Rainfall-Associated Bronchospasm Epidemics: The Epidemiological Effects of Air Pollutants and Weather Variables

Issue 1 - "Update on adverse respiratory effects of outdoor air pollution" Part 2): Outdoor air pollution and respiratory diseases: Perspectives from Angola, Brazil, Canada, Iran, Mozambique and Portugal

OBJECTIVE

To analyse the GARD perspective on the health effects of outdoor air pollution, and to synthesise the Portuguese epidemiological contribution to knowledge on its respiratory impact.

RESULTS

Ambient air pollution has deleterious respiratory effects which are more apparent in larger, densely populated and industrialised countries, such as Canada, Iran, Brazil and Portugal, but it also affects people living in low-level exposure areas. While low- and middle-income countries (LMICs), are particularly affected, evidence based on epidemiological studies from LMICs is both limited and heterogeneous. While nationally, Portugal has a relatively low level of air pollution, many major cities face with substantial air pollution problems. Time series and cross-sectional epidemiological studies have suggested increased respiratory hospital admissions, and increased risk of respiratory diseases in people who live in urban areas and are exposed to even a relatively low level of air pollution.

CONCLUSIONS

Adverse respiratory effects due to air pollution, even at low levels, have been confirmed by epidemiological studies. However, evidence from LMICs is heterogeneous and relatively limited. Furthermore, longitudinal cohort studies designed to study and quantify the link between exposure to air pollutants and respiratory diseases are needed. Worldwide, an integrated approach must involve multi-level stakeholders including governments (in Portugal, the Portuguese Ministry of Health, which hosts GARD-Portugal), academia, health professionals, scientific societies, patient associations and the community at large. Such an approach not only will garner a robust commitment, establish strong advocacy and clear objectives, and raise greater awareness, it will also support a strategy with adequate measures to be implemented to achieve better air quality and reduce the burden of chronic respiratory diseases (CRDs).

Evaluation of short-lived atmospheric fine particles in Tehran, Iran

Fine particles (PM_2.5) have adverse impacts and risks on air quality and human health. The present research focuses on the concentrations of PM_2.5, air quality index (AQI), and assessment of hospital admissions due to COPD attributed to PM_2.5 particle levels in Tehran during the last 10 years from 2011 to 2020. The effects of meteorological parameters (i.e., wind speed, humidity, and temperature) and AQI on PM_2.5 concentrations were examined using data from 21 active monitoring stations of the Air Quality Control Company (AQCC) and Mehrabad Meteorological Station. The health impact assessment of PM_2.5 in terms of hospital admissions due to chronic obstructive pulmonary disease (COPD) was obtained by the AirQ_2.2.3 model. Based on the results, the annual average PM_2.5 concentrations decreased from 2011 through 2020. The results also show a significant effect of meteorological data on the changes in PM_2.5 particle concentration. We also noticed that reduction of annual PM_2.5 concentration from 38.55 (AQI = 104.08) in 2011 to 28.59 μg m⁻³ (AQI = 83.87) in 2020 could prevent 779 (by about 70%) premature deaths, and the estimated number of excess cases human respiratory system attributed to PM_2.5 at central relative risk (RR) during the last decade was 6158 persons. Also, air quality got from unhealthy for sensitive groups of people to moderate air quality. Finally, any reduction in concentrations of PM_2.5 in Tehran can reduce the number of hospital admissions due to COPD significantly. The results of investigations on PM_2.5 particles have shown the need for the national clean air program policies and the necessity of urgent actions to improve the air quality to human health in Tehran.

Effect of Dust Storms on Non-Accidental, Cardiovascular, and Respiratory Mortality: A Case of Dezful City in Iran

BACKGROUND

Despite the fact that Iran has been exposed to severe dust storms during the past 2 decades, few studies have investigated the health effects of these events in Iran. This study was conducted to assess the association between dust storms and daily non-accidental, cardiovascular, and respiratory mortality in Dezful City (Khuzestan Province, Iran) during 2014 to 2019.

METHODS

In this study, mortality, meteorological, and climatological data were obtained from the Dezful University of Medical Sciences, Iranian Meteorological Organization, and Department of Environment in Khuzestan Province, respectively. Days of dust storm were identified based on the daily concentration threshold of particulate matter with an aerodynamic diameter of less than 10 μm (PM10) according to Hoffmanns҆ definition, and then an ecological time-series was used to estimate the short-term effects of dust storms on daily mortality. Statistical analysis was performed using a distributed lag linear model (DLM) and a distributed lag non-linear model (DLNM) packages by R software and the study results were reported as excess mortality.

RESULTS

During the study period, 15 223 deaths were recorded, and 139 dust storms occurred in Dezful city. In addition, there was statistically significant excess risk of mortality due to dust storms in Dezful City (mortality in the group under 15 years of age, lag4: 34.17% and 15-64 years of age groups, lag5: 32.19%, lag6: 3.28%), also dust storms had statistically significant effects on respiratory mortality (lag6: 5.49%).

CONCLUSION

The findings of the current study indicate that dust storms increase the risk of mortality with some lags. An evidence-based early warning system may be able to aware the people of the health effects of dust storms.

Determination of vulnerable regions of SARS-CoV-2 in Malaysia using meteorology and air quality data

This study aims to explore the state-wise assessment of SARS-CoV-2 (COVID-19) pandemic spread in Malaysia with focus on influence of meteorological parameters and air quality. In this study, state-wise COVID-19 data, meteorological parameters and air quality index (AQI) were collected from March 13 to April 30, 2020, which encompass three movement control order (MCO) periods in the country. Overall, total infected cases were observed to be higher in MCO phase 1 and 2 and significantly reduced in MCO phase 3. Due to the variation in the spatial interval of population density and individual immunity, the relationship of these parameters to pandemic spread could not be achieved. The study infers that temperature (T) between 23 and 25 °C and relative humidity (RH) (70-80%) triggered the pandemic spread by increase in the infected cases in northern and central Peninsular Malaysia. Selangor, WP Kuala Lumpur and WP Putrajaya show significantly high infected cases and a definite trend was not observed with respect to a particular meteorological factor. It is identified that high precipitation (PPT), RH and good air quality have reduced the spread in East Malaysia. A negative correlation of T and AQI and positive correlation of RH with total infected cases were found during MCO phase 3. Principal component analysis (PCA) indicated that T, RH, PPT, dew point (DP) and AQI are the main controlling factors for the spread across the country apart from social distancing. Vulnerability zones were identified based on the spatial analysis of T, RH, PPT and AQI with reference to total infected cases. Based on time series analysis, it was determined that higher RH and T in Peninsular Malaysia and high amount of PPT, RH and good air quality in East Malaysia have controlled the spreading during MCO phase 3. The predominance of D614 mutant was observed prior to March and decreases at the end of March, coinciding with the fluctuation of meteorological factors and air quality. The outcome of this study gives a general awareness to the public on COVID-19 and the influence of meteorological factors. It will also help the policymakers to enhance the management plans against the pandemic spreading apart from social distancing in the next wave of COVID-19.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s10668-021-01719-z.

Relationship between the number of hospitalized cardiovascular and respiratory disease and the average concentration of criteria air pollutants (CAP) in Ahvaz

This study aims to investigate the relationship between the number of hospitalized cardiovascular and respiratory patients and the average concentration of criteria air pollutants, including NO₂, SO₂, CO, O₃ and PM₁₀ in Ahvaz in the period of 10 years (2007-2017). Data on referrals and the number of hospitalized cardiovascular and respiratory patients and also on air pollutants are obtained through Hospital Information System and air quality monitoring stations including Department of Environment Protection Station, Naderi Square Station, University Square Station and the Meteorological Organization Station. The data were analyzed by SPSS version 4 and Poisson distribution regression model to evaluate the effects of each pollutant and the rate of hospitalization. In this study, confidence interval and the significance level are considered at 95% and 5%, respectively. Changes in air pollution indices and number of patients with cardiovascular diseases were evaluated using Excel, Stata and ARIMA models. Based on the results of Poisson regression analysis, there was a significant relationship between the average concentration of NO₂, O₃, CO and SO₂ and hospitalization of patients with cardiovascular disease, with a confidence level of less than 5%. This was the case with NO₂ more than other pollutants. Furthermore, there was a significant relationship between the average concentrations of NO₂, CO and O₃ and the hospitalization rate of patients with respiratory problems and a confidence level of 5%. The effect of NO₂ was also higher here. Due to the results, NO₂, CO, and O₃ had a significant direct correlation with cardiovascular and respiratory rates. The effect of NO₂ has been higher than other pollutants. In the study of time intervals of patients with cardiovascular, the results of time-interval analysis indicate the relationship between cardiovascular clients with the "t" time of 7 days earlier and NO₂ as a pollutant. The results of this analysis also revealed the relationship between respiratory patients at the time "t" up to 7 days before and O₃.

The response ranges of pulmonary function and the impact criteria of weather and industrial influence on patients with asthma living in Vladivostok

PURPOSE

To determine the response of pulmonary function (PF) to the influence of environmental factors in patients with different levels of asthma control.

MATERIALS AND METHODS

Patients with controlled (136 people) and uncontrolled (96 people) asthma living in the conditions of monsoon climate and technogenic pollution in Vladivostok were examined. Discriminant analysis that provides the basis for dividing initial data into classes, as according to standards and expert estimates, was used to calculate ranges of PF response in asthma patients. The selection of discriminant functions with the highest values of constant and coefficient made it possible to identify the optimal quantitative ranges.

RESULTS

Analysis of the discriminant value of Wilks' lambda (α) has shown that the intensity of PF response to climatic and technogenic factors varies depending on level of disease control (controlled asthma - α = 0.67-0.79, uncontrolled asthma - α =0.05-0.44). The criteria and ranges of PF response also differ depending on level of disease control. In controlled asthma, PF response reflects an adaptive-compensatory dependence. The reaction to the environmental factors is rather weak; therefore, it could be detected by only more sensitive examination method (body plethysmography). In uncontrolled asthma, the response to the influence of environment quality is active and could be clearly identified by spirography.

CONCLUSIONS

The climatic and technogenic environment of Vladivostok causes strong pathogenic impact on patients with uncontrolled asthma. The effects of dust fraction 0-1 μm, deeply penetrating into respiratory organs, and day-to-day variability of wind speed, which induces weather sensitivity, are particularly adverse.

Cardiovascular and respiratory emergency dispatch due to short-term exposure to ambient PM10 in Dezful, Iran

Introduction: This study was conducted to determine the relation between exposure to particulate matter less than 10 microns (PM₁₀) caused by dust storms and the risk of cardiovascular, respiratory and traffic accident missions carried out by Emergency Medical Services (EMS).

Methods: This was a time-series study conducted in Dezful city, Iran. Daily information on the number of missions by the EMS due to cardiovascular, respiratory and crash problems and data on PM₁₀ were inquired from March 2013 until March 2016. A generalized linear model (GLM) with distributed lag models (DLMs) was used to evaluate the relation between the number of EMS missions and the average daily PM₁₀. The latent effects of PM₁₀ were estimated in single and cumulative lags, up to 14 days.

Results: In the adjusted model, for each IQR increase in the average daily PM₁₀ concentration, the risk of EMS missions in the total population in single lags of 2 to 7 days, and the cumulative lags of 0-7 and 0-14 days after exposure had a 0.8, 0.8, 0.8, 0.8, 0.7, 0.6, 6.7 and 1.4% significant increase. Also, for each IQR increase in the daily mean concentration of PM₁₀ in single 1 to 7, and cumulative lags of 0-2, 0-7, and 0-14 days after exposure, respectively, a 2.4, 2.7, 2.8, 2.9, 2.9, 2.7, 2.5, 7.4, 23.5 and 33. 3 % increase was observed in the risk of EMS cardiovascular missions.

Conclusion: Increase in daily PM₁₀ concentrations in Dezful is associated with an increase in the risk of EMS missions in lags up to two weeks after exposure.

Air pollution and hospital admissions for cardiovascular diseases in Ahvaz, Iran

Cardiovascular disease is one of the main causes of death in Iran. The aim of this study was to determine the relation between air pollution and cardiovascular hospital admissions in Ahwaz, Iran. Daily information about cardiovascular hospital admissions (based on the ICD-10) and data on air pollutants during 2008-2018 were inquired. A quasi-Poisson regression combined with linear distributed lag models; adjusted for trend, seasonality, temperature, relative humidity, weekdays and holidays was used to assess the relation between hospital admission for cardiovascular diseases and the average daily air pollution. The results of this study showed a significant increase in cardiovascular hospital admissions in the total population and women's population in relation to O₃. There was a significant increase in hospital admissions for cardiovascular diseases in the whole population as well as gender and age groups associated with NO₂ and NO. A significant increase was found in hospital admissions for cardiovascular diseases in relation to CO in the 65-74-year-old population. Finally, the results of this study showed that there was a significant increase in hospital admissions for cardiovascular disease associated with SO₂. The main results of the present study confirm the deleterious short term impact of air pollution on cardiovascular morbidity in Ahvaz city. This evidence empasizes the need to implement policies for reducing air pollution.

Short-term effects of air pollution on respiratory mortality in Ahvaz, Iran

Background: Urban air pollutants may affect respiratory mortality. This study was conducted to investigate this effect in Ahvaz, one of the most polluted cities in the world. Methods: The impact of 7 major air pollutants including O3, PM10, NO2, CO, and SO2 were evaluated on respiratory mortality in different gender and age groups using a quasi-Poisson, second degree polynomial constrained, distributed lag model, with single and cumulative lag structures adjusted by trend, seasonality, temperature, relative humidity, weekdays, and holiday. Data were analyzed using the dlnm package in R x64 3.2.5 software. Significance level was set at less than 0.05. Results: In adjusted models, for each IQR increase of O3 in the total population, the risk ratio (RR) for respiratory deaths in 0 to 14- day lags was, respectively, 1.009 (95% CI:1.001-1.016) and 1.009 (95% CI:1.002-1.017), and it was 1.021 (95% CI: 1.002-1.040) in cumulative 0 to 14- day lags. For PM10, in the total population and in adjusted models after 0 to 14- day lags and in cumulative lags of 0 to 14 for an IQR increase in the mean concentration of PM10, the RR for respiratory deaths increased significantly and was, respectively, 1.027 (95% CI:1.002-1.051), 1.029 (95% CI:1.006-1.052), and 1.065 (95% CI:1.005-1.128). NO2 showed a significant association with respiratory deaths only in the 18 to 60 year- old age group and in 9- day lags (RR= 1.318, 95% CI:1.002-1.733). Finally, the results showed that for an IQR increase in the mean concentration of CO and SO2, the adjusted RR for respiratory deaths in 9- day lags in the total population was, respectively, RR= 1.058 (95% CI:1.008-1.111) and 1.126 (95% CI:1.034-1.220). Conclusion: Air pollution in Ahvaz is probably causing increased respiratory mortality.