed to 5.8 ppm HONO. This study aimed to investigate the dose-response effects of HONO exposure on the histopathological alterations in the respiratory tract of guinea pigs to determine the lowest observed adverse effect level (LOAEL) of HONO.

METHODS

We continuously exposed male Hartley guinea pigs (n = 5) to four different concentrations of HONO (0.0, 0.1, 0.4, and 1.7 ppm) for 4 weeks (24 h/day). We performed histopathological analysis by observing lung tissue samples. We examined samples from three guinea pigs in each group under a light microscope and measured the alveolar mean linear intercept (Lm) and the thickness of the bronchial smooth muscle layer. We further examined samples from two guinea pigs in each group under a scanning electron microscope (SEM) and a transmission electron microscope (TEM).

RESULTS

We observed the following dose-dependent changes: pulmonary emphysema-like alterations in the centriacinar regions of alveolar ducts, significant increase in Lm in the 1.7 ppm HONO-exposure group, tendency for hyperplasia and pseudostratification of bronchial epithelial cells, and extension of the bronchial epithelial cells and smooth muscle cells in the alveolar duct regions.

CONCLUSIONS

These histopathological findings suggest that the LOAEL of HONO is < 0.1 ppm.

Evaluation and impact factors of indoor and outdoor gas-phase nitrous acid under different environmental conditions

As an important indoor pollutant, nitrous acid (HONO) can contribute to the concentration of indoor OH radicals by photolysis via sunlight penetrating into indoor environments, thus affecting the indoor oxidizing capability. In order to investigate the concentration of indoor HONO and its impact factors, three different indoor environments and two different locations in urban and suburban areas were selected to monitor indoor and outdoor pollutants simultaneously, including HONO, NO, NO₂, nitrogen oxides (NO_x), O₃, and particle mass concentration. In general, the concentration of indoor HONO was higher than that outdoors. In the urban area, indoor HONO with high average concentration (7.10 ppbV) was well-correlated with the temperature. In the suburban area, the concentration of indoor HONO was only about 1-2 ppbV, and had a good correlation with indoor relative humidity. It was mainly attributed to the heterogeneous reaction of NO₂ on indoor surfaces. The sunlight penetrating into indoor environments from outside had a great influence on the concentration of indoor HONO, leading to a concentration of indoor HONO close to that outdoors.

Association between indoor nitrous acid, outdoor nitrogen dioxide, and asthma attacks: results of a pilot study

The association between nitrogen dioxide (NO₂) and asthma has been investigated. However, conventional NO₂ assays measure nitrous acid (HONO) as NO₂. In this pilot epidemiological observational study, we assessed exposure to indoor HONO and some air pollutants in pediatric asthma patients and examined possible association between exposure and asthma symptoms. Indoor HONO and nitric oxide (NO), which are primarily generated by the combustion of certain substances, were significantly associated with asthma attacks in 2010. In 2010, indoor HONO was closely correlated with indoor NO than with outdoor NO₂. Conversely, in 2012, indoor HONO was closely correlated with outdoor NO₂ and NO than with indoor NO₂ and NO. Outdoor NO₂ was significantly associated with asthma attacks in 2012. Our results highlight the need for further epidemiological studies of the association between indoor HONO and asthma symptoms using multivariate analyses to examine the role of NO₂ in asthma symptoms. Abbreviations: CXCL1: the chemokine (C-X-C motif) ligand 1; EP: the entire study period; FP: the first half of study period; HONO: nitrous acid; NO: nitric oxide; NO₂: nitrogen dioxide; OH radical: hydroxyl radical; SP: the second half of study period; TNF-α: tumor necrosis factor-α; US EPA: United States Environmental Protection Agency; WHO: World Health Organization.

Impacts of six potential HONO sources on HOx budgets and SOA formation during a wintertime heavy haze period in the North China Plain

The Weather Research and Forecasting/Chemistry (WRF-Chem) model updated with six potential HONO sources (i.e., traffic, soil, biomass burning and indoor emissions, and heterogeneous reactions on aerosol and ground surfaces) was used to quantify the impact of the six potential HONO sources on the production and loss rates of OH and HO₂ radicals and the concentrations of secondary organic aerosol (SOA) in the Beijing-Tianjin-Heibei (BTH) region of China during a winter heavy haze period of Nov. 29-Dec. 3, 2017. The updated WRF-Chem model well simulated the observed HONO concentrations at the Wangdu site, especially in the daytime, and well reproduced the observed diurnal variations of regional-mean O₃ in the BTH region. The traffic emission source was an important HONO source during nighttime but not significant during daytime, heterogeneous reactions on ground/aerosol surfaces were important during nighttime and daytime. We found that the six potential HONO sources led to a significant enhancement in the dominant production and loss rates of HO_x on the wintertime heavy haze and nonhaze days (particularly on the heavy haze day), an enhancement of 5-25 μg m^-3 (75-200%) in the ground SOA in the studied heavy haze event, and an enhancement of 2-15 μg m^-3 in the meridional-mean SOA on the heavy haze day, demonstrating that the six potential HONO sources accelerate the HO_x cycles and aggravate haze events. HONO was the key precursor of primary OH in the BTH region in the studied wintertime period, and the photolysis of HONO produced a daytime mean OH production rate of 2.59 ppb h^-1 on the heavy haze day, much higher than that of 0.58 ppb h^-1 on the nonhaze day. Anthropogenic SOA dominated in the BTH region in the studied wintertime period, and its main precursors were xylenes (42%), BIGENE (31%) and toluene (21%).

Impacts of potential HONO sources on the concentrations of oxidants and secondary organic aerosols in the Beijing-Tianjin-Hebei region of China

We first coupled indoor emissions and biomass burning emissions into the WRF-Chem model besides the other four potential HONO sources (i.e., traffic emissions, soil emissions, and heterogeneous reactions on aerosol and ground surfaces). Eight simulations were performed in the Beijing-Tianjin-Hebei region (BTH) of China in August of 2006. The results indicated that traffic emissions and heterogeneous reactions on ground and aerosol surfaces were the key sources of HONO at night, accounting for ~41%, ~27% and ~20% of the nighttime simulated HONO concentrations, respectively. The two heterogeneous reactions were the main contributors during the day, accounting for ~66% (ground surfaces) and ~19% (aerosol surfaces) of the daytime simulated HONO concentrations. The indoor emission source could be the second largest contributor during nighttime and led to a maximum hourly enhancement of 0.59 and 0.76 ppb at the central urban sites of Beijing and Tianjin, respectively. The six potential HONO sources enhanced the monthly meridional-mean concentrations of O₃, OH and HO₂ by 5-44%, 5~>150% and 5~>200%, respectively, leading to an enhancement of 1-3 μg m^-3 in the monthly averaged concentrations of secondary organic aerosol (SOA), and that of 10-35 μg m^-3 in the largest hourly concentrations of SOA within 1000 m above the ground in the BTH. The major precursors of the enhanced SOA were Xylenes, Toluene and BIGALK (lumped alkanes C > 3). The inclusion of the six potential HONO sources in the WRF-Chem model considerably improved the HONO simulations at both urban and suburban sites compared with the corresponding observations. The above results suggested that the six potential HONO sources significantly enhanced the atmospheric oxidation capacity and thus accelerated SOA chemical aging in the BTH of China, leading to large enhancements in the hourly SOA concentrations and aggravating haze events in this region.

Time-Resolved Measurements of Nitric Oxide, Nitrogen Dioxide, and Nitrous Acid in an Occupied New York Home

Indoor oxidizing capacity in occupied residences is poorly understood. We made simultaneous continuous time-resolved measurements of ozone (O₃), nitric oxide (NO), nitrogen dioxide (NO₂), and nitrous acid (HONO) for two months in an occupied detached home with gas appliances in Syracuse, NY. Indoor NO and HONO mixing ratios were higher than those outdoors, whereas O₃ was much lower (sub-ppbv) indoors. Cooking led to peak NO, NO₂, and HONO levels 20-100 times greater than background levels; HONO mixing ratios of up to 50 ppbv were measured. Our results suggest that many reported NO₂ levels may have a large positive bias due to HONO interference. Nitrous acid, NO₂, and NO were removed from indoor air more rapidly than CO₂, indicative of reactive removal processes or surface uptake. We measured spectral irradiance from sunlight entering the residence through glass doors; hydroxyl radical (OH) production rates of (0.8-10) × 10⁷ molecules cm^-3 s^-1 were calculated in sunlit areas due to HONO photolysis, in some cases exceeding rates expected from ozone-alkene reactions. Steady-state nitrate radical (NO₃) mixing ratios indoors were predicted to be lower than 1.65 × 10⁴ molecules cm^-3. This work will help constrain the temporal nature of oxidant concentrations in occupied residences and will improve indoor chemistry models.

Effects of nitrous acid exposure on baseline pulmonary resistance and Muc5ac in rats

We examined the baseline pulmonary resistance (RLung), baseline dynamic lung compliance (Cdyn), cytokine inductions, and histological alterations in rats exposed to nitrous acid (HONO) with secondary products of nitrogen dioxide (NO₂) and nitric oxide (NO) to assess its biological effects. We exposed three groups of nine male F344 rats to different doses of HONO for six weeks (24 h/day). The cumulative values of HONO concentration were measured twice. The average concentrations of nitrogen oxide for each group were 5.8 parts per million (ppm) HONO with secondary products of 0.7 ppm NO₂ and 2.3 ppm NO, 4.1 ppm HONO with 0.1 ppm NO₂ and 0.6 ppm NO, and a clean air control. We measured baseline RLung and baseline Cdyn using tracheal cannulation. A tracheal tube was inserted into the trachea by tracheostomy, and lung function measurements (baseline RLung and baseline Cdyn) were conducted in mechanically ventilated rats. We measured mRNA levels of Cxcl-1, TNF-α, and Muc5ac in the right lung using quantitative RT-PCR, and observed histological alterations and the alveolar mean linear intercept (Lm) on the left lung. Our results demonstrated that HONO exposure significantly increased baseline RLung, Lm and Muc5ac expression, but did not affect baseline Cdyn or expression of Cxcl-1 and TNF-α. Further, we identified bronchial smooth muscle hypertrophy, pulmonary emphysema-like alterations in the alveolar duct centriacinar regions, and increased goblet cells in HONO-exposed rats. The present results suggest that HONO (with secondary products) adversely affects respiratory function, but that these pathologies may be unrelated to inflammation.

Volatile organic compounds (VOC), formaldehyde and nitrogen dioxide (NO2) in schools in Johor Bahru, Malaysia: Associations with rhinitis, ocular, throat and dermal symptoms, headache and fatigue

This paper studied associations between volatile organic compounds (VOC), formaldehyde, nitrogen dioxide (NO₂) and carbon dioxide (CO₂) in schools in Malaysia and rhinitis, ocular, nasal and dermal symptoms, headache and fatigue among students. Pupils from eight randomly selected junior high schools in Johor Bahru, Malaysia (N=462), participated (96%). VOC, formaldehyde and NO₂ were measured by diffusion sampling (one week) and VOC also by pumped air sampling during class. Associations were calculated by multi-level logistic regression adjusting for personal factors, the home environment and microbial compounds in the school dust. The prevalence of weekly rhinitis, ocular, throat and dermal symptoms were 18.8%, 11.6%, 15.6%, and 11.1%, respectively. Totally 20.6% had weekly headache and 22.1% fatigue. Indoor CO₂ were low (range 380-690 ppm). Indoor median NO₂ and formaldehyde concentrations over one week were 23μg/m³ and 2.0μg/m³, respectively. Median indoor concentration of toluene, ethylbenzene, xylene, and limonene over one week were 12.3, 1.6, 78.4 and 3.4μg/m³, respectively. For benzaldehyde, the mean indoor concentration was 2.0μg/m³ (median<1μg/m³). Median indoor levels during class of benzene and cyclohexane were 4.6 and 3.7μg/m³, respectively. NO₂ was associated with ocular symptoms (p<0.001) and fatigue (p=0.01). Formaldehyde was associated with ocular (p=0.004), throat symptoms (p=0.006) and fatigue (p=0.001). Xylene was associated with fatigue (p<0.001) and benzaldehyde was associated with headache (p=0.03). In conclusion, xylene, benzaldehyde, formaldehyde and NO₂ in schools can be risk factors for ocular and throat symptoms and fatigue among students in Malaysia. The indoor and outdoor levels of benzene were often higher than the EU standard of 5μg/m³.

Determination of nitrous acid emission factors from a gasoline vehicle using a chassis dynamometer combined with incoherent broadband cavity-enhanced absorption spectroscopy

Nitrous acid (HONO) is a well-known source of hydroxyl radicals in the troposphere. Vehicle exhaust is considered to be one of the primary emission sources of HONO. In this study, measurements of HONO in gasoline vehicle exhaust were carried out using a chassis dynamometer combined with incoherent broadband cavity-enhanced absorption spectroscopy. When catalysts were warm, concentrations of HONO were higher than those prior to catalysts warming. Other species, such as CO, and total hydrocarbons (THCs), showed the opposite pattern. There were no correlations evident between HONO and other trace species concentrations immediately after emission. The HONO/NOx ratio, a good proxy for the formation of HONO in atmosphere, ranged from 1.1 to 6.8×10^-3, which was consistent with previous studies. HONO emission factors (EFs) were calculated to be 0.01-3.6mgkg^-1 fuel, which was different from the vehicle's specifications and those reported under different driving cycles. Annual HONO emissions in Japan were estimated using the calculated EFs and other statistical data.

Effects of Lung Support Formula on respiratory symptoms among older adults: results of a three-month follow-up study in Shanghai, China

Background

With the acceleration of industrialization in low or middle-income nations, the prevalence of respiratory symptoms among older adults is even more significant now in China. Contemporary treatments using Western medicine, such as anti-inflammatory regimens, may be effective in relieving the symptoms, but may have unexpected side effects. Some natural products may be effective in improving respiratory functions, yet their efficacies remain to be examined in randomized, placebo-controlled studies. To evaluate the effects of Lung Support Formula, a nutritional supplement which contains naturally derived Chinese herbal medicines, we conducted a clinical study among older adults in Shanghai, China.

Methods

A total of 100 patients over 50 years old were recruited and blindly randomized into the treatment or control group. The subjects took either 1 Lung Support Formula capsule or a placebo capsule twice a day for 12 weeks. All subjects were followed-up every 4 weeks to perform investigative and clinical examinations. Repeated measure of analysis of variance was employed to compare the trend of respiratory symptoms scores between the 2 groups during 12 weeks of follow-up.

Results

Fifty patients from the treatment group and 49 patients in the control group completed the 3-month follow-up. No adverse events were reported in the treatment duration. The percentage of patients reported to have chronic cough, chronic expectoration and chronic bronchitis were significantly decreased in the treatment group when compared with baseline after a 3-month intervention (P < 0.05). The respiratory symptoms scores declined gradually with the lapse of time (P < 0.05) in the treatment group and there were no significant changes in the control group by repeated measure of analysis of variance (P > 0.05).

Conclusions

The clinical research shows that use of Lung Support Formula shows significant improvements of respiratory symptoms and is well-tolerated in short-term use among older adults. An additional study involving more subjects and longer-term follow-up would be needed to provide convincing evidence of the improvement of respiratory symptoms in the treatment group.

Urban vs. rural factors that affect adult asthma

In this review, our aim was to examine the influence of geographic variations on asthma prevalence and morbidity among adults, which is important for improving our understanding, identifying the burden, and for developing and implementing interventions aimed at reducing asthma morbidity. Asthma is a complex inflammatory disease of multifactorial origin, and is influenced by both environmental and genetic factors. The disparities in asthma prevalence and morbidity among the world's geographic locations are more likely to be associated with environmental exposures than genetic differences. In writing this article, we found that the indoor factors most consistently associated with asthma and asthma-related symptoms in adults included fuel combustion, mold growth, and environmental tobacco smoke in both urban and rural areas. Asthma and asthma-related symptoms occurred more frequently in urban than in rural areas, and that difference correlated with environmental risk exposures, SES, and healthcare access. Environmental risk factors to which urban adults were more frequently exposed than rural adults were dust mites,high levels of vehicle emissions, and a westernized lifestyle.Exposure to indoor biological contaminants in the urban environment is common.The main risk factors for developing asthma in urban areas are atopy and allergy to house dust mites, followed by allergens from animal dander. House dust mite exposure may potentially explain differences in diagnosis of asthma prevalence and morbidity among adults in urban vs. rural areas. In addition, the prevalence of asthma morbidity increases with urbanization. High levels of vehicle emissions,Western lifestyles and degree of urbanization itself, may affect outdoor and thereby indoor air quality. In urban areas, biomass fuels have been widely replaced by cleaner energy sources at home, such as gas and electricity, but in most developing countries, coal is still a major source of fuel for cooking and heating, particularly in winter. Moreover, exposure to ETS is common at home or at work in urban areas.There is evidence that asthma prevalence and morbidity is less common in rural than in urban areas. The possible reasons are that rural residents are exposed early in life to stables and to farm milk production, and such exposures are protective against developing asthma morbidity. Even so, asthma morbidity is disproportionately high among poor inner-city residents and in rural populations. A higher proportion of adult residents of nonmetropolitan areas were characterized as follows:aged 55 years or older, no previous college admission, low household income, no health insurance coverage, and could not see a doctor due to healthcare service availability, etc. In rural areas, biomass fuels meet more than 70% of the rural energy needs. Progress in adopting modern energy sources in rural areas has been slow. The most direct health impact comes from household energy use among the poor, who depend almost entirely on burning biomass fuels in simple cooking devices that are placed in inadequately ventilated spaces. Prospective studies are needed to assess the long-term effects of biomass smoke on lung health among adults in rural areas.Geographic differences in asthma susceptibility exist around the world. The reason for the differences in asthma prevalence in rural and urban areas may be due to the fact that populations have different lifestyles and cultures, as well as different environmental exposures and different genetic backgrounds. Identifying geographic disparities in asthma hospitalizations is critical to implementing prevention strategies,reducing morbidity, and improving healthcare financing for clinical asthma treatment. Although evidence shows that differences in the prevalence of asthma do exist between urban and rural dwellers in many parts of the world, including in developed countries, data are inadequate to evaluate the extent to which different pollutant exposures contribute to asthma morbidity and severity of asthma between urban and rural areas.

Measurements of nitrous acid in commercial aircraft exhaust at the Alternative Aviation Fuel Experiment

The Alternative Aviation Fuel Experiment (AAFEX), conducted in January of 2009 in Palmdale, California, quantified aerosol and gaseous emissions from a DC-8 aircraft equipped with CFM56-2C1 engines using both traditional and synthetic fuels. This study examines the emissions of nitrous acid (HONO) and nitrogen oxides (NO(x) = NO + NO(2)) measured 145 m behind the grounded aircraft. The fuel-based emission index (EI) for HONO increases approximately 6-fold from idle to takeoff conditions but plateaus between 65 and 100% of maximum rated engine thrust, while the EI for NO(x) increases continuously. At high engine power, NO(x) EI is greater when combusting traditional (JP-8) rather than Fischer-Tropsch fuels, while HONO exhibits the opposite trend. Additionally, hydrogen peroxide (H(2)O(2)) was identified in exhaust plumes emitted only during engine idle. Chemical reactions responsible for emissions and comparison to previous measurement studies are discussed.

Hazard assessment of chemical air contaminants measured in residences

Identifying air pollutants that pose a potential hazard indoors can facilitate exposure mitigation. In this study, we compiled summary results from 77 published studies reporting measurements of chemical pollutants in residences in the United States and in countries with similar lifestyles. These data were used to calculate representative mid-range and upper-bound concentrations relevant to chronic exposures for 267 pollutants and representative peak concentrations relevant to acute exposures for five activity-associated pollutants. Representative concentrations are compared to available chronic and acute health standards for 97 pollutants. Fifteen pollutants appear to exceed chronic health standards in a large fraction of homes. Nine other pollutants are identified as potential chronic health hazards in a substantial minority of homes, and an additional nine are identified as potential hazards in a very small percentage of homes. Nine pollutants are identified as priority hazards based on the robustness of measured concentration data and the fraction of residences that appear to be impacted: acetaldehyde; acrolein; benzene; 1,3-butadiene; 1,4-dichlorobenzene; formaldehyde; naphthalene; nitrogen dioxide; and PM(2.5). Activity-based emissions are shown to pose potential acute health hazards for PM(2.5), formaldehyde, CO, chloroform, and NO(2).

PRACTICAL IMPLICATIONS

This analysis identifies key chemical contaminants of concern in residential indoor air using a comprehensive and consistent hazard-evaluation protocol. The identification of a succinct group of chemical hazards in indoor air will allow for successful risk ranking and mitigation prioritization for the indoor residential environment. This work also indicates some common household activities that may lead to the acute levels of pollutant exposure and identifies hazardous chemicals for priority removal from consumer products and home furnishings.

Performance evaluation of an in situ nitrous acid measurement system and continuous measurement of nitrous acid in an indoor environment

Nitrous acid (HONO) may cause adverse effects to mucous membranes and lung function when people are exposed to higher HONO concentrations than those present in typical indoor residential environments. Therefore, determination of HONO concentration in indoor environments is required to investigate occurrences of high HONO levels. In this work, a high-time-resolution measurement system was utilized to better understand the levels and dynamic behavior of HONO in an indoor environment. The performance of the in situ HONO analyzer applied to this work was evaluated using a 12-hr integrated annular denuder technique under ambient conditions. Both methods for the measurements of HONO were in good agreement, with a regression slope of 0.84, an intercept of 0.09, and correlation coefficient (r2) of 0.67. Indoor HONO and nitrogen oxide concentrations were also observed for approximately 5 days in winter in the living room of an apartment that had a gas range for cooking in the kitchen. Investigation of the relationships among nitric oxide (NO), nitrite (NO2), and HONO concentrations suggests that HONO production during combustion could be the result of direct emission, whereas the heterogeneous NO2 chemistry during the background period and after combustion was the possible pathway of HONO production. Controlled combustion experiments, performed at a burning rate of 50% valve setting, show peak HONO concentrations during the unvented combustion to be approximately 8-10 times higher than background levels depending on the time of day. At a burning rate setting of 50%, the peak concentration of HONO during unvented combustion was found to be 33-37% higher than those from "weak" (airflow = 340 m3/hr) and "strong" (airflow = 540 m3/hr) vented combustions. The decay rate of the HONO concentrations for the unvented combustion conditions was approximately 2-fold higher in the daytime than in the nighttime and significantly less than those of NO and NO2.

Influence of indoor factors in dwellings on the development of childhood asthma

Asthma has become the most common, childhood chronic disease in the industrialized world, and it is also increasing in developing regions. There are huge differences in the prevalence of childhood asthma across countries and continents, and there is no doubt that the prevalence of asthma was strongly increasing during the past decades worldwide. Asthma, as a complex disease, has a broad spectrum of potential determinants ranging from genetics to life style and environmental factors. Environmental factors are likely to be important in explaining the regional differences and the overall increasing trend towards asthma's prevalence. Among the environmental conditions, indoor factors are of particular interest because people spend more than 80% of their time indoors globally. Increasing prices for oil, gas and other sources of primary energy will further lead to better insulation of homes, and ultimately to reduced energy costs. This will decrease air exchange rates and will lower the dilution of indoor air mass with ambient air. Indoor air quality and potential health effects will therefore be an area for future research and for gaining a better understanding of asthma epidemics. This strategic review will summarize the current knowledge of the effects of a broad spectrum of indoor factors on the development of asthma in childhood in Western countries based on epidemiological studies. In conclusion, several epidemiological studies point out, that indoor factors might cause asthma in childhood. Stronger and more consistent findings are seen when exposure to these indoor factors is assessed by surrogates for the source of the actual toxicants. Measurement-based exposure assessments for several indoor factors are less common than using surrogates of the exposure. These studies, however, mainly showed heterogeneous results. The most consistent finding for an induction of asthma in childhood is related to exposure to environmental tobacco smoke, to living in homes close to busy roads, and in damp homes where are visible moulds at home. The causing agents of the increased risk of living in damp homes remained uncertain and needs clarification. Exposure to pet-derived allergens and house dust mites are very commonly investigated and thought to be related to asthma onset. The epidemiological evidence is not sufficient to recommend avoidance measures against pet and dust mites as preventive activities against allergies. More research is also needed to clarify the potential risk for exposure to volatile and semi-volatile organic compounds due to renovation activities, phthalates and chlorine chemicals due to cleaning.

Absorption of inhaled NO(2)

Nitrogen dioxide (NO(2)), a sparingly water-soluble pi-radical gas, is a criteria air pollutant that induces adverse health effects. How is inhaled NO(2)(g) incorporated into the fluid microfilms lining respiratory airways remains an open issue because its exceedingly small uptake coefficient (gamma approximately 10(-7)-10(-8)) limits physical dissolution on neat water. Here, we investigate whether the biological antioxidants present in these fluids enhance NO(2)(g) dissolution by monitoring the surface of aqueous ascorbate, urate, and glutathione microdroplets exposed to NO(2)(g) for approximately 1 ms via online thermospray ionization mass spectrometry. We found that antioxidants catalyze the hydrolytic disproportionation of NO(2)(g), 2NO(2)(g) + H(2)O(l) = NO(3)(-)(aq) + H(+)(aq) + HONO, but are not consumed in the process. Because this function will be largely performed by chloride, the major anion in airway lining fluids, we infer that inhaled NO(2)(g) delivers H(+), HONO, and NO(3)(-) as primary transducers of toxic action without antioxidant participation.

Indoor air quality in homes of patients with chronic obstructive pulmonary disease

RATIONALE

Outdoor air quality is associated with respiratory morbidity and mortality. Less is known of the relationship of indoor air quality to respiratory health of groups vulnerable to outdoor air, such as those with chronic obstructive pulmonary disease (COPD).

OBJECTIVES

To investigate among patients with COPD the association of health status with indoor air quality in their homes.

METHODS

Observational study of indoor environmental characteristics of homes of 148 patients with severe COPD in North East Scotland.

MEASUREMENTS AND MAIN RESULTS

Airborne living room levels of particulate matter with a diameter of 2.5 microm or less (PM(2.5)) (microg/m(3)) were measured over 8 to 14 hours using DustTrak monitors. Nitrogen dioxide exposure (ppb) in living rooms was measured over 1 week. Endotoxin (EU [endotoxin units]/mg) in living room dust was measured. Health status of participants was assessed by the St. George's Respiratory Health Questionnaire (symptoms, activity limitation, and disease impact). The mean age of participants was 69 years. Approximately 45% were male, 39% were smokers, and 49% lived in smoking households. Average indoor PM(2.5) levels were 18 mug/m(3), nitrogen dioxide was 7.8 ppb, and endotoxin levels were 95.8 EU/mg of dust. PM(2.5) was significantly higher in smoking households (P < 0.001) and was associated with higher levels of endotoxin and NO(2). PM(2.5) was significantly associated with increased symptom burden (P < 0.01), with greater effect for current smokers. Endotoxin and nitrogen dioxide exposure were not related to health status.

CONCLUSIONS

Higher levels of PM(2.5) are associated with worse health status of these patients with severe COPD. Indoor levels of PM(2.5) are significantly higher in homes with smokers.

Respiratory responses to diverse indoor combustion air pollution sources

Diverse indoor combustion sources contribute to the indoor air environment. To evaluate the effect of these sources on human respiratory health, we examined associations between respiratory conditions and household factors in the 2360 children's fathers (mean = 38.4 years old) and associations between lung function and household factors in 463 primary school children (mean = 8.3 years old) from Wuhan, China. Factor analysis developed new uncorrelated 'factor' variables. Unconditional logistic regression models or linear regression models, controlling for important covariates, estimated the respiratory health effects. Coal smoke derived from home heating ('heating coal smoke') was associated with high adult reporting of persistent cough, persistent phlegm, and wheeze. Cooking coal smoke was associated with physician-diagnosed adult asthma and decreased forced vital capacity (FVC), and forced expiratory volume at 1 s (FEV(1)) in children. The presence of any home cigarette smoker was associated with more reports of persistent cough, persistent phlegm, cough with phlegm, and bronchitis. Our study suggests that in Wuhan, there may be independent respiratory health effects of different indoor combustion sources and their exposure factors for these study populations.

PRACTICAL IMPLICATIONS

We conclude that multiple indoor air pollution sources could have adverse respiratory health effects on both children and middle-aged men in the city of Wuhan, China. These results may have implications for the Wuhan local government, the Chinese government, or other related organizations in efforts on protecting public health through regulation of indoor air pollution from indoor combustion sources.