Particulate air pollution and survival in a COPD cohort

The concentration of particulate matter in the barn air and its influence on the content of heavy metals in milk

Heavy metals are one of the components of smog, which is mainly the product of burning fossil fuels in residential buildings. These elements, introduced into the body of cattle by inhalation, may enter the milk. The goal of this study was to assess the impact of particulate pollution in the atmospheric air on the concentration of particulate matter in the air of a dairy cattle barn and on the content of selected heavy metals in milk from cows present in the building. Measurements were taken between November and April (148 measurement days). The calculations carried out showed a high correlation (RS = + 0.95) between the concentrations of particulates measured outside and inside the barn, which is indicative of a significant impact of the atmospheric air on the particulate pollution level of the livestock building. The number of days in excess of the daily standard for PM10 inside was 51. The conducted analysis of the chemical composition of the milk collected under high particulate pollution (February) showed that the permitted lead level had been exceeded-21.93 µg/kg (norm 20.00 µg/kg).

Air pollution and mortality in patients with chronic obstructive pulmonary disease: a cohort study in South Korea

Background

Evidence on whether long-term exposure to air pollution increases the mortality risk in patients with chronic obstructive pulmonary disease (COPD) is limited.

Objectives

We aimed to investigate the associations of long-term exposure to particulate matter with diameter <10 µm (PM10) and nitrogen dioxide (NO2) with overall and disease-specific mortality in COPD patients.

Design

We conducted a nationwide retrospective cohort study of 121,423 adults ⩾40 years diagnosed with COPD during 1 January to 31 December 2009.

Methods

Exposure to PM10 and NO2 was estimated for residential location using the ordinary kriging method. We estimated the risk of overall mortality associated with 1-, 3-, and 5-years average concentrations of PM10 and NO2 using Cox proportional hazards models and disease-specific mortality using the Fine and Gray method adjusted for age, sex, income, body mass index, smoking, comorbidities, and exacerbation history.

Results

The adjusted hazard ratios (HRs) for overall mortality associated with a 10 µg/m3 increase in 1-year PM10 and NO2 exposures were 1.004 [95% confidence interval (CI) = 0.985, 1.023] and 0.993 (95% CI = 0.984, 1.002), respectively. The results were similar for 3- and 5-year exposures. For a 10-µg/m3 increase in 1-year PM10 and NO2 exposures, the adjusted HRs for chronic lower airway disease mortality were 1.068 (95% CI = 1.024, 1.113) and 1.029 (95% CI = 1.009, 1.050), respectively. In stratified analyses, exposures to PM10 and NO2 were associated with overall mortality in patients who were underweight and had a history of severe exacerbation.

Conclusion

In this large population-based study of patients with COPD, long-term PM10 and NO2 exposures were not associated with overall mortality but were associated with chronic lower airway disease mortality. PM10 and NO2 exposures were both associated with an increased risk of overall mortality, and with overall mortality in underweight individuals and those with a history of severe exacerbation.

Outdoor air pollution impacts chronic obstructive pulmonary disease deaths in South Asia and China: a systematic review and meta-analysis

Background: Chronic obstructive lung disease is among leading causes of death globally. Exposure to outdoor pollution is an important cause for increased mortality and morbidity. Objective: To present a systemic synthesis evidence regarding impact of outdoor pollution on COPD mortality in south asia and china. Methods: A systematic search on studies with statistical power has been conducted from 1990 - June 30th 2021, in English electronic databases following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines from MEDLINE and PUBMED databases with terms: Chronic Obstructive Pulmonary disease OR COPD OR Chronic Bronchitis OR Emphysema OR COPD Deaths OR Chronic Obstructive Lung Disease OR Airflow Obstruction OR Chronic Airflow Obstruction OR Airflow Obstruction, Chronic OR Bronchitis, Chronic AND Mortality OR Death OR Deceased AND Outdoor pollution, ambient pollution was conducted. Results: Out of 1899 papers screened only 16 found eligible to be included in the study. Subjects with COPD exposed to higher levels of outdoor air pollution had a 49 % higher risk of death as compared to COPD subjects exposed to lower levels of outdoor air pollution. When taken individual pollutants into consideration, common air pollutants like PM10 had an OR of 1.06 at CI 95%, where as SO2 had OR of 0.66 at 95% CI , and NO2 with 1.01 OR at 95% CI. These values suggest that there is an effect of outdoor pollution on COPD but not to a significant level. Conclusion: Despite heterogeneity across selected studies, exposure to outdoor pollutants  found to have risk of COPD mortality. Though it appears to have risk, COPD mortality was not significantly associated with outdoor pollutants. Controlling air pollution can substantially decrease the risk of COPD in South Asia and China. Further research including more prospective and longitudinal studies are urgently needed in COPD sub-groups.

Short term exposure to air pollution and mortality in the US: a double negative control analysis

RATIONALE

Studies examining the association of short-term air pollution exposure and daily deaths have typically been limited to cities and used citywide average exposures, with few using causal models.

OBJECTIVES

To estimate the associations between short-term exposures to fine particulate matter (PM_2.5), ozone (O₃), and nitrogen dioxide (NO₂) and all-cause and cause-specific mortality in multiple US states using census tract or address exposure and including rural areas, using a double negative control analysis.

METHODS

We conducted a time-stratified case-crossover study examining the entire population of seven US states from 2000-2015, with over 3 million non-accidental deaths. Daily predictions of PM_2.5, O₃, and NO₂ at 1x1 km grid cells were linked to mortality based on census track or residential address. For each pollutant, we used conditional logistic regression to quantify the association between exposure and the relative risk of mortality conditioning on meteorological variables, other pollutants, and using double negative controls.

RESULTS

A 10 μg/m³ increase in PM_2.5 exposure at the moving average of lag 0-2 day was significantly associated with a 0.67% (95%CI: 0.34-1.01%) increase in all-cause mortality. 10 ppb increases in NO₂ or O₃ exposure at lag 0-2 day were marginally associated with and 0.19% (95%CI: -0.01-0.38%) and 0.20 (95% CI-0.01, 0.40), respectively. The adverse effects of PM_2.5 persisted when pollution levels were restricted to below the current global air pollution standards. Negative control models indicated little likelihood of omitted confounders for PM_2.5, and mixed results for the gases. PM_2.5 was also significantly associated with respiratory mortality and cardiovascular mortality.

CONCLUSIONS

Short-term exposure to PM_2.5 and possibly O₃ and NO₂ are associated with increased risks for all-cause mortality. Our findings delivered evidence that risks of death persisted at levels below currently permissible.

The Hot Topics, Frontiers and Trends about Research on the Relationship between Air Pollution and Public Health—Visual Analysis Based on Knowledge Map

It is of great practical significance to analyze the hot issues, research frontiers, and trends concerning the relationship between air pollution and public health and to adopt reasonable strategies to control air pollution and prevent health hazards for follow-up research in this field. Unlike traditional literature reviews, this paper adopts a visual, flexible, and scientifically systematic approach to the analysis, which makes these analysis results more intuitive and comprehensive. Based on the core collection of the Web of Science and CNKI databases, this paper uses CiteSpace software to draw and comment on the maps of Chinese and English keywords, publishing time, author, country, and research institutions in this field. The results show the following: (1) The number of studies on the relationship between air pollution and health has increased year by year; researchers have formed sub cooperation networks, and the trend of cooperation and exchange has become more and more obvious in recent years; the impact of air pollution on health is a hot topic in the world. (2) Research hot topics mainly focus on the selection of air pollutants, health economic consequences of air pollution and the global burden of disease it causes, health indicators, research samples, which are gradually being refined, the synergistic governance of air pollution, and climate change. (3) The analysis of research frontiers and trends reveals that, first, the study of air pollutants in the English literature has undergone a refinement from nitrogen dioxide to fine particulate matter, and the sources of air pollutants in the Chinese literature have undergone changes in the petrochemical industry, indoor formaldehyde pollution, and haze. Second, atmospheric pollution has a significant negative impact on health, increasing the incidence of respiratory and cardiovascular diseases, and even causing death. Third, sustained exposure to pollution then causes greater damage to health and will be a key direction for future research. Fourth, the literature not only studies the correlation but also emphasizes the causal inference between air pollution and health and measures the economic costs associated with health. Finally, air pollution and climate change need to be governed synergistically. The article points out that the three areas of sustained pollution exposure, indirect consequences of negative health effects of air pollution, and air pollution and climate change may be the future focus of the field.

Behavioral interventions to reduce particulate matter exposure in patients with COPD

INTRODUCTION

Chronic obstructive pulmonary disease (COPD) is commonly affected by particulate matter (PM) exposure. In this study, we aimed to evaluate whether behavioral interventions to reduce PM exposure improve clinical outcomes in patients with COPD.

METHODS

A multicenter randomized controlled trial will be conducted involving 120 participants recruited from 3 hospitals in the capital region of the Republic of Korea. Patients aged 40 to 80 years with a diagnosis of COPD and a forced expiratory volume at 1 s <80% of the predicted value are eligible for inclusion. The participants will be randomized to either the intervention group or the usual care group (2:1). The behavioral interventions will comprise the following activities: checking air quality forecast; operating indoor air cleaners and regular check-ups of filters; ventilating the home regularly by opening windows; adhering to inhaler treatment; and refraining from going out on high air pollution days. "Internet-of-things"-based, gravimetric, and light-scattering methods will be used to measure indoor and outdoor PM concentrations. To estimate the degree of individual PM exposure, a time-activity diary and land use regression modeling will be used. The efficacy of the behavioral interventions on the following outcomes will be analyzed: amount of PM exposure, changes in forced expiratory volume at 1 s from the baseline, changes in respiratory symptoms and quality of life, risks of exacerbation, hospitalization, and death.

DISCUSSION

Given the harmful effect of air pollutants, individual-level interventions to reduce exposure may be significant. However, there is a lack of evidence on how effective such interventions are to date. This study will be able to provide physicians and patients with evidence-based strategies to reduce PM exposure in daily life.

TRIAL REGISTRATION NUMBER

NCT04878367.

Increasing mortality caused by chronic obstructive pulmonary disease (COPD) in relation with exposure to ambient fine particulate matters: an analysis in Southeastern China

The objective of this study was to investigate the association between ambient particulate matters (PMs) and chronic obstructive pulmonary disease (COPD) mortality. generalized additive mixed model was employed to investigate the effects of ambient fine and coarse PMs on COPD mortality using 13,066 deaths from 2014 to 2016 among six cities in Zhejiang Province in Southeastern China. The daily average death count due to COPD was 3, varying from 1 to 7 among six cities. The daily 24-h mean concentrations were diverse among cities, from 29.7 to 56.8 μg/m³ for PM_2.5, 16.7 to 30.3 μg/m³ for PM_2.5-10, and 50.3 to 87.1 μg/m³ for PM₁₀, respectively. The analysis showed that daily exposure to PM_2.5 and PM₁₀ was associated with increased mortality due to COPD and that weak effects were observed between PM_2.5-10 and COPD mortality. Our results provided solid evidence that the fine particles in air pollution have stronger functions on adverse health effects other than coarser particles in Southeastern China, which may be considered as a potential clinic target in PM-associated COPD.

Particulate air pollution and survival after stroke in older adults: A retrospective cohort study in Korea

Although many studies have evaluated the effects of ambient particulate matter with diameters of less than 2.5 μm (PM_2.5) on stroke mortality in the general population, little is known about the mortality effects of PM_2.5 in post-stroke populations. Therefore, a retrospective cohort was constructed using information from the health insurance database to evaluate whether exposure to PM_2.5 is associated with increased mortality in aged stroke survivors residing in seven Korean metropolitan cities. A total of 45,513 older adults (≥65 years) who visited emergency rooms due to stroke and who were discharged alive between 2008 and 2016 were followed up. By using district-level modeled PM_2.5 concentrations and a time-varying Cox proportional hazard model, associations between 1-month and 2-month moving average PM_2.5 exposures and mortality in stroke survivors were evaluated. The annual average concentration of PM_2.5 was 27.9 μg/m³ in the seven metropolitan cities, and 14,880 subjects died during the follow-up period. A 10 μg/m³ increase in the 1-month and 2-month moving average PM_2.5 exposures was associated with mortality hazard ratios of 1.07 (95% confidence interval: 1.05, 1.09) and 1.06 (95% confidence interval: 1.03, 1.08), respectively. The effects of PM_2.5 were similar across types of stroke (ischemic and hemorrhagic), age groups (65-74, 75-84, and ≥85), and income groups (low and high) but were greater in women than in men. This study highlights the adverse health effects of ambient PM_2.5 in post-stroke populations. Active avoidance behaviors against PM_2.5 are recommended for aged stroke survivors.

Effect of ambient fine particulates (PM2.5) on hospital admissions for respiratory and cardiovascular diseases in Wuhan, China

Background

Positive associations between ambient PM_2.5 and cardiorespiratory disease have been well demonstrated during the past decade. However, few studies have examined the adverse effects of PM_2.5 based on an entire population of a megalopolis. In addition, most studies in China have used averaged data, which results in variations between monitoring and personal exposure values, creating an inherent and unavoidable type of measurement error.

Methods

This study was conducted in Wuhan, a megacity in central China with about 10.9 million people. Daily hospital admission records, from October 2016 to December 2018, were obtained from the Wuhan Information center of Health and Family Planning, which administrates all hospitals in Wuhan. Daily air pollution concentrations and weather variables in Wuhan during the study period were collected. We developed a land use regression model (LUR) to assess individual PM_2.5 exposure. Time-stratified case-crossover design and conditional logistic regression models were adopted to estimate cardiorespiratory hospitalization risks associated with short-term exposure to PM_2.5. We also conducted stratification analyses by age, sex, and season.

Results

A total of 2,806,115 hospital admissions records were collected during the study period, from which we identified 332,090 cardiovascular disease admissions and 159,365 respiratory disease admissions. Short-term exposure to PM_2.5 was associated with an increased risk of a cardiorespiratory hospital admission. A 10 μg/m³ increase in PM_2.5 (lag0–2 days) was associated with an increase in hospital admissions of 1.23% (95% CI 1.01–1.45%) and 1.95% (95% CI 1.63–2.27%) for cardiovascular and respiratory diseases, respectively. The elderly were at higher PM-induced risk. The associations appeared to be more evident in the cold season than in the warm season.

Conclusions

This study contributes evidence of short-term effects of PM_2.5 on cardiorespiratory hospital admissions, which may be helpful for air pollution control and disease prevention in Wuhan.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12931-021-01731-x.

A global association between Covid-19 cases and airborne particulate matter at regional level

Evidences of an association between air pollution and Covid-19 infections are mixed and inconclusive. We conducted an ecological analysis at regional scale of long-term exposure to air-borne particle matter and spread of Covid-19 cases during the first wave of epidemics. Global air pollution and climate data were calculated from satellite earth observation data assimilated into numerical models at 10 km resolution. Main outcome was defined as the cumulative number of cases of Covid-19 in the 14 days following the date when > 10 cumulative cases were reported. Negative binomial mixed effect models were applied to estimate the associations between the outcome and long-term exposure to air pollution at the regional level (PM10, PM2.5), after adjusting for relevant regional and country level covariates and spatial correlation. In total we collected 237,749 Covid-19 cases from 730 regions, 63 countries and 5 continents at May 30, 2020. A 10 μg/m3 increase of pollution level was associated with 8.1% (95% CI 5.4%, 10.5%) and 11.5% (95% CI 7.8%, 14.9%) increases in the number of cases in a 14 days window, for PM2.5 and PM10 respectively. We found an association between Covid-19 cases and air pollution suggestive of a possible causal link among particulate matter levels and incidence of COVID-19.

Particulate Matter and Cardiovascular Risk in Adults with Chronic Obstructive Pulmonary Disease

Rationale: People with chronic obstructive pulmonary disease (COPD) have an increased risk of cardiovascular disease and may be more susceptible to air pollution exposure. However, no study has examined the association between long-term fine particulate matter exposure (≤2.5 μm in aerodynamic diameter) and risk of cardiovascular events in this potentially vulnerable population. Objectives: To estimate the association between long-term fine particulate matter and risk of cardiovascular events among adults with COPD. Methods: This retrospective cohort study included 169,714 adults with COPD who were members of the Kaiser Permanente Northern California health plan during 2007-2016. Electronic health record data were linked to 1 km modeled particulate matter ≤2.5 μm in aerodynamic diameter exposure estimates. We fit Cox proportional hazard models, adjusting for age, sex, race/ethnicity, calendar year, smoking, body mass index, comorbidities, medications, and socioeconomic status. In low exposure analyses, we examined effects below the current regulation limit (12 μg/m³). Measurements and Main Results: Among adults with COPD, a 10-μg/m³ increase in 1-year mean fine particulate matter exposure was associated with an elevated risk of cardiovascular mortality (hazard ratio, 1.10; 95% confidence interval [CI], 1.01-1.20). Effects were stronger in low exposure analyses (hazard ratio, 1.88; 95% CI, 1.56-2.27). Fine particulate matter exposure was not associated with acute myocardial infarction or stroke in overall analyses. Conclusions: Long-term fine particulate matter exposure was associated with an increased risk of cardiovascular mortality among adults with COPD. Current regulations may not sufficiently protect those with COPD.

Effects of short-term exposure to ambient airborne pollutants on COPD-related mortality among the elderly residents of Chengdu city in Southwest China

Background

Chronic obstructive pulmonary disease (COPD) has become a severe global burden in terms of both health and the economy. Few studies, however, have thoroughly assessed the influence of air pollution on COPD-related mortality among elderly people in developing areas in the hinterland of southwestern China. This study is the first to examine the association between short-term exposure to ambient airborne pollutants and COPD-related mortality among elderly people in the central Sichuan Basin of southwestern China.

Methods

Data on COPD-related mortality among elderly people aged 60 and older were obtained from the Population Death Information Registration and Management System (PDIRMS). Data on airborne pollutants comprised of particulate matter < 2.5 μm in aerodynamic diameter (PM_2.5), sulfur dioxide (SO₂), nitrogen dioxide (NO₂), carbon monoxide (CO), and ozone (O₃) were derived from 23 municipal environmental monitoring sites. Data on weather conditions, including daily mean temperature and relative humidity, were obtained from the Chengdu Meteorological Bureau. All data were collected from January 1, 2015, to December 31, 2018. A quasi-Poisson general additive model (GAM) was utilized to assess the effects of short-term exposure to airborne pollutants on COPD-related mortality among elderly people.

Results

A total of 61,058 COPD-related deaths of people aged 60 and older were obtained. Controlling the influences of daily temperature and relative humidity, interquartile range (IQR) concentration increases of PM_2.5 (43 μg/m³), SO₂ (8 μg/m³), NO₂ (18 μg/m³), CO (0.4 mg/m³), and O₃ (78 μg/m³) were associated with 2.7% (95% CI 1.0–4.4%), 4.3% (95% CI 2.1–6.4%), 3.6% (95% CI 1.7–5.6%), 2.7% (95% CI 0.6–4.8%), and 7.4% (95% CI 3.6–11.3%) increases in COPD-related mortality in people aged 60 and older, respectively. The exposure-response curves between each pollutant and the log-relative risk of COPD-related mortality exhibited linear relationships. Statistically significant differences in the associations between pollutants and COPD-related mortality were not observed among sociodemographic factors including age, gender, and marital status. The effects of O₃ remained steady after adjusting for PM_2.5, SO₂, NO₂, and CO each time in the two-pollutant models.

Conclusions

Increased concentrations of ambient airborne pollutants composed of PM_2.5, SO₂, NO₂, O₃, and CO were significantly and positively associated with COPD-related mortality in the central Sichuan Basin, which is located in the hinterland of southwestern China. The adverse effects of O₃ were stable, a finding that should receive more attention.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12199-020-00925-x.

Chronic obstructive pulmonary disease in HIV

Introduction: Chronic obstructive pulmonary disease (COPD) is more prevalent in people with HIV (PWH) than in the general population and leads to an increased burden of morbidity and mortality in this population. The mechanisms behind COPD development and progression in PWH are not fully elucidated, and there are no PWH-specific guidelines for COPD management. Areas covered: The goal of this broad narrative review is to review the epidemiology of COPD in PWH globally, highlight proposed pathways contributing to increased COPD prevalence and progression in PWH, discuss structural and functional changes in the lungs in this population, assesses the excess mortality and comorbidities in PWH with COPD, and address management practices for this unique population. Expert opinion: Understanding how a chronic viral infection leads to COPD, independent of cigarette smoking, is of critical scientific importance. Further research should focus on the pathophysiology of the interaction between HIV and COPD, and determine the role of disease-modifying risk factors such as opportunistic pneumonia and air pollution, as well as generate data from randomized clinical trials on the safety and efficacy of specific therapies for this vulnerable patient population.

Long-term exposure to PM and all-cause and cause-specific mortality: A systematic review and meta-analysis

As new scientific evidence on health effects of air pollution is generated, air quality guidelines need to be periodically updated. The objective of this review is to support the derivation of updated guidelines by the World Health Organization (WHO) by performing a systematic review of evidence of associations between long-term exposure to particulate matter with diameter under 2.5 µm (PM_2.5) and particulate matter with diameter under 10 µm (PM₁₀), in relation to all-cause and cause-specific mortality. As there is especially uncertainty about the relationship at the low and high end of the exposure range, the review needed to provide an indication of the shape of the concentration-response function (CRF). We systematically searched MEDLINE and EMBASE from database inception to 9 October 2018. Articles were checked for eligibility by two reviewers. We included cohort and case-control studies on outdoor air pollution in human populations using individual level data. In addition to natural-cause mortality, we evaluated mortality from circulatory diseases (ischemic heart disease (IHD) and cerebrovascular disease (stroke) also specifically), respiratory diseases (Chronic Obstructive Pulmonary Disease (COPD) and acute lower respiratory infection (ALRI) also specifically) and lung cancer. A random-effect meta-analysis was performed when at least three studies were available for a specific exposure-outcome pair. Risk of bias was assessed for all included articles using a specifically developed tool coordinated by WHO. Additional analyses were performed to assess consistency across geographic region, explain heterogeneity and explore the shape of the CRF. An adapted GRADE (Grading of Recommendations Assessment, Development and Evaluation) assessment of the body of evidence was made using a specifically developed tool coordinated by WHO. A large number (N = 107) of predominantly cohort studies (N = 104) were included after screening more than 3000 abstracts. Studies were conducted globally with the majority of studies from North America (N = 62) and Europe (N = 25). More studies used PM_2.5 (N = 71) as the exposure metric than PM₁₀ (N = 42). PM_2.5 was significantly associated with all causes of death evaluated. The combined Risk Ratio (RR) for PM_2.5 and natural-cause mortality was 1.08 (95%CI 1.06, 1.09) per 10 µg/m³. Meta analyses of studies conducted at the low mean PM_2.5 levels (<25, 20, 15, 12, 10 µg/m³) yielded RRs that were similar or higher compared to the overall RR, consistent with the finding of generally linear or supra-linear CRFs in individual studies. Pooled RRs were almost identical for studies conducted in North America, Europe and Western Pacific region. PM₁₀ was significantly associated with natural-cause and most but not all causes of death. Application of the risk of bias tool showed that few studies were at a high risk of bias in any domain. Application of the adapted GRADE tool resulted in an assessment of "high certainty of evidence" for PM_2.5 with all assessed endpoints except for respiratory mortality (moderate). The evidence was rated as less certain for PM₁₀ and cause-specific mortality ("moderate" for circulatory, IHD, COPD and "low" for stroke mortality. Compared to the previous global WHO evaluation, the evidence base has increased substantially. However, studies conducted in low- and middle- income countries (LMICs) are still limited. There is clear evidence that both PM_2.5 and PM₁₀ were associated with increased mortality from all causes, cardiovascular disease, respiratory disease and lung cancer. Associations remained below the current WHO guideline exposure level of 10 µg/m³ for PM_2.5. Systematic review registration number (PROSPERO ID): CRD42018082577.

Air pollution and chronic obstructive pulmonary disease

There is considerable epidemiological evidence indicating that air pollution has adverse effects on human health and is closely related to respiratory diseases, including chronic obstructive pulmonary disease (COPD). These effects, which can be divided into short- and long-term effects, can manifest as an exacerbation of existing symptoms, impaired lung function, and increased hospitalization and mortality rates. Long-term exposure to air with a high concentration of pollutants may also increase the incidence of COPD. The combined effects of different pollutants may become more complex in the future; hence, there is a need for more intensive research on specific at-risk populations, and formulating corresponding protective strategies is crucial. We aimed to review the epidemiological evidence on the effect of air pollution on COPD, the possible pathophysiological mechanisms underlying this effect, as well as protective measures against the effects of air pollutants in patients with COPD.

The impact of smog on the concentration of particulate matter in the antelope house in the Silesian zoological garden

Persistent negligence in the field of environmental protection in Poland as well as strong dependance of the energy sector on the fossil fuels have led to serious pollution of the air with particulate matter, which at high concentrations is capable of penetrating into the buildings. The aim of this study is to assess the impact of particulate airborne pollution on the concentration of particulate matter inside the antelope house in the Silesian Zoological Garden located within the Upper Silesia in Poland. The research was conducted from February to May in 2018. The records taken in the research period show that the concentration of PM10 exceeded the level of 50 µg/m³ outside the building during 26 days and 11 days when it comes to the concentration of particulate matter inside the antelope house. The quantity of particulate matter in the antelope house is strongly correlated with the concentration of the particles in the air. Despite fitting existing ventilation system with a filter that reduces the dust level by 60% during the highest level of smog, particulate matter concentration in the antelope house exceeded acceptable limit for PM10 more than twofold. Particle size-fraction analysis revealed that as much as 85% of the particles detected in the studied compartment constitute PM2.5.

Effects of PM10 on mortality in pure COPD and asthma-COPD overlap: difference in exposure duration, gender, and smoking status

We investigated the effects of particulate matter (PM) on mortality in patients diagnosed with asthma-COPD overlap (ACO) or ‘pure COPD’. Subjects from the National Health Insurance Service–National Sample Cohort of Korea, who were aged 40 years or above and had newly diagnosed COPD since 2009 were selected. Finally, 6,313 patients were enrolled and divided into ‘pure COPD’ and ACO groups. Average PM₁₀ exposure data were obtained using Kriging interpolation from 2001 to 2013. Hazard ratios(HR) were estimated using a time-varying Cox regression model. Exposure to PM₁₀ for 1, 3, and 6 months was associated with an increase in non-accidental mortality in the entire COPD group, especially the ACO group. When a stratified analysis of 3-month exposure was performed by sex, the highest HR was found in women with ACO (HR = 1.153; 95% confidence intervals [CI]: 1.121, 1.185). A stratified analysis according to smoking status showed that ACO patients had the highest HR among never smokers (HR = 1.151; 95% CI; 1.124, 1.178). Average exposure to PM₁₀ was associated with non-accidental mortality in patients with COPD, especially those diagnosed with ACO. In addition, the adverse effects of PM₁₀ exposure are more severe in women and never-smokers.

A Preliminary Attempt at the Identification and Financial Estimation of the Negative Health Effects of Urban and Industrial Air Pollution Based on the Agglomeration of Gdańsk

This article marks the first attempt on Polish and European scale to identify the relationship between urban and industrial air pollution and the health conditions of urban populations, while also estimating the financial burden of incidence rates among urban populations for diseases selected in the course of this study as having a causal relation with such incidence. This paper presents the findings of a pilot study based on general regression models, intended to explore air pollutants with a statistically relevant impact on the incidence of selected diseases within the Agglomeration of Gdańsk in the years 2010–2018. In discussing the city’s industrial functions, the study takes into consideration the existence within its limits of a large port that services thousands of ships every year, contributing substantially to the volume of emissions (mainly NOx and PM) to the air. The causes considered include the impact of air pollution, seasonality, land- and sea-based emissions, as well as their mutual interactions. All of the factors and their interactions have a significant impact (p ≤ 0.05) on the incidence of selected diseases in the long term (9 years). The source data were obtained from the Polish National Health Fund (NFZ), the Agency for Regional Monitoring of Atmosphere in the Agglomeration of Gdańsk (ARMAAG), the Chief Inspectorate of Environmental Protection (GIOŚ), and the Port of Gdańsk Harbourmaster. The study used 60 variables representing the diseases, classified into 19 groups. The resulting findings were used to formulate a methodology for estimating the financial burden of the negative health effects of air pollution for the agglomeration, and will be utilized as a reference point for further research in selected regions of Poland.

Health Effects of Indoor Air Pollution

Exposure to indoor-generated air pollution causes a large number of deaths and cases of disease. These effects are found, largely, in developing countries where people, especially women and young children, are exposed to high concentrations of smoke produced by biomass burning for cooking. Approximately 3 million deaths occur each year. In developed countries, the problem is much less acute: accidental exposure to high concentrations of carbon monoxide is the main cause of death. It should be remembered, however, that much of people's exposure to pollutants generated outdoors occurs in the indoor environment. Indoor exposure to particulate matter has the same effects as outdoor exposure: the cardiovascular system is most affected, with deaths being due to ischaemic heart disease and stroke. Exposure to particulate matter may also contribute to the development of chronic obstructive pulmonary disease (COPD). Exposure to high concentrations of nitrogen dioxide, although perhaps not having a great effect on measures of lung function, may contribute to the development of emphysema and reduce the resistance of the body to bacterial and viral infections. Lung cancer, due to exposure to carcinogens in wood smoke, also occurs. Efforts to reduce levels of indoor air pollution in developing countries, for example by providing flued cooking stoves, have been shown to reduce the prevalence of disease.

All-cause mortality risk associated with long-term exposure to ambient PM2·5 in China: a cohort study

BACKGROUND

Evidence from cohort studies in North America and Europe indicates that long-term exposure to fine particulate matter (PM_2·5) is associated with an increased mortality risk. However, this association has rarely been quantified at higher ambient concentrations. We estimated the hazard ratio (HR) for all-cause mortality from long-term exposure to PM_2·5 in a well established Chinese cohort of older adults.

METHODS

The Chinese Longitudinal Healthy Longevity Survey (CLHLS) is a prospective cohort study of men and women aged 65 years and older enrolled in 2008 and followed up through 2014 for mortality events. We studied individuals for whom residential locations were available in 2008 for linkage to 1 km grids of PM_2·5 concentrations, derived from satellite remote sensing. Cox proportional hazards models were used to estimate the effect of long-term exposure to PM_2·5 on all-cause mortality, controlling for age, sex, smoking status, drinking status, physical activity, body-mass index, household income, marital status, and education. We then used our results to estimate premature mortality related to PM_2·5 exposure in the population aged 65 years and older in China in 2010.

FINDINGS

13 344 individuals in the CLHLS cohort had data for all timepoints, yielding follow-up data for 49 440 person-years. In a 3-year window, these individuals were exposed to a median PM_2·5 concentration of 50·7 μg/m³ (range 6·7-113·3). The overall HR for a 10 μg/m³ increase in this value was 1·08 (95% CI 1·06-1·09). In stratified analyses, HRs were higher in rural than in urban locations, in southern versus northern regions, and with exposure to lower versus higher PM_2·5 concentrations. Based on the overall HR, we estimated that 1 765 820 people aged 65 years and older in China in 2010 had premature mortality related to PM_2·5 exposure.

INTERPRETATION

Long-term exposure to PM_2·5 is associated with an increased risk of all-cause mortality among adults aged 65 years and older in China, but the magnitude of the risk declines as the concentration of PM_2·5 increases.

FUNDING

National Natural Science Foundation of China, National High-Level Talents Special Support Plan of China for Young Talents, US National Aeronautics and Space Administration, and the Columbia University Global Policy Initiative.

Area-Based Socio-Economic Inequalities in Mortality from Lung Cancer and Respiratory Diseases

Background: After political transformation in 1989/1990, Poland experienced a general improvement in living conditions and quality of life, but the benefits did not extend evenly across all segments of the society. We hypothesized that the regional differences in mortality due to diseases of the respiratory system are related to socioeconomic status (SES) and its changes over time. Materials and methods: An ecological study was carried out in 66 sub-regions of Poland using the data from the period of 2010 to 2014. Age-standardized mortality rates (SMRs) were calculated separately for men and women in three age categories: ≥15, 25–64 years, and ≥65 years. An area-based SES index was derived from the characteristics of the sub-regions using the z-score method. Multiple weighted linear regression models were constructed to estimate a real socioeconomic gradient for mortality resulting from lung cancer and respiratory diseases. Results: In the regions studied, the SMRs for respiratory disease varied from 70/100,000 to 215/100,000 in men and from 18/100,000 to 53/100,000 in women. The SMRs for lung cancer varied from 36/100,000 to 110/100,000 among men and from 26/100,000 to 77/100,000 among women. After adjusting for the prevalence of smoking and environmental pollution, the SES index was found to be inversely associated with the SMR for lung cancer in each category of age among men, and in the age group of 25–64 years among women. An increase of the SES index between 2010 and 2014 was associated with a decrease of SMR for respiratory disease both in men and women, but this change was not significantly associated with the SMR for lung cancer. Conclusion: SES appears to be an important correlate of mortality from respiratory diseases and lung cancer at the population level, particularly in men. A lower SES was associated with greater mortality from lung cancer and respiratory diseases. An increase in SES over time was related to a decrease in mortality from respiratory disease, but not from lung cancer.

The role of environmental exposure to non-cigarette smoke in lung disease

Chronic exposure to household indoor smoke and outdoor air pollution is a major contributor to global morbidity and mortality. The majority of these deaths occur in low and middle-income countries. Children, women, the elderly and people with underlying chronic conditions are most affected. In addition to reduced lung function, children exposed to biomass smoke have an increased risk of developing lower respiratory tract infections and asthma-related symptoms. In adults, chronic exposure to biomass smoke, ambient air pollution, and opportunistic exposure to fumes and dust are associated with an increased risk of developing chronic bronchitis, chronic obstructive pulmonary disease (COPD), lung cancer and respiratory infections, including tuberculosis. Here, we review the evidence of prevalence of COPD in people exposed to non-cigarette smoke. We highlight mechanisms that are likely involved in biomass-smoke exposure-related COPD and other lung diseases. Finally, we summarize the potential preventive and therapeutic strategies for management of COPD induced by non-cigarette smoke exposure.

Long-term exposure to low concentrations of air pollutants and hospitalisation for respiratory diseases: A prospective cohort study in Australia

BACKGROUND

Short- and long-term spatiotemporal variation in exposure to air pollution is associated with respiratory morbidity in areas with moderate-to-high level of air pollution, but very few studies have examined whether these associations also exist in areas with low level exposure.

OBJECTIVES

We assessed the association between spatial variation in long-term exposure to PM_2.5 and NO₂ and hospitalisation for all respiratory diseases, asthma, chronic obstructive pulmonary disease (COPD), and pneumonia, in older adults residing in Sydney, Australia, a city with low-level concentrations.

METHODS

We recorded data on hospitalisations for 100,084 participants, who were aged >45 years at entry in 2006-2009 until June 2014. Annual NO₂ and PM_2.5 concentrations were estimated for the participants' residential addresses and Cox proportional hazards regression was used to model the association between exposure to air pollutants and first episode of hospitalisation, controlling for personal and area level covariates. We further investigated the shape of the exposure-response association and potential effect modification by age, sex, education level, smoking status, and BMI.

RESULTS

NO₂ and PM_2.5 annual mean exposure estimates were 17.5 μg·m^-3 and 4.5 μg·m^-3 respectively. NO₂ and PM_2.5 was positively, although not significantly, associated with asthma. The adjusted hazard ratio for a 1 μg·m^-3 increase in PM_2.5 was 1.08, 95% confidence interval 0.89-1.30. The adjusted hazard ratio for a 5 μg·m^-3 increase in NO₂ was 1.03, 95% confidence interval 0.88-1.19. We found no positive statistically significant associations with hospitalisation for all respiratory diseases, and pneumonia while negative associations were observed with COPD.

CONCLUSIONS

We found weak positive associations of exposure to air pollution with hospitalisation for asthma while there was no evidence of an association for all respiratory diseases.

Winter Is Coming: A Socio-Environmental Monitoring and Spatiotemporal Modelling Approach for Better Understanding a Respiratory Disease

Chronic Obstructive Pulmonary Disease is a progressive lung disease affecting the respiratory function of every sixth New Zealander and over 300 million people worldwide. In this paper, we explored how the combination of social, demographical and environmental conditions (represented by increased winter air pollution) affected hospital admissions due to COPD in an urban area of Christchurch (NZ). We juxtaposed the hospitalisation data with dynamic air pollution data and census data to investigate the spatiotemporal patterns of hospital admissions. Spatial analysis identified high-risk health hot spots both overall and season specific, exhibiting higher rates in winter months not solely due to air pollution, but rather as a result of its combination with other factors that initiate deterioration of breathing, increasing impairments and lead to the hospitalisation of COPD patients. From this we found that socioeconomic deprivation and air pollution, followed by the age and ethnicity structure contribute the most to the increased winter hospital admissions. This research shows the continued importance of including both individual (composition) and area level (composition) factors when examining and analysing disease patterns.

Association between PM10, PM2.5, NO2, O3 and self-reported diabetes in Italy: A cross-sectional, ecological study

INTRODUCTION

Air pollution represents a serious threat to health on a global scale, being responsible for a large portion of the global burden of disease from environmental factors. Current evidence about the association between air pollution exposure and Diabetes Mellitus (DM) is still controversial. We aimed to evaluate the association between area-level ambient air pollution and self-reported DM in a large population sample in Italy.

MATERIALS AND METHODS

We extracted information about self-reported and physician diagnosed DM, risk factors and socio-economic status from 12 surveys conducted nationwide between 1999 and 2013. We obtained annual averaged air pollution levels for the years 2003, 2005, 2007 and 2010 from the AMS-MINNI national integrated model, which simulates the dispersion and transformation of pollutants. The original maps, with a resolution of 4 x 4 km2, were normalized and aggregated at the municipality class of each Italian region, in order to match the survey data. We fit logistic regression models with a hierarchical structure to estimate the relationship between PM10, PM2.5, NO2 and O3 four-years mean levels and the risk of being affected by DM.

RESULTS

We included 376,157 individuals aged more than 45 years. There were 39,969 cases of DM, with an average regional prevalence of 9.8% and a positive geographical North-to-South gradient, opposite to that of pollutants' concentrations. For each 10 μg/m3 increase, the resulting ORs were 1.04 (95% CI 1.01-1.07) for PM10, 1.04 (95% CI 1.02-1.07) for PM2.5, 1.03 (95% CI 1.01-1.05) for NO2 and 1.06 (95% CI 1.01-1.11) for O3, after accounting for relevant individual risk factors. The associations were robust to adjustment for other pollutants in two-pollutant models tested (ozone plus each other pollutant).

CONCLUSIONS

We observed a significant positive association between each examined pollutant and prevalent DM. Risk estimates were consistent with current evidence, and robust to sensitivity analysis. Our study adds evidence about the effects of air pollution on diabetes and suggests a possible role of ozone as an independent factor associated with the development of DM. Such relationship is of great interest for public health and deserves further investigation.

Estimating premature mortality attributable to PM2.5 exposure and benefit of air pollution control policies in China for 2020

In past decade of rapid industrial development and urbanization, China has witnessed increasingly persistent severe haze and smog episodes, posing serious health hazards to the Chinese population, especially in densely populated cities. Quantification of health impacts attributable to PM_2.5 (particulates with aerodynamic diameter≤2.5μm) has important policy implications to tackle air pollution. The Chinese national monitoring network has recently included direct measurements of ground level PM_2.5, providing a potentially more reliable source for exposure assessment. This study reports PM_2.5-related long-term mortality of year 2015 in 161 cities of nine regions across China using integrated exposure risk (IER) model for PM_2.5 exposure-response functions (ERF). It further provides an estimate of the potential health benefits by year 2020 with a realization of the goals of Air Pollution Prevention and Control Action Plan (APPCAP) and the three interim targets (ITs) and Air Quality Guidelines (AQG) for PM_2.5 by the World Health Organization (WHO). PM_2.5-related premature mortality in 161 cities was 652 thousand, about 6.92% of total deaths in China during year 2015. Among all premature deaths, contributions of cerebrovascular disease (stroke), ischemic heart disease (IHD), chronic obstructive pulmonary disease (COPD), lung cancer (LC) and acute lower respiratory infections (ALRIs) were 51.70, 26.26, 11.77, 9.45 and 0.82%, respectively. The premature mortality in densely populated cities is very high, such as Tianjin (12,533/year), Beijing (18,817/year), Baoding (10,932/year), Shanghai (18,679/year), Chongqing (23,561/year), Chengdu (11,809/year), Harbin (9037/year) and Linyi (9141/year). The potential health benefits will be 4.4, 16.2, 34.5, 63.6 and 81.5% of the total present premature mortality when PM_2.5 concentrations in China meet the APPCAP, WHO IT-1, IT-2, IT-3 and AQG respectively, by the year 2020. In the current situation, by the end of year 2030, even if Chines government fulfills its own target to meet national ambient air quality standard of PM_2.5 (35μg/m³), total premature mortality attributable to PM_2.5 will be 574 thousand across 161 cities. The present methodology will greatly help policy makers and pollution control authorities to further analyze cost and benefits of air pollution management programs in China.

Community Vulnerability to Health Impacts of Wildland Fire Smoke Exposure

Identifying communities vulnerable to adverse health effects from exposure to wildfire smoke may help prepare responses, increase the resilience to smoke and improve public health outcomes during smoke days. We developed a Community Health-Vulnerability Index (CHVI) based on factors known to increase the risks of health effects from air pollution and wildfire smoke exposures. These factors included county prevalence rates for asthma in children and adults, chronic obstructive pulmonary disease, hypertension, diabetes, obesity, percent of population 65 years of age and older, and indicators of socioeconomic status including poverty, education, income and unemployment. Using air quality simulated for the period between 2008 and 2012 over the continental U.S. we also characterized the population size at risk with respect to the level and duration of exposure to fire-originated fine particulate matter (fire-PM_2.5) and CHVI. We estimate that 10% of the population (30.5 million) lived in the areas where the contribution of fire-PM_2.5 to annual average ambient PM_2.5 was high (>1.5 μg/m³) and that 10.3 million individuals experienced unhealthy air quality levels for more than 10 days due to smoke. Using CHVI we identified the most vulnerable counties and determined that these communities experience more smoke exposures in comparison to less vulnerable communities.

Ozone Exposure, Cardiopulmonary Health, and Obesity: A Substantive Review

From 1999-2014, obesity prevalence increased among adults and youth. Obese individuals may be uniquely susceptible to the proinflammatory effects of ozone because obese humans and animals have been shown to experience a greater decline in lung function than normal-weight subjects. Obesity is independently associated with limitations in lung mechanics with increased ozone dose. However, few epidemiologic studies have examined the interaction between excess weight and ozone exposure among adults. Using PubMed keyword searches and reference lists, we reviewed epidemiologic evidence to identify potential response-modifying factors and determine if obese or overweight adults are at increased risk of ozone-related health effects. We initially identified 170 studies, of which seven studies met the criteria of examining the interaction of excess weight and ozone exposure on cardiopulmonary outcomes in adults, including four short-term ozone exposure studies in controlled laboratory settings and three community epidemiologic studies. In the studies identified, obesity was associated with decreased lung function and increased inflammatory mediators. Results were inconclusive about the effect modification when data were stratified by sex. Obese and overweight populations should be considered as candidate at-risk groups for epidemiologic studies of cardiopulmonary health related to air pollution exposures. Air pollution is a modifiable risk factor that may decrease lung function among obese individuals with implications for environmental and occupational health policy.

Burden of disease attributed to ambient PM2.5 and PM10 exposure in 190 cities in China

Particulate air pollution is becoming a serious public health concern in urban cities of China. Association of disability-adjusted life years (DALYs) and economic loss with air pollution-related health effects demand quantitative analysis for correctional measures in air quality. This study applies an epidemiology-based exposure-response function to obtain the quantitative estimate of health impact of particulate matter PM_2.5 and PM₁₀ across 190 cities of China during years 2014-2015. The annual average concentration of PM_2.5 and PM₁₀ is 57 ± 18 μg/m³ (ranging from 18 to 119 μg/m³) and 97.7 ± 34.2 μg/m³ (ranging from 33.5 to 252.8 μg/m³), respectively. Based on the present study, the total estimated annual premature mortality due to PM_2.5 is 722,370 [95% confidence interval (CI) = 322,716-987,519], 79% of which accounts for adult cerebrovascular disease (stroke) and ischemic heart disease (IHD). The premature mortality in megacities is very high, such as Chongqing (25,162/year), Beijing (19,702/year), Shanghai (19,617/year), Tianjin (13,726/year), and Chengdu (12,356/year). PM₁₀ pollution has caused 1,491,774 (95% CI = 972,770-1,960,303) premature deaths (age >30) in China. Further, 3,614,064 cases of chronic bronchitis (CB); 13,759,894 cases of asthma attack among all ages; 191,709 COPD-related hospital admission (HA) cases; 499,048 respiratory-related HA; 357,816 cerebrovascular HA; and 308,129 cardiovascular-related HA due to PM₁₀ pollution have been estimated during 2014-2015. Chongqing, Beijing, Baoding, Tianjin, and Shijiazhuang are the top five contributors to pollution-related mortality, accounting for 3.10, 2.71, 2.49, 2.20, and 2.02%, respectively, of the total deaths caused by PM₁₀ pollution. The total DALYs associated with PM_2.5 and PM₁₀ pollution in China is 7.2 and 20.66 million in 2014-2015, and mortality and chronic bronchitis shared about 93.3% of the total DALYs for PM₁₀. During this period, the economic cost of health impact due to PM₁₀ is approximately US$304,122 million, which accounts for about 2.94% of China's gross domestic product (GDP). Megacities are expected to contribute relatively more to the total costs. The present methodology could be used as a tool to help policy makers and pollution control board authorities, to further analyze costs and benefits of air pollution management programs in China.

Feasibility of using low-cost portable particle monitors for measurement of fine and coarse particulate matter in urban ambient air

Exposure to ambient particulate matter (PM) is known as a significant risk factor for mortality and morbidity due to cardiorespiratory causes. Owing to increased interest in assessing personal and community exposures to PM, we evaluated the feasibility of employing a low-cost portable direct-reading instrument for measurement of ambient air PM exposure. A Dylos DC 1700 PM sensor was collocated with a Grimm 11-R in an urban residential area of Houston Texas. The 1-min averages of particle number concentrations for sizes between 0.5 and 2.5 µm (small size) and sizes larger than 2.5 µm (large size) from a DC 1700 were compared with the 1-min averages of PM_2.5 (aerodynamic size less than 2.5 µm) and coarse PM (aerodynamic size between 2.5 and 10 µm) concentrations from a Grimm 11-R. We used a linear regression equation to convert DC 1700 number concentrations to mass concentrations, utilizing measurements from the Grimm 11-R. The estimated average DC 1700 PM_2.5 concentration (13.2 ± 13.7 µg/m³) was similar to the average measured Grimm 11-R PM_2.5 concentration (11.3 ± 15.1 µg/m³). The overall correlation (r²) for PM_2.5 between the DC 1700 and Grimm 11-R was 0.778. The estimated average coarse PM concentration from the DC 1700 (5.6 ± 12.1 µg/m³) was also similar to that measured with the Grimm 11-R (4.8 ± 16.5 µg/m³) with an r² of 0.481. The effects of relative humidity and particle size on the association between the DC 1700 and the Grimm 11-R results were also examined. The calculated PM mass concentrations from the DC 1700 were close to those measured with the Grimm 11-R when relative humidity was less than 60% for both PM_2.5 and coarse PM. Particle size distribution was more important for the association of coarse PM between the DC 1700 and Grimm 11-R than it was for PM_2.5.

IMPLICATIONS

The performance of a low-cost particulate matter (PM) sensor was evaluated in an urban residential area. Both PM_2.5 and coarse PM (PM_10-2.5) mass concentrations were estimated using a DC1700 PM sensor. The calculated PM mass concentrations from the number concentrations of DC 1700 were close to those measured with the Grimm 11-R when relative humidity was less than 60% for both PM_2.5 and coarse PM. Particle size distribution was more important for the association of coarse PM between the DC 1700 and Grimm 11-R than it was for PM_2.5.

Disability-adjusted life years and economic cost assessment of the health effects related to PM2.5 and PM10 pollution in Mumbai and Delhi, in India from 1991 to 2015

Particulate air pollution is becoming a serious public health concern in urban cities in India due to air pollution-related health effects associated with disability-adjusted life years (DALYs) and economic loss. To obtain the quantitative result of health impact of particulate matter (PM) in most populated Mumbai City and most polluted Delhi City in India, an epidemiology-based exposure-response function has been used to calculate the attributable number of mortality and morbidity cases from 1991 to 2015 in a 5-year interval and the subsequent DALYs, and economic cost is estimated of the health damage based on unit values of the health outcomes. Here, we report the attributable number of mortality due to PM₁₀ in Mumbai and Delhi increased to 32,014 and 48,651 in 2015 compared with 19,291 and 19,716 in year 1995. And annual average mortality due to PM_2.5 in Mumbai and Delhi was 10,880 and 10,900. Premature cerebrovascular disease (CEV), ischemic heart disease (IHD), and chronic obstructive pulmonary disease (COPD) causes are about 35.3, 33.3, and 22.9% of PM_2.5-attributable mortalities. Total DALYs due to PM10 increased from 0.34 million to 0.51 million in Mumbai and 0.34 million to 0.75 million in Delhi from average year 1995 to 2015. Among all health outcomes, mortality and chronic bronchitis shared about 95% of the total DALYs. Due to PM₁₀, the estimated total economic cost at constant price year 2005 US$ increased from 2680.87 million to 4269.60 million for Mumbai City and 2714.10 million to 6394.74 million for Delhi City, from 1995 to 2015, and the total amount accounting about 1.01% of India's gross domestic product (GDP). A crucial presumption is that in 2030, PM₁₀ levels would have to decline by 44% (Mumbai) and 67% (Delhi) absolutely to maintain the same health outcomes in year 2015 levels. The results will help policy makers from pollution control board for further cost-benefit analyses of air pollution management programs in Mumbai and Delhi.

Exposure to Indoor Particulate Matter Worsens the Symptoms and Acute Exacerbations in Chronic Obstructive Pulmonary Disease Patients of Southwestern Taiwan: A Pilot Study

Ambient particulate matter (PM) can trigger adverse reactions in the respiratory system, but less is known about the effect of indoor PM. In this longitudinal study, we investigated the relationships between indoor PM and clinical parameters in patients with moderate to very severe chronic obstructive pulmonary disease (COPD). Indoor air quality (PM_2.5 and PM₁₀ levels) was monitored in the patients’ bedroom, kitchen, living room, and front door at baseline and every two months for one year. At each home visit, the patients were asked to complete spirometry and questionnaire testing. Exacerbations were assessed by chart review and questionnaires during home visits. Generalized estimating equation (GEE) analysis (n = 83) showed that the level of wheezing was significantly higher in patients whose living room and kitchen had abnormal (higher than ambient air quality standards in Taiwan) PM_2.5 and PM₁₀ levels. Patients who lived in houses with abnormal outdoor PM_2.5 levels had higher COPD Assessment Test scores (physical domain), and those who lived in houses with abnormal PM₁₀ levels in the living room and kitchen had higher London Chest Activity of Daily Living scores. Increased PM levels were associated with worse respiratory symptoms and increased risk of exacerbation in patients with moderate to very severe COPD.

Inflammatory bowel disease and airway diseases

Airway diseases are the most commonly described lung manifestations of inflammatory bowel disease (IBD). However, the similarities in disease pathogenesis and the sharing of important environmental risk factors and genetic susceptibility suggest that there is a complex interplay between IBD and airway diseases. Recent evidence of IBD occurrence among patients with airway diseases and the higher than estimated prevalence of subclinical airway injuries among IBD patients support the hypothesis of a two-way association. Future research efforts should be directed toward further exploration of this association, as airway diseases are highly prevalent conditions with a substantial public health impact.

Linking e-health records, patient-reported symptoms and environmental exposure data to characterise and model COPD exacerbations: protocol for the COPE study

INTRODUCTION

Relationships between exacerbations of chronic obstructive pulmonary disease (COPD) and environmental factors such as temperature, humidity and air pollution are not well characterised, due in part to oversimplification in the assignment of exposure estimates to individuals and populations. New developments in miniature environmental sensors mean that patients can now carry a personal air quality monitor for long periods of time as they go about their daily lives. This creates the potential for capturing a direct link between individual activities, environmental exposures and the health of patients with COPD. Direct associations then have the potential to be scaled up to population levels and tested using advanced human exposure models linked to electronic health records.

METHODS AND ANALYSIS

This study has 5 stages: (1) development and deployment of personal air monitors; (2) recruitment and monitoring of a cohort of 160 patients with COPD for up to 6 months with recruitment of participants through the Clinical Practice Research Datalink (CPRD); (3) statistical associations between personal exposure with COPD-related health outcomes; (4) validation of a time-activity exposure model and (5) development of a COPD prediction model for London.

ETHICS AND DISSEMINATION

The Research Ethics Committee for Camden and Islington has provided ethical approval for the conduct of the study. Approval has also been granted by National Health Service (NHS) Research and Development and the Independent Scientific Advisory Committee. The results of the study will be disseminated through appropriate conference presentations and peer-reviewed journals.

The Effects of Air Pollution and Temperature on COPD

Chronic Obstructive Pulmonary Disease (COPD) affects 12-16 million people in the United States and is the third-leading cause of death. In developed countries, smoking is the greatest risk factor for the development of COPD, but other exposures also contribute to the development and progression of the disease. Several studies suggest, though are not definitive, that outdoor air pollution exposure is linked to the prevalence and incidence of COPD. Among individuals with COPD, outdoor air pollutants are associated with loss of lung function and increased respiratory symptoms. In addition, outdoor air pollutants are also associated with COPD exacerbations and mortality. There is much less evidence for the impact of indoor air on COPD, especially in developed countries in residences without biomass exposure. The limited existing data suggests that indoor particulate matter and nitrogen dioxide concentrations are linked to increased respiratory symptoms among patients with COPD. In addition, with the projected increases in temperature and extreme weather events in the context of climate change there has been increased attention to the effects of heat exposure. Extremes of temperature-both heat and cold-have been associated with increased respiratory morbidity in COPD. Some studies also suggest that temperature may modify the effect of pollution exposure and though results are not conclusive, understanding factors that may modify susceptibility to air pollution in patients with COPD is of utmost importance.

The burden of COPD mortality due to ambient air pollution in Guangzhou, China

Few studies have investigated the chronic obstructive pulmonary disease (COPD) mortality fraction attributable to air pollution and modification by individual characteristics of air pollution effects. We applied distributed lag non-linear models to assess the associations between air pollution and COPD mortality in 2007-2011 in Guangzhou, China, and the total COPD mortality fraction attributable to air pollution was calculated as well. We found that an increase of 10 μg/m(3) in particulate matter with an aerodynamic diameter of 10 μm or less (PM10), sulfur dioxide (SO2) and nitrogen dioxide (NO2) was associated with a 1.58% (95% confidence interval (CI): 0.12-3.06%), 3.45% (95% CI: 1.30-5.66%) and 2.35% (95% CI: 0.42-4.32%) increase of COPD mortality over a lag of 0-15 days, respectively. Greater air pollution effects were observed in the elderly, males and residents with low educational attainment. The results showed 10.91% (95% CI: 1.02-9.58%), 12.71% (95% CI: 5.03-19.85%) and 13.38% (95% CI: 2.67-22.84%) COPD mortality was attributable to current PM10, SO2 and NO2 exposure, respectively. In conclusion, the associations between air pollution and COPD mortality differed by individual characteristics. There were remarkable COPD mortality burdens attributable to air pollution in Guangzhou.

Association between ambient air pollution and diabetes mellitus in Europe and North America: systematic review and meta-analysis

BACKGROUND

Air pollution is hypothesized to be a risk factor for diabetes. Epidemiological evidence is inconsistent and has not been systematically evaluated.

OBJECTIVES

We systematically reviewed epidemiological evidence on the association between air pollution and diabetes, and synthesized results of studies on type 2 diabetes mellitus (T2DM).

METHODS

We systematically searched electronic literature databases (last search, 29 April 2014) for studies reporting the association between air pollution (particle concentration or traffic exposure) and diabetes (type 1, type 2, or gestational). We systematically evaluated risk of bias and role of potential confounders in all studies. We synthesized reported associations with T2DM in meta-analyses using random-effects models and conducted various sensitivity analyses.

RESULTS

We included 13 studies (8 on T2DM, 2 on type 1, 3 on gestational diabetes), all conducted in Europe or North America. Five studies were longitudinal, 5 cross-sectional, 2 case-control, and 1 ecologic. Risk of bias, air pollution assessment, and confounder control varied across studies. Dose-response effects were not reported. Meta-analyses of 3 studies on PM2.5 (particulate matter ≤ 2.5 μm in diameter) and 4 studies on NO2 (nitrogen dioxide) showed increased risk of T2DM by 8-10% per 10-μg/m3 increase in exposure [PM2.5: 1.10 (95% CI: 1.02, 1.18); NO2: 1.08 (95% CI: 1.00, 1.17)]. Associations were stronger in females. Sensitivity analyses showed similar results.

CONCLUSION

Existing evidence indicates a positive association of air pollution and T2DM risk, albeit there is high risk of bias. High-quality studies assessing dose-response effects are needed. Research should be expanded to developing countries where outdoor and indoor air pollution are high.

The global contribution of outdoor air pollution to the incidence, prevalence, mortality and hospital admission for chronic obstructive pulmonary disease: a systematic review and meta-analysis

Objective: This study aimed to investigate the quantitative effects of outdoor air pollution, represented by 10 µg/m³ increment of PM₁₀, on chronic obstructive pulmonary disease in China, United States and European Union through systematic review and meta-analysis. Methods: Publications in English and Chinese from PubMed and EMBASE were selected. The Cochrane Review Handbook of Generic Inverse Variance was used to synthesize the pooled effects on incidence, prevalence, mortality and hospital admission. Results: Outdoor air pollution contributed to higher incidence and prevalence of COPD. Short-term exposure was associated with COPD mortality increased by 6%, 1% and 1% in the European Union, the United States and China, respectively (p < 0.05). Chronic PM exposure produced a 10% increase in mortality. In a short-term exposure to 10 µg/m³ PM₁₀ increment COPD mortality was elevated by 1% in China (p < 0.05) and hospital admission enrollment was increased by 1% in China, 2% in United States and 1% in European Union (p < 0.05). Conclusions: Outdoor air pollution contributes to the increasing burdens of COPD.10 µg/m³ increase of PM₁₀ produced significant condition of COPD death and exacerbation in China, United States and European Union. Controlling air pollution will have substantial benefit to COPD morbidity and mortality.

Biomass smoke in Burkina Faso: what is the relationship between particulate matter, carbon monoxide, and kitchen characteristics?

In Burkina Faso where cooking with biomass is very common, little information exists regarding kitchen characteristics and their impact on air pollutant levels. The measurement of air pollutants such as respirable particulate matter (PM10), an important component of biomass smoke that has been linked to adverse health outcomes, can also pose challenges in terms of cost and the type of equipment needed. Carbon monoxide could potentially be a more economical and simpler measure of air pollution. The focus of this study was to first assess the association of kitchen characteristics with measured PM10 and CO levels and second, the relationship of PM10 with CO concentrations, across these different kitchen characteristics in households in Nouna, Burkina Faso. Twenty-four-hour concentrations of PM10 (area) were measured with portable monitors and CO (area and personal) estimated using color dosimeter tubes. Data on kitchen characteristics were collected through surveys. Most households used both wood and charcoal burned in three-stone and charcoal stoves. Mean outdoor kitchen PM10 levels were relatively high (774 μg/m(3), 95 % CI 329-1,218 μg/m(3)), but lower than indoor concentrations (Satterthwaite t value, -6.14; p < 0.0001). In multivariable analyses, outdoor kitchens were negatively associated with PM10 (OR = 0.06, 95 % CI 0.02-0.16, p value <0.0001) and CO (OR = 0.03, 95 % CI 0.01-0.11, p value <0.0001) concentrations. Strong area PM10 and area CO correlations were found with indoor kitchens (Spearman's r = 0.82, p < 0.0001), indoor stove use (Spearman's r = 0.82, p < 0.0001), and the presence of a smoker in the household (Spearman's r = 0.83, p < 0.0001). Weak correlations between area PM10 and personal CO levels were observed with three-stone (Spearman's r = 0.23, p = 0.008) and improved stoves (Spearman's r = 0.34, p = 0.003). This indicates that the extensive use of biomass fuels and multiple stove types for cooking still produce relatively high levels of exposure, even outdoors, suggesting that both fuel subsidies and stove improvement programs are likely necessary to address this problem. These findings also indicate that area CO color dosimeter tubes could be a useful measure of area PM10 concentrations when levels are influenced by strong emission sources or when used in indoors. The weaker correlation observed between area PM10 and personal CO levels suggests that area exposures are not as useful as proxies for personal exposures, which can vary widely from those recorded by stationary monitors.

Tele-monitoring reduces exacerbation of COPD in the context of climate change--a randomized controlled trial

BACKGROUND

A home based tele-monitoring system was developed to assess the effects of heat stress (days > 25°C) on clinical and functional status in patients with chronic obstructive pulmonary disease (COPD).

METHODS

Sixty-two COPD patients (GOLD II-IV) were randomized into a tele-monitoring Group (TG, N = 32) or Control Group (CG, N = 30). Tele-monitoring included 1) daily clinical status (COPD Assessment Test-CAT), 2) daily lung function and 3) weekly 6-minute walk test (6MWT). Duration of monitoring lasted a total of nine months (9 M).

RESULTS

From June 1st-August 31st 2012, 32 days with heat stress (29.0 ± 2.5°C) were recorded and matched with 32 thermal comfort days (21.0 ± 2.9°C). During heat stress, the TG showed a significant reduction in lung function and exercise capacity (FEV1% predicted: 51.1 ± 7.2 vs. 57.7 ± 5.0%; P <0.001 and 6MWT performance: 452 ± 85 vs. 600 ± 76 steps; P <0.001) and increase in CAT scores (19.2 ± 7.9 vs. 16.2 ± 7.2; P <0.001).Over summer, significantly fewer TG patients suffered exacerbation of COPD compared to CG patients (3 vs. 14; P = 0.006). Over entire 9 M follow-up, the TG group had fewer exacerbations compared to CG (7 vs. 22; P = 0.012), shorter cumulative hospital stay (34 vs. 97 days) and 43% fewer specialist consultations (24. vs. 42; P = 0.04).

CONCLUSION

Heat stress affects clinical and functional status in COPD. Tele-monitoring reduces exacerbation frequency and health care utilization during heat stress and other periods of the year.

TRIAL REGISTRATION DRKS-ID

DRK00000705.

Has the short-term effect of black smoke exposure on pneumonia mortality been underestimated because hospitalisation is ignored: findings from a case-crossover study

BACKGROUND

Short-term associations have been demonstrated between air pollution and respiratory mortality including pneumonia. Studies typically estimate exposure based only on place of residence, yet many are in hospital prior to death. This study investigates lag length and tests the hypothesis that the effect of 'black smoke' is greater when restricted to pneumonia deaths in the community - Community Deaths from Pneumonia.

METHODS

A time-stratified case-crossover design using conditional logistic regression estimated the daily percentage increase in risk of pneumonia mortality in relation to 'black smoke' in the preceding 30 days. Cases were pneumonia deaths in Edinburgh 1981-1996. Multiple 'control' periods, were defined using the same weekdays for the same month as the case death. Lag structure was investigated by a stratified lag model with five 6-day periods and by distributed lag models. Hospital admissions data, defined a community death as someone who had not been in hospital in any of the 30 days before death.

RESULTS

Of 14,346 subjects who died from pneumonia, 7,536 were community deaths. Larger estimated increases in risks were seen in the community for all lag periods. Both stratified and distributed lag methods suggested positive effect estimates for 18 days after exposure and negative thereafter; the average percent increase per day across the 18 days was 0.70% (95% C.I. 0.29-1.14) for community subjects and 0.30% (95% C.I. 0.03-0.59) for all subjects.

CONCLUSIONS

Studies which fail to account for hospitalisation may underestimate exposure effects as stronger pollution effects on mortality were evident in community based subjects.

Years of life lost in the first wave of the 2009 influenza A(H1N1) pandemic in Hong Kong

The impact of influenza pandemics might be overestimated; the published studies of years of life lost (YLL) have typically ignored the presence of underlying chronic conditions or health risk behaviors in most deaths. We used data on deaths involving laboratory-confirmed 2009 influenza A(H1N1) virus infection that occurred between April 2009 and May 2010 in Hong Kong, China, to adjust for these underlying risk factors. Life expectancy was corrected with hazard-based modifications to the life tables. The excess hazards posed by underlying risk factors were added to the "baseline" age-specific hazards in the local life tables to reflect the life expectancy associated with each underlying risk factor. Of 72 deceased persons with laboratory-confirmed 2009 influenza A(H1N1) virus infection, 56% had underlying risk factors. We estimated that the 2009 pandemic was associated with 1,540 (95% confidence interval: 1,350, 1,630) YLL after adjustment for age and underlying risk factors. This figure is approximately 25% lower than the YLL estimate of 2,080 derived after adjustment for age but not for risk factors. Our analysis demonstrates the potential scale of bias in YLL estimation if underlying risk factors are ignored. The estimation of YLL with correction for underlying risk factors in addition to age could also provide a framework for similar calculations elsewhere.

Chronic obstructive pulmonary disease and cardiovascular disease

Chronic obstructive pulmonary disease (COPD) is an inflammatory disease of the lung associated with progressive airflow limitation and punctuated by episodes of acute exacerbation. There is growing recognition that the inflammatory state associated with COPD is not confined to the lungs but also involves the systemic circulation and can impact nonpulmonary organs. Epidemiologic and mechanistic studies indicate that COPD is associated with a high frequency of coronary artery disease, congestive heart failure and cardiac arrhythmias, independent of shared risk factors. Possible pathways include complex interrelationships between chronic low-grade systemic inflammation and oxidative stress as well as shared risk factors such as age, cigarette smoking, and environmental pollutants. In this review, we provide an overview of the epidemiologic data linking COPD with cardiovascular disease, comment on the interrelationships among COPD, inflammation, and cardiovascular disease, and highlight diagnostic and therapeutic challenges.

Synoptic weather typing applied to air pollution mortality among the elderly in 10 Canadian cities

BACKGROUND

Synoptic circulation patterns (large-scale weather systems) affect ambient levels of air pollution, as well as the relationship between air pollution and human health.

OBJECTIVE

To investigate the air pollution-mortality relationship within weather types and seasons, and to determine which combination of atmospheric conditions may pose increased health threats in the elderly age categories.

METHODS

The relative risk of mortality (RR) due to air pollution was examined using Poisson generalized linear models (GLMs) within specific weather types. Analysis was completed by weather type and age group (all ages, ≤64, 65-74, 75-84, ≥85 years) in ten Canadian cities from 1981 to 1999.

RESULTS

There was significant modification of RR by weather type and age. When examining the entire population, weather type was shown to have the greatest modifying effect on the risk of dying due to ozone (O3). This effect was highest on average for the dry tropical (DT) weather type, with the all-age RR of mortality at a population weighted mean (PWM) found to be 1.055 (95% CI 1.026-1.085). All-weather type risk estimates increased with age due to exposure to carbon monoxide (CO), nitrogen dioxide (NO2), and sulphur dioxide (SO2). On average, RR increased by 2.6, 3.8 and 1.5% for the respective pollutants between the ≤64 and ≥85 age categories. Conversely, mean ozone estimates remained relatively consistent with age. Elevated levels of air pollution were found to be detrimental to the health of elderly individuals for all weather types. However, the entire population was negatively effected by air pollution on the hot dry (DT) and hot humid (MT) days.

CONCLUSIONS

We identified a significant modification of RR for mortality due to air pollution by age, which is enhanced under specific weather types. Efforts should be targeted at minimizing pollutant exposure to the elderly and/or all age groups with respect to weather type in question.

Health effects of air pollution on length of respiratory cancer survival

BACKGROUND

Air pollution has been extensively and consistently linked with mortality. However, no study has investigated the health effects of air pollution on length of survival among diagnosed respiratory cancer patients.

METHODS

In this study, we conducted a population-based study to investigate if air pollution exposure has adverse effects on survival time of respiratory cancer cases in Los Angeles (LA), CA and Honolulu, HI. We selected all White respiratory cancer patients in the two study areas from the 1992-2008 Surveillance Epidemiology and End Results cancer data. Death from respiratory cancer and length of survival were the main outcomes.

RESULTS

Kaplan-Meier survival analysis shows that all respiratory cancer cases exposed to high air pollution referring to the individuals from LA had a significantly shorter survival time than the low pollution exposure group referring to those from Honolulu without adjusting for other covariates (p <0.0001). Moreover, the results from the Cox Proportional-Hazards models suggest that exposure to particles less than 10 micrometers in diameter (PM10) was associated with an increased risk of cancer death (HR = 1.48, 95% CI: 1.44-1.52 per 10 μg/m3 increase in PM10) after adjusting for demographic factors and cancer characteristics. Similar results were observed for particles less than 2.5 micrometers in diameter and ozone.

CONCLUSION

Our study indicates that air pollution may have deleterious effects on the length of survival among White respiratory cancer patients. This study calls for attention to preventive effort from air pollution for this susceptible population in standard cancer patient care. The findings from this study warrant further investigation.

Long-term air pollution exposure and cardio- respiratory mortality: a review

Current day concentrations of ambient air pollution have been associated with a range of adverse health effects, particularly mortality and morbidity due to cardiovascular and respiratory diseases. In this review, we summarize the evidence from epidemiological studies on long-term exposure to fine and coarse particles, nitrogen dioxide (NO2) and elemental carbon on mortality from all-causes, cardiovascular disease and respiratory disease. We also summarize the findings on potentially susceptible subgroups across studies. We identified studies through a search in the databases Medline and Scopus and previous reviews until January 2013 and performed a meta-analysis if more than five studies were available for the same exposure metric.

A discriminant function model as an alternative method to spirometry for COPD screening in primary care settings in China

OBJECTIVE

COPD is often underdiagnosed in a primary care setting where the spirometry is unavailable. This study was aimed to develop a simple, economical and applicable model for COPD screening in those settings.

METHODS

First we established a discriminant function model based on Bayes' Rule by stepwise discriminant analysis, using the data from 243 COPD patients and 112 non-COPD subjects from our COPD survey in urban and rural communities and local primary care settings in Guangdong Province, China. We then used this model to discriminate COPD in additional 150 subjects (50 non-COPD and 100 COPD ones) who had been recruited by the same methods as used to have established the model. All participants completed pre- and post-bronchodilator spirometry and questionnaires. COPD was diagnosed according to the Global Initiative for Chronic Obstructive Lung Disease criteria. The sensitivity and specificity of the discriminant function model was assessed.

RESULTS

THE ESTABLISHED DISCRIMINANT FUNCTION MODEL INCLUDED NINE VARIABLES: age, gender, smoking index, body mass index, occupational exposure, living environment, wheezing, cough and dyspnoea. The sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, accuracy and error rate of the function model to discriminate COPD were 89.00%, 82.00%, 4.94, 0.13, 86.66% and 13.34%, respectively. The accuracy and Kappa value of the function model to predict COPD stages were 70% and 0.61 (95% CI, 0.50 to 0.71).

CONCLUSIONS

This discriminant function model may be used for COPD screening in primary care settings in China as an alternative option instead of spirometry.