Particulate air pollution and hospital emergency room visits for asthma in Seattle

A Roadmap for Using Causal Inference and Machine Learning to Personalize Asthma Medication Selection

Inhaled corticosteroid (ICS) is a mainstay treatment for controlling asthma and preventing exacerbations in patients with persistent asthma. Many types of ICS drugs are used, either alone or in combination with other controller medications. Despite the widespread use of ICSs, asthma control remains suboptimal in many people with asthma. Suboptimal control leads to recurrent exacerbations, causes frequent ER visits and inpatient stays, and is due to multiple factors. One such factor is the inappropriate ICS choice for the patient. While many interventions targeting other factors exist, less attention is given to inappropriate ICS choice. Asthma is a heterogeneous disease with variable underlying inflammations and biomarkers. Up to 50% of people with asthma exhibit some degree of resistance or insensitivity to certain ICSs due to genetic variations in ICS metabolizing enzymes, leading to variable responses to ICSs. Yet, ICS choice, especially in the primary care setting, is often not tailored to the patient's characteristics. Instead, ICS choice is largely by trial and error and often dictated by insurance reimbursement, organizational prescribing policies, or cost, leading to a one-size-fits-all approach with many patients not achieving optimal control. There is a pressing need for a decision support tool that can predict an effective ICS at the point of care and guide providers to select the ICS that will most likely and quickly ease patient symptoms and improve asthma control. To date, no such tool exists. Predicting which patient will respond well to which ICS is the first step toward developing such a tool. However, no study has predicted ICS response, forming a gap. While the biologic heterogeneity of asthma is vast, few, if any, biomarkers and genotypes can be used to systematically profile all patients with asthma and predict ICS response. As endotyping or genotyping all patients is infeasible, readily available electronic health record data collected during clinical care offer a low-cost, reliable, and more holistic way to profile all patients. In this paper, we point out the need for developing a decision support tool to guide ICS selection and the gap in fulfilling the need. Then we outline an approach to close this gap via creating a machine learning model and applying causal inference to predict a patient's ICS response in the next year based on the patient's characteristics. The model uses electronic health record data to characterize all patients and extract patterns that could mirror endotype or genotype. This paper supplies a roadmap for future research, with the eventual goal of shifting asthma care from one-size-fits-all to personalized care, improve outcomes, and save health care resources.

Short animated video increases knowledge and perceived comfort in clinical counseling on inequitable health impacts of air pollution among interprofessional health learners and clinicians

BACKGROUND

Air pollution is a major health risk contributing to global morbidity and mortality, yet clinicians do not routinely engage in counseling patients on this topic. Clinicians cite their lack of education as a common barrier. We developed a two-minute animated video on mitigating air pollution health risks and evaluated the efficacy of this video as an educational tool.

METHODS

In March-June 2021, a convenience sample of Minnesota interprofessional health learners and clinicians viewed the video and completed an electronic survey that assessed pre-/post-video intervention changes in (a) didactic and clinically applied knowledge on health impacts of air pollution, (b) perceived comfort in identifying at-risk patients and counseling them on relevant preventive health behaviors, (c) intentions/barriers to counseling patients, (d) beliefs and attitudes related to the health harms of air pollution, and (e) perceptions of the overall acceptability of the intervention.

RESULTS

The 218 participants included learners and clinicians in medicine, nursing, and advanced practice provision. Respondents' knowledge scores and self-reported level of comfort in identifying high-risk patients and counseling them on preventative health behaviors increased significantly pre-/post-intervention. The video also effectively altered participants' misperceptions about the health impacts of air pollution. While less than half of participants (43.6%) reported they intended to engage in counseling patients as a result of watching the video, 52.3% indicated they might do so. Lack of time during clinical encounters and lack of training were reported as persistent barriers to engaging in this counseling. Overall, participants found the video to be an effective educational tool, indicating that they wanted their colleagues and patients to watch the video and would like to see further short, animated videos on other environmental health topics.

CONCLUSIONS

A two-minute animated educational video significantly improved knowledge of inequitable health impacts of air pollution and improved perceived comfort in identifying and counseling at-risk patients among health professional learners and clinicians regardless of profession, level of training, or pre-intervention knowledge level. Academic health professional training programs and health systems should consider adopting this modality as a tool for educating learners, clinicians, and patients on environmental health risks.

The skin is no barrier to mixtures: Air pollutant mixtures and reported psoriasis or eczema in the Personalized Environment and Genes Study (PEGS)

BACKGROUND

Autoimmune (AI) diseases appear to be a product of genetic predisposition and environmental triggers. Disruption of the skin barrier causes exacerbation of psoriasis/eczema. Oxidative stress is a mechanistic pathway for pathogenesis of the disease and is also a primary mechanism for the detrimental effects of air pollution.

METHODS

We evaluated the association between autoimmune skin diseases (psoriasis or eczema) and air pollutant mixtures in 9060 subjects from the Personalized Environment and Genes Study (PEGS) cohort. Pollutant exposure data on six criteria air pollutants are publicly available from the Center for Air, Climate, and Energy Solutions and the Atmospheric Composition Analysis Group. For increased spatial resolution, we included spatially cumulative exposure to volatile organic compounds from sites in the United States Environmental Protection Agency Toxic Release Inventory and the density of major roads within a 5 km radius of a participant's address from the United States Geological Survey. We applied logistic regression with quantile g-computation, adjusting for age, sex, diagnosis with an autoimmune disease in family or self, and smoking history to evaluate the relationship between self-reported diagnosis of an AI skin condition and air pollution mixtures.

RESULTS

Only one air pollution variable, sulfate, was significant individually (OR = 1.06, p = 3.99E-2); however, the conditional odds ratio for the combined mixture components of PM2.5 (black carbon, sulfate, sea salt, and soil), CO, SO2, benzene, toluene, and ethylbenzene is 1.10 (p-value = 5.4E-3).

SIGNIFICANCE

While the etiology of autoimmune skin disorders is not clear, this study provides evidence that air pollutants are associated with an increased prevalence of these disorders. The results provide further evidence of potential health impacts of air pollution exposures on life-altering diseases.

SIGNIFICANCE AND IMPACT STATEMENT

The impact of air pollution on non-pulmonary and cardiovascular diseases is understudied and under-reported. We find that air pollution significantly increased the odds of psoriasis or eczema in our cohort and the magnitude is comparable to the risk associated with smoking exposure. Autoimmune diseases like psoriasis and eczema are likely impacted by air pollution, particularly complex mixtures and our study underscores the importance of quantifying air pollution-associated risks in autoimmune disease.

Long-term nonlinear relationship between PM2.5 and ten leading causes of death

Air pollution has become a major concern worldwide. Many epidemiological studies have proved relationships between fine particulate matter (PM_2.5) and various diseases, but most studies only use short-term and models for specific groups to derive relationships with acute diseases. This makes it difficult to understand long-term exposure, nonlinear relationships, and spatial-temporal health risks regarding chronic diseases. Therefore, this study proposed to analyze and map PM_2.5 exceedance probability from long-term spatial-temporal monitoring data using radial basis function estimation. We then constructed and compared multiple linear regression and generalized additive models to investigate linear and nonlinear relationships between long-term average PM_2.5 concentration, PM_2.5 potential probability for exceeding the standard, and standardized mortality for the top ten causes of death in all towns and villages in Taiwan nationally from 2010 to 2017. Linear models indicate that increasing PM_2.5 concentration increased malignant neoplasm, pneumonia, and chronic lower respiratory disease mortalities; chronic liver diseases; and cirrhosis; whereas heart diseases and esophagus cancer mortality decreased. For the nonlinear model results, it can be found that there were also significant nonlinear relationships between PM_2.5 concentration and malignant mortalities for neoplasm, heart disease, diabetes; and trachea, bronchus, lung, liver, intrahepatic bile duct, and esophagus cancer. Thus, long-term exposure to PM_2.5 may be a significant risk factor for multiple acute and chronic diseases. Results from this study can be directly applied worldwide to provide air quality and health management references for governments, and important information on long-term health risks for local residents in the study area.

Personal NO2 sensor demonstrates feasibility of in-home exposure measurements for pediatric asthma research and management

BACKGROUND

One of the most common pollutants in residences due to gas appliances, NO₂ has been shown to increase the risk of asthma attacks after small increases in short term exposure. However, standard environmental sampling methods taken at the regional level overlook chronic intermittent exposure due to lack of temporal and spatial granularity. Further, the EPA and WHO do not currently provide exposure recommendations to at-risk populations.

AIMS

A pilot study with pediatric asthma patients was conducted to investigate potential deployment challenges as well as benefits of home-based NO₂ sensors and, when combined with a subject's hospital records and self-reported symptoms, the richness of data available for larger-scale epidemiological studies.

METHODS

We developed a compact personal NO₂ sensor with one minute temporal resolution and sensitivity down to 15 ppb to monitor exposure levels in the home. Patient hospital records were collected along with self-reported symptom diaries, and two example hypotheses were created to further demonstrate how data of this detail may enable study of the impact of NO₂ in this sensitive population.

RESULTS

17 patients (55%) had at least 1 h each day with average NO₂ exposure >21 ppb. Frequency of acute NO₂ exposure >21 ppb was higher in the group with gas stoves (U = 27, p ≤ 0.001), and showed a positive correlation (r_s = 0.662, p = 0.037, 95% CI 0.36-0.84) with hospital admissions.

SIGNIFICANCE

Similar studies are needed to evaluate the true impact of NO₂ in the home environment on at-risk populations, and to provide further data to regulatory bodies when developing updated recommendations.

The Potential Health Costs of PM10 Impacts on a Gold Mine Village, during Company Liquidation: An Analysis of 2013–2017

Windblown dust from tailings storage facilities (TSFs), particularly in towns with liquidated mining companies, exacerbate air pollution. Companies of suddenly closed mine operations evade the responsibility of environmental and socio-economic care required by law. It is common for suddenly closed mines to have poorly rehabilitated TSFs which become a significant source of pollution by dust for the surrounding communities. There is strong evidence that acute exposure to high levels of air pollutants causes significant mortality and morbidity. However, very few studies have estimated the externalities of PM10 emanating from gold TSFs especially when a mine closes suddenly owing to company liquidation. By exploring the externalities of PM10 arising from wind erosion of suspended particulate matter from TSFs, this study fills an existing gap in the literature. A ‘bottom-up’ approach was implemented in this study following the External Energy (ExternE) project, and a gold mine operation that was liquidated between 2013 and 2017, was used as the case study. In this study, the externality of PM10 estimated was the cost of illness focusing specifically on respiratory-related illnesses. The results showed that the estimated cost of illness associated with PM10 inhalation was a total of R 5,560,022 including assessments of both neighboring Wedela and the Gold mine village based on the threshold concentration set by the South African National Ambient Air Quality Standards (NAAQS) guideline and R 66,092,760 when considering the Fund for Research into Industrial Development Growth Equity (FRIDGE), Airshed and Infotox. Thus, it was concluded that air pollution by windblown dust from partially rehabilitated TSFs has the potential to significantly affect surrounding mining communities’ socio-economic status through poor health and the costs thereof.

Outdoor air pollution and the risk of asthma exacerbations in single lag0 and lag1 exposure patterns: a systematic review and meta-analysis

Objective: To synthesize evidence regarding the relationship between outdoor air pollution and risk of asthma exacerbations in single lag0 and lag1 exposure patterns.Methods: We performed a systematic literature search using PubMed, Embase, Cochrane Library, Web of Science, ClinicalTrials, China National Knowledge Internet, Chinese BioMedical, and Wanfang databases. Articles published until August 1, 2020 and the reference lists of the relevant articles were reviewed. Two authors independently evaluated the eligible articles and performed structured extraction of the relevant information. Pooled relative risks (RRs) and 95% confidence intervals (CIs) of lag0 and lag1 exposure patterns were estimated using random-effect models.Results: Eighty-four studies met the eligibility criteria and provided sufficient information for meta-analysis. Outdoor air pollutants were associated with increased risk of asthma exacerbations in both single lag0 and lag1 exposure patterns [lag0: RR (95% CI) (pollutants), 1.057(1.011, 1.103) (air quality index, AQI), 1.007 (1.005, 1.010) (particulate matter of diameter ≤ 2.5 μm, PM_2.5), 1.009 (1.005, 1.012) (particulate matter of diameter, PM₁₀), 1.010 (1.006, 1.014) (NO₂), 1.030 (1.011, 1.048) (CO), 1.005 (1.002, 1.009) (O₃); lag1:1.064(1.022, 1.106) (AQI), 1.005 (1.002, 1.008) (PM_2.5), 1.007 (1.004, 1.011) (PM₁₀), 1.008 (1.004, 1.012) (NO₂), 1.025 (1.007, 1.042) (CO), 1.010 (1.006, 1.013) (O₃)], except SO₂ [lag0: RR (95% CI), 1.004 (1.000, 1.007); lag1: RR (95% CI), 1.003 (0.999, 1.006)]. Subgroup analyses revealed stronger effects in children and asthma exacerbations associated with other events (including symptoms, lung function changes, and medication use).Conclusion: Outdoor air pollution increases the asthma exacerbation risk in single lag0 and lag1 exposure patterns.Trial registration: PROSPERO, CRD42020204097. https://www.crd.york.ac.uk/.Supplemental data for this article is available online at https://doi.org/10.1080/02770903.2021.2008429 .

Air pollution and lung function in children

In this narrative review, we summarize the literature and provide updates on recent studies of air pollution exposures and child lung function and lung function growth. We include exposures to outdoor air pollutants that are monitored and regulated through air quality standards, and air pollutants that are not routinely monitored or directly regulated, including wildfires, indoor biomass and coal burning, gas and wood stove use, and volatile organic compounds. Included is a more systematic review of the recent literature on long-term air pollution and child lung function because this is an indicator of future adult respiratory health and exposure assessment tools have improved dramatically in recent years. We present "summary observations" and "knowledge gaps." We end by discussing what is known about what can be done at the individual/household, local/regional, and national levels to overcome structural impediments, reduce air pollution exposures, and improve child lung function. We found a large literature on adverse air pollution effects on children's lung function level and growth; however, many questions remain. Important areas needing further research include whether early-life effects are fixed or reversible; and what are windows of increased susceptibility, long-term effects of repeated wildfire events, and effects of air quality interventions.

Analysis on the Characteristics of Air Pollution in China during the COVID-19 Outbreak

The COVID-19 pandemic poses a serious global threat to human health. In China, the government immediately implemented lockdown measures to curb the spread of this virus. These measures severely affected transportation and industrial production across the country, resulting in a significant change in the concentration of air pollutants. In this study, the Euclidean distance method was used to select the most similar meteorological field during the COVID-19 lockdown period. Changes in the concentration of air pollutants in China were analyzed under similar meteorological background conditions. Results indicate that, compared with data from 2015–2019, air quality in China significantly improved; with the exception of ozone (O3), the concentration of major air pollutants declined. Compared with baseline conditions, the reduction of air pollutants in China from 25 January to 22 February 2020 (Period 2) was the most significant. In particular, NO2 decreased by 41.7% in the Yangtze River Delta. In Period 2, the reduction of air pollutants in areas other than Hubei gradually decreased, but the reduction of NO2 in Wuhan reached 61.92%, and the reduction of air pollutants in various regions after February 23 was significantly reduced. By excluding the influence of meteorological factors and calculating the contribution of human activities to atmospheric pollutants by linear fitting, in Period 2 the effect of artificial controls on NO2 in Wuhan attained 30.66%, and reached 48.17% from 23 February to 23 March (Period 3). Results from this investigation provides effective theoretical support for pollution prevention and control in China.

Exosomal miRNA-19a and miRNA-614 Induced by Air Pollutants Promote Proinflammatory M1 Macrophage Polarization via Regulation of RORα Expression in Human Respiratory Mucosal Microenvironment

Air pollution exposure leads to various inflammatory diseases in the human respiratory system. Chronic rhinosinusitis is an inflammatory disease caused by viruses, bacteria, or air pollutants. However, the underlying molecular mechanisms through which air particulate matter (PM) causes inflammation and disease remain unclear. In this article, we report that the induction of exosomal microRNAs (miRNAs) from human nasal epithelial cells upon airborne PM exposure promotes proinflammatory M1 macrophage polarization via downregulated RORα expression. Exposure of human nasal epithelial cells to PM results in inflammation-related miRNA expression, and more miRNA is secreted through exosomes delivered to macrophages. Among these, miRNA-19a and miRNA-614 directly bind to the 3'-untranslated region of RORα mRNA and downregulate RORα expression, which leads to inflammation due to inflammatory cytokine upregulation and induces macrophages to a proinflammatory M1-like state. Finally, we showed enhanced expression of miRNA-19a and miRNA-614 but reduced RORα expression in a chronic rhinosinusitis patient tissue compared with the normal. Altogether, our results suggest that PM-induced exosomal miRNAs might play a crucial role in the proinflammatory mucosal microenvironment and macrophage polarization through the regulation of RORα expression.

Immunopathological features of air pollution and its impact on inflammatory airway diseases (IAD)

Air pollution causes significant morbidity and mortality in patients with inflammatory airway diseases (IAD) such as allergic rhinitis (AR), chronic rhinosinusitis (CRS), asthma, and chronic obstructive pulmonary disease (COPD). Oxidative stress in patients with IAD can induce eosinophilic inflammation in the airways, augment atopic allergic sensitization, and increase susceptibility to infection. We reviewed emerging data depicting the involvement of oxidative stress in IAD patients. We evaluated biomarkers, outcome measures and immunopathological alterations across the airway mucosal barrier following exposure, particularly when accentuated by an infectious insult.

Protective equipment and health education program could benefit students from dust pollution

In recent years, children living in the downstream of the Choshui River in Taiwan have been exposed to violent dust episodes. For the sake of the health of these children, we aimed to investigate the effectiveness of protective equipment (sand-proof plastic cover and air purifier) installed outside/inside the classrooms on students' pulmonary function and evaluate the health education program for preventing the adverse consequences of exposure to river-dust episodes. Public elementary school students in Yunlin County, which was severely affected by river-dust, were selected as the participants. Study 1 consisted of three-wave follow-up data (801 person-times) in high-/low-dust exposure regions to examine pulmonary function. Study 2 used 147 and 73 students in the high-/low-dust exposure regions, respectively, to establish our health education intervention. Paired t tests, repeated measures ANOVA, and generalized estimating equation were used to analyze the short- and long-term effects. The results showed that the students' pulmonary function in schools that installed protective equipment was improved. The health education (such as the usage of correct masks and our designed PM_2.5 full-cover sand-proof clothing) improved the students' cognition and behaviors related to river-dust episodes and yielded both short- and long-term effects. Therefore, we suggest more schools with high-dust exposure to adopt protective equipment and health education program. Our designed PM_2.5 full-cover sand-proof clothing can prevent from not only haze but also droplet transmission by infectious diseases such as COVID-19.

The effects of "Fangcang, Huoshenshan, and Leishenshan" hospitals and environmental factors on the mortality of COVID-19

Background

In December 2019, a novel coronavirus disease (COVID-19) broke out in Wuhan, China; however, the factors affecting the mortality of COVID-19 remain unclear.

Methods

Thirty-two days of data (the growth rate/mortality of COVID-19 cases) that were shared by Chinese National Health Commission and Chinese Weather Net were collected by two authors independently. Student’s t-test or Mann-Whitney U test was used to test the difference in the mortality of confirmed/severe cases before and after the use of “Fangcang, Huoshenshan, and Leishenshan” makeshift hospitals (MSHs). We also studied whether the above outcomes of COVID-19 cases were related to air temperature (AT), relative humidity (RH), or air quality index (AQI) by performing Pearson’s analysis or Spearman’s analysis.

Results

Eight days after the use of MSHs, the mortality of confirmed cases was significantly decreased both in Wuhan (t = 4.5, P < 0.001) and Hubei (U = 0, P < 0.001), (t and U are the test statistic used to test the significance of the difference). In contrast, the mortality of confirmed cases remained unchanged in non-Hubei regions (U = 76, P = 0.106). While on day 12 and day 16 after the use of MSHs, the reduce in mortality was still significant both in Wuhan and Hubei; but in non-Hubei regions, the reduce also became significant this time (U = 123, P = 0.036; U = 171, P = 0.015, respectively). Mortality of confirmed cases was found to be negatively correlated with AT both in Wuhan (r =  − 0.441, P = 0.012) and Hubei (r =  − 0.440, P = 0.012). Also, both the growth rate and the mortality of COVID-19 cases were found to be significantly correlated with AQI in Wuhan and Hubei. However, no significant correlation between RH and the growth rate/mortality of COVID-19 cases was found in our study.

Conclusions

Our findings indicated that both the use of MSHs, the rise of AT, and the improvement of air quality were beneficial to the survival of COVID-19 patients.

Short-term effects of air pollution on exacerbations of allergic asthma in Užice region, Serbia

Introduction

Many time-series studies have shown a positive association between air pollution and asthma exacerbation. However, till now only one study in Serbia has examined this relationship.

Aim

To examine the associations between air pollution and asthma emergency department (ED) visits in the Užice region, Serbia.

Material and methods

A time-stratified case-crossover design was applied to 424 ED visits for asthma exacerbation that occurred in the Užice region, Serbia, in 2012–2014. Data about ED visits were routinely collected in the Užice Health Centre. The daily average concentrations of particulate matter (PM_2.5 and PM₁₀), sulphur dioxide (SO₂), nitrogen dioxide (NO₂), and black carbon (BC) were measured by automatic ambient air quality monitoring stations. Odds ratios and their corresponding 95% confidence intervals were estimated using conditional logistic regression adjusted for the potential confounding influence of weather variables (temperature, humidity and air pressure).

Results

Statistically significant associations were observed between ED visits for asthma and 3-day lagged exposure to BC (OR = 3.23; 95% CI: 1.05–9.95), and between ED visits for asthma with coexisting allergic rhinitis and 0-day lag exposure to NO₂ (OR = 1.57; 95% CI: 0.94–2.65), 2-day lag exposure to SO₂ (OR = 1.97; 95% CI: 1.02–3.80), and 3-day lag exposure to PM₁₀ (OR = 2.38; 95% CI: 1.17–4.84).

Conclusions

Exposure to ambient air pollution in the Užice region increases the risk of ED visits for asthma, particularly during the heating season.

Does Air Pollution Influence COVID-19 Outbreaks?

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) [...]

Effect of industrial point-source air pollutants on fractional exhaled nitric oxide in healthy volunteers

BACKGROUND

Few studies have examined the effects of industrial, fixed-site sources of air pollution on lung inflammation in nearby residents. We investigated the effects of short-term exposure to ambient air near a steel plant on the fractional exhaled concentration of nitric oxide (FeNO), a measure of airway inflammation, in healthy volunteers.

METHODS

A cross-over study design was used. Fifty-nine non-smoking participants (mean age 24 years) were randomly assigned to each of two 5-day exposure scenarios: breathing ambient air adjacent to a steel plant or 5 km away at a college campus site. FeNO and on-site air pollutants were measured daily. Mixed effects linear regression models were used for data analysis, adjusting for sex, temperature, humidity and day of week.

RESULTS

Compared with the college site, PM _2.5, ultrafine PM, SO₂, NO₂ and CO levels were significantly greater near the steel plant. FeNO was 15.3% (95% CI, 6.6%, 24.8%) higher near the plant compared to the college site.

CONCLUSIONS

Exposure to ambient air near a steel plant was associated with increased airway inflammation as measured by exhaled nitric oxide.

Wood stove interventions and child respiratory infections in rural communities: KidsAir rationale and methods

BACKGROUND

Acute lower respiratory tract infections (LRTIs) account for >27% of all hospitalizations among US children under five years of age. Residential burning of biomass for heat leads to elevated indoor levels of fine particulate matter (PM2.5) that often exceed current health based air quality standards. This is concerning as PM2.5 exposure is associated with many adverse health outcomes, including a greater than three-fold increased risk of LRTIs. Evidence-based efforts are warranted in rural and American Indian/Alaska Native (AI/AN) communities in the US that suffer from elevated rates of childhood LRTI and commonly use wood for residential heating.

DESIGN

In three rural and underserved settings, we conducted a three-arm randomized controlled, post-only intervention trial in wood stove homes with children less than five years old. Education and household training on best-burn practices were introduced as one intervention arm (Tx1). This intervention was evaluated against an indoor air filtration unit arm (Tx2), as well as a control arm (Tx3). The primary outcome was LRTI incidence among children under five years of age.

DISCUSSION

To date, exposure reduction strategies in wood stove homes have been either inconsistently effective or include factors that limit widespread dissemination and continued compliance in rural and economically disadvantaged populations. As part of the "KidsAIR" study described herein, the overall hypothesis was that a low-cost, educational intervention targeting indoor wood smoke PM2.5 exposures would be a sustainable approach for reducing children's risk of LRTI in rural and AI/AN communities.

The first pollution investigation of road sediment in Gary, Indiana: Anthropogenic metals and possible health implications for a socioeconomically disadvantaged area

An investigation of road sediment in Gary, Indiana revealed high levels of various trace metals such as Zn, Mn, and Cr, often exceeding those of background reference concentrations as shown through geoaccumulation indices and contamination factors. The hazard index (HI) value for Mn in children was >1 (1.7), suggesting possible long-term non-carcinogenic health risk. Mn HI for children is even higher for the five samples closest to a US Steel facility, with an HI of 2.8. Through SEM-EDS analysis, the prevalence of small particulates (PM_2.5 and PM_2.5-10) containing potentially harmful elements such as Mn and Pb illustrate a health risk through direct inhalation or ingestion. The small nature of particulates in general may also pose an increased health risk for respiratory diseases such as asthma. Mn concentrations in the road sediment were particularly high, with 30 out of 32 samples exceeding 1800 ppm. Mn and V concentrations show a strong spatial trend of decreasing concentration away from a US Steel facility. These spatial trends along with correlation plots of the bulk chemistry suggest that industrial steel manufacturing, particularly US Steel in Gary, is a major contributing source of Mn and V. Fe and Cr show a moderate decrease in concentrations away from the US Steel facility, which suggests some sourcing from the steel facility when coupled with bulk chemistry plots. Zn and Cu do not show much evidence of sourcing from the US Steel facility, likely due to increased mixing from other sources. Further work constraining anthropogenic sources, the bioaccessible fraction of metals, and analysis of direct atmospheric particulates can help with remedial activity and risk assessment.

Geostatistical predictive modeling for asthma and chronic obstructive pulmonary disease using socioeconomic and environmental determinants

The spatial distribution of the prevalence of asthma and chronic obstructive pulmonary disease (COPD) remains under the influence of a wide array of environmental, climatic, and socioeconomic determinants. However, a large proportion of these influences remain unexplained. In completion, this study examined the spatial associations between asthma/COPD morbidity and their determinants using ordinary least squares (OLS) and geographically weighted regressions (GWR). Inpatient records collected from the secondary and tertiary care hospitals in Kandy from 2010 to 2014 were considered as the dependent variable. Potential risk factors (explanatory variables) were identified in four distinguished classes: 1) meteorological factors, (2) direct and indirect factors of air pollution, (3) socioeconomic factors, and (4) characteristics of the physical environment. All possible combinations of candidate explanatory variables were evaluated through an exploratory regression. A comparison between the regression models was also explored. The best OLS regression models revealed about 55% of asthma variation and 62% of COPD variation while GWR models yielded 78% and 74% of the variation of asthma and COPD occurrences respectively. Relative humidity, proximity to roads (0-200 m), road density, use of firewood as a source of fuel, and elevation play a vital role in predicting morbidity from asthma and COPD. Both local and global regression models are important in assessing spatial relationships of asthma and COPD. However, the local models exhibit a better prediction capability for assessing non-stationary relationships of asthma and COPD than global models. The geostatistical aspects used in this study may also provide insights for evaluating heterogeneous environmental risk factors in other epidemiological studies across different spatial settings.

The potential of omics approaches to elucidate mechanisms of biodiesel-induced pulmonary toxicity

BACKGROUND

Combustion of biodiesels in place of fossil diesel (FD) has been proposed as a method of reducing transport-related toxic emissions in Europe. While biodiesel exhaust (BDE) contains fewer hydrocarbons, total particulates and carbon monoxide than FD exhaust (FDE), its high nitrogen oxide and ultrafine particle content may still promote pulmonary pathophysiologies.

MAIN BODY

Using a complement of in vitro and in vivo studies, this review documents progress in our understanding of pulmonary responses to BDE exposure. Focusing initially on hypothesis-driven, targeted analyses, the merits and limitations of comparing BDE-induced responses to those caused by FDE exposure are discussed within the contexts of policy making and exploration of toxicity mechanisms. The introduction and progression of omics-led workflows are also discussed, summarising the novel insights into mechanisms of BDE-induced toxicity that they have uncovered. Finally, options for the expansion of BDE-related omics screens are explored, focusing on the mechanistic relevance of metabolomic profiling and offering rationale for expansion beyond classical models of pulmonary exposure.

CONCLUSION

Together, these discussions suggest that molecular profiling methods have identified mechanistically informative, novel and fuel-specific signatures of pulmonary responses to biodiesel exhaust exposure that would have been difficult to detect using traditional, hypothesis driven approaches alone.

Time-Series Analysis of Air Pollution and Health Accounting for Covariate-Dependent Overdispersion

Time-series studies are routinely used to estimate associations between adverse health outcomes and short-term exposures to ambient air pollutants. Use of the Poisson log-linear model with the assumption of constant overdispersion is the most common approach, particularly when estimating associations between daily air pollution concentrations and aggregated counts of adverse health events throughout a geographical region. We examined how the assumption of constant overdispersion plays a role in estimation of air pollution effects by comparing estimates derived from the standard approach with those estimated from covariate-dependent Bayesian generalized Poisson and negative binomial models that accounted for potential time-varying overdispersion. Through simulation studies, we found that while there was negligible bias in effect estimates, the standard quasi-Poisson approach can result in a larger standard error when the constant overdispersion assumption is violated. This was also observed in a time-series study of daily emergency department visits for respiratory diseases and ozone concentration in Atlanta, Georgia (1999-2009). Allowing for covariate-dependent overdispersion resulted in a reduction in the ozone effect standard error, while the ozone-associated relative risk remained robust to different model specifications. Our findings suggest that improved characterization of overdispersion in time-series modeling can result in more precise health effect estimates in studies of short-term environmental exposures.

Perturbation of metabolic pathways mediates the association of air pollutants with asthma and cardiovascular diseases

BACKGROUND

Epidemiologic evidence indicates common risk factors, including air pollution exposure, for respiratory and cardiovascular diseases, suggesting the involvement of common altered molecular pathways.

OBJECTIVES

The goal was to find intermediate metabolites or metabolic pathways that could be associated with both air pollutants and health outcomes ("meeting-in-the-middle"), thus shedding light on mechanisms and reinforcing causality.

METHODS

We applied a statistical approach named 'meet-in-the-middle' to untargeted metabolomics in two independent case-control studies nested in cohorts on adult-onset asthma (AOA) and cardio-cerebrovascular diseases (CCVD). We compared the results to identify both common and disease-specific altered metabolic pathways.

RESULTS

A novel finding was a strong association of AOA with ultrafine particles (UFP; odds ratio 1.80 [1.26, 2.55] per increase by 5000 particles/cm3). Further, we have identified several metabolic pathways that potentially mediate the effect of air pollution on health outcomes. Among those, perturbation of Linoleate metabolism pathway was associated with air pollution exposure, AOA and CCVD.

CONCLUSIONS

Our results suggest common pathway perturbations may occur as a consequence of chronic exposure to air pollution leading to increased risk for both AOA and CCVD.

Ambient air quality and spatio-temporal patterns of cardiovascular emergency department visits

BACKGROUND

Air pollutants have been associated with various adverse health effects, including increased rates of hospital admissions and emergency room visits. Although numerous time-series studies and case-crossover studies have estimated associations between day-to-day variation in pollutant levels and mortality/morbidity records, studies on geographic variations in emergency department use and the spatial effects in their associations with air pollution exposure are rare.

METHODS

We focused on the elderly who visited emergency room for cardiovascular related disease (CVD) in 2011. Using spatially and temporally resolved multi-pollutant exposures, we investigated the effect of short-term exposures to ambient air pollution on emergency department utilization. We developed two statistical models with and without spatial random effects within a hierarchical Bayesian framework to capture the spatial heterogeneity and spatial autocorrelation remaining in emergency department utilization.

RESULTS

Although the cardiovascular effect of spatially homogeneous pollutants, such as PM2.5 and ozone, was unchanged, we found the cardiovascular effect of NO[Formula: see text] was pronounced after accounting for the spatially correlated structure in emergency department utilization. We also identified areas with high ED utilization for CVD among the elderly and assessed the uncertainty associated with risk estimates.

CONCLUSIONS

We assessed the short-term effect of multi-pollutants on cardiovascular risk of the elderly and demonstrated the use of community multiscale air quality model-derived spatially and temporally resolved multi-pollutant exposures to an epidemiological study. Our results indicate that NO[Formula: see text] was significantly associated with the elevated ED utilization for CVD among the elderly.

A Comparison of the Health Effects of Ambient Particulate Matter Air Pollution from Five Emission Sources

This article briefly reviews evidence of health effects associated with exposure to particulate matter (PM) air pollution from five common outdoor emission sources: traffic, coal-fired power stations, diesel exhaust, domestic wood combustion heaters, and crustal dust. The principal purpose of this review is to compare the evidence of health effects associated with these different sources with a view to answering the question: Is exposure to PM from some emission sources associated with worse health outcomes than exposure to PM from other sources? Answering this question will help inform development of air pollution regulations and environmental policy that maximises health benefits. Understanding the health effects of exposure to components of PM and source-specific PM are active fields of investigation. However, the different methods that have been used in epidemiological studies, along with the differences in populations, emission sources, and ambient air pollution mixtures between studies, make the comparison of results between studies problematic. While there is some evidence that PM from traffic and coal-fired power station emissions may elicit greater health effects compared to PM from other sources, overall the evidence to date does not indicate a clear ‘hierarchy’ of harmfulness for PM from different emission sources. Further investigations of the health effects of source-specific PM with more advanced approaches to exposure modeling, measurement, and statistics, are required before changing the current public health protection approach of minimising exposure to total PM mass.

Outdoor air pollution and respiratory health: a bibliometric analysis of publications in peer-reviewed journals (1900 - 2017)

BACKGROUND

Outdoor air pollution is a major threat to global public health that needs responsible participation of researchers at all levels. Assessing research output is an important step in highlighting national and international contribution and collaboration in a certain field. Therefore, the aim of this study was to analyze globally-published literature in outdoor air pollution - related respiratory health.

METHOD

Outdoor air pollution documents related to respiratory health were retrieved from Scopus database. The study period was up to 2017. Mapping of author keywords was carried out using VOSviewer 1.6.6.

RESULTS

Search query yielded 3635 documents with an h-index of 137. There was a dramatic increase in the number of publications in the last decade of the study period. The most frequently encountered author keywords were: air pollution (835 occurrences), asthma (502 occurrences), particulate matter (198 occurrences), and children (203 occurrences). The United States of America ranked first (1082; 29.8%) followed by the United Kingdom (279; 7.7%) and Italy (198; 5.4%). Annual research productivity stratified by income and population size indicated that China ranked first (22.2) followed by the USA (18.8). Analysis of regional distribution of publications indicated that the Mediterranean, African, and South-East Asia regions had the least contribution. Harvard University (92; 2.5%) was the most active institution/organization followed the US Environmental Protection Agency (89; 2.4%). International collaboration was restricted to three regions: Northern America, Europe, and Asia. The top ten preferred journals were in the field of environmental health and respiratory health. Environmental Health Perspective was the most preferred journal for publishing documents in outdoor pollution in relation to respiratory health.

CONCLUSION

Research on the impact of outdoor air pollution on respiratory health had accelerated lately and is receiving a lot of interest. Global research networks that include countries with high level of pollution and limited resources are highly needed to create public opinion in favor of minimizing outdoor air pollution and investing in green technologies.

The health implications of unconventional natural gas development in Pennsylvania

We investigate the health impacts of unconventional natural gas development of Marcellus shale in Pennsylvania between 2001 and 2013 by merging well permit data from the Pennsylvania Department of Environmental Protection with a database of all inpatient hospital admissions. After comparing changes in hospitalization rates over time for air pollution-sensitive diseases in counties with unconventional gas wells to changes in hospitalization rates in nonwell counties, we find a significant association between shale gas development and hospitalizations for pneumonia among the elderly, which is consistent with higher levels of air pollution resulting from unconventional natural gas development. We note that the lack of any detectable impact of shale gas development on younger populations may be due to unobserved factors contemporaneous with drilling, such as migration.

Urban particulate matter stimulation of human dendritic cells enhances priming of naive CD8 T lymphocytes

Epidemiological studies have consistently shown associations between elevated concentrations of urban particulate matter (UPM) air pollution and exacerbations of asthma and chronic obstructive pulmonary disease, which are both associated with viral respiratory infections. The effects of UPM on dendritic cell (DC) -stimulated CD4 T lymphocytes have been investigated previously, but little work has focused on CD8 T-lymphocyte responses despite their importance in anti-viral immunity. To address this, we examined the effects of UPM on DC-stimulated naive CD8 T-cell responses. Expression of the maturation/activation markers CD83, CCR7, CD40 and MHC class I on human myeloid DCs (mDCs) was characterized by flow cytometry after stimulation with UPMin vitro in the presence/absence of granulocyte-macrophage colony-stimulating factor (GM-CSF). The capacity of these mDCs to stimulate naive CD8 T-lymphocyte responses in allogeneic co-culture was then assessed by measuring T-cell cytokine secretion using cytometric bead array, and proliferation and frequency of interferon-γ (IFN-γ)-producing T lymphocytes by flow cytometry. Treatment of mDCs with UPM increased expression of CD83 and CCR7, but not MHC class I. In allogeneic co-cultures, UPM treatment of mDCs enhanced CD8 T-cell proliferation and the frequency of IFN-γ+ cells. The secretion of tumour necrosis factor-α, interleukin-13, Granzyme A and Granzyme B were also increased. GM-CSF alone, and in concert with UPM, enhanced many of these T-cell functions. The PM-induced increase in Granzyme A was confirmed in a human experimental diesel exposure study. These data demonstrate that UPM treatment of mDCs enhances priming of naive CD8 T lymphocytes and increases production of pro-inflammatory cytokines. Such UPM-induced stimulation of CD8 cells may potentiate T-lymphocyte cytotoxic responses upon concurrent airway infection, increasing bystander damage to the airways.

The Association between Air Pollution and Outpatient and Inpatient Visits in Shenzhen, China

Nowadays, air pollution is a severe environmental problem in China. To investigate the effects of ambient air pollution on health, a time series analysis of daily outpatient and inpatient visits in 2015 were conducted in Shenzhen (China). Generalized additive model was employed to analyze associations between six air pollutants (namely SO₂, CO, NO₂, O₃, PM₁₀, and PM_2.5) and daily outpatient and inpatient visits after adjusting confounding meteorological factors, time and day of the week effects. Significant associations between air pollutants and two types of hospital visits were observed. The estimated increase in overall outpatient visits associated with each 10 µg/m³ increase in air pollutant concentration ranged from 0.48% (O₃ at lag 2) to 11.48% (SO₂ with 2-day moving average); for overall inpatient visits ranged from 0.73% (O₃ at lag 7) to 17.13% (SO₂ with 8-day moving average). Our results also suggested a heterogeneity of the health effects across different outcomes and in different populations. The findings in present study indicate that even in Shenzhen, a less polluted area in China, significant associations exist between air pollution and daily number of overall outpatient and inpatient visits.

Daily land use regression estimated woodsmoke and traffic pollution concentrations and the triggering of ST-elevation myocardial infarction: a case-crossover study

Prior work has reported acute associations between ST-elevation myocardial infarction (STEMI) and short-term increases in airborne particulate matter. Subsequently, the association between STEMI and hourly measures of Delta-C (marker of woodsmoke) and black carbon (marker of traffic pollution) measured at a central site in Rochester, NY, were examined, but no association was found. Therefore, land use regression estimates of Delta-C and black carbon concentrations at each patient's residence were developed for 246 STEMI patients treated at the University of Rochester Medical Center during the winters of 2008-2012. Using case-crossover methods, the rate of STEMI associated with increased Delta-C and BC concentration on the same and previous 3 days was estimated after adjusting for 3-day mean temperature and relative humidity. Non-statistically significant increased rates of STEMI associated with interquartile range increases in concentrations of BC in the previous 2 days (1.10 μg/m³; OR = 1.12; 95% CI 0.93, 1.35) and Delta-C in the previous 3 days (0.43 μg/m³; OR = 1.16; 95% CI 0.96, 1.40) were found. Significantly increased rates of STEMI associated with interquartile range increases in concentrations of BC (1.23 μg/m³; OR = 1.04; 95% CI = 0.87, 1.24) or Delta-C (0.40 μg/m³; OR = 0.94; 95% CI = 0.85, 1.09) on the same day were not observed likely due, in part, to temporal misalignment. Therefore, sophisticated spatial-temporal models will be needed to minimize exposure error and bias by better predicting concentrations at individual locations for individual hours, especially for outcomes with short-term responses to air pollution (< 24 h).

Inhaled Fine Particles Induce Alveolar Macrophage Death and Interleukin-1α Release to Promote Inducible Bronchus-Associated Lymphoid Tissue Formation

Particulate pollution is thought to function as an adjuvant that can induce allergic responses. However, the exact cell types and immunological factors that initiate the lung-specific immune responses are unclear. We found that upon intratracheal instillation, particulates such as aluminum salts and silica killed alveolar macrophages (AMs), which then released interleukin-1α (IL-1α) and caused inducible bronchus-associated lymphoid tissue (iBALT) formation in the lung. IL-1α release continued for up to 2 weeks after particulate exposure, and type-2 allergic immune responses were induced by the inhalation of antigen during IL-1α release and iBALT formation, even long after particulate instillation. Recombinant IL-1α was sufficient to induce iBALTs, which coincided with subsequent immunoglobulin E responses, and IL-1-receptor-deficient mice failed to induce iBALT formation. Therefore, the AM-IL-1α-iBALT axis might be a therapeutic target for particulate-induced allergic inflammation.

Phenotypic and genetic aspects of epithelial barrier function in asthmatic patients

The bronchial epithelium is continuously exposed to a multitude of noxious challenges in inhaled air. Cellular contact with most damaging agents is reduced by the action of the mucociliary apparatus and by formation of a physical barrier that controls passage of ions and macromolecules. In conjunction with these defensive barrier functions, immunomodulatory cross-talk between the bronchial epithelium and tissue-resident immune cells controls the tissue microenvironment and barrier homeostasis. This is achieved by expression of an array of sensors that detect a wide variety of viral, bacterial, and nonmicrobial (toxins and irritants) agents, resulting in production of many different soluble and cell-surface molecules that signal to cells of the immune system. The ability of the bronchial epithelium to control the balance of inhibitory and activating signals is essential for orchestrating appropriate inflammatory and immune responses and for temporally modulating these responses to limit tissue injury and control the resolution of inflammation during tissue repair. In asthmatic patients abnormalities in many aspects of epithelial barrier function have been identified. We postulate that such abnormalities play a causal role in immune dysregulation in the airways by translating gene-environment interactions that underpin disease pathogenesis and exacerbation.

Human health impact assessment of exposure to particulate matter: an AirQ software modeling

The aim of this study was to assess the health impacts related to particulate matter less than 10 μm (PM₁₀) exposure in the city of Yazd, Iran. For this aim, AirQ 2.2.3 software was used to model relationship between short-term exposure to PM₁₀ and disease cases proposed by the World Health Organization (WHO). The annual mean concentration of PM₁₀ was 97 μg/m³. The maximum concentration value of PM₁₀ was measured during the summer (731 μg/m³). 4.988% (95%CI: 3.381-6.542%) of the total mortality, 7.3% (95%CI; 4.19-10.21%) of cardiovascular mortality, and 10.21% (95%CI; 4.19-14.89%) of respiratory mortality were related to the PM₁₀ concentrations. Consequently, the AirQ software can provide valuable information about the importance of air pollution and the substantial impacts of PM₁₀ on the society for policymakers.

Hospital admissions in Iran for cardiovascular and respiratory diseases attributed to the Middle Eastern Dust storms

The main objective of this study was to assess the possible effects of airborne particulate matter less than 10 μm in diameter (PM₁₀) from the Middle Eastern Dust (MED) events on human health in Khorramabad (Iran) in terms of estimated hospital admissions (morbidity) for cardiovascular diseases (HACD) and for respiratory diseases (HARD) during the period of 2015 to 2016. The AirQ program developed by the World Health Organization (WHO) was used to estimate the potential health impacts to daily PM₁₀ exposures. The numbers of excess cases for cardiovascular/respiratory morbidity were 20/51, 72/185, and 20/53 on normal, dusty, and MED event days, respectively. The highest number of hospital admissions was estimated for PM₁₀ concentrations in the range of 40 to 49 μg/m³, i.e, lower than the daily (50 μg/m³) limit value established by WHO. The results also showed that 4.7% (95% CI 3.2-6.7%) and 4.2% (95% CI 2.6-5.8%) of HARD and HACD, respectively, were attributed to PM₁₀ concentrations above 10 μg/m³. The study demonstrates a significant impact of air pollution on people, which is manifested primarily as respiratory and cardiovascular problems. To reduce these effects, several immediate actions should be taken by the local authorities to control the impacts of dust storms on residents' health, e.g., developing a green beltway along the Iran-Iraq border and management of water such as irrigation of dry areas that would be effective as mitigation strategies.

Health risk assessment of exposure to the Middle-Eastern Dust storms in the Iranian megacity of Kermanshah

OBJECTIVE

This study assessed the effects of particulate matter (PM), equal or less than 10 μm in aerodynamic diameter (PM₁₀), from the Middle-Eastern Dust events on public health in the megacity of Kermanshah (Iran).

STUDY DESIGN

This study used epidemiological modeling and monitored ambient air quality data to estimate the potential PM₁₀ impacts on public health.

METHODS

The AirQ2.2.3 model was used to calculate mortality and morbidity attributed to PM₁₀ as representative of dust events. Using Visual Basic for Applications, the programming language of Excel software, hourly PM₁₀ concentrations obtained from the local agency were processed to prepare input files for the AirQ2.2.3 model.

RESULTS

Using baseline incidence, defined by the World Health Organization, the number of estimated excess cases for respiratory mortality, hospital admissions for chronic obstructive pulmonary disease, for respiratory diseases, and for cardiovascular diseases were 37, 39, 476, and 184 persons, respectively, from 21st March, 2014 to 20th March, 2015. Furthermore, 92% of mortality and morbidity cases occurred in days with PM₁₀ concentrations lower than 150 μg/m³. The highest percentage of person-days occurred for daily concentrations range of 100-109 μg/m³, causing the maximum health end-points among the citizens of Kermanshah.

CONCLUSIONS

Calculating the number of cumulative excess cases for mortality or morbidity attributed to PM₁₀ provides a good tool for decision and policy-makers in the field of health care to compensate their shortcomings particularly at hospital and healthcare centers for combating dust storms. To diminish these effects, several immediate actions should be managed in the governmental scale to control dust such as spreading mulch and planting new species that are compatible to arid area.

Investigation of an Indoor Air Quality Sensor for Asthma Management in Children

Monitoring indoor air quality is critical because Americans spend 93% of their life indoors, and around 6.3 million children suffer from asthma. We want to passively and unobtrusively monitor the asthma patient's environment to detect the presence of two asthma-exacerbating activities: smoking and cooking using the Foobot sensor. We propose a data-driven approach to develop a continuous monitoring-activity detection system aimed at understanding and improving indoor air quality in asthma management. In this study, we were successfully able to detect a high concentration of particulate matter, volatile organic compounds, and carbon dioxide during cooking and smoking activities. We detected 1) smoking with an error rate of 1%; 2) cooking with an error rate of 11%; and 3) obtained an overall 95.7% percent accuracy classification across all events (control, cooking and smoking). Such a system will allow doctors and clinicians to correlate potential asthma symptoms and exacerbation reports from patients with environmental factors without having to personally be present.

Association between availability of care providers and healthcare utilizations among adults with asthma

BACKGROUND

Limited accessibility to providers may delay appropriate control of asthma exacerbations. The objective of our study is to estimate the contributors to the hospital/emergency department (ED) visits among adults with asthma focusing on the availability of healthcare providers.

METHODS

We conducted a pooled cross-sectional analysis using the 2011-2013 Asthma Call-Back Survey linked with 2012-2016 Area Health Resource Files. We employed multivariable logistic regression with dichotomous outcomes of hospitalization and ED visits. Key covariates were the availability of county-level healthcare provider variables per 100,000 persons such as the number of lung disease specialists (including pulmonary care specialists, and allergy and immunology specialists), the number of hospitals, the number of safety-net facilities including rural health centers (RHCs) and federally qualified health centers (FQHCs), and the number of primary care physicians (PCPs).

RESULTS

Among 25,621 adults, proportions of hospital visits and ED visits were 3.3% and 13.2%, respectively. An additional RHC reduced by 3% the odds of having an ED visit (odds ratio [OR] = 0.97, p = .004). Patients with cost barriers to seeing a PCP were 60% (OR = 1.60, p = .028) more likely to have a hospital visit than those without. In addition, patients with cost barriers to seeing a specialist were 90% (OR = 1.90, p = .007) and 111% (OR = 2.11, p = .001) more likely to have a hospital visit and ED visit, respectively, than those without.

CONCLUSIONS

Hospital and ED visits among adults with asthma are partially related to the availability of providers, and more related to financial barriers. Therefore, financial support for the vulnerable asthma population might be a target for policy makers interested in reducing hospitalizations and ED visits.

Prospective study of insomnia and incident asthma in adults: the HUNT study

Insomnia is highly prevalent among asthmatics; however, few studies have investigated insomnia symptoms and asthma development. We aimed to investigate the association between insomnia and the risk of incident asthma in a population-based cohort.Among 17 927 participants free from asthma at baseline we calculated odds ratios and 95% confidence intervals for the risk of incident asthma among those with insomnia compared to those without. Participants reported sleep initiation problems, sleep maintenance problems and nonrestorative sleep. Chronic insomnia was defined as those reporting one or more insomnia symptom at baseline and 10 years earlier. Incident asthma was defined by questions on asthma at baseline and follow-up (average 11 years).The prevalence of sleep initiation problems, sleep maintenance problems and nonrestorative sleep were 1%, 1% and 5%, respectively. The multi-adjusted odds ratios were 1.18 (95% CI 0.97-1.44), 1.30 (95% CI 1.03-1.64) and 1.70 (95% CI 1.37-2.11) for people with one, two and three insomnia symptoms, respectively, compared with people without symptoms (p<0.01 for trend). The risk of developing asthma in those with chronic insomnia was three times higher (adjusted OR 3.16, 95% CI 1.37-6.40) than those without.Insomnia symptoms were associated with increased risk of incident asthma in this study.

Estimation of students' exposure to metal concentrations from river-dust episodes during 1994-2012

Two elementary schools (Shiuguang and Fongrong) from Yulin County in Taiwan, near a main area of potential exposure to Aeolian river-dust, were selected to collect outdoor and indoor PM₁₀ aerosols and to measure five metals in PM₁₀ (As, Ni, Cr, Cd, and Mn). Significant relationships (p < 0.01) were found between outdoor PM₁₀ concentrations at Lunbei's air quality monitoring station and the two elementary schools. The outdoor PM₁₀ concentrations at the monitoring station and the schools' indoor PM₁₀ concentrations also showed significant correlations. This study also established a relationship between the outdoor and indoor concentrations of PM₁₀ and metals in the schools. Estimations were made regarding students' 8 h of exposure to metal concentrations from river-dust episodes during 1994-2012, based on correlation equations that were shown to be statistically significant.

Exposure to PM10, NO2, and O3 and impacts on human health

Air pollution is emerging as a risk factor for human health like cancer and other health outcomes in developing countries, especially Iran where air pollutant concentrations are elevated. Additionally, some of the crucial environmental problems are caused by air pollution. Nevertheless, the data on health effects of air pollution are limited. The main objective of this study was to assess the health impacts attributed to particulate matter less than 10 μg/m³ (PM₁₀), nitrogen dioxide (NO₂), and ozone (O₃) in Kermanshah City (Iran). The diurnal averages of PM₁₀ and NO₂ levels and 1-h averages of O₃ concentrations were applied to assess the cardiovascular mortality due to exposure to these pollutants during the years 2014 and 2015. The excess number of cardiovascular mortality was estimated by relative risk (RR) and baseline incidence (BI) defined by the World Health Organization (WHO). The excess in mortality risk for cardiovascular diseases is of 188 premature deaths related to PM₁₀, 33 related to NO₂, and 83 related to O₃, respectively. The results indicate that a 10-μg/m³ change in PM₁₀, NO₂, and O₃ generates a relative risk of 1.066, 1.012, and 1.020, respectively. The excess of relative risk is of 6.6, 1.2, and 2.0%, respectively. Immediate policies and actions are needed to reduce the various sources of these pollutants from transport and energy manufacture facilities in Kermanshah.

Citizen Science, Air Quality, and the Internet of Things

This chapter discusses the emergence of the Internet of Things, using a case study of a citizen science initiative, focusing in particular on issues involved in measuring air quality. The core of the citizen science initiative was formed by a world-wide network of early adaptors of the Internet of Things who, motivated by public health issues, set out to create widely available tools for air quality measuring. With these tools, they established a global, citizen-led, air quality measurement network. Besides highlighting a number of social and technological issues which are involve any such enterprise, this chapter engages with the discourse surrounding the use of IoT in collective sensing projects. Two questions are salient here. Firstly, can IoT technology be used in a citizen science context to monitor air quality? And secondly, does the construction of these devices lead to a successful mobilisation around issues of air quality?

Are sleep disorders associated with increased mortality in asthma patients?

BACKGROUND

South Korea has experienced problems regarding poor management of symptoms of asthma patients and remarkable increases in sleep disorders. However, few studies have investigated these issues. We examined the relationship between sleep disorders and mortality in asthma patients to suggest effective alternatives from a novel perspective.

METHODS

We used data from the National Health Insurance Service (NHIS) National Sample Cohort 2004-2013, which included medical claims filed for 186,491 patients who were newly diagnosed with asthma during the study period. We performed survival analyses using a Cox proportional hazards model with time-dependent covariates to examine the relationship between sleep disorders and mortality in asthma patients.

RESULTS

There were 5179 (2.78%) patients who died during the study period. Sleep disorders in patients previously diagnosed with asthma were associated with a higher risk of mortality (hazard ratio [HR]: 1.451, 95% confidence interval [CI]: 1.253-1.681). In addition, significant interaction was found between sleep disorders and Charlson comorbidity index.

CONCLUSIONS

Our findings suggest that an increased prevalence of sleep disorders in asthma patients increases the risk of mortality. Considering the worsening status of asthma management and the rapid growth of sleep disorders in South Korea, clinicians and health policymakers should work to develop interventions to address these issues.

Pro-inflammatory response and oxidative stress induced by specific components in ambient particulate matter in human bronchial epithelial cells

Previous studies have shown that biological effect of particulate matter (PM2.5) is involved in including chemical composition and mass concentration, but the precise components and biological action on human bronchial epithelial cell line (BEAS-2B) are still unclear. The aim of this study was to evaluate the in vitro toxicity of PM2.5 collected at six urban sites in China, and to investigate how particle composition affects cytotoxicity. We used human bronchial epithelial (BEAS-2B) cell lines as model in vitro to expose to PM2.5 from different source, and then reactive oxygen species (ROS), superoxide dismutase activity and total antioxidant capacity were analyzed. Furthermore, we estimated the polycyclic aromatic hydrocarbon (PAH) and transition metal and the endotoxin contents. The mRNA expression of IL-1β and IL-10 following exposure to PM2.5 was measured by QRT-PCR. We also observed the mitochondrial membrane potential (MMP) using JC-1 staining, and apoptosis of BEAS-2B using flow cytometry. In addition, double-stranded DNA breaks (DSBs) were assessed using γ-H2AX immunofluorescence. Our results show that high concentrations of PAHs and elemental Ni were strongly associated with high apoptosis rates and high expression of IL-1β, in addition, Fe element was associated with the ROS level, furthermore, Fe and Cr element were associated with DNA damage in BEAS-2B cells. The cytotoxic effects of urban PM2.5 derived from six different cities in China appear dependent on the specific components in each. Our results indicate that air quality standards based on PM2.5 components may be more relevant than concentration-response functions (CRF). © 2014 Wiley Periodicals, Inc. Environ Toxicol 31: 923-936, 2016.

Urban Enhancement of PM10 Bioaerosol Tracers Relative to Background Locations in the Midwestern United States

Bioaerosols are well-known immune-active particles that exacerbate respiratory diseases. Human exposures to bioaerosols and their resultant health impacts depend on their ambient concentrations, seasonal and spatial variation, and co-pollutants, which are not yet widely characterized. In this study, chemical and biological tracers of bioaerosols were quantified in respirable particulate matter (PM10) collected at three urban and three background sites in the Midwestern United States across four seasons in 2012. Endotoxins from gram negative bacteria (and a few gram positive bacteria), water-soluble proteins, and tracers for fungal spores (fungal glucans, arabitol and mannitol) were ubiquitous and showed significant seasonal variation and dependence on temperature. Fungal spores were elevated in spring and peaked in summer, following the seasonal growing cycle, while endotoxins peaked in autumn during the row crop harvesting season. Paired comparisons of bioaerosols in urban and background sites revealed significant urban enhancements in PM10, fungal glucans, endotoxins and water-soluble proteins relative to background locations, such that urban populations have a greater outdoor exposure to bioaerosols. These bioaerosols contribute, in part, to the urban excesses in PM10. Higher bioaerosol mass fractions in urban areas relative to background sites indicate that urban areas serve as a source of bioaerosols. Similar urban enhancements in water-soluble calcium and its correlation with bioaerosol tracers point towards wind-blown soil as an important source of bioaerosols in urban areas.

Urban Enhancement of PM10 Bioaerosol Tracers Relative to Background Locations in the Midwestern United States

Bioaerosols are well-known immune-active particles that exacerbate respiratory diseases. Human exposures to bioaerosols and their resultant health impacts depend on their ambient concentrations, seasonal and spatial variation, and co-pollutants, which are not yet widely characterized. In this study, chemical and biological tracers of bioaerosols were quantified in respirable particulate matter (PM₁₀) collected at three urban and three background sites in the Midwestern United States across four seasons in 2012. Endotoxins from gram negative bacteria (and a few gram positive bacteria), water-soluble proteins, and tracers for fungal spores (fungal glucans, arabitol and mannitol) were ubiquitous and showed significant seasonal variation and dependence on temperature. Fungal spores were elevated in spring and peaked in summer, following the seasonal growing cycle, while endotoxins peaked in autumn during the row crop harvesting season. Paired comparisons of bioaerosols in urban and background sites revealed significant urban enhancements in PM₁₀, fungal glucans, endotoxins and water-soluble proteins relative to background locations, such that urban populations have a greater outdoor exposure to bioaerosols. These bioaerosols contribute, in part, to the urban excesses in PM₁₀. Higher bioaerosol mass fractions in urban areas relative to background sites indicate that urban areas serve as a source of bioaerosols. Similar urban enhancements in water-soluble calcium and its correlation with bioaerosol tracers point towards wind-blown soil as an important source of bioaerosols in urban areas.

Age of asthma onset and vulnerability to ambient air pollution: an observational population-based study of adults from Southern Taiwan

Background

Late-onset asthma (onset > 12 years) is pathologically distinct from early-onset asthma. The mechanism of air pollution is not a classic allergic inflammation and could have differential effect on late-onset and early-onset asthma. However, there is little known about the association of onset-age phenotype and air pollution. In this population-based study, we aimed to determine the association of asthma severity outcomes and air pollution regarding age at onset of asthma.

Methods

In 2004, we conducted a cross-sectional questionnaire survey about respiratory health among schoolchildren’s parents randomly selected from 94 of 816 elementary and middle schools in southern Taiwan. Participants ever having typical asthma symptoms were enrolled. We used kriging method to estimate individual exposure to ambient air pollution in the preceding year before the year of asthma severity survey. Ordered logistic regression was used to determine the association of exposure and asthma severity scores. Age at asthma onset of 12 years was used as a cut-off to define early- or late-onset asthma.

Results

The study surveyed 35,682 participants. Data from 23,551 participants remained satisfactory with a response rate of 66 %. Among 20,508 participants aged 26–50 years, 703 questionnaire-determined asthmatics were identified and included for analysis. Using the median of PM₁₀ (66 μg/m³) as a cut-off, those exposed to higher PM₁₀ were more likely to have higher severity scores (OR = 1.74; 95 % CI, 1.13 – 2.70) only for asthmatics with asthma onset at > 12 years.

Conclusions

In adulthood, exposure to PM₁₀ has a greater effect on late-onset asthma than early-onset asthma and deserves greater attention among ambient air pollutants.

Electronic supplementary material

The online version of this article (doi:10.1186/s12890-016-0218-0) contains supplementary material, which is available to authorized users.