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Singh A, Bartington SE, Abreu P, Anderson R, Cowell N, Leach FC. Impacts of daily household activities on indoor particulate and NO 2 concentrations; a case study from oxford UK. Heliyon 2024; 10:e34210. [PMID: 39165984 PMCID: PMC11333897 DOI: 10.1016/j.heliyon.2024.e34210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 07/02/2024] [Accepted: 07/04/2024] [Indexed: 08/22/2024] Open
Abstract
This study explores indoor air pollutant (PM1, PM2.5 and NO2) concentrations over a 15-week period during the COVID-19 pandemic in a typical suburban household in Oxford, UK. A multi-room intensive monitoring study was conducted in a single dwelling using 10 air quality sensors measuring real-time pollutant concentrations at 10 second intervals to assess temporal and spatial variability in PM1, PM2.5 and NO2 concentrations, identify pollution-prone areas, and investigate the impact of residents' activities on indoor air quality. Significant spatial variations in PM concentrations were observed within the study dwelling, with highest hourly concentrations (769.0 & 300.9 μg m-3 for PM2.5, and PM1, respectively) observed in the upstairs study room, which had poor ventilation. Cooking activities were identified as a major contributor to indoor particulate pollution, with peak concentrations aligning with cooking events. Indoor NO2 levels were typically higher than outdoor levels, particularly in the kitchen where a gas-cooking appliance was used. There was no significant association observed between outdoor and indoor PM concentrations; however, a clear correlation was evident between kitchen PM emissions and indoor levels. Similarly, outdoor NO2 had a limited influence on indoor air quality compared to kitchen activities. Indoor sources were found to dominate for both PM and NO2, with higher Indoor/Outdoor (I/O) ratios observed in the upstairs bedroom and the kitchen. Overall, our findings highlight the contribution of indoor air pollutant sources and domestic activities to indoor air pollution exposure, notably during the COVID-19 pandemic when people were typically spending more time in domestic settings. Our novel findings, which suggest high levels of pollutant concentrations in upstairs (first floor) rooms, underscore the necessity for targeted interventions. These interventions include the implementation of source control measures, effective ventilation strategies and occupant education for behaviour change, all aimed at improving indoor air quality and promoting healthier living environments.
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Affiliation(s)
- Ajit Singh
- Institute of Applied Health Research, University of Birmingham, Edgbaston Park Road, Birmingham, B15 2TT, UK
- School of Geography, Earth and Environmental Sciences, University of Birmingham, Edgbaston Park Road, Birmingham, B15 2TT, UK
| | - Suzanne E. Bartington
- Institute of Applied Health Research, University of Birmingham, Edgbaston Park Road, Birmingham, B15 2TT, UK
| | - Pedro Abreu
- Oxford City Council, St Aldates Chambers, 109 St Aldates, Oxford, OX1 1DS, UK
| | - Ruth Anderson
- Oxfordshire County Council, County Hall, New Road, Oxford, OX1 1ND, UK
| | - Nicole Cowell
- School of Geography, Earth and Environmental Sciences, University of Birmingham, Edgbaston Park Road, Birmingham, B15 2TT, UK
- Centre for Environmental Policy, Imperial College London, Weeks Building, 16-18 Prince's Garden, London SW7 1NE, UK
| | - Felix C.P. Leach
- Department for Engineering Science, University of Oxford, Parks Road, Oxford, OX1 3PJ, UK
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Zhang T, Lui KH, Ho SSH, Chen J, Chuang HC, Ho KF. Characterization of airborne endotoxin in personal exposure to fine particulate matter (PM 2.5) and bioreactivity for elderly residents in Hong Kong. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2024; 280:116530. [PMID: 38833976 DOI: 10.1016/j.ecoenv.2024.116530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 05/17/2024] [Accepted: 05/29/2024] [Indexed: 06/06/2024]
Abstract
The heavy metals and bioreactivity properties of endotoxin in personal exposure to fine particulate matter (PM2.5) were characterized in the analysis. The average personal exposure concentrations to PM2.5 were ranged from 6.8 to 96.6 μg/m3. The mean personal PM2.5 concentrations in spring, summer, autumn, and winter were 32.1±15.8, 22.4±11.8, 35.3±11.9, and 50.2±19.9 μg/m3, respectively. There were 85 % of study targets exceeded the World Health Organization (WHO) PM2.5 threshold (24 hours). The mean endotoxin concentrations ranged from 1.086 ± 0.384-1.912 ± 0.419 EU/m3, with a geometric mean (GM) varied from 1.034 to 1.869. The concentration of iron (Fe) (0.008-1.16 μg/m3) was one of the most abundant transition metals in the samples that could affect endotoxin toxicity under Toll-Like Receptor 4 (TLR4) stimulation. In summer, the interleukin 6 (IL-6) levels showed statistically significant differences compared to other seasons. Spearman correlation analysis showed endotoxin concentrations were positively correlated with chromium (Cr) and nickel (Ni), implying possible roles as nutrients and further transport via adhering to the surface of fine inorganic particles. Mixed-effects model analysis demonstrated that Tumor necrosis factor-α (TNF-α) production was positively associated with endotoxin concentration and Cr as a combined exposure factor. The Cr contained the highest combined effect (0.205-0.262), suggesting that Cr can potentially exacerbate the effect of endotoxin on inflammation and oxidative stress. The findings will be useful for practical policies for mitigating air pollution to protect the public health of the citizens.
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Affiliation(s)
- Tianhang Zhang
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Ka Hei Lui
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Steven Sai Hang Ho
- Division of Atmosphere Sciences, Desert Research Institute, Reno, NV 89512, United States; Hong Kong Premium Services and Research Laboratory, Cheung Sha Wan, Kowloon, Hong Kong, China
| | - Jiayao Chen
- School of Architecture, Planning and Environmental Policy, University College Dublin, Dublin, Ireland
| | - Hsiao-Chi Chuang
- School of Respiratory Therapy, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Kin Fai Ho
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China.
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Fandiño-Del-Rio M, Matsui EC, Peng RD, Meeker JD, Quirós-Alcalá L. Phthalate biomarkers and associations with respiratory symptoms and healthcare utilization among low-income urban children with asthma. ENVIRONMENTAL RESEARCH 2022; 212:113239. [PMID: 35405131 DOI: 10.1016/j.envres.2022.113239] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 03/28/2022] [Accepted: 03/31/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Phthalates are synthetic chemicals present in building materials, personal care products and other consumer goods. Limited studies link phthalates to pediatric asthma incidence; however, their effects on respiratory-related outcomes among those with pre-existing asthma remains unclear. OBJECTIVE We examined associations between phthalates and asthma symptoms, healthcare use, lung function, and lung inflammation among children with asthma. METHODS We collected repeated measures of urinary biomarkers for select phthalates and phthalate replacements (MBzP, MCINP, MCIOP, MCPP, MECPTP, MEHHTP, molar sum of DEHP biomarkers [MECPP, MEHHP, MEHP, MEOHP], MEP, MiBP, MnBP) and asthma symptoms, healthcare utilization, lung function, and inflammation among 148 predominantly low-income Black children (5-17 years) with persistent asthma every 3 months for one year. We used generalized estimating equations to assess associations between biomarker concentrations and asthma-related measures adjusting for age, sex, race/ethnicity, caregiver's education level, presence of smokers in the home, and season. We also considered co-exposures to other contaminants previously associated with asthma morbidity. RESULTS We observed consistent positive associations with individual DEHP biomarkers, the molar sum of DEHP, and BBzP with increased odds of asthma symptoms and with healthcare utilization (adjusted Odds Ratio for general asthma symptoms: ΣDEHP:1.49,95% Confidence Interval, CI:1.08-2.07; BBzP:1.34, CI:1.04-1.73). We observed similar associations between the DEHP phthalate replacement biomarker MEHHTP and most asthma symptoms evaluated; and with select low molecular weight phthalates (DiBP, DBP) and healthcare utilization. Results were similar when controlling for other environmental exposures (e.g., PM2.5, BPA). No associations were observed with lung function or inflammation, and overall, we did not observe consistent evidence of sexually dimorphic effects. CONCLUSION In the present study, we found evidence to suggest that exposure to select phthalates may be associated with asthma symptoms and healthcare utilization. These findings warrant confirmation given the high asthma burden and widespread and disparate phthalate exposures reported among select populations of color.
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Affiliation(s)
- Magdalena Fandiño-Del-Rio
- Johns Hopkins University, Bloomberg School of Public Health, Department of Environmental Health and Engineering, Baltimore, MD, USA.
| | | | - Roger D Peng
- Johns Hopkins University, Bloomberg School of Public Health, Department of Biostatistics, Baltimore, MD, USA.
| | - John D Meeker
- Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, MI, USA.
| | - Lesliam Quirós-Alcalá
- Johns Hopkins University, Bloomberg School of Public Health, Department of Environmental Health and Engineering, Baltimore, MD, USA.
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Grant TL, Wood RA. The influence of urban exposures and residence on childhood asthma. Pediatr Allergy Immunol 2022; 33:e13784. [PMID: 35616896 PMCID: PMC9288815 DOI: 10.1111/pai.13784] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 04/21/2022] [Accepted: 04/22/2022] [Indexed: 12/19/2022]
Abstract
Children with asthma who live in urban neighborhoods experience a disproportionately high asthma burden, with increased incident asthma and increased asthma symptoms, exacerbations, and acute visits and hospitalizations for asthma. There are multiple urban exposures that contribute to pediatric asthma morbidity, including exposure to pest allergens, mold, endotoxin, and indoor and outdoor air pollution. Children living in urban neighborhoods also experience inequities in social determinants of health, such as increased poverty, substandard housing quality, increased rates of obesity, and increased chronic stress. These disparities then in turn can increase the risk of urban exposures and compound asthma morbidity as poor housing repair is a risk factor for pest infestation and mold exposure and poverty is a risk factor for exposure to air pollution. Environmental interventions to reduce in-home allergen concentrations have yielded inconsistent results. Population-level interventions including smoking bans in public places and legislation to decrease traffic-related air pollution have been successful at reducing asthma morbidity and improving lung function growth. Given the interface and synergy between urban exposures and social determinants of health, it is likely population and community-level changes will be needed to decrease the excess asthma burden in children living in urban neighborhoods.
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Affiliation(s)
- Torie L Grant
- Division of Pediatric Allergy, Immunology, and Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Robert A Wood
- Division of Pediatric Allergy, Immunology, and Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Air Quality Index and Emergency Department Visits and Hospitalizations for Childhood Asthma. Ann Am Thorac Soc 2022; 19:1139-1148. [DOI: 10.1513/annalsats.202105-539oc] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Zhang X, Li D, Xie J, Liu J. Environmental perceptions, mental performance, and physiological responses of people with respiratory allergies exposed to reduced Indoor Air Quality. INDOOR AIR 2021; 31:1458-1472. [PMID: 33432603 DOI: 10.1111/ina.12793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 12/24/2020] [Indexed: 06/12/2023]
Abstract
To investigate the need of allergic population for indoor environment quality, exposure effects of poor air quality on subjects with respiratory allergies were compared with those on healthy people, including perceptual responses, health symptoms, mental performance, and physiological responses. The experimental intervention was with and without ventilation at thermally neutral rooms, creating two exposure conditions indicated by CO2 concentration ranges of 502 to 3297 ppm (2438 ± 1527 ppm) and 517 to 5687 ppm (3615 ± 1527 ppm). 63 subjects (32 allergic subjects and 31 non-allergic subjects) were exposed to both conditions for 3 hours. The main results suggested that, compared with healthy people, people with respiratory allergy seem to be more sensitive or less acceptable to reduced air quality polluted by occupants during instantaneous exposure. Besides, the allergic group performed worse in cognitive tests than non-allergic group. After 3 hours of continuous exposure, people with respiratory allergy reported stronger intensity of respiratory irritations and seemed to suffer more inflammation indicated by a higher level of interleukin 1L-1β.
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Affiliation(s)
- Xiaojing Zhang
- Key Laboratory of Green Built Environment and Energy Efficient Technology, Beijing University of Technology, Beijing, China
| | - Dandan Li
- Key Laboratory of Green Built Environment and Energy Efficient Technology, Beijing University of Technology, Beijing, China
| | - Jingchao Xie
- Key Laboratory of Green Built Environment and Energy Efficient Technology, Beijing University of Technology, Beijing, China
| | - Jiaping Liu
- Key Laboratory of Green Built Environment and Energy Efficient Technology, Beijing University of Technology, Beijing, China
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Fong WCG, Grevatt S, Potter S, Tidbury T, Kadalayil L, Bennett K, Larsson M, Nicolas F, Kurukulaaratchy R, Arshad SH. The Efficacy of the Dyson Air Purifier in Improving Asthma Control: Protocol for a Single-Center, Investigator-Led, Randomized, Double-Blind, Placebo-Controlled Trial. JMIR Res Protoc 2021; 10:e28624. [PMID: 34313599 PMCID: PMC8367098 DOI: 10.2196/28624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 05/19/2021] [Accepted: 05/19/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Indoor air quality has been shown to influence asthma control and outcomes. Air purifiers and high-efficiency particulate air filtration devices can improve indoor air quality by reducing the indoor levels of air pollution and allergens. However, the influence of this improved indoor air quality on asthma control remains unclear; hence, randomized controlled trials are needed to further elucidate this phenomenon. OBJECTIVE This study aims to investigate the effect of reducing the levels of allergens and pollutants in the bedroom and living room through the use of Dyson air purifiers (Dyson Pure Cool) on asthma control. METHODS This is an 18-month long, investigator-led, randomized, double-blinded, placebo-controlled, single-center trial. Subjects will be randomized in a 1:1 ratio to active or placebo Dyson filters. The primary outcome is the change in the scores of Asthma Control Questionnaire 6 and Asthma-specific Quality of Life Questionnaire from baseline. Secondary outcomes include changes in lung function (forced expiratory volume in one second, forced expiratory volume in one second/forced vital capacity ratio, and midexpiratory flows), peak expiratory flow measurements, airway hyperresponsiveness (assessed by methacholine bronchial challenge), fractional exhaled nitric oxide, and indoor air pollutant levels. The sample size will be 50 subjects, and all subjects will have a confirmed diagnosis of mild persistent to moderate persistent asthma along with an Asthma Control Questionnaire 6 score of >1.5. RESULTS This study was approved by the West Midlands Research Ethics Committee (18/WM/0277). The study results will be published in peer-reviewed scientific journals; presented at relevant scientific conferences; and shared in plain English with participants in our newsletters, in our clinics, and via the David Hide Asthma and Allergy Research Centre website. Our trial began in September 2019 and is expected to end in August 2021. CONCLUSIONS This is a double-blinded, placebo-controlled, randomized, investigator-led study to investigate the efficacy of a novel air purifier in improving asthma control in adults. The trial period of 18 months will facilitate the collection of robust data and will therefore generate clear signals. However, this extended trial duration may lead to patient withdrawal. Furthermore, this trial is conducted at a single center and in a location with a homogenous cohort of people, which may affect translatability. Nonetheless, it is hoped that the findings of this trial may help further inform clinicians regarding the utility of this novel device as an adjunct in asthma care. TRIAL REGISTRATION ClinicalTrials.gov NCT04729530; https://clinicaltrials.gov/ct2/show/NCT04729530. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/28624.
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Affiliation(s)
- Wei Chern Gavin Fong
- David Hide Asthma and Allergy Research Centre, Newport, United Kingdom
- School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Susan Grevatt
- David Hide Asthma and Allergy Research Centre, Newport, United Kingdom
| | - Stephen Potter
- David Hide Asthma and Allergy Research Centre, Newport, United Kingdom
| | - Tracey Tidbury
- David Hide Asthma and Allergy Research Centre, Newport, United Kingdom
| | - Latha Kadalayil
- David Hide Asthma and Allergy Research Centre, Newport, United Kingdom
- School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Kaisha Bennett
- David Hide Asthma and Allergy Research Centre, Newport, United Kingdom
| | - Maria Larsson
- David Hide Asthma and Allergy Research Centre, Newport, United Kingdom
| | - Frédéric Nicolas
- Dyson Technology Limited, Tetbury Hill, Malmesbury, Wiltshire, United Kingdom
| | - Ramesh Kurukulaaratchy
- David Hide Asthma and Allergy Research Centre, Newport, United Kingdom
- School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Syed Hasan Arshad
- David Hide Asthma and Allergy Research Centre, Newport, United Kingdom
- School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
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Zeng XW, Lodge CJ, Lowe AJ, Guo Y, Abramson MJ, Bowatte G, Hu LW, Yang BY, Chen ZX, Dharmage SC, Dong GH. Current pet ownership modifies the adverse association between long-term ambient air pollution exposure and childhood asthma. Clin Transl Allergy 2021; 11:e12005. [PMID: 33900047 PMCID: PMC8099301 DOI: 10.1002/clt2.12005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 01/27/2021] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Recent studies suggest that household endotoxin and allergens can modify the impact of air pollutants on development of asthma; however, epidemiological evidence is limited and conflicting. OBJECTIVES To investigate whether pet ownership modified the association between ambient air pollution and asthma in children. METHODS We conducted a population-based cross-sectional study, the Seven Northeast Cities Study in China and recruited a total of 59,754 children from 94 schools during 2012-2013. Long-term air pollutant concentrations, including airborne particulate matter with a diameter of 1 μm or less (PM1 ), PM2.5 , PM10 , and nitrogen dioxide (NO2 ) from 2009 to 2012 were estimated using a random forest model. We collected information of respiratory health in children using the Epidemiologic Standardization Project Questionnaire of the American Thoracic Society (ATS-DLD-78-A). Regression models were used to evaluate associations between pet ownership and air pollution on asthma after adjusting for potential covariates. RESULTS Exposure to increasing levels of air pollutants was associated with higher prevalence of asthma, but associations were significantly attenuated in children who owned pets. For example, compared to children without pets, those who owned pets did not have an increased risk of symptoms of asthma (odds ratio, 1.01, 95% confidence interval: 0.78, 1.30), wheeze (0.96, 95% confidence interval [CI]: 0.76, 1.21), and cough (1.01, 95% CI: 0.87, 1.18) for each 10 µg/m3 increase in PM1 (P-int < 0.05). Similar trends were observed for other air pollutants. Dog and bird ownership decreased the associations of asthma and cough with air pollutant exposure. The main findings were consistent with a series of sensitivity analyses. CONCLUSION Current pet ownership may reduce the adverse impact of long-term air pollution on childhood asthma. Longitudinal studies are needed to confirm this finding which could have important implications for public health.
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Affiliation(s)
- Xiao-Wen Zeng
- Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou, China.,Melbourne School of Population & Global Health, Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Caroline J Lodge
- Melbourne School of Population & Global Health, Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Adrian J Lowe
- Melbourne School of Population & Global Health, Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Yuming Guo
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Michael J Abramson
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Gayan Bowatte
- Melbourne School of Population & Global Health, Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, The University of Melbourne, Melbourne, Victoria, Australia.,Department of Basic Sciences, Faculty of Allied Health Sciences, University of Peradeniya, Peradeniya, Sri Lanka.,National Institute of Fundamental Studies, Kandy, Sri Lanka
| | - Li-Wen Hu
- Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Bo-Yi Yang
- Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Zan-Xiong Chen
- Maternal and Child Hospital of Maoming City, Maoming, China
| | - Shyamali C Dharmage
- Melbourne School of Population & Global Health, Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Guang-Hui Dong
- Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou, China
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Indoor Microbial Exposures and Chronic Lung Disease: From Microbial Toxins to the Microbiome. Clin Chest Med 2021; 41:777-796. [PMID: 33153695 DOI: 10.1016/j.ccm.2020.08.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Effects of environmental microbial exposures on human health have long been of interest. Microbes were historically assumed to be harmful, but data have suggested that microbial exposures can modulate the immune system. We focus on the effects of indoor environmental microbial exposure on chronic lung diseases. We found contradictory data in bacterial studies using endotoxin as a surrogate for bacterial exposure. Contradictory data also exist in studies of fungal exposure. Many factors may modulate the effect of environmental microbial exposures on lung health, including coexposures. Future studies need to clarify which method of assessing environmental microbial exposures is most relevant.
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Rosser F, Han YY, Forno E, Acosta-Pérez E, Canino G, Celedón JC. Indoor endotoxin, proximity to a major roadway, and severe asthma exacerbations among children in Puerto Rico. Ann Allergy Asthma Immunol 2020; 125:658-664.e2. [PMID: 32911057 DOI: 10.1016/j.anai.2020.09.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 08/31/2020] [Accepted: 09/02/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Few studies have examined concurrent exposure to household endotoxin and traffic-related air pollution in relation to childhood asthma, yet both factors are associated with asthma outcomes. OBJECTIVE To examine whether proximity to a major roadway (a traffic-related air pollution proxy) modifies the estimated effects of indoor endotoxin on asthma outcomes in children. METHODS Cross-sectional study of 200 children with asthma (ages, 6-14 years) living in Puerto Rico. Residential distance to a major roadway was calculated as the distance from the participant's residential US census block centroid to the nearest major road. The outcomes of interest were severe asthma exacerbations, missed school days for asthma, atopy, lung function, and bronchodilator response (BDR). Logistic, linear, or negative binomial regression was used for the multivariable analysis. RESULTS In the multivariable analysis, there was an interaction between indoor endotoxin and residential distance to a roadway on severe asthma exacerbations (P = .02) and BDR (P = .07). In an analysis stratified by distance to a roadway, each log10-unit increase in endotoxin was associated with 4.21 times increased odds of severe asthma exacerbations among children living within 499 m (the lower 3 quartiles of residential distance) to a road (95% confidence interval, 1.5-12.0). Among subjects living further than 499 m away from a roadway, each log10-unit increase in endotoxin was associated with reduced odds of severe asthma exacerbations (odds ratio, 0.03; 95% confidence interval, 0.001-0.67). Similar but less substantial findings were observed for BDR. CONCLUSION Our findings suggest that residential proximity to a major road modifies the estimated effect of endotoxin on severe asthma exacerbations in children.
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Affiliation(s)
- Franziska Rosser
- Division of Pediatric Pulmonary Medicine, Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Yueh-Ying Han
- Division of Pediatric Pulmonary Medicine, Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Erick Forno
- Division of Pediatric Pulmonary Medicine, Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Edna Acosta-Pérez
- Department of Pediatrics, Behavioral Sciences Research Institute, University of Puerto Rico, San Juan, Puerto Rico
| | - Glorisa Canino
- Department of Pediatrics, Behavioral Sciences Research Institute, University of Puerto Rico, San Juan, Puerto Rico
| | - Juan C Celedón
- Division of Pediatric Pulmonary Medicine, Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pennsylvania.
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Yen YC, Yang CY, Wang TN, Yen PC, Ho CK, Mena KD, Lee TC, Chen KS, Lin YC, Chen PS. Household airborne endotoxin associated with asthma and allergy in elementary school-age children: a case-control study in Kaohsiung, Taiwan. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2020; 27:19502-19509. [PMID: 32212084 PMCID: PMC7244453 DOI: 10.1007/s11356-020-07899-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 01/27/2020] [Indexed: 06/10/2023]
Abstract
To evaluate the association between the presence of asthma and allergy, and airborne endotoxin in homes of school-age children in Kaohsiung City, Taiwan, with a case-control study design by matching the age and class exposure. Data collection of home visits included an interviewer-administered questionnaire and air sampling of participants' homes for endotoxin, bacteria, and fungi, as well as temperature and relative humidity measurements. Endotoxin was detected in all air samples with a median value of 0.67 EU m-3. In the adjusted logistic regression model, household airborne endotoxin was associated with higher prevalence of asthma and allergy; OR = 4.88 (95% CI 1.16-20.55) for Q3 (between 0.67 and 1.97 EU m -3) vs. Q1 (< 0.31 EU m -3), with statistical significance. Airborne fungi were associated with higher prevalence of asthma and allergy; OR = 4.47 (95% CI 1.13-17.69) for Q3 (between 314 and 699 CFU m -3) vs. Q1 (< 159 CFU m -3) in adjusted logistic regression models. Airborne endotoxin and fungi were significantly associated with children's asthma and allergy.
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Affiliation(s)
- Yu-Chuan Yen
- Department of Public Health, College of Health Science, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chun-Yuh Yang
- Department of Public Health, College of Health Science, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Tsu-Nai Wang
- Department of Public Health, College of Health Science, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Pei-Chun Yen
- Department of Public Health, College of Health Science, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chi-Kung Ho
- Department of Public Health, College of Health Science, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Kristina D Mena
- Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Tzu-Chi Lee
- Department of Public Health, College of Health Science, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Health Promotion and Health Education, National Taiwan Normal University, Taipei, Taiwan
| | - Kang-Shin Chen
- Institute of Environmental Engineering, College of Engineering, National Sun Yat-Sen University, Kaohsiung, Taiwan
| | - Yuan-Chung Lin
- Institute of Environmental Engineering, College of Engineering, National Sun Yat-Sen University, Kaohsiung, Taiwan
| | - Pei-Shih Chen
- Department of Public Health, College of Health Science, Kaohsiung Medical University, Kaohsiung, Taiwan.
- Institute of Environmental Engineering, College of Engineering, National Sun Yat-Sen University, Kaohsiung, Taiwan.
- Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
- Research Center for Environmental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
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Mendy A, Wilkerson J, Salo PM, Zeldin DC, Thorne PS. Endotoxin clustering with allergens in house dust and asthma outcomes in a U.S. national study. Environ Health 2020; 19:35. [PMID: 32178682 PMCID: PMC7077112 DOI: 10.1186/s12940-020-00585-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 02/28/2020] [Indexed: 06/10/2023]
Abstract
BACKGROUND Endotoxin is ubiquitous in the environment, but its clustering with indoor allergens is not well characterized. This study examined the clustering patterns of endotoxin with allergens in house dust and their association with asthma outcomes. METHODS We analyzed data from 6963 participants of the 2005-2006 National Health and Nutrition Examination Survey. House dust sampled from bedroom floor and bedding was evaluated for endotoxin and allergens from fungi, cockroach, dog, cat, mites, and rodents. Two-step cluster analysis and logistic regressions were performed to identify the clustering patterns and their associations with current asthma and wheeze in the past 12 months, adjusting for covariates. RESULTS Of the homes, 17.8% had low endotoxin and allergen levels in house dust (Cluster 1). High endotoxin level clustered with Alternaria and pet allergens in the homes of participants with a high socioeconomic status who own pets (Cluster 2) (48.9%). High endotoxin clustered with Aspergillus, dust mites, cockroach, and rodent allergens in the homes of participants with low socioeconomic status (Cluster 3) (33.3%). Compared to Cluster 1, Cluster 2 was associated with higher asthma prevalence (OR 1.42, 95% CI: 1.06-1.91) and wheeze (OR 1.32, 95% CI: 1.07-1.63). Cluster 3 was positively associated with wheeze only in participants sensitized to inhalant allergens (OR 1.42, 95% CI: 1.06-1.91) or exposed to tobacco smoke (OR 1.72, 95% CI: 1.15-2.60). CONCLUSIONS The clustering of endotoxin with allergens in dust from homes with pets or of people with low socioeconomic status is associated with asthma and wheeze.
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Affiliation(s)
- Angelico Mendy
- Department of Occupational and Environmental Health, University of Iowa, Iowa City, Iowa, USA
| | | | - Pӓivi M Salo
- Division of Intramural Research, National Institute of Environmental Health Sciences, NIH Research Triangle Park, Durham, North Carolina, USA
| | - Darryl C Zeldin
- Division of Intramural Research, National Institute of Environmental Health Sciences, NIH Research Triangle Park, Durham, North Carolina, USA
| | - Peter S Thorne
- Department of Occupational and Environmental Health, University of Iowa, Iowa City, Iowa, USA.
- University of Iowa College of Public Health, 100 CPHB, S341A, 145 N Riverside Dr, Iowa City, IA, 52242-2207, USA.
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Mendy A, Wilkerson J, Salo PM, Weir CH, Feinstein L, Zeldin DC, Thorne PS. Synergistic Association of House Endotoxin Exposure and Ambient Air Pollution with Asthma Outcomes. Am J Respir Crit Care Med 2020; 200:712-720. [PMID: 30965018 DOI: 10.1164/rccm.201809-1733oc] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Rationale: House endotoxin and ambient air pollution are risk factors for asthma; however, the effects of their coexposure on asthma are not well characterized.Objectives: To examine potential synergistic associations of coexposure to house dust endotoxin and ambient air pollutants with asthma outcomes.Methods: We analyzed data of 6,488 participants in the National Health and Nutrition Examination Survey 2005-2006. Dust from bedding and bedroom floor was analyzed for endotoxin content. The Community Multiscale Air Quality Modeling System (CMAQ) and Downscaler Model data were used to determine annual average particulate matter ≤2.5 μm in aerodynamic diameter (PM2.5), ozone (O3), and nitrogen dioxide (NO2) exposures at participants' residential locations. The associations of the coexposures with asthma outcomes were assessed and tested for synergistic interaction.Measurements and Main Results: In adjusted analysis, PM2.5 (CMAQ) (odds ratio [OR], 1.12; 95% confidence interval [CI], 1.07-1.18), O3 (Downscaler Model) (OR, 1.07; 95% CI, 1.02-1.13), and log10 NO2 (CMAQ) (OR, 3.15; 95% CI, 1.33-7.45) were positively associated with emergency room visits for asthma in the past 12 months. Coexposure to elevated concentrations of house dust endotoxin and PM2.5 (CMAQ) was synergistically associated with the outcome, increasing the odds by fivefold (OR, 5.01; 95% CI, 2.54-9.87). A synergistic association was also found for coexposure to higher concentrations of endotoxin and NO2 in children (OR, 3.45; 95% CI, 1.65-7.18).Conclusions: Coexposure to elevated concentrations of residential endotoxin and ambient PM2.5 in all participants and NO2 in children is synergistically associated with increased emergency room visits for asthma. Therefore, decreasing exposure to both endotoxin and air pollution may help reduce asthma morbidity.
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Affiliation(s)
- Angelico Mendy
- Department of Occupational and Environmental Health, University of Iowa, Iowa City, Iowa
| | | | - Pӓivi M Salo
- Division of Intramural Research, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, North Carolina; and
| | - Charles H Weir
- Office of Emergency Management, U.S. Department of Health and Human Services, Atlanta, Georgia
| | | | - Darryl C Zeldin
- Division of Intramural Research, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, North Carolina; and
| | - Peter S Thorne
- Department of Occupational and Environmental Health, University of Iowa, Iowa City, Iowa
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14
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Yen YC, Yang CY, Ho CK, Yen PC, Cheng YT, Mena KD, Lee TC, Chen PS. Indoor ozone and particulate matter modify the association between airborne endotoxin and schoolchildren's lung function. THE SCIENCE OF THE TOTAL ENVIRONMENT 2020; 705:135810. [PMID: 31972944 DOI: 10.1016/j.scitotenv.2019.135810] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 11/26/2019] [Accepted: 11/26/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND To date, the effect of household airborne pollutants on the association between airborne endotoxin and lung function of schoolchildren is unknown. OBJECTIVES The objective of this study is to evaluate whether indoor air pollutants such as carbon monoxide (CO), carbon dioxide (CO2), nitrogen dioxide (NO2), sulfur dioxide (SO2), ozone (O3), particulate matter with aerodynamic diameter <10 and 2.5 μm (PM10, PM2.5) can modify the association between airborne endotoxin and school children's lung function in a heavy industrial city in Taiwan. METHODS We recruited 120 elementary school-age children in Kaohsiung City, Taiwan. Aerosol samples were collected on a filter membrane for 24 h period and then analyzed for endotoxin. Air pollutants were measured for 24 h in living rooms while school children's lung function was measured. The modification of air pollutants on the relationship between airborne endotoxin and children's lung function was estimated after adjusting the gender, age, height, weight, and case-control status. RESULTS We found that both O3 and PM10 concentrations significantly modified the relationships between airborne endotoxin and school children's lung function. Among children living in homes with O3 ≥ 0.01 ppm or PM10 ≥ 62 μg/m3, airborne endotoxin was negatively associated with lung functions, whereas among those living in homes with O3 < 0.01 ppm or PM10 < 62 μg/m3, airborne endotoxin was positively associated with lung functions. CONCLUSIONS The indoor air pollutant concentration of O3 and PM10 modifies the association between airborne endotoxin and school children's lung function.
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Affiliation(s)
- Yu-Chuan Yen
- Department of Public Health, College of Health Science, Kaohsiung Medical University, Kaohsiung City, Taiwan
| | - Chun-Yuh Yang
- Department of Public Health, College of Health Science, Kaohsiung Medical University, Kaohsiung City, Taiwan
| | - Chi-Kung Ho
- Department of Public Health, College of Health Science, Kaohsiung Medical University, Kaohsiung City, Taiwan
| | - Pei-Chun Yen
- Department of Public Health, College of Health Science, Kaohsiung Medical University, Kaohsiung City, Taiwan
| | - Yu-Ting Cheng
- Department of Public Health, College of Health Science, Kaohsiung Medical University, Kaohsiung City, Taiwan
| | - Kristina D Mena
- Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, University of Texas Health Science Center at Houston, TX, United States
| | - Tzu-Chi Lee
- Department of Public Health, College of Health Science, Kaohsiung Medical University, Kaohsiung City, Taiwan; Department of Health Promotion and Health Education, National Taiwan Normal University, Taiwan
| | - Pei-Shih Chen
- Department of Public Health, College of Health Science, Kaohsiung Medical University, Kaohsiung City, Taiwan; Institute of Environmental Engineering, College of Engineering, National Sun Yat-Sen University, Kaohsiung, Taiwan; Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung City, Taiwan; Research Center for Environmental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
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15
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Virot E, Godet J, Khayath N, Ott M, Dazy A, de Blay F. Cluster analysis of indoor environmental factors associated with symptoms of mite allergy. Ann Allergy Asthma Immunol 2019; 123:280-283. [PMID: 31175929 DOI: 10.1016/j.anai.2019.05.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 04/30/2019] [Accepted: 05/23/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND The clinical efficacy of controlling environmental allergens as a component of allergic asthma treatment remains controversial. Multifaceted allergen reductions appeared to be the most efficient methods. However, they require home visits with indoor technicians. OBJECTIVE To examine the characteristics of indoor environments that might be related to symptoms of children and adult patients with mite allergic rhinitis and/or asthma. METHODS We included 315 patients allergic to house dust mites with rhinitis and/or asthma who had been visited at home by 2 medical indoor environment counselors (MIECs) from the Strasbourg University Hospital between January 2007 and June 2015. In a cluster analysis, we analyzed 42 characteristics of respiratory symptoms, dwelling characteristics, and indoor pollutants in this population. RESULTS Three clusters were defined among the patients. Cluster 1 included 55 patients, all with rhinitis, 32% with asthma, and all living in an urban area. Clusters 2 and 3 included 86 and 174 patients, respectively. The important factors in these 2 clusters were asthma incidence and exposure to different indoor pollutants, such as indoor perfumes, cleaning products, and tobacco smoke. CONCLUSION Our results underlined the variability of indoor environments and the importance of MIEC home visits to investigate individual patient environments and propose an appropriate avoidance management plan. Our results showed that sensitization to mite and exposure to indoor chemical pollutants were associated with severe asthma.
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Affiliation(s)
- Edouard Virot
- Chest Disease Department, Strasbourg University Hospital, Strasbourg, France.
| | - Julien Godet
- Public Health Department, Strasbourg University Hospital, Strasbourg, France
| | - Naji Khayath
- Chest Disease Department, Strasbourg University Hospital, Strasbourg, France; Federation of Translational Medicine, FHU Homicare, Strasbourg University Hospital, Strasbourg, France
| | - Martine Ott
- Chest Disease Department, Strasbourg University Hospital, Strasbourg, France
| | - Audrey Dazy
- Chest Disease Department, Strasbourg University Hospital, Strasbourg, France
| | - Frederic de Blay
- Chest Disease Department, Strasbourg University Hospital, Strasbourg, France; Federation of Translational Medicine, FHU Homicare, Strasbourg University Hospital, Strasbourg, France
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16
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Putcha N, Fawzy A, Paul GG, Lambert AA, Psoter KJ, Sidhaye VK, Woo J, Wells JM, Labaki WW, Doerschuk CM, Kanner RE, Han MK, Martinez C, Paulin LM, Martinez FJ, Wise RA, O’Neal WK, Barr RG. Anemia and Adverse Outcomes in a Chronic Obstructive Pulmonary Disease Population with a High Burden of Comorbidities. An Analysis from SPIROMICS. Ann Am Thorac Soc 2018; 15:710-717. [PMID: 30726108 PMCID: PMC6207135 DOI: 10.1513/annalsats.201708-687oc] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 03/12/2018] [Indexed: 11/20/2022] Open
Abstract
RATIONALE Chronic obstructive pulmonary disease (COPD) is a common cause of morbidity and associated with a significant burden of comorbidities. Although anemia is associated with adverse outcomes in COPD, its contribution to outcomes in individuals with other comorbid chronic diseases is not well understood. OBJECTIVES This study examines the association of anemia with outcomes in a large, well-characterized COPD cohort, and attempts to understand the contribution of anemia to outcomes and phenotypes in individuals with other comorbidities. METHODS Participants with COPD from SPIROMICS (the Subpopulations and Intermediate Outcome Measures in COPD Study) were analyzed in adjusted models to determine the associations of normocytic anemia with clinical outcomes, computed tomographic measures, and biomarkers. Analysis was additionally performed to understand the independence and possible interactions related to cardiac and metabolic comorbidities. RESULTS A total of 1,789 individuals with COPD from SPIROMICS had data on hemoglobin, and of these 7.5% (n = 135) were found to have normocytic anemia. Anemic participants were older with worse airflow obstruction, a higher proportion of them were African Americans, and they had a higher burden of cardiac and metabolic comorbidities. Anemia was strongly associated with 6-minute walk distance (β, -61.43; 95% confidence interval [CI], -85.11 to -37.75), modified Medical Research Council dyspnea questionnaire (β, 0.27; 95% CI, 0.11-0.44), and St. George's Respiratory Questionnaire (β, 3.90; 95% CI, 1.09-6.71), and these adjusted associations were stronger among those with two or more cardiac and metabolic comorbidities. Anemia was associated with higher levels of serum C-reactive protein, soluble receptor for advanced glycosylation end-products, and epithelial cadherin-1, findings that persisted when in those with a high burden of comorbidities. CONCLUSIONS Anemia is associated with worse exercise capacity, greater dyspnea, and greater disease severity among adults with COPD, particularly among those with comorbid chronic cardiac and metabolic diseases. The biomarkers found in anemic individuals suggest inflammation, lung tissue injury, and oxidative stress as possible pathways for the adverse correlations of anemia with outcomes in COPD; however, substantial further study is required to better understand these potential mechanisms. Clinical trial registered with www.clinicaltrials.gov (NCT01969344).
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Affiliation(s)
- Nirupama Putcha
- Division of Pulmonary and Critical Care Medicine, Department of Medicine and
| | - Ashraf Fawzy
- Division of Pulmonary and Critical Care Medicine, Department of Medicine and
| | - Gabriel G. Paul
- Division of Pulmonary and Critical Care Medicine, Department of Medicine and
| | - Allison A. Lambert
- Division of Pulmonary and Critical Care Medicine, Department of Medicine and
| | - Kevin J. Psoter
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - John Woo
- Division of Pulmonary and Critical Care Medicine, Department of Medicine and
| | | | | | - Claire M. Doerschuk
- Marsico Lung Institute, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | | | - MeiLan K. Han
- University of Michigan Medical School, Ann Arbor, Michigan
| | | | - Laura M. Paulin
- Division of Pulmonary and Critical Care Medicine, Department of Medicine and
| | | | - Robert A. Wise
- Division of Pulmonary and Critical Care Medicine, Department of Medicine and
| | - Wanda K. O’Neal
- Marsico Lung Institute, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | | | - on behalf of the SPIROMICS Investigators
- Division of Pulmonary and Critical Care Medicine, Department of Medicine and
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
- University of Alabama at Birmingham, Birmingham, Alabama
- University of Michigan Medical School, Ann Arbor, Michigan
- Marsico Lung Institute, University of North Carolina School of Medicine, Chapel Hill, North Carolina
- University of Utah School of Medicine, Salt Lake City, Utah
- Cornell University School of Medicine, New York, New York; and
- Columbia University Medical Center, New York, New York
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17
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Gold DR, Adamkiewicz G, Arshad SH, Celedón JC, Chapman MD, Chew GL, Cook DN, Custovic A, Gehring U, Gern JE, Johnson CC, Kennedy S, Koutrakis P, Leaderer B, Mitchell H, Litonjua AA, Mueller GA, O'Connor GT, Ownby D, Phipatanakul W, Persky V, Perzanowski MS, Ramsey CD, Salo PM, Schwaninger JM, Sordillo JE, Spira A, Suglia SF, Togias A, Zeldin DC, Matsui EC. NIAID, NIEHS, NHLBI, and MCAN Workshop Report: The indoor environment and childhood asthma-implications for home environmental intervention in asthma prevention and management. J Allergy Clin Immunol 2017; 140:933-949. [PMID: 28502823 PMCID: PMC5632590 DOI: 10.1016/j.jaci.2017.04.024] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 04/14/2017] [Indexed: 01/19/2023]
Abstract
Environmental exposures have been recognized as critical in the initiation and exacerbation of asthma, one of the most common chronic childhood diseases. The National Institute of Allergy and Infectious Diseases; National Institute of Environmental Health Sciences; National Heart, Lung, and Blood Institute; and Merck Childhood Asthma Network sponsored a joint workshop to discuss the current state of science with respect to the indoor environment and its effects on the development and morbidity of childhood asthma. The workshop included US and international experts with backgrounds in allergy/allergens, immunology, asthma, environmental health, environmental exposures and pollutants, epidemiology, public health, and bioinformatics. Workshop participants provided new insights into the biologic properties of indoor exposures, indoor exposure assessment, and exposure reduction techniques. This informed a primary focus of the workshop: to critically review trials and research relevant to the prevention or control of asthma through environmental intervention. The participants identified important limitations and gaps in scientific methodologies and knowledge and proposed and prioritized areas for future research. The group reviewed socioeconomic and structural challenges to changing environmental exposure and offered recommendations for creative study design to overcome these challenges in trials to improve asthma management. The recommendations of this workshop can serve as guidance for future research in the study of the indoor environment and on environmental interventions as they pertain to the prevention and management of asthma and airway allergies.
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Affiliation(s)
- Diane R Gold
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, Mass; Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Mass.
| | - Gary Adamkiewicz
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Mass
| | - Syed Hasan Arshad
- David Hide Asthma and Allergy Research Centre, Isle of Wight, and Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Juan C Celedón
- Division of Pulmonary Medicine, Allergy and Immunology, Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, Pa
| | | | - Ginger L Chew
- Centers for Disease Control and Prevention (CDC), National Center for Environmental Health, Division of Environmental Hazards and Health Effects | Air Pollution and Respiratory Health Branch, Atlanta, Ga
| | - Donald N Cook
- Immunity, Inflammation and Disease Laboratory, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC
| | - Adnan Custovic
- Section of Paediatrics and MRC and Asthma UK Centre in Allergic Mechanisms of Asthma, Imperial College London, London, United Kingdom
| | - Ulrike Gehring
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - James E Gern
- Departments of Pediatrics and Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wis
| | - Christine C Johnson
- Department of Public Health Sciences, Henry Ford Hospital & Health System, Detroit, Mich
| | - Suzanne Kennedy
- Department of Pediatrics, NC Children's Hospital, University of North Carolina, Chapel Hill, NC
| | - Petros Koutrakis
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Mass
| | - Brian Leaderer
- Yale School of Public Health, Yale School of Medicine, Yale School of Forestry and Environmental Studies, Center for Perinatal, Pediatric and Environmental Epidemiology (CPPEE), New Haven, Conn
| | | | - Augusto A Litonjua
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, Mass
| | - Geoffrey A Mueller
- Genome Integrity and Structural Biology Laboratory, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC
| | - George T O'Connor
- Pulmonary Center, Boston University School of Medicine, Boston, Mass
| | - Dennis Ownby
- Division of Allergy-Immunology and Rheumatology, Department of Pediatrics, Augusta University, Augusta, Ga
| | - Wanda Phipatanakul
- Asthma, Allergy and Immunology, Boston Children's Hospital, Harvard Medical School, Boston, Mass
| | - Victoria Persky
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, Ill
| | - Matthew S Perzanowski
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY
| | - Clare D Ramsey
- Departments of Medicine and Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Päivi M Salo
- Division of Intramural Research, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC
| | - Julie M Schwaninger
- Division of Allergy, Immunology, and Transplantation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, Md
| | - Joanne E Sordillo
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, Mass
| | - Avrum Spira
- Division of Computational Biomedicine, Department of Medicine, Boston University School of Medicine, Boston, Mass
| | - Shakira F Suglia
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Ga
| | - Alkis Togias
- Division of Allergy, Immunology, and Transplantation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, Md
| | - Darryl C Zeldin
- Division of Intramural Research, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC
| | - Elizabeth C Matsui
- Division of Pediatric Allergy/Immunology, Johns Hopkins University, Baltimore, Md
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18
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Peters KO, Williams DAL, Abubaker S, Curtin-Brosnan J, McCormack MC, Peng R, Breysse PN, Matsui EC, Hansel NN, Diette GB, Strickland PT. Predictors of polycyclic aromatic hydrocarbon exposure and internal dose in inner city Baltimore children. JOURNAL OF EXPOSURE SCIENCE & ENVIRONMENTAL EPIDEMIOLOGY 2017; 27:290-298. [PMID: 27966668 PMCID: PMC5516642 DOI: 10.1038/jes.2016.57] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 09/23/2016] [Indexed: 05/29/2023]
Abstract
Polycyclic aromatic hydrocarbons (PAHs), the by-products of incomplete combustion of organic materials, are commonly found on particulate matter (PM) and have been associated with the development of asthma and asthma exacerbation in urban populations. We examined time spent in the home and outdoors as predictors of exposures to airborne PAHs and measured urinary 1-hydroxypyrene-glucuronide (1-OHPG) as internal dose of PAHs in 118 children aged 5-12 years from Baltimore, MD. During weeklong periods (Saturday-Saturday) in each of four seasons: daily activities were assessed using questionnaires, indoor air nicotine and PM concentrations were monitored, and urine specimens were collected on Tuesday (day 3) and Saturday (day 7) for measurement of 1-OHPG. Time spent in non-smoking homes was associated with significantly decreased 1-OHPG concentration in urine (β=-0.045, 95% CI (-0.076, -0.013)), and secondhand smoke (SHS) exposures modified these associations, with higher urinary 1-OHPG concentrations in children spending time in smoking homes than non-smoking homes (P-value for interaction=0.012). Time spent outdoors was associated with increased urinary 1-OHPG concentrations (β=0.097, 95% CI (0.037, 0.157)) in boys only. Our results suggest that SHS and ambient (outdoor) air pollution contribute to internal dose of PAHs in inner city children.
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Affiliation(s)
- Kamau O. Peters
- Department of Environmental Health Sciences, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - D’ Ann L. Williams
- Department of Environmental Health Sciences, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Salahadin Abubaker
- Department of Environmental Health Sciences, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Jean Curtin-Brosnan
- Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Meredith C. McCormack
- Department of Environmental Health Sciences, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
- Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Roger Peng
- Department of Biostatistics, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Patrick N. Breysse
- Department of Environmental Health Sciences, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Elizabeth C. Matsui
- Department of Environmental Health Sciences, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
- Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Nadia N. Hansel
- Department of Environmental Health Sciences, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
- Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Gregory B. Diette
- Department of Environmental Health Sciences, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
- Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Paul T. Strickland
- Department of Environmental Health Sciences, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
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19
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Negherbon JP, Romero K, Williams DL, Guerrero-Preston RE, Hartung T, Scott AL, Breysse PN, Checkley W, Hansel NN. Whole Blood Cytokine Response to Local Traffic-Related Particulate Matter in Peruvian Children With and Without Asthma. Front Pharmacol 2017; 8:157. [PMID: 28424616 PMCID: PMC5371665 DOI: 10.3389/fphar.2017.00157] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2016] [Accepted: 03/10/2017] [Indexed: 12/23/2022] Open
Abstract
This study sought to investigate if acute phase immune responses of whole blood from Peruvian children with controlled and uncontrolled asthma differed from children without asthma, following exposure to traffic-related particulate matter (TRPM). TRPM, including particulate matter from diesel combustion, has been shown to stimulate acute airway inflammation in individuals with and without asthma. For this study, a whole blood assay (WBA) was used to test peripheral whole blood samples from 27 children with asthma, and 12 without asthma. Participant blood samples were stimulated, ex vivo, for 24-h with an aqueous extract of TRPM that was collected near study area highways in Lima, Peru. All participant blood samples were tested against the same TRPM extract, in addition to purified bacterial endotoxin and pyrogen-free water, which served as positive and negative WBA controls, respectively. The innate and adaptive cytokine responses were evaluated in cell-free supernatants of the whole blood incubations. Comparatively similar levels were recorded for nine out of the 10 cytokines measured [e.g., – Interleukin (IL)-1β, IL-6, IL-10], regardless of study participant asthma status. However, IL-8 levels in TRPM-stimulated blood from children with uncontrolled asthma were diminished, compared to subjects without asthma (633 pg/ml vs. 1,023 pg/ml, respectively; p < 0.01); IL-8 responses for subjects with controlled asthma were also reduced, but to a lesser degree (799 pg/ml vs. 1,023 pg/ml, respectively; p = 0.10). These relationships were present before, and after, adjusting for age, sex, obesity/overweight status, C-reactive protein levels, and residential proximity to the study area’s major roadway. For tests conducted with endotoxin, there were no discernible differences in cytokine response between groups, for all cytokines measured. The WBA testing conducted for this study highlighted the capacity of the TRPM extract to potently elicit the release of IL-8 from the human whole blood system. Although the small sample size of the study limits the capacity to draw definitive conclusions, the IL-8 responses suggest that that asthma control may be associated with the regulation of a key mediator in neutrophil chemotaxis, at a systemic level, following exposure to PM derived from traffic-related sources.
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Affiliation(s)
- Jesse P Negherbon
- Department of Environmental Health Sciences, Bloomberg School of Public Health, The Johns Hopkins University, BaltimoreMD, USA
| | | | - D'Ann L Williams
- Department of Environmental Health Sciences, Bloomberg School of Public Health, The Johns Hopkins University, BaltimoreMD, USA
| | - Rafael E Guerrero-Preston
- Head and Neck Cancer Research Division, Department of Otolaryngology, School of Medicine, The Johns Hopkins University, BaltimoreMD, USA
| | - Thomas Hartung
- Department of Environmental Health Sciences, Bloomberg School of Public Health, The Johns Hopkins University, BaltimoreMD, USA.,Center for Alternatives to Animal Testing, Bloomberg School of Public Health, The Johns Hopkins University, BaltimoreMD, USA
| | - Alan L Scott
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Bloomberg School of Public Health, The Johns Hopkins University, BaltimoreMD, USA
| | - Patrick N Breysse
- Department of Environmental Health Sciences, Bloomberg School of Public Health, The Johns Hopkins University, BaltimoreMD, USA
| | - William Checkley
- Asociación Benéfica PrismaLima, Perú.,Division of Pulmonary and Critical Care, School of Medicine, The Johns Hopkins University, BaltimoreMD, USA
| | - Nadia N Hansel
- Department of Environmental Health Sciences, Bloomberg School of Public Health, The Johns Hopkins University, BaltimoreMD, USA.,Division of Pulmonary and Critical Care, School of Medicine, The Johns Hopkins University, BaltimoreMD, USA
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Al Said A, Cushen B, Costello RW. Targeting patients with asthma for omalizumab therapy: choosing the right patient to get the best value for money. Ther Adv Chronic Dis 2017; 8:31-45. [PMID: 28348726 DOI: 10.1177/2040622317690494] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 12/22/2016] [Indexed: 11/15/2022] Open
Abstract
The asthma syndrome has many manifestations, termed phenotypes, that arise by specific cellular and molecular mechanisms, termed endotypes. Understanding an individual's asthma phenotype helps clinicians make rational therapeutic decisions while the understanding of endotypes has led to the development of specific precision medications. Allergic asthma is an example of an asthma phenotype and omalizumab, a monoclonal antibody that neutralizes serum immunoglobulin (Ig)E, is a specific targeted treatment which was developed as a result of an understanding of the endotype of allergic asthma. Omalizumab has been widely used in clinical practice in Europe for over a decade as an add-on therapy to treat patients who have severe refractory allergic asthma. Over this period, many centres have reported their experience with omalizumab as an add-on therapy in patients with severe asthma. These 'real world' clinical effectiveness studies have confirmed the benefits, cost-effectiveness and clinical utility of this medication. Combining the outcomes of both sources of research has yielded important insights that may benefit patients with severe asthma, clinicians who treat them, as well as the funding agencies that reimburse the cost of this medication. The purpose of this review is to describe how to identify and evaluate a patient with asthma for whom treatment with omalizumab may be of clinical and cost-effective benefit. The assessment and investigations used to confirm allergic asthma, the objective assessment of adherence to asthma therapy and the expected benefits of add-on omalizumab treatment are described.
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Affiliation(s)
| | | | - Richard W Costello
- Department of Medicine, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin 9, Ireland
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21
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Bose S, Rivera-Mariani F, Chen R, Williams D, Belli A, Aloe C, McCormack MC, Breysse PN, Hansel NN. Domestic exposure to endotoxin and respiratory morbidity in former smokers with COPD. INDOOR AIR 2016; 26:734-42. [PMID: 26547489 PMCID: PMC5324735 DOI: 10.1111/ina.12264] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Accepted: 10/31/2015] [Indexed: 05/28/2023]
Abstract
Indoor air pollution has been linked to adverse chronic obstructive pulmonary disease (COPD) health, but specific causative agents have not yet been identified. We evaluated the role of indoor endotoxin exposure upon respiratory health in former smokers with COPD. Eighty-four adults with moderate to severe COPD were followed longitudinally and indoor air and dust samples collected at baseline, 3 and 6 months. Respiratory outcomes were repeatedly assessed at each time point. The associations between endotoxin exposure in air and settled dust and health outcomes were explored using generalizing estimating equations in multivariate models accounting for confounders. Dust endotoxin concentrations in the main living area were highest in spring and lowest in fall, while airborne endotoxins remained steady across seasons. Airborne and dust endotoxin concentrations were weakly correlated with one another (rs = +0.24, P = 0.005). Endotoxin concentrations were not significantly associated with respiratory symptoms, rescue medication use, quality of life, or severe exacerbations. In vitro whole-blood assays of the pro-inflammatory capacity of PM10 filters with and without endotoxin depletion demonstrated that the endotoxin component of indoor air pollution was not the primary trigger for interleukin-1β release. Our findings support that endotoxin is not the major driver in the adverse effects of indoor PM upon COPD morbidity.
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Affiliation(s)
- S Bose
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA.
| | - F Rivera-Mariani
- Department of Biology, Miami Dade College Wolfson Campus, Miami, FL, USA
| | - R Chen
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - D Williams
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - A Belli
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - C Aloe
- Division of Pediatric Allergy and Immunology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - M C McCormack
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - P N Breysse
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - N N Hansel
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
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22
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Dutmer CM, McGraw MD, Liu AH. Inner-city asthma: special considerations for management. Curr Opin Allergy Clin Immunol 2016; 16:148-56. [PMID: 26859370 DOI: 10.1097/aci.0000000000000254] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Asthma is prevalent in inner-city populations, exhibiting significant morbidity and mortality. This review focuses on the consequential findings of recent literature, providing insight into onset of asthma, complicating factors, prediction of exacerbations, and novel treatment strategies. RECENT FINDINGS Analyses of environmental influence on inner-city children demonstrated novel interactions, implicating potentially protective benefits from early life exposures to pests and pets and isolating detrimental effects of air pollution on asthma morbidity. Through detailed characterization of inner-city asthmatics, predictors of seasonal exacerbations surfaced. Focused, season-specific treatment of inner-city asthmatics with omalizumab identified those most likely to benefit from season-tailored therapy. Comparative studies of urban and rural populations revealed that race and household income, rather than location of residence, impose the greatest risk for increased asthma prevalence and morbidity. SUMMARY Challenging previously conceived exposure-disease relationships, recent literature has elucidated new avenues in the complex interplay between immunologically active exposures and their effects on inner-city asthma. These findings, and improved understanding of other relevant exposures, could steer the direction of primary (and secondary) disease prevention research. Moreover, careful identification of asthma characteristics has effectively established predictors of exacerbations, highlighting individuals for which additional therapies are warranted and for whom such treatments are most likely to be effective.
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Affiliation(s)
- Cullen M Dutmer
- aAllergy and Immunology bPulmonary Medicine Sections, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado, USA
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23
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Asthma in Urban Children: Epidemiology, Environmental Risk Factors, and the Public Health Domain. Curr Allergy Asthma Rep 2016; 16:33. [DOI: 10.1007/s11882-016-0609-6] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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24
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Putcha N, Barr RG, Han MK, Woodruff PG, Bleecker ER, Kanner RE, Martinez FJ, Smith BM, Tashkin DP, Bowler RP, Eisner MD, Rennard SI, Wise RA, Hansel NN. Understanding the impact of second-hand smoke exposure on clinical outcomes in participants with COPD in the SPIROMICS cohort. Thorax 2016; 71:411-420. [PMID: 26962015 PMCID: PMC5235992 DOI: 10.1136/thoraxjnl-2015-207487] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND Second-hand smoke (SHS) exposure has been linked to the development of and morbidity from lung disease. We sought to advance understanding of the impact of SHS on health-related outcomes in individuals with COPD. METHODS Among the participants with COPD in SPIROMICS, recent SHS exposure was quantified as (1) hours of reported exposure in the past week or (2) reported living with a smoker. We performed adjusted regression for SHS with outcomes, testing for interactions with gender, race, smoking and obesity. RESULTS Of the 1580 participants with COPD, 20% reported living with a smoker and 27% reported exposure in the past week. Living with a smoker was associated with worse St George's Respiratory Questionnaire score (SGRQ, β 3.10; 95% CI 0.99 to 5.21), COPD Assessment Test score (β 1.43; 95% CI 0.52 to 2.35) and increased risk for severe exacerbations (OR 1.51, 95% CI 1.04 to 2.17). SHS exposure in the past week was associated with worse SGRQ (β 2.52; 95% CI 0.47 to 4.58), nocturnal symptoms (OR 1.58; 95% CI 1.19 to 2.10), wheezing (OR 1.34; 95% CI 1.02 to 1.77), chronic productive cough (OR 1.77; 95% CI 1.33 to 2.35) and difficulty with cough and sputum (Ease of Cough and Sputum scale, β 0.84; 95% CI 0.42 to 1.25). SHS was associated with increased airway wall thickness on CT but not emphysema. Active smokers, obese individuals and individuals with less severe airflow obstruction also had higher susceptibility to SHS for some outcomes. CONCLUSION Individuals with COPD, including active smokers, have significant SHS exposure, associated with worse outcomes and airway wall thickness. Active smokers and obese individuals may have worse outcomes associated with SHS. TRIAL REGISTRATION NUMBER NCT01969344 (clinicaltrials.gov).
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Affiliation(s)
- Nirupama Putcha
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - R. Graham Barr
- Columbia University School of Medicine, New York, NY, USA
| | - Meilan K. Han
- University of Michigan School of Medicine, Ann Arbor, MI, USA
| | - Prescott G. Woodruff
- University of California San Francisco School of Medicine, San Francisco, CA, USA
| | - Eugene R. Bleecker
- Wake Forest University Center for Genomics and Personalized Medicine Research, Winston-Salem, NC, USA
| | - Richard E. Kanner
- University of Utah Health Sciences Center, Salt Lake City, Utah, USA
| | | | | | - Donald P. Tashkin
- University of California Los Angeles, David Geffen School of Medicine, Los Angeles, CA, USA
| | | | - Mark D. Eisner
- University of California San Francisco School of Medicine, San Francisco, CA, USA
- Genentech, Inc., South San Francisco, CA
| | | | - Robert A. Wise
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Nadia N. Hansel
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
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25
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Associations of Early Life Exposures and Environmental Factors With Asthma Among Children in Rural and Urban Areas of Guangdong, China. Chest 2016; 149:1030-41. [PMID: 26836923 DOI: 10.1016/j.chest.2015.12.028] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Revised: 12/13/2015] [Accepted: 12/21/2015] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Environmental factors may play important roles in asthma, but findings have been inconsistent. OBJECTIVE The goal of this study was to determine the associations between early life exposures, environmental factors, and asthma in urban and rural children in southeast China. METHODS A screening questionnaire survey was conducted in 7,164 children from urban Guangzhou and 6,087 from rural Conghua. In the second stage, subsamples of 854 children (419 from Guangzhou, 435 from Conghua) were recruited for a case-control study that included a detailed questionnaire enquiring on family history, early life environmental exposures, dietary habits, and laboratory tests (including histamine airway provocation testing, skin prick tests, and serum antibody analyses). House dust samples from 76 Guangzhou families and 80 Conghua families were obtained to analyze levels of endotoxins, house dust mites, and cockroach allergens. RESULTS According to the screening survey, the prevalence of physician-diagnosed asthma was lower in children from Conghua (3.4%) than in those from Guangzhou (6.9%) (P < .001). A lower percentage of asthma was reported in rural subjects compared with urban subjects (2.8% vs. 29.4%; P < .001) in the case-control study. Atopy (OR, 1.91 [95% CI, 1.58-2.29]), parental atopy (OR, 2.49 [95% CI, 1.55-4.01]), hospitalization before 3 years of age (OR, 2.54 [95% CI, 1.37-4.70]), high consumption of milk products (OR, 1.68 [95% CI, 1.03-2.73]), and dust Dermatophagoides farinae group 1 allergen (OR, 1.71 [95% CI, 1.34-2.19]) were positively associated with asthma. Living in a crop-farming family at < 1 year of age (OR, 0.15 [95% CI, 0.08-0.32]) and dust endotoxin levels (OR, 0.69 [95% CI, 0.50-0.95]) were negatively associated with asthma. CONCLUSIONS Rural children from an agricultural background exhibited a reduced risk of asthma. Early life exposure to crop farming and high environmental endotoxin levels might protect the children from asthma in southern China.
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26
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Liu AH. Revisiting the hygiene hypothesis for allergy and asthma. J Allergy Clin Immunol 2015; 136:860-5. [DOI: 10.1016/j.jaci.2015.08.012] [Citation(s) in RCA: 109] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Revised: 08/24/2015] [Accepted: 08/24/2015] [Indexed: 12/17/2022]
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Lasso-Pirot A, Delgado-Villalta S, Spanier AJ. Early childhood wheezers: identifying asthma in later life. J Asthma Allergy 2015; 8:63-73. [PMID: 26203265 PMCID: PMC4508083 DOI: 10.2147/jaa.s70066] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Wheeze in young children is common, and asthma is the most common noncommunicable disease in children. Prevalence studies of recurrent asthma-like symptoms in children under the age of 5 years have reported that one third of children in the US and Europe are affected, and rates and severity appear to be higher in developing countries. Over the last few decades, significant research efforts have focused on identification of risk factors and predictors of wheeze and on tools to identify which children who wheeze will progress to develop asthma. We reviewed the phenotypes of childhood wheezing, genetic risk factors, environmental factors, testing/predictive indices, and primary prevention. While it is generally agreed that a complex interaction of environmental exposure and genetic susceptibility contributes to the development of asthma, limitations in predictive tools and tests restrict our ability to provide families with guidance as to whether their child with wheeze will ultimately develop asthma. Additional research is needed to clarify childhood wheeze phenotypes, to develop tools to determine which children will develop asthma, and to determine how and when to intervene. If these areas can be addressed, it would help reduce this large burden on children, families, and society.
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Affiliation(s)
- Anayansi Lasso-Pirot
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, USA
| | | | - Adam J Spanier
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, USA
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28
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Szefler SJ. Advances in pediatric asthma in 2014: Moving toward a population health perspective. J Allergy Clin Immunol 2015; 135:644-52. [PMID: 25649079 DOI: 10.1016/j.jaci.2014.12.1921] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Revised: 12/29/2014] [Accepted: 12/29/2014] [Indexed: 01/30/2023]
Abstract
Last year's "Advances in pediatric asthma in 2013: Coordinating asthma care" concluded that, "Enhanced communication systems will be necessary among parents, clinicians, health care providers and the pharmaceutical industry so that we continue the pathway of understanding the disease and developing new treatments that address the unmet needs of patients who are at risk for severe consequences of unchecked disease persistence or progression." This year's summary will focus on further advances in pediatric asthma related to prenatal and postnatal factors altering the natural history of asthma, assessment of asthma control, and new insights regarding the management of asthma in children as indicated in Journal of Allergy and Clinical Immunology publications in 2014. A major theme of this review is how new research reports can be integrated into medical communication in a population health perspective to assist clinicians in asthma management. The asthma specialist is in a unique position to convey important messages to the medical community related to factors that influence the course of asthma, methods to assess and communicate levels of control, and new targets for intervention, as well as new immunomodulators. By enhancing communication among patients, parents, primary care physicians, and specialists within provider systems, the asthma specialist can provide timely information that can help to reduce asthma morbidity and mortality.
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Affiliation(s)
- Stanley J Szefler
- Pediatric Asthma Research Program, Section of Pediatric Pulmonary Medicine, Breathing Institute, Department of Pediatrics, Children's Hospital Colorado, and the Department of Pediatrics, University of Colorado Denver School of Medicine, Aurora, Colo.
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29
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McCormack MC, Belli AJ, Kaji DA, Matsui EC, Brigham EP, Peng RD, Sellers C, Williams DL, Diette GB, Breysse PN, Hansel NN. Obesity as a susceptibility factor to indoor particulate matter health effects in COPD. Eur Respir J 2015; 45:1248-57. [PMID: 25573407 DOI: 10.1183/09031936.00081414] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Accepted: 11/02/2014] [Indexed: 11/05/2022]
Abstract
Our goal was to investigate whether obesity increases susceptibility to the adverse effects of indoor particulate matter on respiratory morbidity among individuals with chronic obstructive pulmonary disease (COPD). Participants with COPD were studied at baseline, 3 and 6 months. Obesity was defined as a body mass index ≥30 kg·m(-2). At each time point, indoor air was sampled for 5-7 days and particulate matter (PM) with an aerodynamic size ≤2.5 μm (PM2.5) and 2.5-10 μm (PM2.5-10) was measured. Respiratory symptoms, health status, rescue medication use, exacerbations, blood biomarkers and exhaled nitric oxide were assessed simultaneously. Of the 84 participants enrolled, 56% were obese and all were former smokers with moderate-to-severe COPD. Obese participants tended to have less severe disease as assessed by Global Initiative for Chronic Obstructive Pulmonary Disease stage and fewer pack-years of smoking. There was evidence that obesity modified the effects of indoor PM on COPD respiratory outcomes. Increases in PM2.5 and PM2.5-10 were associated with greater increases in nocturnal symptoms, dyspnoea and rescue medication use among obese versus non-obese participants. The impact of indoor PM on exacerbations, respiratory status and wheeze also tended to be greater among obese versus non-obese participants, as were differences in airway and systemic inflammatory responses to indoor PM. We found evidence that obesity was associated with exaggerated responses to indoor fine and coarse PM exposure among individuals with COPD.
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Affiliation(s)
- Meredith C McCormack
- Dept of Medicine, Division of Pulmonary and Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD, USA Dept of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Andrew J Belli
- Dept of Medicine, Division of Pulmonary and Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Deepak A Kaji
- Dept of Medicine, Division of Pulmonary and Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Elizabeth C Matsui
- Dept of Pediatrics, Division of Allergy and Immunology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Emily P Brigham
- Dept of Medicine, Division of Pulmonary and Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Roger D Peng
- Dept of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Cortlandt Sellers
- Dept of Medicine, Division of Pulmonary and Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - D'Ann L Williams
- Dept of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Gregory B Diette
- Dept of Medicine, Division of Pulmonary and Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD, USA Dept of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Patrick N Breysse
- Dept of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Nadia N Hansel
- Dept of Medicine, Division of Pulmonary and Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD, USA Dept of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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30
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Lang-Yona N, Lehahn Y, Herut B, Burshtein N, Rudich Y. Marine aerosol as a possible source for endotoxins in coastal areas. THE SCIENCE OF THE TOTAL ENVIRONMENT 2014; 499:311-8. [PMID: 25201818 DOI: 10.1016/j.scitotenv.2014.08.054] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Revised: 07/12/2014] [Accepted: 08/19/2014] [Indexed: 04/15/2023]
Abstract
Marine aerosols, that are very common in the highly populated coastal cities and communities, may contain biological constituents. Some of this biological fraction of marine aerosols, such as cyanobacteria and plankton debris, may influence human health by inflammation and allergic reactions when inhaled. In this study we identify and compare sources for endotoxins sampled on filters in an on-shore and more-inland site. Filter analysis included endotoxin content, total bacteria, gram-negative bacteria and cyanobacteria genome concentrations as well as ion content in order to identify possible sources for the endotoxins. Satellite images of chlorophyll-a levels and back trajectory analysis were used to further study the cyanobacteria blooms in the sea, close to the trajectory of the sampled air. The highest endotoxin concentrations found in the shoreline site were during winter (3.23±0.17 EU/m(3)), together with the highest cyanobacteria genome (1065.5 genome/m(3)). The elevated endotoxin concentrations were significantly correlated with cyanobacterial levels scaled to the presence of marine aerosol (r=0.90), as well as to chlorophyll-a (r=0.96). Filters sampled further inland showed lower and non-significant correlation between endotoxin and cyanobacteria (r=0.70, P value=0.19), suggesting decrease in marine-originated endotoxin, with possible contributions from other sources of gram-negative non-cyanobacteria. We conclude that marine cyanobacteria may be a dominant contributor to elevated endotoxin levels in coastal areas.
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Affiliation(s)
- Naama Lang-Yona
- Department of Earth and Planetary Sciences, Weizmann Institute of Science, Israel
| | - Yoav Lehahn
- Department of Earth and Planetary Sciences, Weizmann Institute of Science, Israel
| | - Barak Herut
- Israel Oceanographic and Limnological Research, National Institute of Oceanography, Haifa, Israel
| | - Noa Burshtein
- Department of Earth and Planetary Sciences, Weizmann Institute of Science, Israel
| | - Yinon Rudich
- Department of Earth and Planetary Sciences, Weizmann Institute of Science, Israel.
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31
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Pacheco CM, Ciaccio CE, Nazir N, Daley CM, DiDonna A, Choi WS, Barnes CS, Rosenwasser LJ. Homes of low-income minority families with asthmatic children have increased condition issues. Allergy Asthma Proc 2014; 35:467-74. [PMID: 25584914 DOI: 10.2500/aap.2014.35.3792] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The home is increasingly associated with asthma. It acts both as a reservoir of asthma triggers and as a refuge from seasonal outdoor allergen exposure. Racial/ethnic minority families with low incomes tend to reside in neighborhoods with low housing quality. These families also have higher rates of asthma. This study explores the hypothesis that black and Latino urban households with asthmatic children experienced more home mechanical, structural condition-related areas of concern than white households with asthmatic children. Participant families (n = 140) took part in the Kansas City Safe and Healthy Homes Program, had at least one asthmatic child, and met income qualifications of no more than 80% of local median income; many were below 50%. Families self-identified their race. Homes were assessed by environmental health professionals using a standard set of criteria and a specific set of on-site and laboratory sampling and analyses. Homes were given a score for areas of concern between 0 (best) and 53 (worst). The study population self-identified as black (46%), non-Latino white (26%), Latino (14.3%), and other (12.9%). Mean number of areas of concern were 18.7 in Latino homes, 17.8 in black homes, 13.3 in other homes, and 13.2 in white homes. Latino and black homes had significantly more areas of concern. White families were also more likely to be in the upper portion of the income. In this set of 140 low-income homes with an asthmatic child, households of minority individuals had more areas of condition concerns and generally lower income than other families.
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Affiliation(s)
- Christina M. Pacheco
- Center for American Indian Community Health, University of Kansas Medical Center, Kansas City, Kansas, USA
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32
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Affiliation(s)
- Lauren Cohn
- 1 Section of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut; and
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33
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Carlsten C, Georas SN. Update in environmental and occupational lung diseases 2013. Am J Respir Crit Care Med 2014; 189:1037-43. [PMID: 24787066 DOI: 10.1164/rccm.201401-0108up] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Chris Carlsten
- 1 Division of Respiratory Medicine, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; and
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34
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Jobe AH, Tibboel D. Update in pediatric lung disease 2013. Am J Respir Crit Care Med 2014; 189:1031-6. [PMID: 24787065 DOI: 10.1164/rccm.201402-0230up] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Alan H Jobe
- 1 Department of Pediatrics, Cincinnati Children's Hospital, University of Cincinnati, Cincinnati, Ohio; and
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35
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Kanchongkittiphon W, Gaffin JM, Phipatanakul W. The indoor environment and inner-city childhood asthma. Asian Pac J Allergy Immunol 2014; 32:103-10. [PMID: 25003723 PMCID: PMC4110514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Accepted: 03/21/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVE Exposure to indoor pollutants and allergens has been speculated to cause asthma symptoms and exacerbations and influence the risk of developing asthma. The aim of this article is to review the medical literature regarding the role of the indoor environment on inner-city childhood asthma. DATA SOURCES A literature search was performed in PubMed. Studies focusing on inner-city indoor allergen, childhood asthma, and environmental controls were included. RESULTS The prevalence of asthma in children is increasing especially in inner-city area. Exposure to high levels of indoor allergens and pollutants has been related to asthma development. Studies have shown that mouse, cockroach, pets, dust mite, mold, tobacco smoke, endotoxin and nitrogen dioxide are the important exposures. Recent studies have shown that indoor environmental control is beneficial in reducing asthma morbidity and development. CONCLUSIONS Inner-city children are exposed to various indoor allergens and pollutants that may lead to asthma development and exacerbation of existing asthma. Multifaceted environmental controls are beneficial in improving asthma symptom and maybe a viable prevention strategy. Further prospective studies of environmental intervention are needed to further identify effective strategies to improve and prevent asthma symptoms in inner-city children.
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Affiliation(s)
- Watcharoot Kanchongkittiphon
- Division of Allergy and Immunology, Boston Children’s Hospital, Boston, MA, U.S
- Harvard Medical School, Boston, MA, U.S
- Department of Pediatrics, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Jonathan M. Gaffin
- Harvard Medical School, Boston, MA, U.S
- Division of Respiratory Diseases, Boston Children’s Hospital, Boston, MA, U.S
| | - Wanda Phipatanakul
- Division of Allergy and Immunology, Boston Children’s Hospital, Boston, MA, U.S
- Harvard Medical School, Boston, MA, U.S
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36
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Wright LS, Phipatanakul W. Environmental remediation in the treatment of allergy and asthma: latest updates. Curr Allergy Asthma Rep 2014; 14:419. [PMID: 24488258 DOI: 10.1007/s11882-014-0419-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
In the modern era, the prevalence of asthma and allergies are increasing. It has been speculated that environmental exposures are contributing to this rise. Several studies demonstrate that common indoor allergen exposures exacerbate asthma. Minimizing exposure to allergens and remediating the environment play a critical role in the treatment of asthma and allergies. The most effective environmental control measures are tailored multifaceted interventions which include education, thorough cleaning, using high-efficiency particulate air (HEPA) filters, integrated pest management, and maintenance of these practices.
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Affiliation(s)
- Lakiea S Wright
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA,
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Goss CH, Mayer-Hamblett N. The yin and yang of indoor airborne exposures to endotoxin. Am J Respir Crit Care Med 2014; 188:1181-3. [PMID: 24236583 DOI: 10.1164/rccm.201309-1703ed] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Affiliation(s)
- Christopher H Goss
- 1 Department of Medicine University of Washington School of Medicine Seattle, Washington and Department of Pediatrics and Biostatistics University of Washington Seattle, Washington
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