Air pollution and hospital admissions for the elderly in Detroit, Michigan

Risk Factors for Respiratory Viral Infections: A Spotlight on Climate Change and Air Pollution

Climate change has both direct and indirect effects on human health, and some populations are more vulnerable to these effects than others. Viral respiratory infections are most common illnesses in humans, with estimated 17 billion incident infections globally in 2019. Anthropogenic drivers of climate change, chiefly the emission of greenhouse gases and toxic pollutants from burning of fossil fuels, and the consequential changes in temperature, precipitation, and frequency of extreme weather events have been linked with increased susceptibility to viral respiratory infections. Air pollutants like nitrogen dioxide, particulate matter, diesel exhaust particles, and ozone have been shown to impact susceptibility and immune responses to viral infections through various mechanisms, including exaggerated or impaired innate and adaptive immune responses, disruption of the airway epithelial barrier, altered cell surface receptor expression, and impaired cytotoxic function. An estimated 90% of the world's population is exposed to air pollution, making this a topic with high relevance to human health. This review summarizes the available epidemiologic and experimental evidence for an association between climate change, air pollution, and viral respiratory infection.

Health Disparity Resulting from the Effect of Built Environment on Temperature-Related Mortality in a Subtropical Urban Setting

Whereas previous studies have assessed the overall health impact of temperature in Hong Kong, the aim of this study was to investigate whether the health impact is modified by local temperature of small geographic units, which may be related to the diverse socioeconomic characteristics of these units. The effects of local temperature on non-accidental and cause-specific mortality were analyzed using Bayesian spatial models at a small-area level, adjusting for potential confounders, i.e., area-level air pollutants, socioeconomic status, and green space, as well as spatial dependency. We found that a 10% increase in green space density was associated with an estimated 4.80% decrease in non-accidental mortality risk and a 5.75% decrease in cardiovascular disease mortality risk in Hong Kong, whereas variation in local annual temperature did not significantly contribute to mortality. We also found that the spatial variation of mortality within this city could be explained by the geographic distribution of green space and socioeconomic factors rather than local temperature or air pollution. The findings and methodology of this study may help to further understanding and investigation of social and structural determinants of health disparities, particularly place-based built environment across class-based small geographic units in a city, taking into account the intersection of multiple factors from individual to population levels.

Au W, Zhao W, Xia ZL. A Systematic Review and Meta-Analysis of Short-Term Ambient Ozone Exposure and COPD Hospitalizations

Chronic obstructive pulmonary disease (COPD) is the third leading cause of death globally and ozone exposure is a main cause of its disease burden. However, studies on COPD hospitalizations from short-term ambient level ozone exposure have not generated consensus results. To address the knowledge gap, comprehensive and systematic searches in several databases were conducted using specific keywords for publications up to February 14, 2020. Random-effect models were used to derive overall excess risk estimates between short-term ambient-level ozone exposure and COPD hospitalizations. The influence analyses were used to test the robustness of the results. Both meta-regression and subgroup analyses were used to explore the sources of heterogeneity and potential modifying factors. Based on the results from 26 eligible studies, the random-effect model analyses show that a 10 µg/m³ increase in maximum 8-h ozone concentration was associated with 0.84% (95% CI: 0.09%, 1.59%) higher COPD hospitalizations. The estimates were higher for warm season and multiple-day lag but lower for old populations. Results from subgroup analyses also indicate a multiple-day lag trend and bigger significant health effects during longer day intervals. Although characteristics of individual studies added modest heterogeneity to the overall estimates, the results remained robust during further analyses and exhibited no evidence of publication bias. Our systematic review and meta-analysis indicate that short-term ambient level ozone exposure was associated with increased risk of COPD hospitalizations. The significant association with multiple-day lag trend indicates that a multiple-day exposure metric should be considered for establishing ambient ozone quality and exposure standards for improvement of population health. Future investigations and meta-analysis studies should include clinical studies as well as more careful lag selection protocol.

The benefits of lower ozone due to air pollution emission reductions (2002-2011) in the Eastern United States during extreme heat

Using the Community Multiscale Air Quality (CMAQ) model and the Benefits Mapping and Analysis Program - Community Edition (BenMAP-CE) tool, we estimate the benefits of anthropogenic emission reductions between 2002 and 2011 in the Eastern United States (US) with respect to surface ozone concentrations and ozone-related health and economic impacts, during a month of extreme heat, July 2011. Based on CMAQ simulations using emissions appropriate for 2002 and 2011, we estimate that emission reductions since 2002 likely prevented 10- 15 ozone exceedance days (using the 2011 maximum 8-hr average ozone standard of 75 ppbv) throughout the Ohio River Valley and 5- 10 ozone exceedance days throughout the Washington, DC - Baltimore, MD metropolitan area during this extremely hot month. CMAQ results were fed into the BenMAP-CE tool to determine the health and health-related economic benefits of anthropogenic emission reductions between 2002 and 2011. We estimate that the concomitant health benefits from the ozone reductions were significant for this anomalous month: 160-800 mortalities (95% confidence interval (CI): 70-1,010) were avoided in July 2011 in the Eastern U.S, saving an estimated $1.3-$6.6 billion (CI: $174 million-$15.5 billion). Additionally, we estimate that emission reductions resulted in 950 (CI: 90-2,350) less hospital admissions from respiratory symptoms, 370 (CI: 180-580) less hospital admissions for pneumonia, 570 (CI: 0-1650) less Emergency Room (ER) visits from asthma symptoms, 922,020 (CI: 469,960-1,370,050) less minor restricted activity days (MRADs), and 430,240 (CI: -280,350-963,190) less symptoms of asthma exacerbation during July 2011.Implications: We estimate the benefits of air pollution emission reductions on surface ozone concentrations and ozone-related impacts on human health and the economy between 2002 and 2011 during an extremely hot month, July 2011, in the eastern United States (US) using the CMAQ and BenMAP-CE models. Results suggest that, during July 2011, emission reductions prevented 10-15 ozone exceedance days in the Ohio River Valley and 5-10 ozone exceedance days in the Mid Atlantic; saved 160-800 lives in the Eastern US, saving $1.3 - $6.5 billion; and resulted in 950 less hospital admissions for respiratory symptoms, 370 less hospital admissions for pneumonia, 570 less Emergency Room visits for asthma symptoms, 922,020 less minor restricted activity days, and 430,240 less symptoms of asthma exacerbation.

Impact of ambient air pollution and wheeze-associated disorders in children in Southeast Asia: a systematic review and meta-analysis

Several systematic reviews have been conducted so far to examine the effect of air pollution on respiratory diseases, but there has not been a corresponding meta-analysis to estimate the effect sizes for wheeze-associated diseases/disorders, which is one of the leading causes of emergency department visits and hospitalizations for children worldwide. The aim of this review is to systematically evaluate the relationship between air pollution and risk of wheeze-associated disorders in children in Southeast Asia. We searched the relevant computerized databases (PubMed, EMBASE, Web of Science, Scopus and Cochrane library) for indexed publications up to July 2018. Finally, eight studies were qualified for performing a random-effect meta-analysis to compute the pooled effect sizes. The results show that each increase of 10 μg/m3 in concentrations of PM2.5, PM1 was associated with 1-2% increase in risk of wheeze-associated disorders. Positive associations were found for PM10, SO2, NO2, NOx but no association was found for CO and O3. We confirmed the strong effect of fine particulate matters on respiratory health and recommend an updated meta-analysis should be done when more studies are available.

Causal Modeling in Environmental Health

The field of environmental health has been dominated by modeling associations, especially by regressing an observed outcome on a linear or nonlinear function of observed covariates. Readers interested in advances in policies for improving environmental health are, however, expecting to be informed about health effects resulting from, or more explicitly caused by, environmental exposures. The quantification of health impacts resulting from the removal of environmental exposures involves causal statements. Therefore, when possible, causal inference frameworks should be considered for analyzing the effects of environmental exposures on health outcomes.

Seasonal association between ambient ozone and hospital admission for respiratory diseases in Hanoi, Vietnam

BACKGROUND

Many studies have indicated the detrimental effect of ambient ozone to respiratory health in different countries. The levels of ozone in Hanoi, Vietnam are frequently above the WHO guideline but very few studies on the effects of ambient ozone on human health have been conducted in this location. This study aimed to examine the effects of ozone on hospital admission for respiratory diseases in Hanoi, by diseases, ages and seasons.

METHODS

Hospital admissions, air pollutants and meteorological data were collected from January 2010 to June 2014. We used generalized linear models and distributed lag linear model to assess the association. In addition to full year analysis, we conducted restricted analysis of the data for two summer (from June-August) and winter (from December-February) seasons and grouped hospital admissions by diseases and ages (all ages, children 0 to 5 years and elderly >65 years). The delayed effect of ozone was assessed using lags of up to 5 days.

RESULTS

Ozone has a stronger effect on the risk of hospital admission for respiratory diseases and wheeze-associated disorders in the winter. For respiratory diseases, children were affected by ozone more than other age groups in both winter and summer. Each increase of 10 μg/m3 of ozone is associated with an increase of 6.2% risk of admission for respiratory disease among children in the winter and 1.2% in the summer. For wheeze-associated disorders, the elderly group seemed to be more affected by ozone in full year and winter but no significant association was found between ozone and admission for wheeze-associated diseases in any age group.

CONCLUSIONS

Ozone is a risk factor for respiratory admission, especially amongst children under 5 years old in Hanoi, and ozone has a stronger effect in the winter than in the summer in this city.

Air-quality-related health impacts from climate change and from adaptation of cooling demand for buildings in the eastern United States: An interdisciplinary modeling study

BACKGROUND

Climate change negatively impacts human health through heat stress and exposure to worsened air pollution, amongst other pathways. Indoor use of air conditioning can be an effective strategy to reduce heat exposure. However, increased air conditioning use increases emissions of air pollutants from power plants, in turn worsening air quality and human health impacts. We used an interdisciplinary linked model system to quantify the impacts of heat-driven adaptation through building cooling demand on air-quality-related health outcomes in a representative mid-century climate scenario.

METHODS AND FINDINGS

We used a modeling system that included downscaling historical and future climate data with the Weather Research and Forecasting (WRF) model, simulating building electricity demand using the Regional Building Energy Simulation System (RBESS), simulating power sector production and emissions using MyPower, simulating ambient air quality using the Community Multiscale Air Quality (CMAQ) model, and calculating the incidence of adverse health outcomes using the Environmental Benefits Mapping and Analysis Program (BenMAP). We performed simulations for a representative present-day climate scenario and 2 representative mid-century climate scenarios, with and without exacerbated power sector emissions from adaptation in building energy use. We find that by mid-century, climate change alone can increase fine particulate matter (PM2.5) concentrations by 58.6% (2.50 μg/m3) and ozone (O3) by 14.9% (8.06 parts per billion by volume [ppbv]) for the month of July. A larger change is found when comparing the present day to the combined impact of climate change and increased building energy use, where PM2.5 increases 61.1% (2.60 μg/m3) and O3 increases 15.9% (8.64 ppbv). Therefore, 3.8% of the total increase in PM2.5 and 6.7% of the total increase in O3 is attributable to adaptive behavior (extra air conditioning use). Health impacts assessment finds that for a mid-century climate change scenario (with adaptation), annual PM2.5-related adult mortality increases by 13,547 deaths (14 concentration-response functions with mean incidence range of 1,320 to 26,481, approximately US$126 billion cost) and annual O3-related adult mortality increases by 3,514 deaths (3 functions with mean incidence range of 2,175 to 4,920, approximately US$32.5 billion cost), calculated as a 3-month summer estimate based on July modeling. Air conditioning adaptation accounts for 654 (range of 87 to 1,245) of the PM2.5-related deaths (approximately US$6 billion cost, a 4.8% increase above climate change impacts alone) and 315 (range of 198 to 438) of the O3-related deaths (approximately US$3 billion cost, an 8.7% increase above climate change impacts alone). Limitations of this study include modeling only a single month, based on 1 model-year of future climate simulations. As a result, we do not project the future, but rather describe the potential damages from interactions arising between climate, energy use, and air quality.

CONCLUSIONS

This study examines the contribution of future air-pollution-related health damages that are caused by the power sector through heat-driven air conditioning adaptation in buildings. Results show that without intervention, approximately 5%-9% of exacerbated air-pollution-related mortality will be due to increases in power sector emissions from heat-driven building electricity demand. This analysis highlights the need for cleaner energy sources, energy efficiency, and energy conservation to meet our growing dependence on building cooling systems and simultaneously mitigate climate change.

Climate Change and Respiratory Infections

The rate of global warming has accelerated over the past 50 years. Increasing surface temperature is melting glaciers and raising the sea level. More flooding, droughts, hurricanes, and heat waves are being reported. Accelerated changes in climate are already affecting human health, in part by altering the epidemiology of climate-sensitive pathogens. In particular, climate change may alter the incidence and severity of respiratory infections by affecting vectors and host immune responses. Certain respiratory infections, such as avian influenza and coccidioidomycosis, are occurring in locations previously unaffected, apparently because of global warming. Young children and older adults appear to be particularly vulnerable to rapid fluctuations in ambient temperature. For example, an increase in the incidence in childhood pneumonia in Australia has been associated with sharp temperature drops from one day to the next. Extreme weather events, such as heat waves, floods, major storms, drought, and wildfires, are also believed to change the incidence of respiratory infections. An outbreak of aspergillosis among Japanese survivors of the 2011 tsunami is one such well-documented example. Changes in temperature, precipitation, relative humidity, and air pollution influence viral activity and transmission. For example, in early 2000, an outbreak of Hantavirus respiratory disease was linked to a local increase in the rodent population, which in turn was attributed to a two- to threefold increase in rainfall before the outbreak. Climate-sensitive respiratory pathogens present challenges to respiratory health that may be far greater in the foreseeable future.

Global Associations between Air Pollutants and Chronic Obstructive Pulmonary Disease Hospitalizations. A Systematic Review

RATIONALE

Exacerbations are key events in chronic obstructive pulmonary disease (COPD), affecting lung function decline and quality of life. The effect of exposure to different air pollutants on COPD exacerbations is not clear.

OBJECTIVES

To carry out a systematic review, examining associations between air pollutants and hospital admissions for COPD exacerbations.

METHODS

MEDLINE, Embase, BIOSIS, Science Citation Index, and the Air Pollution Epidemiology Database were searched for publications published between 1980 and September 2015. Inclusion criteria were focused on studies presenting solely a COPD outcome defined by hospital admissions and a measure of gaseous air pollutants and particle fractions. The association between each pollutant and COPD admissions was investigated in metaanalyses using random effects models. Analyses were stratified by geographical clusters for investigation of the consistency of the evidence worldwide.

MEASUREMENTS AND MAIN RESULTS

Forty-six studies were included, and results for all the pollutants under investigation showed marginal positive associations; however, the number of included studies was small, the studies had high heterogeneity, and there was evidence of small-study bias. Geographical clustering of the effects of pollution on COPD hospital admissions was evident and reduced heterogeneity significantly.

CONCLUSIONS

The most consistent association was between a 1-mg/m³ increase in carbon monoxide level and COPD-related admissions (odds ratio, 1.02; 95% confidence interval, 1.01-1.03). The heterogeneity was moderate, and there was a consistent positive association in both Europe and North America, although levels were clearly below World Health Organization guideline values. There is mixed evidence on the effects of environmental pollution on COPD exacerbations. Limitations of previous studies included the low spatiotemporal resolution of pollutants, inadequate control for confounding factors, and the use of aggregated health data that ignored personal characteristics. The need for more targeted exposure estimates in a large number of geographical locations is evident.

To Investigate the Effects of Air Pollution (PM10 and SO2) on the Respiratory Diseases Asthma and Chronic Obstructive Pulmonary Disease

OBJECTIVES

Effects of air pollution parameters of sulfur dioxide (SO2) and particulate matter (PM10) values on the respiratory system were investigated.

MATERIAL AND METHODS

Data of SO₂ and PM10 were obtained daily for air pollution and classified into two groups: Group I (2006-2007), coal burning years and Group II (2008-2009), natural gas+ coal burning. Groups I and II were divided into two subgroups according to the months of combustion as combustible (November-April) and noncombustible (May-October). The number of patients with asthma and chronic obstructive pulmonary disorder (COPD) was recorded between 2006 and 2009.

RESULTS

There was no statistically significant difference between Groups I and II for PM10 and SO₂ (p>0.05). Within the years, the values of SO₂ and PM10 were statistically different between the groups defined by month (p<0.01). The number of patients in the combustible and noncombustible subgroups were found to be different for every 4 years, and the numbers of patients with COPD or asthma were not changed through the years. There was a strong correlation between PM10 and COPD (r=0.59, p<0.01) and a weak correlation between PM10 and asthma (r=0.25, p>0.05). A correlation was found between SO₂ and COPD (p<0.01) but not between SO₂ and asthma (p>0.05). The number of visits for COPD and asthma was statistically different between combustible and noncombustible subgroups (X2:58.61, p=0.000; X2:34.55, p=0.000, respectively). The r2 values for SO₂ and PM10 for COPD patients were 17% and 24%, respectively, in contrast to 8% and 5%, respectivley for asthma patients.

CONCLUSION

Air pollution is known to increase respiratory disease occurrences. With decrease in the usage of solid fuel, air pollution could be reduced and may be effective in preventing respiratory diseases.

Human Health and Economic Impacts of Ozone Reductions by Income Group

Low-income households may be disproportionately affected by ozone pollution and ozone policy. We quantify how three factors affect the relative benefits of ozone policies with household income: (1) unequal ozone reductions; (2) policy delay; and (3) economic valuation methods. We model ozone concentrations under baseline and policy conditions across the full continental United States to estimate the distribution of ozone-related health impacts across nine income groups. We enhance an economic model to include these impacts across household income categories, and present its first application to evaluate the benefits of ozone reductions for low-income households. We find that mortality incidence rates decrease with increasing income. Modeled ozone levels yield a median of 11 deaths per 100 000 people in 2005. Proposed policy reduces these rates by 13%. Ozone reductions are highest among low-income households, which increases their relative welfare gains by up to 4% and decreases them for the rich by up to 8%. The median value of reductions in 2015 is either $30 billion (in 2006 U.S. dollars) or $1 billion if reduced mortality risks are valued with willingness-to-pay or as income from increased life expectancy. Ozone reductions were relatively twice as beneficial for the lowest- compared to the highest-income households. The valuation approach affected benefits more than a policy delay or differential ozone reductions with income.

Impact of air quality guidelines on COPD sufferers

Background

COPD is one of the leading causes of morbidity and mortality in both high- and low-income countries and a major public health burden worldwide. While cigarette smoking remains the main cause of COPD, outdoor and indoor air pollution are important risk factors to its etiology. Although studies over the last 30 years helped reduce the values, it is not very clear if the current air quality guidelines are adequately protective for COPD sufferers.

Objective

This systematic review was to summarize the up-to-date literature on the impact of air pollution on the COPD sufferers.

Methods

PubMed and Google Scholar were utilized to search for articles related to our study’s focus. Search terms included “COPD exacerbation”, “air pollution”, “air quality guidelines”, “air quality standards”, “COPD morbidity and mortality”, “chronic bronchitis”, and “air pollution control” separately and in combination. We focused on articles from 1990 to 2015. We also used articles prior to 1990 if they contained relevant information. We focused on articles written in English or with an English abstract. We also used the articles in the reference lists of the identified articles.

Results

Both short-term and long-term exposures to outdoor air pollution around the world are associated with the mortality and morbidity of COPD sufferers even at levels below the current air quality guidelines. Biomass cooking in low-income countries was clearly associated with COPD morbidity in adult nonsmoking females.

Conclusion

There is a need to continue to improve the air quality guidelines. A range of intervention measures could be selected at different levels based on countries’ socioeconomic conditions to reduce the air pollution exposure and COPD burden.

ALAT-2014 Chronic Obstructive Pulmonary Disease (COPD) Clinical Practice Guidelines: questions and answers

ALAT-2014 COPD Clinical Practice Guidelines used clinical questions in PICO format to compile evidence related to risk factors, COPD screening, disease prognosis, treatment and exacerbations. Evidence reveals the existence of risk factors for COPD other than tobacco, as well as gender differences in disease presentation. It shows the benefit of screening in an at-risk population, and the predictive value use of multidimensional prognostic indexes. In stable COPD, similar benefits in dyspnea, pulmonary function and quality of life are achieved with LAMA or LABA long-acting bronchodilators, whereas LAMA is more effective in preventing exacerbations. Dual bronchodilator therapy has more benefits than monotherapy. LAMA and combination LABA/IC are similarly effective, but there is an increased risk of pneumonia with LABA/IC. Data on the efficacy and safety of triple therapy are scarce. Evidence supports influenza vaccination in all patients and anti-pneumococcal vaccination in patients <65years of age and/or with severe airflow limitation. Antibiotic prophylaxis may decrease exacerbation frequency in patients at risk. The use of systemic corticosteroids and antibiotics are justified in exacerbations requiring hospitalization and in some patients managed in an outpatient setting.

Effect modification of ozone-related mortality risks by temperature in 97 US cities

Many time-series studies have characterized the relationship between short-term ozone exposure and adverse health outcomes, controlling for temperature as a confounder. Temperature may also modify ozone effects, though this has been largely under-investigated. In this study, we explored whether temperature modifies the effect of short-term ozone exposure on mortality. We used the database developed for the National Morbidity and Mortality Air Pollution Study to estimate ozone mortality risks in 97 US cities in May through September, 1987-2000. We treated temperature as a confounder as well as an effect modifier by estimating risks at low, moderate, and high temperature categories. When temperature was treated as a confounder, a 10-ppb increase in daily 24-h ozone was associated with a 0.47% (95% CI: 0.19%-0.76%) increase in mortality. When we assessed effect modification by temperature, the interaction between ozone and temperature was not statistically significant. However, there was a U-shaped pattern in mortality risk, which was greater at the low (<25th percentile) and high (>75th percentile) temperature levels than moderate temperature levels. At the high temperature category, a 10% increase in AC prevalence mitigated mortality risk associated with 10-ppb of ozone exposure by -0.18% (95% CI: -0.35%, -0.02%). Furthermore, ozone mortality risk in the high temperature category increased as we restricted our analyses to hotter days. On days where temperatures exceeded the 75th, 90th, and 95th percentile temperatures, a 10-ppb increase in ozone was associated with a 0.65% (95% CI: 0.20%-1.09%), 0.83% (95% CI: 0.17%-1.48%), and 1.35% (95% CI: 0.44%-2.27%) increase in mortality, respectively. These results suggested that high temperatures may exacerbate physiological responses to short-term ozone exposure.

Short term effects of particle exposure on hospital admissions in the Mid-Atlantic states: a population estimate

Background

Many studies report significant associations between PM_2.5 (particulate matter <2.5 micrometers) and hospital admissions. These studies mostly rely on a limited number of monitors which introduces exposure error, and excludes rural and suburban populations from locations where monitors are not available, reducing generalizability and potentially creating selection bias.

Methods

Using prediction models developed by our group, daily PM2.5 exposure was estimated across the Mid-Atlantic (Washington D.C., and the states of Delaware, Maryland, New Jersey, Pennsylvania, Virginia, New York and West Virginia). We then investigated the short-term effects of PM_2.5 exposures on emergency hospital admissions of the elderly in the Mid-Atlantic region.We performed case-crossover analysis for each admission type, matching on day of the week, month and year and defined the hazard period as lag01 (a moving average of day of admission exposure and previous day exposure).

Results

We observed associations between short-term exposure to PM_2.5 and hospitalization for all outcomes examined. For example, for every 10-µg/m³ increase in short-term PM _2.5 there was a 2.2% increase in respiratory diseases admissions (95% CI = 1.9 to 2.6), and a 0.78% increase in cardiovascular disease (CVD) admission rate (95% CI = 0.5 to 1.0). We found differences in risk for CVD admissions between people living in rural and urban areas. For every10-µg/m³ increase in PM _2.5 exposure in the ‘rural’ group there was a 1.0% increase (95% CI = 0.6 to 1.5), while for the ‘urban’ group the increase was 0.7% (95% CI = 0.4 to 1.0).

Conclusions

Our findings showed that PM_2.5 exposure was associated with hospital admissions for all respiratory, cardio vascular disease, stroke, ischemic heart disease and chronic obstructive pulmonary disease admissions. In addition, we demonstrate that our AOD (Aerosol Optical Depth) based exposure models can be successfully applied to epidemiological studies investigating the health effects of short-term exposures to PM_2.5.

Long- and short-term exposure to PM2.5 and mortality: using novel exposure models

BACKGROUND

Many studies have reported associations between ambient particulate matter (PM) and adverse health effects, focused on either short-term (acute) or long-term (chronic) PM exposures. For chronic effects, the studied cohorts have rarely been representative of the population. We present a novel exposure model combining satellite aerosol optical depth and land-use data to investigate both the long- and short-term effects of PM2.5 exposures on population mortality in Massachusetts, United States, for the years 2000-2008.

METHODS

All deaths were geocoded. We performed two separate analyses: a time-series analysis (for short-term exposure) where counts in each geographic grid cell were regressed against cell-specific short-term PM2.5 exposure, temperature, socioeconomic data, lung cancer rates (as a surrogate for smoking), and a spline of time (to control for season and trends). In addition, for long-term exposure, we performed a relative incidence analysis using two long-term exposure metrics: regional 10 × 10 km PM2.5 predictions and local deviations from the cell average based on land use within 50 m of the residence. We tested whether these predicted the proportion of deaths from PM-related causes (cardiovascular and respiratory diseases).

RESULTS

For short-term exposure, we found that for every 10-µg/m increase in PM 2.5 exposure there was a 2.8% increase in PM-related mortality (95% confidence interval [CI] = 2.0-3.5). For the long-term exposure at the grid cell level, we found an odds ratio (OR) for every 10-µg/m increase in long-term PM2.5 exposure of 1.6 (CI = 1.5-1.8) for particle-related diseases. Local PM2.5 had an OR of 1.4 (CI = 1.3-1.5), which was independent of and additive to the grid cell effect.

CONCLUSIONS

We have developed a novel PM2.5 exposure model based on remote sensing data to assess both short- and long-term human exposures. Our approach allows us to gain spatial resolution in acute effects and an assessment of long-term effects in the entire population rather than a selective sample from urban locations.

Pulmonary responses in current smokers and ex-smokers following a two hour exposure at rest to clean air and fine ambient air particles

Background

Increased susceptibility of smokers to ambient PM may potentially promote development of COPD and accelerate already present disease.

Objectives

To characterize the acute and subacute lung function response and inflammatory effects of controlled chamber exposure to concentrated ambient fine particles (CAFP) with MMAD ≤ 2.5 microns in ex-smokers and lifetime smokers.

Methods

Eleven subjects, aged 35–74 years, came to the laboratory 5 times; a training day and two exposure days separated by at least 3 weeks, each with a post-exposure visit 22 h later. Double-blind and counterbalanced exposures to “clean air” (mean 1.5 ± 0.6 μg/m³) or CAFP (mean 108.7 ± 24.8 μg/m³ ) lasted 2 h with subjects at rest.

Results

At 3 h post-exposure subjects’ DTPA clearance half-time significantly increased by 6.3 min per 100 μg/m³ of CAFP relative to “clean air”. At 22 h post-exposure they showed significant reduction of 4.3% per 100 μg/m³ in FEV₁ and a significant D_LCO decrease by 11.1% per 100 μg/m³ of CAFP relative to “clean air”. At both 3 h and 22 h the HDL cholesterol level significantly decreased by 4.5% and 4.1%, respectively. Other blood chemistries and markers of lung injury, inflammation and procoagulant activity were within the normal range of values at any condition.

Conclusions

The results suggest that an acute 2 h resting exposure of smokers and ex-smokers to fine ambient particulate matter may transiently affect pulmonary function (spirometry and D_LCO) and increase DTPA clearance half-time. Except for a post exposure decrease in HDL no other markers of pulmonary inflammation, prothrombotic activity and lung injury were significantly affected under the conditions of exposure.

Dysregulation of macrophage activation profiles by engineered nanoparticles

Although the potential human health impacts from exposure to engineered nanoparticles (ENPs) are uncertain, past epidemiological studies have established correlations between exposure to ambient air pollution particulates and the incidence of pneumonia and lung infections. Using amorphous silica and superparamagnetic iron oxide (SPIO) as model high production volume ENPs, we examined how macrophage activation by bacterial lipopolysaccharide (LPS) or the lung pathogen Streptococcus pneumoniae is altered by ENP pretreatment. Neither silica nor SPIO treatment elicited direct cytotoxic or pro-inflammatory effects in bone marrow-derived macrophages. However, pretreatment of macrophages with SPIO caused extensive reprogramming of nearly 500 genes regulated in response to LPS challenge, hallmarked by exaggerated activation of oxidative stress response pathways and suppressed activation of both pro- and anti-inflammatory pathways. Silica pretreatment altered regulation of only 67 genes, but there was strong correlation with gene sets affected by SPIO. Macrophages exposed to SPIO displayed a phenotype suggesting an impaired ability to transition from an M1 to M2-like activation state, characterized by suppressed IL-10 induction, enhanced TNFα production, and diminished phagocytic activity toward S. pneumoniae. Studies in macrophages deficient in scavenger receptor A (SR-A) showed SR-A participates in cell uptake of both the ENPs and S. pneumonia and co-regulates the anti-inflammatory IL-10 pathway. Thus, mechanisms for dysregulation of innate immunity exist by virtue that common receptor recognition pathways are used by some ENPs and pathogenic bacteria, although the extent of transcriptional reprogramming of macrophage function depends on the physicochemical properties of the ENP after internalization. Our results also illustrate that biological effects of ENPs may be indirectly manifested only after challenging normal cell function. Nanotoxicology screening strategies should therefore consider how exposure to these materials alters susceptibility to other environmental exposures.

Comparing models of the effect of air pollutants on hospital admissions and symptoms for chronic obstructive pulmonary disease

There is an increasing interest in the use of hospital admission for Chronic obstructive pulmonary disease (COPD) in studies of short-term exposure effects attributed to air pollutants. However, little is known about the effect of air pollutants on COPD symptoms. This study was undertaken to determine whether there was an association between air pollutant levels and both hospital admissions and symptoms for COPD. For model comparison, we present Generalized Linear Model, Generalized Additive Model and a general approach for Bayesian inference via Markov chain Monte Carlo in generalized additive model. Furthermore, for comparing the predictive accuracy, Artificial Neural Networks (ANN) approach is given.

A direct sensitivity approach to predict hourly ozone resulting from compliance with the National Ambient Air Quality Standard

In setting primary ambient air quality standards, the EPA's responsibility under the law is to establish standards that protect public health. As part of the current review of the ozone National Ambient Air Quality Standard (NAAQS), the US EPA evaluated the health exposure and risks associated with ambient ozone pollution using a statistical approach to adjust recent air quality to simulate just meeting the current standard level, without specifying emission control strategies. One drawback of this purely statistical concentration rollback approach is that it does not take into account spatial and temporal heterogeneity of ozone response to emissions changes. The application of the higher-order decoupled direct method (HDDM) in the community multiscale air quality (CMAQ) model is discussed here to provide an example of a methodology that could incorporate this variability into the risk assessment analyses. Because this approach includes a full representation of the chemical production and physical transport of ozone in the atmosphere, it does not require assumed background concentrations, which have been applied to constrain estimates from past statistical techniques. The CMAQ-HDDM adjustment approach is extended to measured ozone concentrations by determining typical sensitivities at each monitor location and hour of the day based on a linear relationship between first-order sensitivities and hourly ozone values. This approach is demonstrated by modeling ozone responses for monitor locations in Detroit and Charlotte to domain-wide reductions in anthropogenic NOx and VOCs emissions. As seen in previous studies, ozone response calculated using HDDM compared well to brute-force emissions changes up to approximately a 50% reduction in emissions. A new stepwise approach is developed here to apply this method to emissions reductions beyond 50% allowing for the simulation of more stringent reductions in ozone concentrations. Compared to previous rollback methods, this application of modeled sensitivities to ambient ozone concentrations provides a more realistic spatial response of ozone concentrations at monitors inside and outside the urban core and at hours of both high and low ozone concentrations.

Effect of air pollution on daily morbidity in Karachi, Pakistan

Levels of daily particulates (PM2.5) were monitored at two sites in Karachi, Pakistan. One site (Korangi) is an industrial and residential neighborhood, while the other (Tibet Center) is a commercial and residential area near a major highway. Monitoring was done daily for a period of six weeks during spring, summer, fall and winter. Particulate levels were extraordinarily high, with the great majority of days falling into the “unhealthy for sensitive groups” or “very unhealthy” categories. The mean PM2.5 levels in Karachi exceeded the WHO's 24 h air quality guideline almost every day and often by a factor of greater than 5-fold. Daily emergency room (ER) visits and hospital admissions for cardiovascular diseases were obtained by review of medical records at three major tertiary and specialized hospitals. ER and hospitalizations were reported relative to days in which the concentration of PM2.5 was less than 50 μg/m3, and by 50 μg/m3 increments up to 300 μg/m3. There were statistically significant elevations in rates of hospital admissions at each of the PM2.5 categories at the Korangi site, and at concentrations >150 μg/m3 at the Tibet Center site. ER visits were significantly elevated only at PM2.5 concentrations of between 151 and 200 μg/m3 at both sites. These results show that the extremely elevated concentrations of PM2.5 in Karachi, Pakistan are, as expected, associated with significantly elevated rates of hospital admission, and to a lesser extent, ER visits for cardiovascular disease.

Health benefits from large-scale ozone reduction in the United States

BACKGROUND

Exposure to ozone has been associated with adverse health effects, including premature mortality and cardiopulmonary and respiratory morbidity. In 2008, the U.S. Environmental Protection Agency (EPA) lowered the primary (health-based) National Ambient Air Quality Standard (NAAQS) for ozone to 75 ppb, expressed as the fourth-highest daily maximum 8-hr average over a 24-hr period. Based on recent monitoring data, U.S. ozone levels still exceed this standard in numerous locations, resulting in avoidable adverse health consequences.

OBJECTIVES

We sought to quantify the potential human health benefits from achieving the current primary NAAQS standard of 75 ppb and two alternative standard levels, 70 and 60 ppb, which represent the range recommended by the U.S. EPA Clean Air Scientific Advisory Committee (CASAC).

METHODS

We applied health impact assessment methodology to estimate numbers of deaths and other adverse health outcomes that would have been avoided during 2005, 2006, and 2007 if the current (or lower) NAAQS ozone standards had been met. Estimated reductions in ozone concentrations were interpolated according to geographic area and year, and concentration-response functions were obtained or derived from the epidemiological literature.

RESULTS

We estimated that annual numbers of avoided ozone-related premature deaths would have ranged from 1,410 to 2,480 at 75 ppb to 2,450 to 4,130 at 70 ppb, and 5,210 to 7,990 at 60 ppb. Acute respiratory symptoms would have been reduced by 3 million cases and school-loss days by 1 million cases annually if the current 75-ppb standard had been attained. Substantially greater health benefits would have resulted if the CASAC-recommended range of standards (70-60 ppb) had been met.

CONCLUSIONS

Attaining a more stringent primary ozone standard would significantly reduce ozone-related premature mortality and morbidity.

Outdoor air pollution and respiratory health in Asia

With the rapid economic development occurring in the last decade in many countries of Asia, the level of air pollution has increased from both industrial and motor vehicle emissions. Compared with Europe and North America, the potential health effects of this increasing air pollution in Asia remain largely unmeasured. Recent data published by the Health Effects Institute from some major cities in India and China reveal that a 10 µg/m(3) increase in PM(10) was associated with an increase in mortality of 0.6% in daily all-natural cause mortality, with higher risks being found at extremes of high temperatures and in the lowest economically advantaged population. Other Asian studies have confirmed the link between hospital admissions for the worsening of COPD and the increase in asthma prevalence to levels of outdoor air pollutants. Although potential health effects appear to be similar to already-published Western data, it is important that further studies be carried out in Asia that will inform the public and the authorities of the necessity to curb levels of outdoor air pollutants to acceptable levels.

Air quality and exercise-related health benefits from reduced car travel in the midwestern United States

BACKGROUND

Automobile exhaust contains precursors to ozone and fine particulate matter (PM ≤ 2.5 µm in aerodynamic diameter; PM2.5), posing health risks. Dependency on car commuting also reduces physical fitness opportunities.

OBJECTIVE

In this study we sought to quantify benefits from reducing automobile usage for short urban and suburban trips.

METHODS

We simulated census-tract level changes in hourly pollutant concentrations from the elimination of automobile round trips ≤ 8 km in 11 metropolitan areas in the upper midwestern United States using the Community Multiscale Air Quality (CMAQ) model. Next, we estimated annual changes in health outcomes and monetary costs expected from pollution changes using the U.S. Environmental Protection Agency Benefits Mapping Analysis Program (BenMAP). In addition, we used the World Health Organization Health Economic Assessment Tool (HEAT) to calculate benefits of increased physical activity if 50% of short trips were made by bicycle.

RESULTS

We estimate that, by eliminating these short automobile trips, annual average urban PM2.5 would decline by 0.1 µg/m3 and that summer ozone (O3) would increase slightly in cities but decline regionally, resulting in net health benefits of $4.94 billion/year [95% confidence interval (CI): $0.2 billion, $13.5 billion), with 25% of PM2.5 and most O3 benefits to populations outside metropolitan areas. Across the study region of approximately 31.3 million people and 37,000 total square miles, mortality would decline by approximately 1,295 deaths/year (95% CI: 912, 1,636) because of improved air quality and increased exercise. Making 50% of short trips by bicycle would yield savings of approximately $3.8 billion/year from avoided mortality and reduced health care costs (95% CI: $2.7 billion, $5.0 billion]. We estimate that the combined benefits of improved air quality and physical fitness would exceed $8 billion/year.

CONCLUSION

Our findings suggest that significant health and economic benefits are possible if bicycling replaces short car trips. Less dependence on automobiles in urban areas would also improve health in downwind rural settings.

Meta-analysis of the Association between Short-Term Exposure to Ambient Ozone and Respiratory Hospital Admissions

Ozone is associated with health impacts including respiratory outcomes; however, results differ across studies. Meta-analysis is an increasingly important approach to synthesizing evidence across studies. We conducted meta-analysis of short-term ozone exposure and respiratory hospitalizations to evaluate variation across studies and explore some of the challenges in meta-analysis. We identified 136 estimates from 96 studies and investigated how estimates differed by age, ozone metric, season, lag, region, disease category, and hospitalization type. Overall results indicate associations between ozone and various types of respiratory hospitalizations; however, study characteristics affected risk estimates. Estimates were similar, but higher, for the elderly compared to all ages and for previous day exposure compared to same day exposure. Comparison across studies was hindered by variation in definitions of disease categories, as some (e.g., asthma) were identified through ≥3 different sets of ICD codes. Although not all analyses exhibited evidence of publication bias, adjustment for publication bias generally lowered overall estimates. Emergency hospitalizations for total respiratory disease increased 4.47% (95% interval 2.48, 6.50%) per 10ppb 24-hr ozone among the elderly without adjustment for publication bias and 2.97% (1.05, 4.94%) with adjustment. Comparison of multi-city study results and meta-analysis based on single-city studies further suggested publication bias.

Ambient wood smoke exposure and respiratory symptoms in Tasmania, Australia

Wood smoke exposure has been associated with adverse respiratory health outcomes, with much of the current research focused on wood smoke from domestic heating and cooking. This study examined the association between respiratory symptoms and outdoor wood smoke in Launceston, Tasmania, where ~30% of homes use wood burners for domestic heating. This ecological study examined data from participants of the 2004 Tasmanian Longitudinal Health Study postal survey and compared the prevalence of respiratory symptoms in Launceston (n=601) with that in Hobart (n=1071), a larger Tasmanian city with much less wood smoke. Multivariate logistic regression models were used to investigate the associations of interest while adjusting for gender, atopy, history of allergic disease and current smoking status. There were no significant differences in symptom prevalence between Launceston and Hobart. Two subgroup analyses, which examined participants with pre-existing chronic respiratory disease, and those who reported actively using a wood burner in their home, also did not find significant differences. Any impact of wood smoke on non-specific respiratory symptoms might have been overshadowed by other important determinants of respiratory health, such as vehicle exhaust and tobacco smoking, or were too small to have been detected. However, the lack of detectable differences in symptom prevalence might also reflect the success of regulatory action by local governments to reduce wood smoke emissions in Launceston. The results of other epidemiological studies support an association between ambient wood smoke exposure and adverse respiratory health. Further investigations of wood smoke exposure in Australian settings are needed to investigate the lack of significant associations found in this study, especially studies of indoor air quality and health impacts in children and elderly populations.

[Atmospheric air pollution: a risk factor for COPD?]

Tobacco smoking is the leading cause of COPD worldwide but other risk factors have been recognized. Air pollution is one of them, but its exact role in the development of COPD is hard to demonstrate. Its physiological effects on lung function have only been studied since the nineties by long and tedious cohort studies. Difficulties arise from the heterogeneity of air pollution (gas and particles); thus, its respiratory effects have to be examined for every component separately, and in different populations. It is also necessary to analyse the effects of atmospheric pollution in the short and the long term, considering both its physiological, clinical and toxicological effects, from childhood to adulthood. These factors make it difficult to obtain statistically significant results. Nevertheless, most studies seem to point to a role of air pollution in the development of COPD via oxydative stress but further studies are needed to confirm the exact effect of each component of air pollution on the respiratory tract. These studies could lead to improved public health policies and results are awaited that would identify at-risk populations, decide appropriate preventive measures and propose documented thresholds in pollution exposure... thereby limiting the spread of COPD.

Short-term association between air pollution and emergency room admissions for chronic obstructive pulmonary disease in Nis, Serbia

The present study assesses the short-term association between black smoke (BS) and sulphur dioxide (SO2) levels in urban air and the daily number of emergency room admissions for chronic obstructive pulmonary disease (COPD) in Nis, Serbia. Generalised linear models extending Poisson regression were fitted controlling for time trend, seasonal variations, days of the week, temperature, relative humidity, air pressure, precipitation, rainfall, snowfall, overcast, and wind velocity. The emergency room admissions for all ages for COPD were significantly associated with previous-day level of BS and lag 0-2 (1,60% and 2,26% increase per 10 microg/m3, respectively). After controlling for SO2, single lagged (lag 1 and lag 2) as well as mean lagged values of BS (up to lag 0-3) were significantly associated with COPD emergencies. No effect was found for SO2, even after controlling for black smoke. The present findings support the conclusion that current levels of ambient BS may have an effect on the respiratory health of susceptible persons.

Effects of Asian dust storm events on hospital admissions for chronic obstructive pulmonary disease in Taipei, Taiwan

In spring, windblown dust storms originating in the deserts of Mongolia and China make their way to Taipei city. These occurrences are known as Asian dust storm (ADS) events. These ADS events lead to enhanced PM(10) levels over that contributed by the usual local sources. The objective of this study was to assess the possible associations of PM(10) with hospital admissions for chronic obstructive pulmonary disease (COPD) in Taipei, Taiwan, during the period 1996-2001. We identified 54 dust storm episodes that were classified as index days. Daily COPD admissions on the index days were compared with admissions on the comparison days. We selected 2 comparison days for each index day, 7 days before the index days and 7 days after the index days. The effects of dust storms on hospital admissions for COPD were prominent 3 days after the event (relative risk = 1.057; 95% confidence interval = 0.982-1.138). However, the association was not statistically significant. There may not have been enough power to detect associations resulting from the inadequate sample size of COPD admissions on ADS events days. However, It seems worthwhile to pay more attention to the ADS events and health in the future.

Measuring the gains from improved air quality in the San Joaquin Valley

Many regions worldwide are experiencing rapid urbanization, and often along with growth in the local economy and population comes worsening air quality. Such regions typically find that addressing the additional challenge of polluted air is difficult. This paper reports the results of an assessment of the present health and related economic costs of poor air quality in the San Joaquin Valley of California. Further, it suggests how such assessments can support strategies to pursue pollution reductions that offer the largest near-term gains, by rigorously modeling the associations between pollution levels, demographic groups, and recognized adverse health effects.

Impact of the FcgammaII-receptor on quartz uptake and inflammatory response by alveolar macrophages

The inflammatory response following particle inhalation is described as a key event in the development of lung diseases, e.g., fibrosis and cancer. The essential role of alveolar macrophages (AM) in the pathogenicity of particles through their functions in lung clearance and mediation of inflammation is well known. However, the molecular mechanisms and direct consequences of particle uptake are still unclear. Inhibition of different classic phagocytosis receptors by flow cytometry shows a reduction of the dose-dependent quartz particle (DQ12) uptake in the rat AM cell line NR8383. Thereby the strongest inhibitory effect was observed by blocking the FcgammaII-receptor (FcgammaII-R). Fluorescence immunocytochemistry, demonstrating FcgammaII-R clustering at particle binding sites as well as transmission electron microscopy, visualizing zippering mechanism-like morphological changes, confirmed the role of the FcgammaII-R in DQ12 phagocytosis. FcgammaII-R participation in DQ12 uptake was further strengthened by the quartz-induced activation of the Src-kinase Lyn, the phospho-tyrosine kinases Syk (spleen tyrosine kinase) and PI3K (phosphatidylinositol 3-kinase), as shown by Western blotting. Activation of the small GTPases Rac1 and Cdc42, shown by immunoprecipitation, as well as inhibition of tyrosine kinases, GTPases, or Rac1 provided further support for the role of the FcgammaII-R. Consistent with the uptake results, FcgammaII-R activation with its specific ligand caused a similar generation of reactive oxygen species and TNF-alpha release as observed after treatment with DQ12. In conclusion, our results indicate a major role of FcgammaII-R and its downstream signaling cascade in the phagocytosis of quartz particles in AM as well as in the associated generation and release of inflammatory mediators.

Effects of exposure measurement error on particle matter epidemiology: a simulation using data from a panel study in Baltimore, MD

Ascertaining the true risk associated with exposure to particulate matter (PM) is difficult, given the fact that pollutant components are frequently correlated with each other and with other gaseous pollutants; relationships between ambient concentrations and personal exposures are often not well understood; and PM, unlike its gaseous co-pollutants, does not represent a single chemical. In order to examine differences between observed versus true health risk estimate from epidemiologic studies, we conducted a simulation using data from a recent multi-pollutant exposure assessment study in Baltimore, MD. The objectives of the simulation were twofold: (a) to estimate the distribution of personal air pollutant exposures one might expect to observe within a population, given the corresponding ambient concentrations found in that location and; (b) using an assumed true health risk with exposure to one pollutant, to estimate the distribution of health risk estimates likely to be observed in an epidemiologic study using ambient pollutant concentrations as a surrogate of exposure as compared with actual personal pollutant exposures. Results from the simulations showed that PM2.5 was the only pollutant where a true association with its total personal exposures resulted in a significant observed association with its ambient concentrations. The simulated results also showed that true health risks associated with personal exposure to O3 and NO2 would result in no significant observed associations with any of their respective ambient concentrations. Conversely, a true association with PM2.5 would result in a significant, observed association with NO2 (beta=0.0115, 95% confidence interval (CI): 0.0056, 0.0185) and a true association with exposure to SO4(2-) would result in an observed significant association with O3 (beta=0.0035, 95% CI: 0.0021, 0.0051) given the covariance of the ambient pollutant concentrations. The results provide an indication that, in Baltimore during this study period, ambient gaseous concentrations may not have been adequate surrogates for corresponding personal gaseous exposures to allow the question to be investigated using central site monitors. Alternatively, the findings may suggest that in some locations, observed associations with the gaseous pollutants should be interpreted with caution, as they may be reflecting associations with PM or one of its chemical components.

Fine particles, a major threat to children

BACKGROUND

There is a growing body of evidence for serious health consequences of exposure to ambient air pollution. The general question of who is susceptible is one of the most important gaps in current knowledge regarding particulate matter (PM)-related health effects. Who is susceptible depends on the specific health endpoint being evaluated and the level and length of exposure. Here, we restrict the review on the impact of fine particle exposure on children's health to the following outcomes: infant death, lung function, respiratory symptoms and reproductive outcomes.

METHODS

This is a strategic review of children's susceptibility to ambient fine particles and characteristics of infant and children which underlie their increased susceptibility to PM.

RESULTS

Ambient fine PM is associated with intra-uterine growth retardation, infant mortality; it is associated with impaired lung function and increased respiratory symptoms, particularly in asthmatics. Concerning infant mortality, exposure to PM is strongly and consistently associated with postneonatal respiratory mortality and less consistently with sudden infant death syndrome. Although most of the studies reported adverse effects for this health outcome, the evidence is weaker than for infant death. Exposure to fine PM has been associated with impaired lung function and lung function growth. Most of the studies reported increased prevalence of symptom with increased exposure to fine PM.

CONCLUSION

Fine PM is a major threat to children, because of their higher exposure to PM compared to adults, the immature state of the lung in childhood and also of the immune function at birth. The first months of life might be a period of particular sensitivity. Although the mechanisms of air pollution effects have not yet been completely understood, pregnant women, infants and children need specific protection against exposure to fine particles.

Air pollution and hospital admissions for chronic obstructive pulmonary disease in a subtropical city: Taipei, Taiwan

This study was undertaken to determine whether there was an association between air pollutant levels and hospital admissions for chronic obstructive pulmonary disease (COPD) in Taipei, Taiwan. Hospital admissions for COPD and ambient air pollution data for Taipei were obtained for the period 1996-2003. The relative risk of hospital admission was estimated using a case-crossover approach, controlling for weather variables, day of the week, seasonality, and long-term time trends. In the single-pollutant model, on warm days (> or = 20 degrees C) statistically significant positive associations were found in all pollutants except sulphur dioxide (SO2). However, statistically significant effects for COPD admissions on cool days (< 20 degrees C) were observed only for SO2 levels. For the two-pollutant model, NO2 and O3 were significant in combination with each of the other four pollutants on warm days. This study provides evidence that higher levels of ambient air pollutants increases the risk of hospital admissions for COPD in Taiwan.

Air pollution particles diminish bacterial clearance in the primed lungs of mice

Epidemiological studies reveal increased incidence of lung infection when air pollution particle levels are increased. We postulate that one risk factor for bacterial pneumonia, prior viral infection, can prime the lung for greater deleterious effects of particles via the interferon-gamma (IFN-gamma) characteristic of successful host anti-viral responses. To test this postulate, we developed a mouse model in which mice were treated with gamma-interferon aerosol, followed by exposure to concentrated ambient particles (CAPs) collected from urban air. The mice were then infected with Streptococcus pneumoniae and the effect of these treatments on the lung's innate immune response was evaluated. The combination of IFN-gamma priming and CAPs exposure enhanced lung inflammation, manifest as increased polymorphonuclear granulocyte (PMN) recruitment to the lung, and elevated expression of pro-inflammatory cytokine mRNAs. Combined priming and CAPs exposure resulted in impaired pulmonary bacterial clearance, as well as increased oxidant production and diminished bacterial uptake by alveolar macrophages (AMs) and PMNs. The data suggest that priming and CAPs exposure lead to an inflamed alveolar milieu where oxidant stress causes loss of antibacterial functions in AMs and recruited PMNs. The model reported here will allow further analysis of priming and CAPs exposure on lung sensitivity to infection.

Air pollution and hospital admissions for chronic obstructive pulmonary disease in a tropical city: Kaohsiung, Taiwan

This study was undertaken to determine whether there is an association between air pollutants levels and hospital admissions for chronic obstructive pulmonary disease (COPD) in Kaohsiung, Taiwan. Hospital admissions for COPD and ambient air pollution data for Kaohsiung were obtained for the period from 1996 to 2003. The odds ratio of hospital admission was estimated using a case-crossover approach, controlling for weather variables, day of the week, seasonality, and long-term time trends. In the single-pollutant models, on warm days (> or =25 degrees C) statistically significant positive associations were found in all pollutants except sulphur dioxide (SO2). On cool days (< 25 degrees C), all pollutants were significantly associated with COPD admissions. For the two-pollutant models, CO and O3 were significant in combination with each of the other four pollutants on warm days. On cool days, NO2 remained statistically significant in all the two-pollutant models. This study provides evidence that higher levels of ambient pollutants increase the risk of hospital admissions for COPD.

Air pollution and mortality in Chile: susceptibility among the elderly

OBJECTIVE

The estimated mortality rate associated with ambient air pollution based on general population studies may not be representative of the effects on certain subgroups. The objective of the present study was to determine the influence of relatively high concentrations of air pollution on mortality in a general population sample and in the very elderly.

STUDY DESIGN

Daily time-series analyses tested the association between daily air pollution and daily mortality in seven Chilean urban centers during 1997-2003. Results were adjusted for day of the week and humidex.

RESULTS

Daily averaged particulate matter with aerodynamic matter < 10 microm (PM(10)) was 84.88 microg/m(3), sulfur dioxide was 14.08 ppb, and carbon monoxide was 1.29 ppb. The 1-hr maximum ozone was 100.13 ppb. The percentage increases in nonaccidental mortality associated with an increase in PM(10) equivalent to its mean were 4.53 (t-ratio 1.52) for those < 65 years and 14.03 (3.87) for those > 85 years. Respective values were 4.96 (1.17) and 8.56 (2.02) for O(3); 4.77 (2.50) and 7.92 (3.23) for SO(2); and 4.10 (2.52) and 8.58 (4.45) for CO.

CONCLUSION

Our results suggest that the very elderly are particularly susceptible to dying from air pollution. Concentrations deemed acceptable for the general population may not adequately protect the very elderly.

Effect of concentrated ambient particles on macrophage phagocytosis and killing of Streptococcus pneumoniae

Particulate air pollution is linked to increased pneumonia epidemiologically and diminished lung bacterial clearance experimentally. We investigated the effect of concentrated ambient particles (CAPs, </= PM(2.5)) on the interaction of murine primary alveolar macrophages (AMs) and the murine macrophage cell line, J774 A.1, with Streptococcus pneumoniae. We found that CAPs increased binding of bacteria by both primary AMs and J774 cells (66.7 +/- 10.6% and 58.9 +/- 4.0%, respectively, n = 4). In contrast to bacterial binding, CAPs decreased internalization in both AMs and J774 (55.4 +/- 8.5% and 54.7 +/- 5.1%, respectively, n = 4). The rate of killing of internalized bacteria was similar, but CAPs caused a decrease in the absolute number of bacteria killed by macrophages, mainly due to decreased internalization. Additional analyses showed that soluble components of CAPs mediated the enhanced binding and decreased internalization of S. pneumoniae. Chelation of iron in soluble CAPs substantially reversed, while addition of iron as ferric ammonium citrate restored inhibition of phagocytosis of S. pneumoniae in vitro. The results identify phagocytic internalization as a specific target for toxic effects of air pollution particles on AMs.

Role of Gastroesophageal Reflux Symptoms in Exacerbations of COPD

BACKGROUND AND AIMS

The impact of gastroesophageal reflux disease (GERD) on exacerbations of COPD has never been evaluated. The aims of this investigation were to determine the prevalence of gastroesophageal reflux (GER) symptoms in COPD patients and the effect of GER on the rate of exacerbations of COPD per year.

METHODS

A questionnaire-based, cross sectional survey was performed. Subjects were recruited from the outpatient pulmonary clinics at the University of Florida Health Science Center/Jacksonville. Included patients had an established diagnosis of COPD. Exclusion criteria were respiratory disorders other than COPD, known esophageal disease, active peptic ulcer disease, Zollinger-Ellison syndrome, mastocytosis, scleroderma, and current alcohol abuse. Those meeting criteria and agreeing to participate were asked to complete the Mayo Clinic GERD questionnaire by either personal/telephone interview. Clinically significant reflux was defined as heartburn and/or acid regurgitation weekly. Other outcome measures noted were frequency and type of COPD exacerbations. Statistical analysis was performed using the Fisher exact test for categorical data and the independent t test for interval data.

RESULTS

Eighty-six patients were enrolled and interviewed (mean age, 67.5 years). Male patients accounted for 55% of the study group. Overall, 37% of patients reported GER symptoms. The mean FEV(1) percentage of predicted was similar in those with or without GER. The rate of exacerbations of COPD was twice as high in patients with GER symptoms compared to those without GER symptoms (3.2/yr vs 1.6/yr, p = 0.02).

CONCLUSIONS

The presence of GER symptoms appears to be associated with increased exacerbations of COPD.

The relationship between changes in daily air pollution and hospitalizations in Perth, Australia 1992-1998: a case-crossover study

A case-crossover study was undertaken to investigate the relationship between daily air pollutant concentrations and daily hospitalizations for selected disease categories in Perth, Western Australia. Daily measurements of particles (measured by nephelometry and PM2.5), photochemical oxidants (measured as ozone), nitrogen dioxide (NO2) and carbon monoxide (CO) concentrations were obtained from 1992 to 1998 via a metropolitan network of monitoring stations. Daily PM2.5 concentrations were estimated using monitored data, modelling and interpolation. Hospital morbidity data for respiratory, cardiovascular (CVD), gastrointestinal (GI) diseases, chronic obstructive pulmonary diseases (COPD) excluding asthma; pneumonia/influenza diseases; and asthma were obtained and categorized into all ages, less than 15 years and greater than 65 years. Gastrointestinal morbidity was used as a control disease. The data were analyzed using conditional logistic regression. The results showed a small number of significant associations for daily changes in particle concentrations, nitrogen dioxide and carbon monoxide for the respiratory diseases, CODP, pneumonia, asthma and CVD hospitalizations. Changes in ozone concentrations were not significantly associated with any disease outcomes. These data provide useful information on the potential health impacts of air pollution in an airshed with very low sulphur dioxide concentrations and lower nitrogen dioxide concentrations commonly found in many other cities.

A Retrospective Investigation of PM10 in Ambient Air and Cardiopulmonary Hospital Admissions in Allegheny County, Pennsylvania: 1995???2000

OBJECTIVE

Air quality in Allegheny County, Pennsylvania, has improved over the last decade, and we investigated whether the lower concentrations of fine particulate matter (PM10) are still associated with adverse health outcomes.

METHODS

Daily cardiopulmonary hospital admissions in elderly residents of Allegheny County and countywide average PM10 measures were available from 1995 through 2000. Using generalized additive models (GAM), a Poisson regression model was fit to the number of daily admissions using predictor variables: lags of PM10, daily temperature and humidity, day of the week, and time.

RESULTS

Our findings suggest that there is a positive association of PM10 with hospital admissions, and the effect is related to current-day PM10 levels.

CONCLUSIONS

Even at the lower levels of ambient air pollution as measured by PM10, there is still a suggestion of an adverse health effect in the elderly.