Impacts of event-specific air quality improvements on total hospital admissions and reduced systemic inflammation in COPD patients

Short-term effects of air pollution on hospital admissions of respiratory diseases in Hamadan, Iran, 2015 to 2021

The short-term effects of air pollution on respiratory diseases have been reported in many countries. Urban areas are most affected because of the many sources of pollution and the large number of people living there. This study aims to investigate the effect of short-term exposure to air pollutants on respiratory hospital admissions in the city of Hamadan. In this ecological study, daily hospital admission data were collected from Shahid Beheshti Hospital in Hamadan. Daily information on air pollutants (CO, SO2, NO2, O3, PM2.5 and PM10) from Hamadan Department of Environment (DoE) organization and of climate factors from Hamadan Meteorological Office were collected. A negative binomial regression model was used to examine the effect of air pollution on daily respiratory hospitalizations. The effect of exposure to pollutants was measured whit different time lags (0-7 days). Furthermore, the effect of meteorological variables was controlled. Subgroup analyses were performed by sex and age group. A total of 12,454 hospitalizations for respiratory diseases were recorded. Results showed a strong and immediate effect of CO on respiratory hospital admissions with highest association at lag 7 (relative risk (RR) = 1.38, 95% CI: 1.33, 1.42). The effects of CO and SO2 on respiratory hospitalizations are greater for men than women. Regarding the short-term effects of PM2.5, SO2 and O3, adults (aged less than 65) were more prone to hospitalization for respiratory diseases. These results show that exposure to air pollution, particularly CO, may increase hospital admissions due to respiratory illness. So reducing the concentration of these pollutants can reduce the number of hospital admissions.

Study Protocol. Evaluating the life-course health impact of a city-wide system approach to improve air quality in Bradford, UK: A quasi-experimental study with implementation and process evaluation

BACKGROUND

Air quality is a major public health threat linked to poor birth outcomes, respiratory and cardiovascular disease, and premature mortality. Deprived groups and children are disproportionately affected. Bradford will implement a Clean Air Zone (CAZ) as part of the Bradford Clean Air Plan (B-CAP) in 2022 to reduce pollution, providing a natural experiment. The aim of the current study is to evaluate the impact of the B-CAP on health outcomes and air quality, inequalities and explore value for money. An embedded process and implementation evaluation will also explore barriers and facilitators to implementation, impact on attitudes and behaviours, and any adverse consequences.

METHODS

The study is split into 4 work packages (WP). WP1A: 20 interviews with decision makers, 20 interviews with key stakeholders; 10 public focus groups and documentary analysis of key reports will assess implementation barriers, acceptability and adverse or unanticipated consequences at 1 year post-implementation (defined as point at which charging CAZ goes 'live'). WP1B: A population survey (n = 2000) will assess travel behaviour and attitudes at baseline and change at 1 year post-implementation). WP2: Routine air quality measurements will be supplemented with data from mobile pollution sensors in 12 schools collected by N = 240 pupil citizen scientists (4 within, 4 bordering and 4 distal to CAZ boundary). Pupils will carry sensors over four monitoring periods over a 12 month period (two pre, and two post-implementation). We will explore whether reductions in pollution vary by CAZ proximity. WP3A: We will conduct a quasi-experimental interrupted time series analysis using a longitudinal routine health dataset of > 530,000 Bradford residents comparing trends (3 years prior vs 3 years post) in respiratory health (assessed via emergency/GP attendances. WP3B: We will use the richly-characterised Born in Bradford cohort (13,500 children) to explore health inequalities in respiratory health using detailed socio-economic data. WP4: will entail a multi-sectoral health economic evaluation to determine value for money of the B-CAP.

DISCUSSION

This will be first comprehensive quasi-experimental evaluation of a city-wide policy intervention to improve air quality. The findings will be of value for other areas implementing this type of approach.

TRIAL REGISTRATION

ISRCTN67530835 https://doi.org/10.1186/ISRCTN67530835.

Short-term effects of gaseous air pollutants on outpatient visits for respiratory diseases: a case-crossover study in Baotou, China

Air pollution is a major public health problem throughout the world. Although there have been several studies in this field, most of them have focused on particulate matter and only covered a few key cities. This study aimed to assess a potential association between exposure to gaseous air pollutants and outpatient visits for respiratory diseases in Baotou, China. Daily outpatient visits for respiratory diseases and daily averages of air pollutants and meteorological parameters from 2015 to 2020 were obtained. Time-stratified case-crossover design and restricted cubic splines were used to perform the analyses. Stratified analyses were performed in different hospital departments and districts. Significant association between the concentrations of air pollutants and outpatient visits for respiratory diseases was observed. The odds ratios of outpatient visits for respiratory diseases associated with per 10 μg/m³ increases in concentrations of NO₂ and SO₂, and per 10 mg/m³ increases in concentrations of CO were 1.033 (95% CI: 1.018 to 1.049), 0.965 (95% CI: 0.954 to 0.976), and 1.038 (95% CI: 1.006 to 1.071), respectively. Short-term exposure to NO₂, SO₂, and CO was positively associated with outpatient visits for respiratory diseases, with stronger effects among children. The relationship between O₃ and respiratory diseases varied at different concentrations.

The Effects of Fine Dust, Ozone, and Nitrogen Dioxide on Health

BACKGROUND

Air pollutants, especially fine dust, ozone, and nitrogen dioxide, pose a danger to health worldwide. In 2005, the World Health Organization (WHO), in order to protect public health, issued global recommendations for maximum levels of fine dust (10 μg/m3 for fine dust particles smaller than 2.5 μm [PM2.5]), ozone, and nitrogen dioxide. The recommended levels are regularly exceeded in many places in Germany.

METHODS

This review is based on relevant publications retrieved by a selective search in PubMed and, in part, on an expert statement issued in the name of the International Society for Environmental Epidemiology (ISEE) and the European Respiratory Society (ERS).

RESULTS

Air pollutants affect the entire body, from the beginning of intrauterine development all the way to the end of life, causing premature death mainly through lung and heart disease. An epidemiological study has shown, for example, that mor- tality rises approximately 7% for every incremental long-term exposure to 5 μg/m3 PM2.5 (95% confidence interval: [2; 13]). Aside from lung and heart disease, the carcinogenic effect of fine dust is now well established. High fine-dust exposure has also been linked to metabolic diseases. For example, in a meta-analysis of cohort studies, the incidence of type 2 diabetes mellitus was found to be associated with elevated fine dust concentrations, with a 25% relative risk increase [10; 43] for every 10 µg/m3 of PM2.5. More recent studies have shown that these substances cause harm even in concentrations that are below the recommended limits.

CONCLUSION

It is very important for public health that the current EU standards for rkedly lowered so that health risks can be further reduced, in accordance with the recommendations of the WHO.

[Urban air pollution and hospital admissions for asthma and acute respiratory disease in Murcia city (Spain)]

INTRODUCTION

Urban air pollution is a major threat to child and adolescent health. Children are more vulnerable to its effects, being associated with higher morbidity and mortality due to acute and chronic diseases, especially respiratory ones. A study is performed on the relationship between urban air pollution and the rate of hospital admissions due to acute respiratory diseases.

PATIENTS AND METHODS

An ecological study was conducted on young people under 17 years-old in the city of Murcia, who had visited hospital emergency departments due to respiratory diseases (ICD-9) during 2015. A logistic regression was performed on the risk of hospital admission that included consultations in relation to the average daily levels of environmental pollutants (NO₂, O₃, PM10, SO₂) obtained from the Air Quality Surveillance and Control network of the Region of Murcia. Other control variables, such as gender, age, average daily ambient temperature, and season of the year.

RESULTS

A total of 12,354 (56% boys and 44% girls) children consulted in the emergency department for respiratory disease. Of those, 3.5% were admitted, with a mean age of 2.54 (95% CI; 2.16-2.91) years. The odds ratio (OR) of hospital admission for respiratory diseases: NO₂ 1.02 (95% CI; 1.01-1.04; P<.01), O₃ 1.01 (95% CI; 1.00-1.03; P<.01) male 1.4 (95% CI 1.11-1.79; P<.01) and winter 2.10 (95% CI 1.40-3.21; P<.01). Admissions for asthma: PM10 1.02 (95% CI; 1.01-1.04; P<.05), O₃ 1.04 (95% CI; 1.01-1.06; P<.01). Admissions for bronchiolitis: Age 0.69 (95% CI; 0.48-0.99; P<.05); NO₂ 1.03 (95% CI; 1.01-1.05; P<.01).

CONCLUSIONS

Urban air pollution increases hospital admissions in children due to acute respiratory diseases, especially asthma and bronchiolitis. Implementing preventive measures, expanding time series and collaborative studies with open data, would help improve public health and air quality in the cities.

Toxicological effects of ambient fine (PM2.5-0.18) and ultrafine (PM0.18) particles in healthy and diseased 3D organo-typic mucocilary-phenotype models

The knowledge of the underlying mechanisms by which particulate matter (PM) exerts its health effects is still incomplete since it may trigger various symptoms as some persons may be more susceptible than others. Detailed studies realized in more relevant in vitro models are highly needed. Healthy normal human bronchial epithelial (NHBE), asthma-diseased human bronchial epithelial (DHBE), and COPD-DHBE cells, differentiated at the air-liquid interface, were acutely or repeatedly exposed to fine (i.e., PM_2.5-0.18, also called FP) and quasi-ultrafine (i.e., PM_0.18, also called UFP) particles. Immunofluorescence labelling of pan-cytokeratin, MUC5AC, and ZO-1 confirmed their specific cell-types. Baselines of the inflammatory mediators secreted by all the cells were quite similar. Slight changes of TNFα, IL-1β, IL-6, IL-8, GM-CSF, MCP-1, and/or TGFα, and of H3K9 histone acetylation supported a higher inflammatory response of asthma- and especially COPD-DHBE cells, after exposure to FP and especially UFP. At baseline, 35 differentially expressed genes (DEG) in asthma-DHBE, and 23 DEG in COPD-DHBE, compared to NHBE cells, were reported. They were involved in biological processes implicated in the development of asthma and COPD diseases, such as cellular process (e.g., PLA2G4C, NLRP1, S100A5, MUC1), biological regulation (e.g., CCNE1), developmental process (e.g., WNT10B), and cell component organization and synthesis (e.g., KRT34, COL6A1, COL6A2). In all the FP or UFP-exposed cell models, DEG were also functionally annotated to the chemical metabolic process (e.g., CYP1A1, CYP1B1, CYP1A2) and inflammatory response (e.g., EREG). Another DEG, FGF-1, was only down-regulated in asthma and specially COPD-DHBE cells repeatedly exposed. While RAB37 could help to counteract the down-regulation of FGF-1 in asthma-DHBE cells, the deregulation of FGR, WNT7B, VIPR1, and PPARGC1A could dramatically contribute to make it worse in COPD-DHBE cells. Taken together, these data contributed to support the highest effects of UFP versus FP and highest sensitivity of asthma- and notably COPD-DHBE versus NHBE cells.