Personal exposures to traffic-related air pollution and acute respiratory health among Bronx schoolchildren with asthma

Seventy-five years of impactful environmental and occupational health research at the Nelson Institute of Environmental Medicine at New York University

Founded in 1947 as the Institute of Industrial Medicine, the Nelson Institute and Department of Environmental Medicine at New York University (NYU) Grossman School of Medicine (NYUGSOM) was supported by a National Institute of Environmental Health Science (NIEHS) Center Grant for over 56 years. Nelson Institute researchers generated 75 years of impactful research in environmental and occupational health, radiation effects, toxicology, and cancer. Environmental health research is continuing at NYUGSOM in its departments of medicine and population health. The objective of this historical commentary is to highlight the major achievements of the Nelson Institute and the department in the context of its history at facilities in Sterling Forest, Tuxedo, NY and Manhattan, NY. Aspects of our discussion include leadership, physical facilities, and research in many areas, including air pollution, health effects of environmental radiation exposures, inhalation toxicology methodology, carcinogenesis by chemicals, metals, and hormones, cancer chemoprevention, human microbiome, ecotoxicology, epidemiology, biostatistics, and community health concerns. The research of the institute and department benefited from unique facilities, strong leadership focused on team-based science, and outstanding investigators, students, and staff. A major lasting contribution has been the training of hundreds of graduate students and postdoctoral fellows, many of whom have been and are training the next generation of environmental and occupational health researchers at various institutions.

Genome-Wide DNA methylation profile analysis identifies differentially methylated loci associated with personal PM2.5 exposure in adults with asthma

Particulate matter with aerodynamic diameters ≤2.5 µm (PM2.5) is a major environmental risk factor for acute asthma exacerbation, and the underlying mechanism is not completely understood. Studies have indicated that DNA methylation is a potential mechanism linking PM2.5 to its health effects. We conducted a panel study involving 24 adult patients with asthma in Beijing,China between 2017 and 2019. PM2.5 and other atmospheric pollutant exposure data were repeatedly measured. Blood samples were collected for genome-wide DNA methylation analysis. A linear mixed-effects (LME) model was conducted to identify differentially methylated probes (DMPs) associated with PM2.5 exposure. After filtering out probes that did not meet the criteria through quality control, 811,001 CpG sites were included in the LME model, and 36 DMPs were strongly associated with personal PM2.5 exposure at false discovery rate (FDR) < 0.05, of which 22 and 14 DMPs negatively and positively correlated with personal PM2.5 exposure, respectively. Functional analysis revealed that DMPs affected smooth muscle cell contraction and development, extracellular matrix synthesis and secretion, T cell activation and differentiation, and inflammatory factor production. This study provides evidence linking personal PM2.5 exposure to genome-wide DNA methylation in adult patients with asthma. Identifying enrichment pathways can provide biological insights into the acute health effects of PM2.5.

Home and school pollutant exposure, respiratory outcomes, and influence of historical redlining

BACKGROUND

The discriminatory and racist policy of historical redlining in the United States during the 1930s played a role in perpetuating contemporary environmental health disparities.

OBJECTIVE

Our objectives were to determine associations between home and school pollutant exposure (fine particulate matter [PM2.5], NO2) and respiratory outcomes (Composite Asthma Severity Index, lung function) among school-aged children with asthma and examine whether associations differed between children who resided and/or attended school in historically redlined compared to non-redlined neighborhoods.

METHODS

Children ages 6 to 17 with moderate-to-severe asthma (N = 240) from 9 US cities were included. Combined home and school exposure to PM2.5 and NO2 was calculated based on geospatially assessed monthly averaged outdoor pollutant concentrations. Repeated measures of Composite Asthma Severity Index and lung function were collected.

RESULTS

Overall, 37.5% of children resided and/or attended schools in historically redlined neighborhoods. Children in historically redlined neighborhoods had greater exposure to NO2 (median: 15.4 vs 12.1 parts per billion) and closer distance to a highway (median: 0.86 vs 1.23 km), compared to those in non-redlined neighborhoods (P < .01). Overall, PM2.5 was not associated with asthma severity or lung function. However, among children in redlined neighborhoods, higher PM2.5 was associated with worse asthma severity (P < .005). No association was observed between pollutants and lung function or asthma severity among children in non-redlined neighborhoods (P > .005).

CONCLUSIONS

Our findings highlight the significance of historical redlining and current environmental health disparities among school-aged children with asthma, specifically, the environmental injustice of PM2.5 exposure and its associations with respiratory health.

Traffic-related air pollution in marginalized neighborhoods: a community perspective

OBJECTIVES

Marginalized communities are exposed to higher levels of traffic-related air pollution (TRAP) than the general population. TRAP exposure is linked to pulmonary toxicity, neurotoxicity, and cardiovascular toxicity often through mechanisms of inflammation and oxidative stress. Early life exposure to TRAP is also implicated in higher rates of asthma in these same communities. There is a critical need for additional epidemiological, in vivo, and in vitro studies to define the health risks of TRAP exposure affecting the most vulnerable groups to set strict, protective air pollution standards in these communities.

MATERIALS AND METHODS

A literature review was conducted to summarize recent findings (2010-2024) concerning TRAP exposure and toxic mechanisms that are relevant to the most affected underserved communities.

CONCLUSIONS

Guided by the perspectives of NYC community scientists, this contemporary review of toxicological and epidemiological studies considers how the exposome could lead to disproportionate exposures and health effects in underserved populations.

Association between lead and circulating markers of inflammation among traffic enforcers in Metro Manila, Philippines: the MMDA traffic enforcer's health study

PURPOSE

Several epidemiological studies have linked lead (Pb) exposure to induced oxidative stress and the promotion of inflammatory response. We performed a within-subjects study (repeated measures study) to evaluate the relationship between the concentration of blood lead (B-Pb) and toenail lead (T-Pb) and circulating markers of inflammation.

METHODS

We evaluated the associations between B-Pb concentrations and T-Pb concentrations and circulating markers of inflammation, soluble intracellular adhesion molecule-1 (s-ICAM-1), soluble vascular adhesion molecule-1 (s-VCAM-1), and high-sensitivity C-reactive protein (hs-CRP) on 158 traffic enforcers from the Metropolitan Manila Development Authority (MMDA) traffic enforcer's health study. Linear mixed-effects models with random subject-specific intercepts were fitted to estimate the association between B-Pb and T-Pb exposure and circulating markers of inflammation, adjusting for confounding factors.

RESULTS

Traffic enforcers were middle-aged men (89.4%) with a mean age (± SD) of 37.1 years ± 8.9 years and had a total of 293 valid markers of inflammation measurements. B-Pb concentration was related to increased hs-CRP levels. A 10% increase in B-Pb was associated with a 5.7% increase in hs-CRP level [95% confidence interval (95% CI): 1.3-10.1]. However, B-Pb was not associated with s-ICAM-1 and s-VCAM-1. Furthermore, no associations were observed between T-Pb and all the circulating markers of inflammation.

CONCLUSIONS

Low-level B-Pb may increase hs-CRP among traffic enforcers. Moreover, the study suggests that Pb via the oxidative and inflammation pathways may have an essential role in the development of cardiovascular disease. Furthermore, MMDA and the Department of Labor and Employment can use our study's findings as evidence to conduct routine screening of blood heavy metals, especially Pb, among MMDA and other traffic enforcers as part of their yearly medical examination.

Hyperlocal environmental data with a mobile platform in urban environments

Environmental data with a high spatio-temporal resolution is vital in informing actions toward tackling urban sustainability challenges. Yet, access to hyperlocal environmental data sources is limited due to the lack of monitoring infrastructure, consistent data quality, and data availability to the public. This paper reports environmental data (PM, NO2, temperature, and relative humidity) collected from 2020 to 2022 and calibrated in four deployments in three global cities. Each data collection campaign targeted a specific urban environmental problem related to air quality, such as tree diversity, community exposure disparities, and excess fossil fuel usage. Firstly, we introduce the mobile platform design and its deployment in Boston (US), NYC (US), and Beirut (Lebanon). Secondly, we present the data cleaning and validation process, for the air quality data. Lastly, we explain the data format and how hyperlocal environmental datasets can be used standalone and with other data to assist evidence-based decision-making. Our mobile environmental sensing datasets include cities of varying scales, aiming to address data scarcity in developing regions and support evidence-based environmental policymaking.

Environmental Justice in Greater Los Angeles: Impacts of Spatial and Ethnic Factors on Residents' Socioeconomic and Health Status

Environmental justice advocates that all people are protected from disproportionate impacts of environmental hazards. Despite this ideal aspiration, social and environmental inequalities exist throughout greater Los Angeles. Previous research has identified and mapped pollutant levels, demographic information, and the population's socioeconomic status and health issues. Nevertheless, the complex interrelationships between these factors remain unclear. To close this knowledge gap, we first measured the spatial centrality using sDNA software. These data were then integrated with other socioeconomic and health data collected from CalEnvironScreen, with census tract as the unit of analysis. Finally, structural equation modeling (SEM) was executed to explore direct, indirect, and total effects among variables. The results show that the White population tends to reside in the more segregated areas and lives closer to green space, contributing to higher housing stability, financial security, and more education attainment. In contrast, people of color, especially Latinx, experience the opposite of the environmental benefits. Spatial centrality exhibits a significant indirect effect on environmental justice by influencing ethnicity composition and pollution levels. Moreover, green space accessibility significantly influences environmental justice via pollution. These findings can assist decision-makers to create a more inclusive society and curtail social segregation for all individuals.

Long-Term PM2.5 Exposure Is Associated with Symptoms of Acute Respiratory Infections among Children under Five Years of Age in Kenya, 2014

Introduction: Short-term exposures to air pollutants such as particulate matter (PM) have been associated with increased risk for symptoms of acute respiratory infections (ARIs). Less well understood is how long-term exposures to fine PM (PM2.5) might increase risk of ARIs and their symptoms. This research uses georeferenced Demographic Health Survey (DHS) data from Kenya (2014) along with a remote sensing based raster of PM2.5 concentrations to test associations between PM2.5 exposure and ARI symptoms in children for up to 12 monthly lags. Methods: Predicted PM2.5 concentrations were extracted from raster of monthly averages for latitude/longitude locations of survey clusters. These data and other environmental and demographic data were used in a logistic regression model of ARI symptoms within a distributed lag nonlinear modeling framework (DLNM) to test lag associations of PM2.5 exposure with binary presence/absence of ARI symptoms in the previous two weeks. Results: Out of 7036 children under five for whom data were available, 46.8% reported ARI symptoms in the previous two weeks. Exposure to PM2.5 within the same month and as an average for the previous 12 months was 18.31 and 22.1 µg/m3, respectively, far in excess of guidelines set by the World Health Organization. One-year average PM2.5 exposure was higher for children who experienced ARI symptoms compared with children who did not (22.4 vs. 21.8 µg/m3, p < 0.0001.) Logistic regression models using the DLNM framework indicated that while PM exposure was not significantly associated with ARI symptoms for early lags, exposure to high concentrations of PM2.5 (90th percentile) was associated with elevated odds for ARI symptoms along a gradient of lag exposure time even when controlling for age, sex, types of cooking fuels, and precipitation. Conclusions: Long-term exposure to high concentrations of PM2.5 may increase risk for acute respiratory problems in small children. However, more work should be carried out to increase capacity to accurately measure air pollutants in emerging economies such as Kenya.

Controlled human exposure to diesel exhaust: results illuminate health effects of traffic-related air pollution and inform future directions

Air pollution is an issue of increasing interest due to its globally relevant impacts on morbidity and mortality. Controlled human exposure (CHE) studies are often employed to investigate the impacts of pollution on human health, with diesel exhaust (DE) commonly used as a surrogate of traffic related air pollution (TRAP). This paper will review the results derived from 104 publications of CHE to DE (CHE-DE) with respect to health outcomes. CHE-DE studies have provided mechanistic evidence supporting TRAP’s detrimental effects on related to the cardiovascular system (e.g., vasomotor dysfunction, inhibition of fibrinolysis, and impaired cardiac function) and respiratory system (e.g., airway inflammation, increased airway responsiveness, and clinical symptoms of asthma). Oxidative stress is thought to be the primary mechanism of TRAP-induced effects and has been supported by several CHE-DE studies. A historical limitation of some air pollution research is consideration of TRAP (or its components) in isolation, limiting insight into the interactions between TRAP and other environmental factors often encountered in tandem. CHE-DE studies can help to shed light on complex conditions, and several have included co-exposure to common elements such as allergens, ozone, and activity level. The ability of filters to mitigate the adverse effects of DE, by limiting exposure to the particulate fraction of polluted aerosols, has also been examined. While various biomarkers of DE exposure have been evaluated in CHE-DE studies, a definitive such endpoint has yet to be identified. In spite of the above advantages, this paradigm for TRAP is constrained to acute exposures and can only be indirectly applied to chronic exposures, despite the critical real-world impact of living long-term with TRAP. Those with significant medical conditions are often excluded from CHE-DE studies and so results derived from healthy individuals may not apply to more susceptible populations whose further study is needed to avoid potentially misleading conclusions. In spite of limitations, the contributions of CHE-DE studies have greatly advanced current understanding of the health impacts associated with TRAP exposure, especially regarding mechanisms therein, with important implications for regulation and policy.

Impact of the State of Emergency during the COVID-19 Pandemic in 2020 on Asthma Exacerbations among Children in Kobe City, Japan

The coronavirus disease (COVID-19) pandemic altered environmental factors. We studied the impact of these changes on asthma exacerbation (AE) by comparing the AE-related environmental factors between COVID-19 (2020) and pre-COVID-19 (2011–2019) eras. Between 2011 and 2020, 278,465 children (<16 years old) visited our emergency department, and 7476 were diagnosed with AE. The number of patients showed spring and fall peaks in 2011–2019. Multivariate analyses showed significant positive relationships of the number of AE patients with the average temperature among all patients and 0–5-year-olds and with sulfur dioxide (SO₂) levels in 2011–2019 among 0–5-year-olds. Although the spring peak in the number of patients was not observed in 2020 after declaration of a state of emergency, the fall peak was again observed after the state of emergency was lifted. No changes in average temperature were detected, but SO₂ was significantly reduced following declaration of the state of emergency in 2020. Therefore, SO₂ reduction might have contributed to the disappearance of the peak of AE. However, a fall peak was observed again in 2020, although SO₂ levels continued to be low. These data suggest that person to person interaction seems to be associated with AE, presumably due to unknown viral infections.

Respiratory function declines in children with asthma associated with chemical species of fine particulate matter (PM2.5) in Nagasaki, Japan

BACKGROUND

The differential effects of PM_2.5 fractions on children's lung function remain inconclusive. This study aimed to examine whether lung function in asthmatic children was associated with increased PM_2.5 fractions in urban areas in Nagasaki prefecture, Japan, where the air pollution level is relatively low but influenced by transboundary air pollution.

METHODS

We conducted a multiyear panel study of 73 asthmatic children (boys, 60.3%; mean age, 8.2 years) spanning spring 2014-2016 in two cities. We collected self-measured peak expiratory flow (PEF) twice a day and daily time-series data for PM_2.5 total mass and its chemical species. We fitted a linear mixed effects model to examine short-term associations between PEF and PM_2.5, adjusting for individual and time-varying confounders. A generalized linear mixed effects model was also used to estimate the association for worsening asthma defined by severe PEF decline. Back-trajectory and cluster analyses were used to investigate the long-range transboundary PM_2.5 in the study areas.

RESULTS

We found that morning PEFs were adversely associated with higher levels of sulfate (- 1.61 L/min; 95% CI: - 3.07, - 0.15) in Nagasaki city and organic carbon (OC) (- 1.02 L/min; 95% CI: - 1.94, - 0.09) in Isahaya city, per interquartile range (IQR) increase at lag1. In addition, we observed consistent findings for worsening asthma, with higher odds of severe PEF decline in the morning for sulfate (odds ratio (OR) = 2.31; 95% CI: 1.12, 4.77) and ammonium (OR = 1.73; 95% CI: 1.06, 2.84) in Nagasaki city and OC (OR = 1.51; 95% CI: 1.06, 2.15) in Isahaya city, per IQR increase at lag1. The significant chemical species were higher on days that could be largely attributed to the path of Northeast China origin (for sulfate and ammonium) or both the same path and local sources (for OC) than by other clusters.

CONCLUSIONS

This study provides evidence of the differential effects of PM_2.5 fractions on lung function among asthmatic children in urban areas, where the Japanese national standards of air quality have been nearly met. Continuous efforts to promote mitigation actions and public awareness of hazardous transboundary air pollution are needed to protect susceptible children with asthma.

Natural gas development, flaring practices and paediatric asthma hospitalizations in Texas

BACKGROUND

Recent advancements in drilling technology led to a rapid increase in natural gas development (NGD). Air pollution may be elevated in these areas and may vary by drilling type (conventional and unconventional), production volume and gas flaring. Impacts of NGD on paediatric asthma are largely unknown. This study quantifies associations between specific NGD activities and paediatric asthma hospitalizations in Texas.

METHODS

We leveraged a database of Texas inpatient hospitalizations between 2000 and 2010 at the zip code level by quarter to examine associations between NGD and paediatric asthma hospitalizations, where our primary outcome is 0 vs ≥1 hospitalization. We used quarterly production reports to assess additional drilling-specific exposures at the zip code-level including drilling type, production and gas flaring. We developed logistic regression models to assess paediatric asthma hospitalizations by zip code-quarter-year observations, thus capturing spatiotemporal exposure patterns.

RESULTS

We observed increased odds of ≥1 paediatric asthma hospitalization in a zip code per quarter associated with increasing tertiles of NGD exposure and show that spatiotemporal variation impacts results. Conventional drilling, compared with no drilling, is associated with odds ratios up to 1.23 [95% confidence interval (CI): 1.13, 1.34], whereas unconventional drilling is associated with odds ratios up to 1.59 (95% CI: 1.46, 1.73). Increasing production volumes are associated with increased paediatric asthma hospitalizations in an exposure-response relationship, whereas associations with flaring volumes are inconsistent.

CONCLUSIONS

We found evidence of associations between paediatric asthma hospitalizations and NGD, regardless of drilling type. Practices related to production volume may be driving these positive associations.

Air quality around schools: Part I - A comprehensive literature review across high-income countries

Children are particularly vulnerable to the detrimental health impacts of poor air quality. In the UK, recent initiatives at local council level have focussed on mitigating children's air pollution exposure at school. However, an overview of the available evidence on concentration and exposure in school environments - and a summary of key knowledge gaps - has so far been lacking. To address this, we conducted a review bringing together recent academic and grey literature, relating to air quality in outdoor school environments - including playgrounds, drop-off zones, and the school commute - across high-income countries. We aimed to critically assess, synthesise, and categorise the available literature, to produce recommendations on future research and mitigating actions. Our searches initially identified 883 articles of interest, which were filtered down in screening and appraisal to a final total of 100 for inclusion. Many of the included studies focussed on nitrogen dioxide (NO₂), and particulate matter (PM) in both the coarse and fine fractions, around schools across a range of countries. Some studies also observed ozone (O₃) and volatile organic compounds (VOCs) outside schools. Our review identified evidence that children can encounter pollution peaks on the school journey, at school gates, and in school playgrounds; that nearby traffic is a key determinant of concentrations outside schools; and that factors relating to planning and urban design - such as the type of playground paving, and amount of surrounding green space - can influence school site concentrations. The review also outlines evidence gaps that can be targeted in future research. These include the need for more personal monitoring studies that distinguish between the exposure that takes place indoors and outdoors at school, and a need for a greater number of studies that conduct before-after evaluation of local interventions designed to mitigate children's exposure, such as green barriers and road closures. Finally, our review also proposes some tangible recommendations for policymakers and local leaders. The creation of clean air zones around schools; greening of school grounds; careful selection of new school sites; promotion of active travel to and from school; avoidance of major roads on the school commute; and scheduling of outdoor learning and play away from peak traffic hours, are all advocated by the evidence collated in this review.

Quantification of the Environmental Impacts of Highway Construction Using Remote Sensing Approach

Highways provide key social and economic functions but generate a wide range of environmental consequences that are poorly quantified and understood. Here, we developed a before–during–after control-impact remote sensing (BDACI-RS) approach to quantify the spatial and temporal changes of environmental impacts during and after the construction of the Wujing Highway in China using three buffer zones (0–100 m, 100–500 m, and 500–1000 m). Results showed that land cover composition experienced large changes in the 0–100 m and 100–500 m buffers while that in the 500–1000 m buffer was relatively stable. Vegetation and moisture conditions, indicated by the normalized difference vegetation index (NDVI) and the normalized difference moisture index (NDMI), respectively, demonstrated obvious degradation–recovery trends in the 0–100 m and 100–500 m buffers, while land surface temperature (LST) experienced a progressive increase. The maximal relative changes as annual means of NDVI, NDMI, and LST were about −40%, −60%, and 12%, respectively, in the 0–100m buffer. Although the mean values of NDVI, NDMI, and LST in the 500–1000 m buffer remained relatively stable during the study period, their spatial variabilities increased significantly after highway construction. An integrated environment quality index (EQI) showed that the environmental impact of the highway manifested the most in its close proximity and faded away with distance. Our results showed that the effect distance of the highway was at least 1000 m, demonstrated from the spatial changes of the indicators (both mean and spatial variability). The approach proposed in this study can be readily applied to other regions to quantify the spatial and temporal changes of disturbances of highway systems and subsequent recovery.

A review of health effects associated with exposure to jet engine emissions in and around airports

BACKGROUND

Airport personnel are at risk of occupational exposure to jet engine emissions, which similarly to diesel exhaust emissions include volatile organic compounds and particulate matter consisting of an inorganic carbon core with associated polycyclic aromatic hydrocarbons, and metals. Diesel exhaust is classified as carcinogenic and the particulate fraction has in itself been linked to several adverse health effects including cancer.

METHOD

In this review, we summarize the available scientific literature covering human health effects of exposure to airport emissions, both in occupational settings and for residents living close to airports. We also report the findings from the limited scientific mechanistic studies of jet engine emissions in animal and cell models.

RESULTS

Jet engine emissions contain large amounts of nano-sized particles, which are particularly prone to reach the lower airways upon inhalation. Size of particles and emission levels depend on type of aircraft, engine conditions, and fuel type, as well as on operation modes. Exposure to jet engine emissions is reported to be associated with biomarkers of exposure as well as biomarkers of effect among airport personnel, especially in ground-support functions. Proximity to running jet engines or to the airport as such for residential areas is associated with increased exposure and with increased risk of disease, increased hospital admissions and self-reported lung symptoms.

CONCLUSION

We conclude that though the literature is scarce and with low consistency in methods and measured biomarkers, there is evidence that jet engine emissions have physicochemical properties similar to diesel exhaust particles, and that exposure to jet engine emissions is associated with similar adverse health effects as exposure to diesel exhaust particles and other traffic emissions.

Adverse Environmental Exposure and Respiratory Health in Children

The burden imposed by pollution falls more on those living in low-income and middle-income countries, affecting children more than adults. Most air pollution results from incomplete combustion and contains a mixture of particulate matter and gases. Air pollution exposure has negative impacts on respiratory health. This article concentrates on air pollution in 2 settings, the child's home and the ambient environment. There is an inextricable 2-way link between air pollution and climate change, and the effects of climate change on childhood respiratory health also are discussed.

The relationship between personal exposure and ambient PM2.5 and black carbon in Beijing

This study is part of the "Air Polluion Impacts on Cardiopulmonary disease in Beijing: an integrated study of Exposure Science, Toxicologenomics & Environmental Epidemiology (APIC-ESTEE)" project under the UK-China joint research programme "Atmospheric Pollution and Human Health in a Chinese Megacity (APHH-China)". The aim is to capture the spatio-temporal variability in people's exposure to fine particles (PM_2.5) and black carbon (BC) air pollution in Beijing, China. A total of 120 students were recruited for a panel study from ten universities in Haidian District in northwestern Beijing from December 2017 to June 2018. Real-time personal concentrations of PM_2.5 and BC were measured over a 24-h period with two research-grade portable personal exposure monitors. Personal microenvironments (MEs) were determined by applying an algorithm to the handheld GPS unit data. On average, the participants spent the most time indoors (79% in Residence and 16% in Workplace), and much less time travelling by Walking, Cycling, Bus and Metro. Similar patterns were observed across participant gender and body-mass index classifications. The participants were exposed to 33.8 ± 27.8 μg m^-3 PM_2.5 and to 1.9 ± 1.2 μg m^-3 BC over the 24-h monitoring period, on average 24.3 μg m^-3 (42%) and 0.8 μg m^-3 (28%) lower, respectively, than the concurrent fixed-site ambient measurements. Relative differences between personal and ambient BC concentrations showed greater variability across the MEs, highlighting significant contributions from Dining and travelling by Bus, which involve potential combustion of fuels. This study demonstrates the potential value of personal exposure monitoring in investigating air pollution related health effects, and in evaluating the effectiveness of pollution control and intervention measures.

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

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

Associations of ambient air pollutants with airway and allergic symptoms in 13,335 preschoolers in Shanghai, China

Findings are inconsistent in studies for impacts of outdoor air pollutants on airway health in childhood. In this paper, we collected data regarding airway and allergic symptoms in the past year before a survey in 13,335 preschoolers from a cross-sectional study. Daily averaged concentrations of ambient sulphur dioxide (SO₂), nitrogen dioxide (NO₂), and particulate matter with an aerodynamic diameter ≤10 μm (PM₁₀) in the past year before the survey were collected in the kindergarten-located district. We investigated associations of 12-month average concentrations of these pollutants with childhood airway and allergic symptoms. In the two-level (district-child) logistic regression analyses, exposure to higher level of NO₂ and of PM₁₀ increased odds of wheeze symptoms (adjusted OR, 95%CI: 1.03, 1.01-1.05 for per 3.0 μg/m³ increase in NO₂; 1.22, 1.09-1.39 for per 7.6 μg/m³ increase in PM₁₀), wheeze with a cold (1.03, 1.01-1.06; 1.22, 1.08-1.39), dry cough during night (1.05, 1.03-1.08; 1.23, 1.09-1.40), rhinitis symptoms (1.11, 1.08-1.13; 1.32, 1.07-1.63), rhinitis on pet (1.11, 1.05-1.18; 1.37, 0.95-1.98) and pollen (1.12, 1.03-1.21; 1.23, 0.84-1.82) exposure, eczema symptoms (1.09, 1.05-1.12; 1.22, 0.98-1.52), and lack of sleep due to eczema (1.12, 1.07-1.18; 1.58, 1.25-1.98). Exposures to NO₂ and PM₁₀ were also significantly and positively associated with the accumulative score of airway symptoms. Similar positive associations were found of NO₂ and of PM₁₀ with the individual symptoms and symptom scores among preschoolers from different kindergarten-located district. These results indicate that ambient NO₂ and PM₁₀ likely are risk factors for airway and allergic symptoms in childhood in Shanghai, China.

Bayesian analysis of the short-term association of NO2 exposure with local burden of asthmatic symptoms in children

Short-term exposure to air pollution has been associated with exacerbation of respiratory diseases such as asthma. Substantial heterogeneity in effect estimates has been observed between previous studies. This study aims to quantify the local burden of daily asthma symptoms in asthmatic children in a medium-sized city. Air pollution exposure was estimated using the nearest sensor in a fine resolution urban air quality sensor network in the city of Eindhoven, the Netherlands. Bayesian estimates of the exposure response function were obtained by updating a priori information from a meta-analysis with data from a panel study using a daily diary. Five children participated in the panel study, resulting in a total of 400 daily diary records. Positive associations between NO₂ and lower respiratory symptoms and medication use were observed. The odds ratio for any lower respiratory symptoms was 1.07 (95% C.I. 0.92, 1.28) expressed per 10 μg m^-3 for current day NO₂ concentration, using data from the panel study only (uninformative prior). Odds ratios for dry cough and phlegm were close to unity. The pattern of associations agreed well with the updated meta-analysis. The meta-analytic random effects summary estimate was 1.05 (1.02, 1.07) for LRS. Credible intervals substantially narrowed when adding prior information from the meta-analysis. The odds ratio for lower respiratory symptoms with an informative prior was 1.06 (0.99, 1.14). Burden of disease maps showed a strong spatial variability in the number of asthmatic symptoms associated with ambient NO₂ derived from a regression kriging model. In total, 70 cases of asthmatic symptoms can daily be associated with NO₂ exposure in the city of Eindhoven. We conclude that Bayesian estimates are useful in estimation of specific local air pollution effect estimates and subsequent local burden of disease calculations. With the fine resolution air quality network, neighborhood-specific burden of asthmatic symptoms was assessed.

Outdoor Air Pollution and New-Onset Airway Disease. An Official American Thoracic Society Workshop Report

Although it is well accepted that air pollution exposure exacerbates preexisting airway disease, it has not been firmly established that long-term pollution exposure increases the risk of new-onset asthma or chronic obstruction pulmonary disease (COPD). This Workshop brought together experts on mechanistic, epidemiological, and clinical aspects of airway disease to review current knowledge regarding whether air pollution is a causal factor in the development of asthma and/or COPD. Speakers presented recent evidence in their respective areas of expertise related to air pollution and new airway disease incidence, followed by interactive discussions. A writing committee summarized their collective findings. The Epidemiology Group found that long-term exposure to air pollution, especially metrics of traffic-related air pollution such as nitrogen dioxide and black carbon, is associated with onset of childhood asthma. However, the evidence for a causal role in adult-onset asthma or COPD remains insufficient. The Mechanistic Group concluded that air pollution exposure can cause airway remodeling, which can lead to asthma or COPD, as well as asthma-like phenotypes that worsen with long-term exposure to air pollution, especially fine particulate matter and ozone. The Clinical Group concluded that air pollution is a plausible contributor to the onset of both asthma and COPD. Available evidence indicates that long-term exposure to air pollution is a cause of childhood asthma, but the evidence for a similar determination for adult asthma or COPD remains insufficient. Further research is needed to elucidate the exact biological mechanism underlying incident childhood asthma, and the specific air pollutant that causes it.

Personal level exposure and hazard potential of particulate matter during haze and non-haze periods in Singapore

Severe haze episodes originating from biomass burning are common in Southeast Asia. However, there is a paucity of data on the personal exposure and characteristics of Particulate Matter (PM) present in ambient air during haze and non-haze periods. Aims of this study were to monitor 24 h ambulatory exposure to PM among school children in Singapore; characterize haze and non-haze PM for their physicochemical properties, cytotoxicity and inflammatory potential, using bronchial epithelial cell culture model (BEAS-2B). Forty-six children had ambulatory PM exposure monitored using portable Aethalometer and their hourly activity recorded. The mean (±SE) PM exposure on a typical school day was 3343 (±174.4) ng/m³/min. Higher PM exposure was observed during haze periods and during commuting to and from the school. Characterization of PM collected showed a drastic increase in the proportion of ultrafine particle (UFP) in haze PM. These PM fraction showed higher level of sulphur, potassium and trace metals in comparison to those collected during non-haze periods. Dose dependent increases in abiotic reactive oxygen species generation, activation of NF-κB and cytotoxicity were observed for both haze and non-haze PM. Generally, haze PM induced significantly higher release of IL-6, IL-8 and TNFα by BEAS-2B cells in comparison to non-haze PM. In summary, this study provides experimental evidence for higher PM exposure during haze period which has the potential to elicit oxidative stress and pro-inflammatory cytokine release from airway epithelial cells.

Estimating exposure to fine particulate matter emissions from vehicle traffic: Exposure misclassification and daily activity patterns in a large, sprawling region

Vehicle traffic is responsible for a significant portion of toxic air pollution in urban areas that has been linked to a wide range of adverse health outcomes. Most vehicle air quality analyses used for transportation planning and health effect studies estimate exposure from the measured or modeled concentration of an air pollutant at a person's home. This study evaluates exposure to fine particulate matter from vehicle traffic and the magnitude and cause of exposure misclassification that result from not accounting for population mobility during the day in a large, sprawling region. We develop a dynamic exposure model by integrating activity-based travel demand, vehicle emission, and air dispersion models to evaluate the magnitude, components and spatial patterns of vehicle exposure misclassification in the Atlanta, Georgia metropolitan area. Overall, we find that population exposure estimates increase by 51% when population mobility is accounted for. Errors are much larger in suburban and rural areas where exposure is underestimated while exposure may be overestimated near high volume roadways and in the urban core. Exposure while at work and traveling account for much of the error. We find much larger errors than prior studies, all of which have focused on more compact urban regions. Since many people spend a large part of their day away from their homes and vehicle emissions are known to create "hotspots" along roadways, home-based exposure is unlikely to be a robust estimator of a person's actual exposure. Accounting for population mobility in vehicle emission exposure studies may reveal more effective mitigation strategies, important differences in exposure between population groups with different travel patterns, and reduce exposure misclassification in health studies.

Application of land use regression to assess exposure and identify potential sources in PM2.5, BC, NO2 concentrations

BACKGROUND

Understanding spatial variation of air pollution is critical for public health assessments. Land Use Regression (LUR) models have been used increasingly for modeling small-scale spatial variation in air pollution concentrations. However, they have limited application in China due to the lack of spatially resolved data.

OBJECTIVE

Based on purpose-designed monitoring networks, this study developed LUR models to predict fine particulate matter (PM_2.5), black carbon (BC) and nitrogen dioxide (NO₂) exposure and to identify their potential outdoor-origin sources within an urban/rural region, using Taizhou, China as a case study.

METHOD

Two one-week integrated samples were collected at 30 PM_2.5 (BC) sites and 45 NO₂ sites in each two distinct seasons. Samples of 1/3 of the sites were collected simultaneously. Annual adjusted average was calculated and regressed against pre-selected GIS-derived predictor variables in a multivariate regression model.

RESULTS

LUR explained 65% of the spatial variability in PM_2.5, 78% in BC and 73% in NO₂. Mean (±Standard Deviation) of predicted PM_2.5, BC and NO₂ exposure levels were 48.3 (±6.3) μg/m³, 7.5 (±1.4) μg/m³ and 27.3 (±8.2) μg/m³, respectively. Weak spatial corrections (Pearson r = 0.05-0.25) among three pollutants were observed, indicating the presence of different sources. Regression results showed that PM_2.5, BC and NO₂ levels were positively associated with traffic variables. The former two also increased with farm land use; and higher NO₂ levels were associated with larger industrial land use. The three pollutants were correlated with sources at a scale of ≤5 km and even smaller scales (100-700m) were found for BC and NO₂.

CONCLUSION

We concluded that based on a purpose-designed monitoring network, LUR model can be applied to predict PM_2.5, NO₂ and BC concentrations in urban/rural settings of China. Our findings highlighted important contributors to within-city heterogeneity in outdoor-generated exposure, and indicated traffic, industry and agriculture may significantly contribute to PM_2.5, NO₂ and BC concentrations.

Targeting Vitamin D Deficiency to Limit Exacerbations in Respiratory Diseases: Utopia or Strategy With Potential?

Patients with respiratory diseases such as cystic fibrosis, chronic obstructive pulmonary disease, or asthma often experience an acute worsening of respiratory symptoms, termed exacerbations. Although the course of exacerbations is disease specific, they are mostly triggered by a respiratory infection. Exacerbations often require hospitalization and are an important cause of mortality. Treatments of exacerbations aim to minimize the negative impact and to prevent subsequent events. Despite many existing therapy options, many patients do not benefit from therapy and suffer from recurrent events. Vitamin D deficiency is a worldwide problem and is extremely prevalent in these patients. Vitamin D, known for its calcemic effects, also has immunomodulatory and anti-infectious actions and can therefore be a possible agent to treat or prevent exacerbations. This review will focus on vitamin D as a potential candidate to treat or prevent exacerbations in CF, COPD, and asthma.

Classroom indoor PM2.5 sources and exposures in inner-city schools

Children spend over 6 h a day in schools and have higher asthma morbidity from school environmental exposures. The present study aims to determine indoor and outdoor possible sources affecting indoor PM_2.5 in classrooms. Weeklong indoor PM_2.5 samples were collected from 32 inner-city schools from a Northeastern U.S. community during three seasons (fall, winter and spring) during the years 2009 to 2013. Concurrently, daily outdoor PM_2.5 samples were taken at a central monitoring site located at a median distance of 4974 m (range 1065-11,592 m) from the schools. Classroom indoor concentrations of PM_2.5 (an average of 5.2 μg/m³) were lower than outdoors (an average of 6.5 μg/m³), and these averages were in the lower range compared to the findings in other schools' studies. The USEPA PMF model was applied to the PM_2.5 components measured simultaneously from classroom indoor and outdoor to estimate the source apportionment. The major sources (contributions) identified across all seasons of indoor PM_2.5 were secondary pollution (41%) and motor vehicles (17%), followed by Calcium (Ca)-rich particles (12%), biomass burning (15%), soil dust (6%), and marine aerosols (4%). Likewise, the major sources of outdoor PM_2.5 across all seasons were secondary pollution (41%) and motor vehicles (26%), followed by biomass burning (17%), soil dust (7%), road dust (3%), and marine aerosols (1%). Secondary pollution was the greatest contributor to indoor and outdoor PM_2.5 over all three seasons, with the highest contribution during spring with 53% to indoor PM_2.5 and 45% to outdoor PM_2.5. Lower contributions of this source during fall and winter are most likely attributed to less infiltration indoors. In contrast, the indoor contribution of motor vehicles source was highest in the fall (29%) and winter (25%), which was presumably categorized by a local source. From the relationship between indoor-to-outdoor sulfur ratios and each source contribution, we also estimated the local and regional influence on indoor PM_2.5 concentration. Overall, the observed differences to indoor PM_2.5 are related to seasonality, and the distinct characteristics and behavior of each classroom/school.

Characteristics of PM2.5 and Black Carbon Exposure Among Subway Workers

This study aimed to assess the characteristics of exposure to both PM_2.5 and black carbon (BC) among subway workers. A total of 61 subway workers, including 26, 23, and 12 subway station managers, maintenance engineers, and train drivers, respectively, were investigated in 2018. Real-time measurements of airborne PM_2.5 and BC were simultaneously conducted around the breathing zones of workers. Maintenance engineers had the highest average levels of exposure to both PM_2.5 and BC (PM_2.5, 76 µg/m³; BC, 9.3 µg/m³), followed by train drivers (63.2 µg/m³, 5.9 µg/m³) and subway station managers (39.7 µg/m³, 2.2 µg/m³). In terms of the relationship between mass concentrations of PM_2.5 and BC, train drivers demonstrated the strongest correlation (R = 0.72), indicating that the proportion of BC contained in PM_2.5 is relatively steady. The average proportion of BC in PM_2.5 among maintenance engineers (13.0%) was higher than that among train drivers (9.4%) and subway station managers (6.4%). Univariate and mixed effect multiple analyses demonstrated the type of task and worksite to be significant factors affecting exposure levels in maintenance engineers and subway station managers. The use of diesel engine motorcars in tunnel maintenance was found to be a key contributor to PM_2.5 and BC exposure levels among subway workers.

Ambient air pollution exposure and risk and progression of interstitial lung abnormalities: the Framingham Heart Study

BACKGROUND

Ambient air pollution accelerates lung function decline among adults, however, there are limited data about its role in the development and progression of early stages of interstitial lung disease.

AIMS

To evaluate associations of long-term exposure to traffic and ambient pollutants with odds of interstitial lung abnormalities (ILA) and progression of ILA on repeated imaging.

METHODS

We ascertained ILA on chest CT obtained from 2618 Framingham participants from 2008 to 2011. Among 1846 participants who also completed a cardiac CT from 2002 to 2005, we determined interval ILA progression. We assigned distance from home address to major roadway, and the 5-year average of fine particulate matter (PM_2.5), elemental carbon (EC, a traffic-related PM_2.5 constituent) and ozone using spatio-temporal prediction models. Logistic regression models were adjusted for age, sex, body mass index, smoking status, packyears of smoking, household tobacco exposure, neighbourhood household value, primary occupation, cohort and date.

RESULTS

Among 2618 participants with a chest CT, 176 (6.7%) had ILA, 1361 (52.0%) had no ILA, and the remainder were indeterminate. Among 1846 with a preceding cardiac CT, 118 (6.4%) had ILA with interval progression. In adjusted logistic regression models, an IQR difference in 5-year EC exposure of 0.14 µg/m³ was associated with a 1.27 (95% CI 1.04 to 1.55) times greater odds of ILA, and a 1.33 (95% CI 1.00 to 1.76) times greater odds of ILA progression. PM_2.5 and O₃ were not associated with ILA or ILA progression.

CONCLUSIONS

Exposure to EC may increase risk of progressive ILA, however, associations with other measures of ambient pollution were inconclusive.

Exposure to air pollution is associated with adverse cardiopulmonary health effects in international travellers

BACKGROUND

With the number of annual global travellers reaching 1.2 billion, many individuals encounter greater levels of air pollution when they travel abroad to megacities around the world. This study's objective was to determine if visits to cities abroad with greater levels of air pollution adversely impact cardiopulmonary health.

METHODS

A total of 34 non-smoking healthy adult participants who travelled abroad to selected cities from the New York City (NYC) metropolitan area were pre-trained to measure lung function, blood pressure and heart rate (HR)/HR variability (HRV) and record symptoms before, during and after travelling abroad. Outdoor particulate matter (PM)2.5 concentrations were obtained from central monitors in each city. Associations between PM exposure concentrations and cardiopulmonary health endpoints were analysed using a mixed effects statistical design.

RESULTS

East and South Asian cities had significantly higher PM2.5 concentrations compared with pre-travel NYC PM2.5 levels, with maximum concentrations reaching 503 μg/m3. PM exposure-related associations for lung function were statistically significant and strongest between evening Forced Expiratory Volume in the first second (FEV1) and same-day morning PM2.5 concentrations; a 10-μg/m3 increase in outdoor PM2.5 was associated with a mean decrease of 7 mL. Travel to a highly polluted city (PM2.5 > 100 μg/m3) was associated with a 209-ml reduction in evening FEV1 compared with a low polluted city (PM2.5 < 35 μg/m3). In general, participants who travelled to East and South Asian cities experienced increased respiratory symptoms/scores and changes in HR and HRV.

CONCLUSIONS

Exposure to increased levels of PM2.5 in cities abroad caused small but statistically significant acute changes in cardiopulmonary function and respiratory symptoms in healthy young adults. These data suggest that travel-related exposure to increased PM2.5 adversely impacts cardiopulmonary health, which may be particularly important for travellers with pre-existing respiratory or cardiac disease.

Evaluation of the Impact of Black Carbon on the Worsening of Allergic Respiratory Diseases in the Region of Western Serbia: A Time-Stratified Case-Crossover Study

Background and Objectives: Many epidemiological studies have shown a positive association between black carbon (BC) and the exacerbation of allergic rhinitis and allergic asthma. However, none of the studies in Serbia examined this relationship yet. The aim of this study was to examine the associations between BC and emergency department (ED) visits for allergic rhinitis and allergic asthma in the Užice region of Serbia. Materials and Methods: A time-stratified case-crossover design was applied to 523 ED visits for allergic rhinitis and asthma exacerbation that occurred in the Užice region of Serbia between 2012–2014. Data regarding ED visits were routinely collected in the Health Center of Užice. The daily average concentrations of BC were measured by automatic ambient air quality monitoring stations. Odds ratios (ORs) and their corresponding 95% confidence intervals (CIs) were estimated using conditional logistic regression adjusted for the potential confounding influence of weather variables (temperature, humidity, and air pressure). Results: Statistically significant associations were observed between ED visits for allergic rhinitis and 2-day lagged exposure to BC (OR = 3.20; CI = 1.00–10.18; p = 0.049) and allergic asthma and 3-day lagged exposure to BC (OR = 3.23; CI = 1.05–9.95; p = 0.041). Conclusion: Exposure to BC in the Užice region increases the risk of ED visits for allergic rhinitis and asthma, particularly during the heating season.

Metabolic Syndrome Biomarkers of World Trade Center Airway Hyperreactivity: A 16-Year Prospective Cohort Study

Airway hyperreactivity (AHR) related to environmental exposure is a significant public health risk worldwide. Similarly, metabolic syndrome (MetSyn), a risk factor for obstructive airway disease (OAD) and systemic inflammation, is a significant contributor to global adverse health. This prospective cohort study followed N = 7486 World Trade Center (WTC)-exposed male firefighters from 11 September 2001 (9/11) until 1 August 2017 and investigated N = 539 with newly developed AHR for clinical biomarkers of MetSyn and compared them to the non-AHR group. Male firefighters with normal lung function and no AHR pre-9/11 who had blood drawn from 9 September 2001–24 July 2002 were assessed. World Trade Center-Airway Hyperreactivity (WTC-AHR) was defined as either a positive bronchodilator response (BDR) or methacholine challenge test (MCT). The electronic medical record (EMR) was queried for their MetSyn characteristics (lipid profile, body mass index (BMI), glucose), and routine clinical biomarkers (such as complete blood counts). We modeled the association of MetSyn characteristics at the first post-9/11 exam with AHR. Those with AHR were significantly more likely to be older, have higher BMIs, have high intensity exposure, and have MetSyn. Smoking history was not associated with WTC-AHR. Those present on the morning of 9/11 had 224% increased risk of developing AHR, and those who arrived in the afternoon of 9/11 had a 75.9% increased risk. Having ≥3 MetSyn parameters increased the risk of WTC-AHR by 65.4%. Co-existing MetSyn and high WTC exposure are predictive of future AHR and suggest that systemic inflammation may be a contributor.

Advancing environmental exposure assessment science to benefit society

Awareness of the human health impacts of exposure to air pollution is growing rapidly. For example, it has become evident that the adverse health effects of air pollution are more pronounced in disadvantaged populations. Policymakers in many jurisdictions have responded to this evidence by enacting initiatives that lead to lower concentrations of air pollutants, such as urban traffic restrictions. In this review, we focus on the interplay between advances in environmental exposure assessment and developments in policy. We highlight recent progress in the granular measurement of air pollutants and individual-level exposures, and how this has enabled focused local policy actions. Finally, we detail an illustrative study designed to link individual-level health-relevant exposures with economic, behavioral, biological, familial, and environmental variables.

Developing a geostatistical simulation method to inform the quantity and placement of new monitors for a follow-up air sampling campaign

Sampling campaign design is a crucial aspect of air pollution exposure studies. Selection of both monitor numbers and locations is important for maximizing measured information, while minimizing bias and costs. We developed a two-stage geostatistical-based method using pilot NO₂ samples from Lanzhou, China with the goal of improving sample design decision-making, including monitor numbers and spatial pattern. In the first step, we evaluate how additional monitors change prediction precision through minimized kriging variance. This was assessed in a Monte Carlo fashion by adding up to 50 new monitors to our existing sites with assigned concentrations based on conditionally simulated NO₂ surfaces. After identifying a number of additional sample sites, a second step evaluates their potential placement using a similar Monte Carlo scheme. Evaluations are based on prediction precision and accuracy. Costs are also considered in the analysis. It was determined that adding 28-locations to the existing Lanzhou NO₂ sampling campaign captured 73.5% of the total kriged variance improvement and resulted in predictions that were on average within 10.9 μg/m³ of measured values, while using 56% of the potential budget. Additional monitor sites improved kriging variance in a nonlinear fashion. This method development allows for informed sampling design by quantifying prediction improvement (accuracy and precision) against the costs of monitor deployment.

Children environmental exposure to particulate matter and polycyclic aromatic hydrocarbons and biomonitoring in school environments: A review on indoor and outdoor exposure levels, major sources and health impacts

Children, an important vulnerable group, spend most of their time at schools (up to 10 h per day, mostly indoors) and the respective air quality may significantly impact on children health. Thus, this work reviews the published studies on children biomonitoring and environmental exposure to particulate matter (PM) and polycyclic aromatic hydrocarbons (PAHs) at school microenvironments (indoors and outdoors), major sources and potential health risks. A total of 28, 35, and 31% of the studies reported levels that exceeded the international outdoor ambient air guidelines for PM₁₀, PM_2.5, and benzo(a)pyrene, respectively. Indoor and outdoor concentrations of PM₁₀ at European schools, the most characterized continent, ranged between 7.5 and 229 μg/m³ and 21-166 μg/m³, respectively; levels of PM_2.5 varied between 4 and 100 μg/m³ indoors and 6.1-115 μg/m³ outdoors. Despite scarce information in some geographical regions (America, Oceania and Africa), the collected data clearly show that Asian children are exposed to the highest concentrations of PM and PAHs at school environments, which were associated with increased carcinogenic risks and with the highest values of urinary total monohydroxyl PAH metabolites (PAH biomarkers of exposure). Additionally, children attending schools in polluted urban and industrial areas are exposed to higher levels of PM and PAHs with increased concentrations of urinary PAH metabolites in comparison with children from rural areas. Strong evidences demonstrated associations between environmental exposure to PM and PAHs with several health outcomes, including increased risk of asthma, pulmonary infections, skin diseases, and allergies. Nevertheless, there is a scientific gap on studies that include the characterization of PM fine fraction and the levels of PAHs in the total air (particulate and gas phases) of indoor and outdoor air of school environments and the associated risks for the health of children. There is a clear need to improve indoor air quality in schools and to establish international guidelines for exposure limits in these environments.

The Australian Child Health and Air Pollution Study (ACHAPS): A national population-based cross-sectional study of long-term exposure to outdoor air pollution, asthma, and lung function

Most studies of long-term air pollution exposure and children's respiratory health have been performed in urban locations with moderate pollution levels. We assessed the effect of outdoor nitrogen dioxide (NO₂), as a proxy for urban air pollution, on current asthma and lung function in Australia, a low-pollution setting. We undertook a national population-based cross-sectional study of children aged 7-11 years living in 12 Australian cities. We collected information on asthma symptoms from parents via questionnaire and measured children's lung function (forced expiratory volume in 1 s [FEV₁], forced vital capacity [FVC]) and fractional exhaled nitric oxide [Fe_NO]). We estimated recent NO₂ exposure (last 12 months) using monitors near each child's school, and used a satellite-based land-use regression (LUR) model to estimate NO₂ at each child's school and home. Our analysis comprised 2630 children, among whom the prevalence of current asthma was 14.9%. Mean (±SD) NO₂ exposure was 8.8 ppb (±3.2) and 8.8 ppb (±2.3) for monitor- and LUR-based estimates, respectively. Mean percent predicted post-bronchodilator FEV₁ and FVC were 101.7% (±10.5) and 98.8% (±10.5), respectively. The geometric mean Fe_NO concentration was 9.4 ppb (±7.1). An IQR increase in NO₂ (4.0 ppb) was significantly associated with increased odds of having current asthma; odds ratios (ORs) were 1.24 (95% CI: 1.08, 1.43) and 1.54 (95% CI: 1.26, 1.87) for monitor- and LUR-based estimates, respectively. Increased NO₂ exposure was significantly associated with decreased percent predicted FEV₁ (-1.35 percentage points [95% CI: -2.21, -0.49]) and FVC (-1.19 percentage points [95% CI: -2.04, -0.35], and an increase in Fe_NO of 71% (95% CI: 38%, 112%). Exposure to outdoor NO₂ was associated with adverse respiratory health effects in this population-based sample of Australian children. The relatively low NO₂ levels at which these effects were observed highlight the potential benefits of continuous exposure reduction.

Characteristics of peak concentrations of black carbon encountered by elementary school children

The objectives of this study were to examine characteristics of peak concentrations, including frequency, duration, and relative magnitude, and estimate its contributions to overall daily exposure to BC by activity and microenvironment. We assessed daily personal exposures from August 2015 to January 2016 (75.2% of weekdays and 24.8% of weekend days; 64.1% of school days and 35.9% of holidays) among forty 10-12 years old children living in the Seoul metropolitan area. These children were equipped with a microaethalometer (BC monitor) and recorded a time-activity diary. Pre-administrated questionnaires and follow-up interviews also provided information on children's time-activity patterns. Owing to the absence of a generally accepted threshold, peaks were alternatively defined as BC concentrations higher TWA, the 95th percentile, and the 99th percentile. Peak concentrations made substantial contributions to total daily exposure to BC (peaks ≥ TWA: 60%, peaks ≥95th-percentile: 19%, and peaks ≥99th-percentile: 6%). Average peak levels higher than TWA and the 95th percentile differed significantly by activity and ME. Transportation and cooking led to frequent peak occurrences which disproportionately contributed to daily integrated exposure relative to time spent in these activities. Walking was characterized by occasional brief but high-magnitude peaks exceeding the 99th percentile, which produced the most intense potential dose (0.09% of daily time spent on walking accounted for 1.6% of daily potential dose). It might be attributed to encounters with high emissions sources such as passing/idling vehicles and environmental tobacco smoke. Trips by diesel vehicle produced frequently occurring and long-duration peaks above the 95th percentile that contributed 2% to total daily exposure (corresponding time: 0.3%). Charbroiling meat incurred sustained peaks as intense as those in trips by diesel vehicles. Peaks during commuting showed relatively high exposure intensity on weekdays, possibly because of increased surrounding traffic volume on these days, while those during cooking accounted for a more elevated residential contribution to daily integrated exposure.

RISK EFFECTS OF NEAR-ROADWAY POLLUTANTS AND ASTHMA STATUS ON BRONCHITIC SYMPTOMS IN CHILDREN

Supplemental Digital Content is available in the text.

Background:

Bronchitic symptoms in children pose a significant clinical and public health burden. Exposures to criteria air pollutants affect bronchitic symptoms, especially in children with asthma. Less is known about near-roadway exposures.

Methods:

Bronchitic symptoms (bronchitis, chronic cough, or phlegm) in the past 12 months were assessed annually with 8 to 9 years of follow-up on 6757 children from the southern California Children’s Health Study. Residential exposure to freeway and non-freeway near-roadway air pollution was estimated using a line-source dispersion model. Mixed-effects logistic regression models were used to relate near-roadway air pollutant exposures to bronchitic symptoms among children with and without asthma.

Results:

Among children with asthma, a 2 SD increase in non-freeway exposures (odds ratio [OR]: 1.44; 95% confidence interval [CI]: 1.17, 1.78) and freeway exposures (OR: 1.31; 95% CI: 1.06, 1.60) were significantly associated with increased risk of bronchitic symptoms. Among children without asthma, only non-freeway exposures had a significant association (OR: 1.14; 95% CI: 1.00, 1.29). Associations were strongest among children living in communities with lower regional particulate matter.

Conclusions:

Near-roadway air pollution was associated with bronchitic symptoms, especially among children with asthma and those living in communities with lower regional particulate matter. Better characterization of traffic pollutants from non-freeway roads is needed since many children live in close proximity to this source.

Effects of personal air pollution exposure on asthma symptoms, lung function and airway inflammation

BACKGROUND

There is evidence that air pollution increases the risk of asthma hospitalizations and healthcare utilization, but the effects on day-to-day asthma control are not fully understood.

OBJECTIVE

We undertook a prospective single-centre panel study to test the hypothesis that personal air pollution exposure is associated with asthma symptoms, lung function and airway inflammation.

METHODS

Thirty-two patients with a clinical diagnosis of asthma were provided with a personal air pollution monitor (Cairclip NO₂ /O₃ ) which was kept on or around their person throughout the 12-week follow-up period. Ambient levels of NO₂ and particulate matter were modelled based upon satellite imaging data. Directly measured ozone, NO₂ and particulate matter levels were obtained from a monitoring station in central Leicester. Participants made daily electronic records of asthma symptoms, peak expiratory flow and exhaled nitric oxide. Spirometry and asthma symptom questionnaires were completed at fortnightly study visits. Data were analysed using linear mixed effects models and cross-correlation.

RESULTS

Cairclip exposure data were of good quality with clear evidence of diurnal variability and a missing data rate of approximately 20%. We were unable to detect consistent relationships between personal air pollution exposure and clinical outcomes in the group as a whole. In an exploratory subgroup analysis, total oxidant exposure was associated with increased daytime symptoms in women but not men.

CONCLUSIONS AND CLINICAL RELEVANCE

We did not find compelling evidence that air pollution exposure impacts on day-to-day clinical control in an unselected asthma population, but further studies are required in larger populations with higher exposure levels. Women may be more susceptible than men to the effects of air pollution, an observation which requires confirmation in future studies.

Low Dose Carbon Black Nanoparticle Exposure Does Not Aggravate Allergic Airway Inflammation in Mice Irrespective of the Presence of Surface Polycyclic Aromatic Hydrocarbons

Exposure to exogenous noxae, such as particulate matter, can trigger acute aggravations of allergic asthma—a chronic inflammatory airway disease. We tested whether Carbon Black nanoparticles (CBNP) with or without surface polycyclic aromatic hydrocarbons (PAH) aggravate an established allergic airway inflammation in mice. In an ovalbumin mouse model, Printex^®90 (P90), P90 coated with benzo[a]pyrene (P90-BaP) or 9-nitroanthracene (P90-9NA), or acetylene soot exhibiting a mixture of surface PAH (AS-PAH) was administered twice (70 µL, 100 µg/mL) during an established allergic airway inflammation. We analyzed the immune cell numbers and chemokine/cytokine profiles in bronchoalveolar lavages, the mRNA expressions of markers for PAH metabolism (Cyp1a1, 1b1), oxidative stress (HO-1, Gr, Gpx-3), inflammation (KC, Mcp-1, IL-6, IL-13, IL-17a), mucin synthesis (Muc5ac, Muc5b), the histology of mucus-producing goblet cells, ciliary beat frequency (CBF), and the particle transport speed. CBNP had a comparable primary particle size, hydrodynamic diameter, and ζ-potential, but differed in the specific surface area (P90 > P90-BaP = P90-9NA = AS-PAH) and surface chemistry. None of the CBNP tested increased any parameter related to inflammation. The unmodified P90, however, decreased the tracheal CBF, decreased the Muc5b in intrapulmonary airways, but increased the tracheal Muc5ac. Our results demonstrated that irrespective of the surface PAH, a low dose of CBNP does not acutely aggravate an established allergic airway inflammation in mice.

Air Pollution and Other Environmental Modulators of Cardiac Function

Cardiovascular disease (CVD) is the leading cause of death in developed regions and a worldwide health concern. Multiple external causes of CVD are well known, including obesity, diabetes, hyperlipidemia, age, and sedentary behavior. Air pollution has been linked with the development of CVD for decades, though the mechanistic characterization remains unknown. In this comprehensive review, we detail the background and epidemiology of the effects of air pollution and other environmental modulators on the heart, including both short- and long-term consequences. Then, we provide the experimental data and current hypotheses of how pollution is able to cause the CVD, and how exposure to pollutants is exacerbated in sensitive states. Published 2017. Compr Physiol 7:1479-1495, 2017.

Ultrafine particles and black carbon personal exposures in asthmatic and non-asthmatic children at school age

Traffic-related air pollution (TRAP) exposure during childhood is associated with asthma; however, the contribution of the different TRAP pollutants in each microenvironment (home, school, transportation, others) in asthmatic and non-asthmatic children is unknown. Daily (24-h) personal black carbon (BC), ultrafine particle (UFP), and alveolar lung-deposited surface area (LDSA) individual exposure measurements were obtained from 100 children (29 past and 21 current asthmatics, 50 non-asthmatics) aged 9±0.7 years from the INMA-Sabadell cohort (Catalonia, Spain). Time spent in each microenvironment was derived by the geolocation provided by the smartphone and a new spatiotemporal map-matching algorithm. Asthmatics and non-asthmatics spent the same amount of time at home (60% and 61%, respectively), at school (20% and 23%), on transportation (8% and 7%), and in other microenvironments (7% and 5%). The highest concentrations of all TRAPs were attributed to transportation. No differences in TRAP concentrations were found overall or by type of microenvironment between asthmatics and non-asthmatics, nor when considering past and current asthmatics, separately. In conclusion, asthmatic and non-asthmatic children had a similar time-activity pattern and similar average exposures to BC, UFP, and LDSA concentrations. This suggests that interventions should be tailored to general population, rather than to subgroups defined by disease.

Evaluation of Sources and Patterns of Elemental Composition of PM2.5 at Three Low-Income Neighborhood Schools and Residences in Quito, Ecuador

Elemental characterization of fine particulate matter was undertaken at schools and residences in three low income neighborhoods in Quito, Ecuador. The three zones were located in the northern (Cotocollao), south central (El Camal), and south east (Los Chillos) neighborhoods and were classified as zones 1–3, respectively. Forty elements were quantified via ICP-MS analysis. Amongst the geogenic elements, the concentration of Si was the most abundant followed by S, Al, and Ca. Elements with predominantly anthropogenic sources such as Zn, V, and Ni were higher in zone 3 school followed by zone 2 and zone 1 schools. Enrichment factors were calculated to study the role of crustal sources in the elemental concentrations. Geogenic elements, except K, all had values <10 and anthropogenic elements such as Ni, V, Zn, Pb, As, Cr had >10. Principal Component Analysis suggested that Ni and V concentrations were strongly attributable to pet coke and heavy oil combustion. Strong associations between As and Pb could be attributed to traffic and other industrial emissions. Resuspended dust, soil erosion, vehicular emissions (tailpipe, brake and tire wear, and engine abrasion), pet coke, heavy oil combustion, and heavy industrial operations were major contributors to air pollution.

Physical activity, black carbon exposure, and DNA methylation in the FOXP3 promoter

Background

Physical activity is associated with improvement in lung function; however, pollution exposure during physical activity can lead to a transient reduction in lung function. This paradoxical relationship may be linked to altered T regulatory (Treg) cell activity, which increases with exercise and suppresses airway inflammation, but decreases in association with exposure to air pollution. To clarify these relationships, we investigated buccal cell DNA methylation of the forkhead box p3 (FOXP3) gene promoter, a proposed biomarker of Treg activity. We hypothesized that active urban children would have lower FOXP3 promoter methylation, associated with better lung function compared to non-active children. We also hypothesized that this relationship would be attenuated by high exposure to the air pollutant black carbon (BC).

Methods

We performed a cross-sectional study of 135 children ages 9–14 who live in New York City. Activity was measured across 6 days. BC exposure was assessed by personal monitors worn for two 24-h periods, followed by lung function assessment. Buccal swabs were collected for DNA methylation analysis of three regions (six CpG sites) in the FOXP3 promoter.

Results

In multivariable regression models, overall, there was no significant relationship between physical activity and FOXP3 promoter methylation (p > 0.05). However, in stratified analyses, among children with higher BC exposure (≥1200 ng/m³), physical activity was associated with 2.37% lower methylation in promoter 2 (CpGs −77, −65, and −58) (β_estimate = −2.37%, p < 0.01) but not among those with lower BC exposure (β_estimate = 0.54%, p > 0.05). Differences across strata were statistically significant (p_interaction = 0.04). Among all children, after controlling for BC concentration, promoter 2 methylation was associated with reduced FEV₁/FVC (β_estimate = −0.40%, p < 0.01) and reduced FEF_25–75% (β_estimate = −1.46%, p < 0.01).

Conclusions

Physical activity in urban children appeared associated with lower FOXP3 promoter methylation, a possible indicator of greater Treg function, under conditions of high BC exposure. Reduced FOXP3 promoter methylation was associated with higher lung function. These findings suggest that physical activity may induce immunologic benefits, particularly for urban children with greater risk of impaired lung function due to exposure to higher air pollution. FOXP3 promoter buccal cell methylation may function as a useful biomarker of that benefit.

Electronic supplementary material

The online version of this article (doi:10.1186/s13148-017-0364-0) contains supplementary material, which is available to authorized users.

Effect of personal exposure to black carbon on changes in allergic asthma gene methylation measured 5 days later in urban children: importance of allergic sensitization

Background

Asthma gene DNA methylation may underlie the effects of air pollution on airway inflammation. However, the temporality and individual susceptibility to environmental epigenetic regulation of asthma has not been fully elucidated. Our objective was to determine the timeline of black carbon (BC) exposure, measured by personal sampling, on DNA methylation of allergic asthma genes 5 days later to capture usual weather variations and differences related to changes in behavior and activities. We also sought to determine how methylation may vary by seroatopy and cockroach sensitization and by elevated fractional exhaled nitric oxide (FeNO).

Methods

Personal BC levels were measured during two 24-h periods over a 6-day sampling period in 163 New York City children (age 9–14 years), repeated 6 months later. During home visits, buccal cells were collected as noninvasive surrogates for lower airway epithelial cells and FeNO measured as an indicator of airway inflammation. CpG promoter loci of allergic asthma genes (e.g., interleukin 4 (IL4), interferon gamma (IFNγ), inducible nitric oxide synthase (NOS2A)), arginase 2 (ARG2)) were pyrosequenced at the start and end of each sampling period.

Results

Higher levels of BC were associated with lower methylation of IL4 promoter CpG⁻⁴⁸ 5 days later. The magnitude of association between BC exposure and demethylation of IL4 CpG⁻⁴⁸ and NOS2A CpG⁺⁵⁰⁹⁹ measured 5 days later appeared to be greater among seroatopic children, especially those sensitized to cockroach allergens (RR [95% CI] 0.55 [0.37–0.82] and 0.67 [0.45–0.98] for IL4 CpG⁻⁴⁸ and NOS2A CpG⁺⁵⁰⁹⁹, respectively), compared to non-sensitized children (RR [95% CI] 0.87 [0.65–1.17] and 0.95 [0.69–1.33] for IL4 CpG⁻⁴⁸ and NOS2A CpG⁺⁵⁰⁹⁹, respectively); however, the difference was not statistically different. In multivariable linear regression models, lower DNA methylation of IL4 CpG⁻⁴⁸ and NOS2A CpG⁺⁵⁰⁹⁹ were associated with increased FeNO.

Conclusions

Our results suggest that exposure to BC may exert asthma proinflammatory gene demethylation 5 days later that in turn may link to airway inflammation. Our results further suggest that seroatopic children, especially those sensitized to cockroach allergens, may be more susceptible to the effect of acute BC exposure on epigenetic changes.

Electronic supplementary material

The online version of this article (doi:10.1186/s13148-017-0361-3) contains supplementary material, which is available to authorized users.

Context-sensitive ecological momentary assessments; integrating real-time exposure measurements, data-analytics and health assessment using a smartphone application

INTRODUCTION

Modern sensor technology makes it possible to collect vast amounts of environmental, behavioural and health data. These data are often linked to contextual information on for example exposure sources which is separately collected with considerable lag time, leading to complications in assessing transient and/or highly spatially variable environmental exposures. Context-Sensitive Ecological Momentary Assessments¹ (CS-EMAs) could be used to address this. We present a case study using radiofrequency-electromagnetic fields (RF-EMF) exposure as an example for implementing CS-EMA in environmental research.

METHODS

Participants were asked to install a custom application on their own smartphone and to wear an RF-EMF exposimeter for 48h. Questionnaires were triggered by the application based on a continuous data stream from the exposimeter. Triggers were divided into four categories: relative and absolute exposure levels, phone calls, and control condition. After the two days of use participants filled in an evaluation questionnaire.

RESULTS

74% of all CS-EMAs were completed, with an average time of 31s to complete a questionnaire once it was opened. Participants reported minimal influence on daily activities. There were no significant differences found between well-being and type of RF-EMF exposure.

CONCLUSIONS

We show that a CS-EMA based method could be used in environmental research. Using several examples involving environmental stressors, we discuss both current and future applications of this methodology in studying potential health effects of environmental factors.

Mouse models of severe asthma: Understanding the mechanisms of steroid resistance, tissue remodelling and disease exacerbation

Severe asthma has significant disease burden and results in high healthcare costs. While existing therapies are effective for the majority of asthma patients, treatments for individuals with severe asthma are often ineffective. Mouse models are useful to identify mechanisms underlying disease pathogenesis and for the preclinical assessment of new therapies. In fact, existing mouse models have contributed significantly to our understanding of allergic/eosinophilic phenotypes of asthma and facilitated the development of novel targeted therapies (e.g. anti-IL-5 and anti-IgE). These therapies are effective in relevant subsets of severe asthma patients. Unfortunately, non-allergic/non-eosinophilic asthma, steroid resistance and disease exacerbation remain areas of unmet clinical need. No mouse model encompasses all features of severe asthma. However, mouse models can provide insight into pathogenic pathways that are relevant to severe asthma. In this review, as examples, we highlight models relevant to understanding steroid resistance, chronic tissue remodelling and disease exacerbation. Although these models highlight the complexity of the immune pathways that may underlie severe asthma, they also provide insight into new potential therapeutic approaches.

Perception and reality of particulate matter exposure in New York City taxi drivers

Exposure to fine particulate matter (PM2.5) and black carbon (BC) have been linked to negative health risks, but exposure among professional taxi drivers is understudied. This pilot study measured drivers' knowledge, attitudes, and beliefs (KAB) about air pollution compared with direct measures of exposures. Roadside and in-vehicle levels of PM2.5 and BC were continuously measured over a single shift on each subject, and exposures compared with central site monitoring. One hundred drivers completed an air pollution KAB questionnaire, and seven taxicabs participated in preliminary in-cab air sampling. Taxicab PM2.5 and BC concentrations were elevated compared with nearby central monitoring. Average PM2.5 concentrations per 15-min interval were 4-49 μg/m3. BC levels were also elevated; reaching>10 μg/m3. Fifty-six of the 100 drivers surveyed believed they were more exposed than non-drivers; 81 believed air pollution causes health problems. Air pollution exposures recorded suggest that driver exposures would likely exceed EPA recommendations if experienced for 24 h. Surveys indicated that driver awareness of this was limited. Future studies should focus on reducing exposures and increasing awareness among taxi drivers.