Differential effects of airway anesthesia on ozone-induced pulmonary responses in human subjects

Prediction of COVID-19 Cases from the Nexus of Air Quality and Meteorological Phenomena: Bangladesh Perspective

An integrated approach was used to estimate the number of COVID-19 patients related to air quality and meteorological phenomena. Additionally, the air quality during pre-lockdown, lockdown, and post-lockdown stages of the COVID-19 pandemic was assessed to determine the effect of the infection containment measures taken in Bangladesh during the pandemic. The air quality was assessed based on measurements of nitrogen dioxide (NO₂), sulfur dioxide (SO₂), ozone (O₃), carbon monoxide (CO), black carbon, particulate matter (PM_2.5 and PM₁₀), and aerosol optical depth. Time-averaged maps of these parameters have been generated from NASA's (National Aeronautics and Space Administration) website. Values of these parameters have also been collected from a continuous air monitoring station (CAMS) located in Bangladesh's north-western city Rajshahi. The comparison shows that lockdown during the pandemic has brought significant improvements in air quality. However, the improvement was not sustained, since rapid increases in the air pollutant concentrations were observed in the post-lockdown period. Furthermore, Pearson correlation coefficients between each air quality variable and the daily new COVID-19 case rates were calculated. Different meteorological variables during the same time periods were determined to observe the variation in Rajshahi city. Relationships of these variables with the case rates were also established. Additionally, statistical analyses of the obtained data have been conducted for the measured variables using the Kruskal-Wallis test to assess the differences in the observed data among the pre-lockdown, lockdown, and post-lockdown periods. Dunn's "Q" test was employed to test if the variables showed significance statistical difference during the Kruskal-Wallis test for pairwise comparisons. From the study, it has been observed that both meteorological variables and air quality parameters have significant relationship with daily new COVID-19 case rates. Both positive and negative associations of these parameters with the COVID-19 case rates have been observed. Very high air pollution has been observed in the post-lockdown period. Thus, it is recommended that appropriate authorities undertake corrective measures to protect the environment in cities with large populations. This study provides guidance for decision makers and health officials for future research and potentially reducing the spread of COVID-19.

The impact of COVID 19 on air pollution levels and other environmental indicators - A case study of Egypt

The outbreak of coronavirus disease (COVID-19) not only affected health and economics, but also its effect extended to include other aspects, such as the environment. Using Egypt as a case study, this paper presents the impact of COVID-19 pandemic on air pollution levels by studying nitrogen dioxide (NO₂), ozone (O₃), particulate matter represented in absorbing aerosol index (AAI), carbon monoxide (CO), and greenhouse gas (GHG) emissions. The paper also highlights the impact of COVID-19 pandemic on other environmental indicators including environmental noise, medical and municipal solid wastes. The paper presents the Egyptian COVID-19 story from its different angles including the development of confirmed COVID-19 cases, containment measures from the government, the impact on the country's economy and the national energy consumption so as to effectively evaluate the effect on both the air pollution levels and the other studied environmental indicators. For the other environmental indicators, a strong link was observed between COVID-19 lockdown and the reduction in environmental noise, beaches, surface and groundwater pollution. For environmental noise, this has been confirmed by officially governmental announcements which reported that the level of environmental noise in Egypt was reduced by about 75% during the lockdown period. On the other hand, there are some negative effects, including an increase in medical solid waste (from 70 to 300 ton/day), municipal solid waste, as well as a less efficient solid waste recycling process. For air pollution levels, the data were obtained from National Aeronautics and Space Administration (NASA) and European Space Agency satellite data sets. The data for the lockdown period in 2020 have been extracted and compared to the corresponding months in the selected baseline period (2015-2019) to identify the effect that the lockdown period had on the air pollution levels in Egypt with focus on Cairo and Alexandria governorates. It was found that the AAI decreased by about 30%, the NO₂ decreased by 15 and 33% over Cairo and Alexandria governorates, respectively, and that the CO decreased by about 5% over both governorates. In addition, the GHG emissions in Egypt were reduced by at least 4% during the pandemic. In contrast, ozone levels increased by about 2% over Cairo and Alexandria governorates. It can be concluded that the implemented containment measures during COVID-19 pandemic had resulted in both positive and negative environmental impacts. The positive environmental impacts are not sustainable and deterioration on them is expected to occur after the lockdown as it was before the pandemic. Therefore, stricter laws must be enacted to protect the environment in Egypt.

The impact of COVID 19 on air pollution levels and other environmental indicators - A case study of Egypt

The outbreak of coronavirus disease (COVID-19) not only affected health and economics, but also its effect extended to include other aspects, such as the environment. Using Egypt as a case study, this paper presents the impact of COVID-19 pandemic on air pollution levels by studying nitrogen dioxide (NO₂), ozone (O₃), particulate matter represented in absorbing aerosol index (AAI), carbon monoxide (CO), and greenhouse gas (GHG) emissions. The paper also highlights the impact of COVID-19 pandemic on other environmental indicators including environmental noise, medical and municipal solid wastes. The paper presents the Egyptian COVID-19 story from its different angles including the development of confirmed COVID-19 cases, containment measures from the government, the impact on the country's economy and the national energy consumption so as to effectively evaluate the effect on both the air pollution levels and the other studied environmental indicators. For the other environmental indicators, a strong link was observed between COVID-19 lockdown and the reduction in environmental noise, beaches, surface and groundwater pollution. For environmental noise, this has been confirmed by officially governmental announcements which reported that the level of environmental noise in Egypt was reduced by about 75% during the lockdown period. On the other hand, there are some negative effects, including an increase in medical solid waste (from 70 to 300 ton/day), municipal solid waste, as well as a less efficient solid waste recycling process. For air pollution levels, the data were obtained from National Aeronautics and Space Administration (NASA) and European Space Agency satellite data sets. The data for the lockdown period in 2020 have been extracted and compared to the corresponding months in the selected baseline period (2015-2019) to identify the effect that the lockdown period had on the air pollution levels in Egypt with focus on Cairo and Alexandria governorates. It was found that the AAI decreased by about 30%, the NO₂ decreased by 15 and 33% over Cairo and Alexandria governorates, respectively, and that the CO decreased by about 5% over both governorates. In addition, the GHG emissions in Egypt were reduced by at least 4% during the pandemic. In contrast, ozone levels increased by about 2% over Cairo and Alexandria governorates. It can be concluded that the implemented containment measures during COVID-19 pandemic had resulted in both positive and negative environmental impacts. The positive environmental impacts are not sustainable and deterioration on them is expected to occur after the lockdown as it was before the pandemic. Therefore, stricter laws must be enacted to protect the environment in Egypt.

Exercise-Induced Bronchoconstriction and the Air We Breathe

An association between airway dysfunction and airborne pollutant inhalation exists. Volatilized airborne fluorocarbons in ski wax rooms, particulate matter, and trichloromines in indoor environments are suspect to high prevalence of exercise-induced bronchoconstriction and new-onset asthma in athletes competing in cross-country skiing, ice rink sports, and swimming. Ozone is implicated in acute decreases in lung function and the development of new-onset asthma from exposure during exercise. Mechanisms and genetic links are proposed for pollution-related new-onset asthma. Oxidative stress from airborne pollutant inhalation is a common thread to progression of airway damage. Key pollutants and mechanisms for each are discussed.

Pulmonary function, bronchial reactivity, and epithelial permeability are response phenotypes to ozone and develop differentially in healthy humans

Effect of laboratory exposure to O₃ (220 ppb) and filtered air (FA) on respiratory physiology were evaluated at two time points (acute and 1 day postexposure) in healthy cohort (n = 138, 18-35 yr, 40% women) comprised mainly of Caucasian (60%) and African American (33.3%) subjects. Randomized exposures had a crossover design and durations of 2.25 h that included rest and treadmill walking. Airway responsiveness (AHR) to methacholine (Mch) and permeability of respiratory epithelium (EI) to hydrophilic radiomarker ((99m)Tc-DTPA, MW = 492), were measured at 1-day postexposure. O₃ significantly affected FEV₁ and FVC indices acutely with mean decrements from pre-exposure values on the order of 7.7 to 8.8% and 1.8 to 2.3% at 1-day post. Acute FEV₁ and FVC decreases were most robust in African American male subjects. At 1-day post, O₃ induced significant changes in AHR (slope of Mch dose response curve) and EI (Tc(99m)-DTPA clearance half-time). Based on conventional thresholds of response and dichotomous classification of subjects as responders and nonresponders, sensitivity to O₃ was shown to be nonuniform. Acute decrements ≥ 15% in FEV₁, a doubling of Mch slope, or ≥ 15% increase in EI developed in 20.3%, 23.1%, and 25.9%, respectively, of subjects evaluated. Results demonstrate a diffuse sensitivity to O₃ and physiological responses, either acutely (decreases in FEV₁) or 1 day post (development of AHR or change in EI) occur differentially in healthy young adults. Random overlap among subjects classified as responsive for respective FEV₁, AHR, and EI endpoints suggests these are separate and independent phenotypes of O₃ exposure.

Air pollution toxicology--a brief review of the role of the science in shaping the current understanding of air pollution health risks

Human and animal toxicology has had a profound impact on our historical and current understanding of air pollution health effects. Early animal toxicological studies of air pollution had distinctively military or workplace themes. With the discovery that ambient air pollution episodes led to excess illness and death, there became an emergence of toxicological studies that focused on industrial air pollution encountered by the general public. Not only did the pollutants investigated evolve from ambient mixtures to individual pollutants but also the endpoints and outcomes evaluated became more sophisticated, resulting in our present state of the science. Currently, a large toxicological database exists for the effects of particulate matter and ozone, and we provide a focused review of some of the major contributions to the biological understanding for these two "criteria" air pollutants. A limited discussion of the toxicological advancements in the scientific knowledge of two hazardous air pollutants, formaldehyde and phosgene, is also included. Moving forward, the future challenge of air pollution toxicology lies in the health assessment of complex mixtures and their interactions, given the projected impacts of climate change and altered emissions on ambient conditions. In the coming years, the toxicologist will need to be flexible and forward thinking in order to dissect the complexity of the biological system itself, as well as that of air pollution in all its varied forms.

Ozone activates airway nerves via the selective stimulation of TRPA1 ion channels

Inhalation of ozone is a major health risk in industrialized nations. Ozone can impair lung function and induce respiratory symptoms through sensory neural-mediated pathways, yet the specific interaction of ozone with airway sensory nerves has yet to be elucidated. Here we demonstrate, using a vagally innervated ex vivo tracheal-lung mouse preparation, that ozone selectively and directly evokes action potential discharge in a subset of nociceptive bronchopulmonary nerves, namely slow conducting C-fibres. Sensitivity to ozone correlated with the transient receptor potential (TRP) A1 agonist, cinnamaldehyde, with ozone having no effect on cinnamaldehyde-insensitive fibres. C-fibre responses to ozone were abolished by ruthenium red (TRP inhibitor). Ozone also stimulated a subset of nociceptive sensory neurones isolated from vagal ganglia of wild-type mice, but failed to activate neurones isolated from transient receptor potential ankyrin 1 (TRPA1) knockout mice. Ozone activated HEK293 cells transfected with TRPA1, but failed to activate non-transfected HEK293 or HEK293 transfected with the capsaicin-sensitive transient receptor potential vanilloid 1 (TRPV1) channel. Thus, ozone is not an indiscriminate neuronal activator, but rather it potently and selectively activates a subset of airway C-fibres by directly stimulating TRPA1.

6.6-hour inhalation of ozone concentrations from 60 to 87 parts per billion in healthy humans

RATIONALE

Identification of the minimal ozone (O(3)) concentration and/or dose that induces measurable lung function decrements in humans is considered in the risk assessment leading to establishing an appropriate National Ambient Air Quality Standard for O(3) that protects public health.

OBJECTIVES

To identify and/or predict the minimal mean O(3) concentration that produces a decrement in FEV(1) and symptoms in healthy individuals completing 6.6-hour exposure protocols.

METHODS

Pulmonary function and subjective symptoms were measured in 31 healthy adults (18-25 yr, male and female, nonsmokers) who completed five 6.6-hour chamber exposures: filtered air and four variable hourly patterns with mean O(3) concentrations of 60, 70, 80, and 87 parts per billion (ppb).

MEASUREMENTS AND MAIN RESULTS

Compared with filtered air, statistically significant decrements in FEV(1) and increases in total subjective symptoms scores (P < 0.05) were measured after exposure to mean concentrations of 70, 80, and 87 ppb O(3). The mean percent change in FEV(1) (+/-standard error) at the end of each protocol was 0.80 +/- 0.90, -2.72 +/- 1.48, -5.34 +/- 1.42, -7.02 +/- 1.60, and -11.42 +/- 2.20% for exposure to filtered air and 60, 70, 80, and 87 ppb O(3), respectively.

CONCLUSIONS

Inhalation of 70 ppb O(3) for 6.6 hours, a concentration below the current 8-hour National Ambient Air Quality Standard of 75 ppb, is sufficient to induce statistically significant decrements in FEV(1) in healthy young adults.

Time course of ozone-induced changes in breathing pattern in healthy exercising humans

We examined the time course of O3-induced changes in breathing pattern in 97 healthy human subjects (70 men and 27 women). One- to five-minute averages of breathing frequency (fB) and minute ventilation (V̇e) were used to generate plots of cumulative breaths and cumulative exposure volume vs. time and cumulative exposure volume vs. cumulative breaths. Analysis revealed a three-phase response; delay, no response detected; onset, fB began to increase; response, fB stabilized. Regression analysis was used to identify four parameters: time to onset, number of breaths at onset, cumulative inhaled dose of ozone at onset of O3-induced tachypnea, and the percent change in fB. The effect of altering O3 concentration, V̇e, atropine treatment, and indomethacin treatment were examined. We found that the lower the O3 concentration, the greater the number of breaths at onset of tachypnea at a fixed ventilation, whereas number of breaths at onset of tachypnea remains unchanged when V̇e is altered and O3 concentration is fixed. The cumulative inhaled dose of O3 at onset of tachypnea remained constant and showed no relationship with the magnitude of percent change in fB. Atropine did not affect any of the derived parameters, whereas indomethacin did not affect time to onset, number of breaths at onset, or cumulative inhaled dose of O3 at onset of tachypnea but did attenuate percent change in fB. The results are discussed in the context of dose response and intrinsic mechanisms of action.

Human pulmonary responses with 30-minute time intervals of exercise and rest when exposed for 8 hours to 0.12 ppm ozone via square-wave and acute triangular profiles

Hazucha et al. (1992) compared pulmonary function responses during 8-h square-wave exposures to FA and to 0.12 ppm O3, as well as to an acute triangular exposure to a mean O3 concentration of 0.12 ppm. With 30 min of moderate exercise each hour during 8 h of continuous exposure, significantly greater pulmonary function responses were observed between 5 h and 7 h when O3 was varied in an acute triangular configuration from 0.00 ppm to 0.24 ppm over the first 4 h and back to 0.00 ppm during the last 4 h than when O3 concentration was maintained constant at 0.12 ppm throughout. These investigators employed equal periods of 30 min of exercise, in which mean VE was approximately 40 L/min, and 30 min of rest, with pulmonary function measurements taken at the end of each hour. This procedure (i.e., taking measurements at the end of each hour) could attenuate the full effect that would be observed very soon after exercise cessation, and permit some recovery to occur. Accordingly, in the present study, the primary objective was to determine what effect observations of pulmonary responses assessed immediately following repeated 30 min exercise bouts, as well as those at the end of each hour (following approximately 30 min rest) during 8-h square-wave exposures to FA and to 0.12 ppm O3, as well as to an acute triangular exposure to a mean O3 concentration of 0.12 ppm. During the last 4 h of the 8-h, 0.12-ppm square-wave exposure, the 30-min mean increases in FEV1.0 responses were consistently greater at the end of the first half hour immediately following exercise (-1.22%) than at the end of the second half-hour following 30 min of rest (+0.01%). Further, even though O3 concentration was steadily decreasing from 0.24 ppm to 0 ppm during the last 4 h of the triangular exposure, similar increases in FEV1.0 decrement (-1.38%) immediately after each 30 min exercise bout, and small recovery at the end of each 30 min rest (+0.56%) were observed. Symptom scores in both exposures during the last 4 h also showed this effect.

Association of tumor necrosis factor-alpha polymorphisms and ozone-induced change in lung function

Ozone is a major air pollutant with adverse health effects which exhibit marked inter-individual variability. In mice, regions of genetic linkage with ozone-induced lung injury include the tumor necrosis factor-alpha (TNF), lymphotoxin-alpha (LTA), Toll-like receptor 4 (TLR4), superoxide dismutase (SOD2), and glutathione peroxidase (GPX1) genes. We genotyped polymorphisms in these genes in 51 individuals who had undergone ozone challenge. Mean change in FEV1 with ozone challenge, as a percentage of baseline, was -3% in TNF -308G/A or A/A individuals, compared with -9% in G/G individuals (p = 0.024). When considering TNF haplotypes, the smallest change in FEV1 with ozone exposure was associated with the TNF haplotype comprising LTA +252G/TNF -1031T/TNF -308A/TNF -238G. This association remained statistically significant after correction for age, sex, disease, and ozone concentration (p = 0.047). SOD2 or GPX1 genotypes were not associated with lung function, and the TLR4 polymorphism was too infrequent to analyze. The results of this study support TNF as a genetic factor for susceptibility to ozone-induced changes in lung function in humans, and has potential implications for stratifying health risks of air pollution.

Effects of ozone on lung function and lung diseases

Ozone (O3) is an air pollutant produced by sunlight-driven reactions involving the oxides of nitrogen and volatile organic compounds. The population of many large metropolitan areas in the US is exposed to high levels of O3, particularly in the summer months. Individuals exposed to O3 levels in human experiments at higher than common ambient levels develop reversible reductions in lung function often associated with symptoms, such as airway hyperreactivity and lung inflammation. Animal models have helped characterize potential mechanisms of lung injury from O3 exposure. Defining the adverse effects of chronic exposure to ambient levels of O3 on lung function and disease have been challenging, in part due to the presence of co-pollutants, such as particulate matter. The US Environmental Protection Agency's 1997 revised standard for O3 (0.08 ppm averaged over 8 hours) is designed to provide better protection to susceptible individuals. The revised standard is being implemented following the failure of court challenges.

Update on the health effects of outdoor air pollution

The number of studies conducted on the health effects of air pollution has increased exponentially. Important methodological advances include the application of novel observational study designs, in particular the multi-city design, and the development and application of airborne particle concentrators for use in experimental human exposure studies and toxicological studies. Experimental data are validating and providing insight into some surprising observational findings.

Air pollution and health

The health effects of air pollution have been subject to intense study in recent years. Exposure to pollutants such as airborne particulate matter and ozone has been associated with increases in mortality and hospital admissions due to respiratory and cardiovascular disease. These effects have been found in short-term studies, which relate day-to-day variations in air pollution and health, and long-term studies, which have followed cohorts of exposed individuals over time. Effects have been seen at very low levels of exposure, and it is unclear whether a threshold concentration exists for particulate matter and ozone below which no effects on health are likely. In this review, we discuss the evidence for adverse effects on health of selected air pollutants.