Asthma and air pollution in the Los Angeles area

Assessing the impact of green nudges on ozone concentration: Evidence from China's night refueling policy

Ozone (O₃) pollution poses health risks and premature mortality, and gas stations are one of the largest sources of urban volatile organic compounds (VOCs, the main precursor to O₃). This paper investigates whether the government's call for night refueling, which can be regarded as a green nudge, can guide changes in consumer behavior and consequently improve environmental quality. Using a difference-in-differences (DID) estimation and weekly monitoring site air quality panel data, we analyze the effect of the Night Refueling Preferential Policy on O₃ concentrations. We find that the policy can reduce O₃ concentrations by 10% by encouraging consumers to refuel at night. The reduction in O₃ has brought great benefits to human health, leading to a 4-5‰ reduction in non-accidental mortality and a 6-8‰ reduction in cardiovascular mortality in Jiangsu province. The economic benefits of this policy would be approximately 62-189 billion Chinese Yuan (CNY) if it were implemented nationwide. The findings of this study suggest that the government can influence consumer behavior to promote environmental quality.

Bioaccessibility of potentially toxic metals in soil, sediments and tailings from a north Africa phosphate-mining area: Insight into human health risk assessment

The risk assessment of phosphate mining/processing industrial activities on the environment and human health is crucial to properly manage and minimize the risks over time. In this work, we studied the inhalation and dermal bioaccessibility of potentially toxic metals (PTM) in different particle-size fractions of urban soil, sediments and tailings from Gafsa-Metlaoui phosphate mining area, to assess afterwards the non-carcinogenic (NCR) and carcinogenic (CR) risks for the health of local citizens and workers constantly exposed to airborne particulate matter (PM) originating from these sources of contamination. Samples were separated in particle-size fractions by centrifugation and consecutive cycles of sedimentation and decanting. The pseudo-total concentrations and bioaccessible fractions of PTM were extracted by aqua regia and in vitro bioaccessibility tests, respectively. Both sediments and tailings showed higher-than-background concentrations of PTM (mainly Cd, Zn and Cr), with a tendency to accumulate these metals in fine particles (<10 μm). In urban soil, only Cd was above the background concentration. The bioaccessibility of PTM via inhalation was significantly higher in artificial lysosomal fluid (ALF) than in simulated epithelial lung fluid (SELF): basically, Cd was the most bioaccessible metal (relative bioaccessibility up to 80%), followed by the medium-to-high bioaccessible Zn (47%), Pb (46%) and Cu (39%), and the least bioaccessible Cr (16%). In synthetic skin surface liquid (NIHS 96-10), only Cd was bioaccessible at worrying extent (20-44%). On the basis of US.EPA risk assessment, the exposure to PTM bioaccessible fractions or pseudo-total concentrations would not cause serious NCR and CR risks for human health. Significant health risks (Hazard Index >1 and CR > 10^-4), especially for children, can occur if ingestion route is also considered. The findings underline the need for adequate protection of contaminated soil, sediments and mine tailings laying nearby urban agglomerates, to reduce the health risks for inhabitants and workers of Gafsa-Metlaoui mining area.

Volatile Organic Compounds in a Petrochemical Region in Arid of NW China: Chemical Reactivity and Source Apportionment

We measured volatile organic compounds (VOCs) during the heating, non-heating, and sandstorm periods in the air of the Dushanzi district in NW China and investigated their concentrations, chemical reactivity, and sources. The observed concentrations of total VOCs (TVOCs) were 22.35 ± 17.60, 33.20 ± 34.15, and 17.05 ± 13.61 ppbv in non-heating, heating, and sandstorm periods, respectively. C2-C5 alkanes, C2-C3 alkenes, benzene, and toluene were the most abundant species, contributing more than 60% of the TVOCs. Among these VOCs, alkenes such as propene had the highest chemical reactivity, accounting for more than 60% of total hydroxyl radical loss rate (LOH) and ozone formation potential (OFP). Chemical reactivity was the highest in the heating period. The average reaction rate constant (KOH-avg) and average maximum incremental reactivity coefficient (MIR-avg) of the total observed VOCs were (8.72 ± 1.42) × 10−12 cm3/mol∙s and 2.42 ± 0.16 mol/mol, respectively. The results of the source apportionment via the Positive Matrix Factorization (PMF) model showed that coal combustion (43.08%) and industrial processes (38.86%) were the major sources of VOCs in the air of the Dushanzi district. The contribution of coal combustion to VOCs was the highest in the heating period, while that of industrial solvents and oil volatilization was the lowest.

Effects of childhood exposure to PM2.5 in a Memphis pediatric asthma cohort

The effects of childhood exposure to ambient air pollution and their influences on healthcare utilization and respiratory outcomes in Memphis pediatric asthma cohort are still unknown. This study seeks to (1) investigate individual-level associations between asthma and exposure measures in high asthma rate and low asthma rate areas and (2) determine factors that influence asthma at first year of a child's life, first 2 years, first 5 years, and during their childhood. Datasets include physician-diagnosed asthma patients, on-road and individual PM_2.5 emissions, and high-resolution spatiotemporal PM_2.5 estimates. Spatial analytical and logistic regression models were used to analyze the effects of childhood exposure on outcomes. Increased risk was associated with African American (AA) (odds ratio (OR) = 3.09, 95% confidence interval (CI) 2.80-3.41), aged < 5 years old (OR = 1.31, 95% 1.17-1.47), public insurance (OR = 2.80, 95% CI 2.60-3.01), a 2.5-km radius from on-road emission sources (OR = 3.06, 95% CI 2.84-3.30), and a 400-m radius from individual PM_2.5 sources (OR = 1.33, 95% CI 1.25-1.41) among the cohort with residence in high asthma rate areas compared to low asthma rates areas. A significant interaction was observed between race and insurance with the odds of AA being approximately five times (OR = 4.68, 95% CI 2.23-9.85), public insurance being about three times (OR = 2.65, 95% CI 1.68-4.17), and children in their first 5 years of life have more hospital visits than other age groups. Findings from this study can guide efforts to minimize emissions, manage risk, and design interventions to reduce disease burden.

Rainfall-Associated Bronchospasm Epidemics: The Epidemiological Effects of Air Pollutants and Weather Variables

BACKGROUND

This study compares different risk factors in patients visiting a hospital during five rainfall-associated bronchospasm epidemics in Ahvaz and those visiting on other occasions.

METHODS

This case-control study was conducted on 5307 patients with bronchospasm admitted to the Emergency Department of Imam Khomeini Hospital in Ahvaz (Iran) from late October to December (as the epidemic) and 916 patients admitted from late January to March (as the nonepidemic) in 2011 to 2015.

RESULTS

A total of the 41.7% of the cases and 48.8% of the controls had episodes of bronchospasm, suggesting a significant difference between the two groups (P < 0.001). The mean concentrations of PM10, NO, NO2, and NO x pollutants (except O3) were significantly higher in the nonepidemic periods (P < 0.05). The adjusted analysis showed a direct significant relationship between emergency respiratory admissions and each unit of increase in NO and SO2 concentration during the epidemic periods and NO2 concentration during the nonepidemic periods. During the epidemic periods, a direct and significant relationship was also observed between respiratory admissions and each unit of increase in relative humidity and evaporation.

CONCLUSION

The results suggest that certain pollutants and weather variables are associated with the risk of emergency respiratory admissions during epidemic periods.

Climate change and respiratory health

OBJECTIVE

To discuss the nature of climate change and both its immediate and long-term effects on human respiratory health.

METHODS

This review is based on information from a presentation of the American College of Chest Physicians course on Occupational and Environmental Lung Disease held in Toronto, Canada, June 2013. It is supplemented by a PubMed search for climate change, global warming, respiratory tract diseases, and respiratory health. It is also supplemented by a search of Web sites including the Environmental Protection Agency, National Oceanic and Atmospheric Administration, World Meteorological Association, National Snow and Ice Data Center, Carbon Dioxide Information Analysis Center, Inter-Governmental Panel on Climate Change, and the World Health Organization.

RESULTS

Health effects of climate change include an increase in the prevalence of certain respiratory diseases, exacerbations of chronic lung disease, premature mortality, allergic responses, and declines in lung function.

CONCLUSIONS

Climate change, mediated by greenhouse gases, causes adverse health effects to the most vulnerable patient populations-the elderly, children, and those in distressed socioeconomic strata.

An association between air pollution and daily outpatient visits for respiratory disease in a heavy industry area

In this work we used daily outpatient data from the Landseed Hospital in a heavily industrial area in northern Taiwan to study the associations between daily outpatient visits and air pollution in the context of a heavily polluted atmospheric environment in Chung-Li area during the period 2007–2011. We test the normality of each data set, control for the confounding factors, and calculate correlation coefficient between the outpatient visits and air pollution and meteorology, and use multiple linear regression analysis to seek significance of these associations. Our results show that temperature and relative humidity tend to be negatively associated with respiratory diseases. NO and are two main air pollutants that are positively associated with respiratory diseases, followed by , , , CO, and . Young outpatients (age 0–15 years) are most sensitive to changing air pollution and meteorology factors, followed by the eldest (age 66 years) and age 16–65 years of outpatients. Outpatients for COPD diseases are most sensitive to air pollution and meteorology factors, followed by allergic rhinitis, asthma, and pneumonia diseases. In the context of sex difference to air pollution and meteorological factors, male outpatients are more sensitive than female outpatients in the 16–65 age groups, while female outpatients are more sensitive than male outpatients in the young 0–15 age groups and in the eldest age groups. In total, female outpatients are more sensitive to air pollution and meteorological factors than male outpatients.

Relating weather types to asthma-related hospital admissions in New York State

Many previous studies have looked into the relationship between asthma and individual weather variables, but comparatively few have looked at this relationship using holistic weather types (WTs). Utilizing the Spatial Synoptic Classification, this research considers up to 6 days of lag time while investigating the asthma-to-WT relationship in two age groups (under 18 and 18 and over) throughout New York State. Results indicate that a cold and dry WT in autumn corresponds to increased asthma admissions and spike days in admissions in New York City (NYC) for the school-aged population, while hot and dry WTs in summer correspond to spike days in asthma admissions in both age groups. However, results vary considerably for other regions, seasons and WTs, and spike day analysis yields clearer results than the analysis of total anomalous admissions. When stratified by multiple regions and age groups, the sample size of daily asthma admissions is a limiting factor outside of NYC.

PARTICULATE MATTER AIR POLLUTION REDUCTION SCENARIOS IN OSAKA, HOUSTON, BANGKOK AND SEOUL: A PROSPECTIVE HEALTH BENEFITS ANALYSIS

The objectives of this study were to assess potential health and productivity benefits for the year 2010 with five scenarios for reducing particulate matter (PM10 and PM2.5) air pollution in the cities of Osaka, Houston, Bangkok and Seoul. Assuming a uniform 10% decline in ambient PM levels, the preventible cases of: (1) premature mortality ranged from 35 in Houston to 379 in Seoul, (2) chronic bronchitis ranged from 95 in Houston to 1,631 in Seoul, (3) cardiovascular disease ranged from 68 in Houston to 818 in Seoul, (4) pneumonia ranged from 28 in Houston to 336 in Seoul, (5) asthma attacks ranged from 388 in Osaka to 96,876 in Seoul, and (6) acute bronchitis ranged from 186 in Houston to 2,973 in Seoul. The per million population central estimate of the purchasing power parity adjusted value of health and productivity benefits ranged from $25 million in Bangkok to $160 million in Osaka. There was a wide variability in measured PM10 levels across cities. Percentages of active monitors reporting concentrations above 50 μg/m3 (annual average) or 150 μg/m3 (24-hour average) in 2001–2002 were 0% in Houston, 5% in Osaka, 33% in Bangkok and 92% in Seoul. Assuming a non-uniform reduction in PM only at concentration hotspots with levels above air quality standards, the number of preventible cases of mortality ranged from 0 in Houston to 1,104 in Seoul. The central estimate of total benefits ranged from $0 in Houston to $240 million in Seoul.

Health effects associated with passenger vehicles: monetary values of air pollution

Air pollution is regarded as one of the highest priorities in environmental protection in both developed and developing countries. High levels of air pollution have adverse effects on human health that might cause premature death. This study presents the monetary value estimates for the adverse human health effects resulted from ambient air pollution. It aids decision makers to set priorities in the public health relevance of pollution abatement. The main driver of policymaker is the need to reduce the avoidable cardiopulmonary morbidity and mortality from pollutant exposures. The monetary valuation involves 2 steps: (i) relate levels of pollutants to mortality and morbidity (concentration-response relationships) and (ii) apply unit economic values. Cost of air pollution associated with passenger vehicles running over a major traffic bridge (6th of October Elevated Highway) is presented as a case study to demonstrate the use of monetary value of air pollution. The study proves that the cost of air pollution is extremely high and should not be overlooked.

Measuring the gains from improved air quality in the San Joaquin Valley

Many regions worldwide are experiencing rapid urbanization, and often along with growth in the local economy and population comes worsening air quality. Such regions typically find that addressing the additional challenge of polluted air is difficult. This paper reports the results of an assessment of the present health and related economic costs of poor air quality in the San Joaquin Valley of California. Further, it suggests how such assessments can support strategies to pursue pollution reductions that offer the largest near-term gains, by rigorously modeling the associations between pollution levels, demographic groups, and recognized adverse health effects.

Ancillary human health benefits of improved air quality resulting from climate change mitigation

BACKGROUND

Greenhouse gas (GHG) mitigation policies can provide ancillary benefits in terms of short-term improvements in air quality and associated health benefits. Several studies have analyzed the ancillary impacts of GHG policies for a variety of locations, pollutants, and policies. In this paper we review the existing evidence on ancillary health benefits relating to air pollution from various GHG strategies and provide a framework for such analysis.

METHODS

We evaluate techniques used in different stages of such research for estimation of: (1) changes in air pollutant concentrations; (2) avoided adverse health endpoints; and (3) economic valuation of health consequences. The limitations and merits of various methods are examined. Finally, we conclude with recommendations for ancillary benefits analysis and related research gaps in the relevant disciplines.

RESULTS

We found that to date most assessments have focused their analysis more heavily on one aspect of the framework (e.g., economic analysis). While a wide range of methods was applied to various policies and regions, results from multiple studies provide strong evidence that the short-term public health and economic benefits of ancillary benefits related to GHG mitigation strategies are substantial. Further, results of these analyses are likely to be underestimates because there are a number of important unquantified health and economic endpoints.

CONCLUSION

Remaining challenges include integrating the understanding of the relative toxicity of particulate matter by components or sources, developing better estimates of public health and environmental impacts on selected sub-populations, and devising new methods for evaluating heretofore unquantified and non-monetized benefits.

Generation of Hydroxyl Radicals from Dissolved Transition Metals in Surrogate Lung Fluid Solutions

Epidemiological research has linked exposure to atmospheric particulate matter (PM) to several adverse health effects, including cardiovascular and pulmonary morbidity and mortality. Despite these links, the mechanisms by which PM causes adverse health effects are poorly understood. The generation of hydroxyl radical (.OH) and other reactive oxygen species (ROS) through transition metal-mediated pathways is one of the main hypotheses for PM toxicity. In order to better understand the ability of particulate transition metals to produce ROS, we have quantified the amounts of .OH produced from dissolved iron and copper in a cell-free, surrogate lung fluid (SLF). We also examined how two important biological molecules, citrate and ascorbate, affect the generation of .OH by these metals. We have found that Fe(II) and Fe(III) produce little .OH in the absence of ascorbate and citrate, but that they efficiently make .OH in the presence of ascorbate and this is further enhanced when citrate is also added. In the presence of ascorbate, with or without citrate, the oxidation state of iron makes little difference on the amount of .OH formed after 24 hours. In the case of Cu(II), the production of .OH is greatly enhanced in the presence of ascorbate, but is inhibited by the addition of citrate. The mechanism for this effect is unclear, but appears to involve formation of a citrate-copper complex that is apparently less reactive than free, aquated copper in either the generation of HOOH or in the Fenton-like reaction of copper with HOOH to make .OH. By quantifying the amount of .OH that Fe and Cu can produce in surrogate lung fluid, we have provided a first step into being able to predict the amounts of .OH that can be produced in the human lung from exposure to PM containing known amounts of transition metals.

Air pollution, weather, and associated risk factors related to asthma prevalence and attack rate

Asthma is an important public health challenge. The objective of this research was to investigate the relationship of air pollution and weather to adolescent asthma prevalence and attack rate. A 6-month mass screening asthma study was conducted from October 1995 to March 1996 in Taiwan. The study population included junior high school students from throughout the country (1,139,452 students). Eighty-nine percent of students completed questionnaires (International Study of Asthma and Allergies in Childhood-ISAAC and New England Core Questionnaires) and passed a logical screening error program. Lung function data was collected to assist in the diagnosis of asthma status. From the students screened during this mass survey, a stratified random sample of 64,660 students was analyzed for asthma prevalence and attack rate. Using a regression model to compare the USEPA National Ambient Air Quality Standards 2000 (NAAQS, 2000) to asthma prevalence, this investigation found that the standards may not provide enough protection for adolescents after controlling for age, rhinitis, eczema, urban birth location, parental education level, exercise, cigarette smoking, environmental tobacco smoking, alcohol beverage consumption and weather factors. The general estimating equations (GEE) model, a repeated measurement regression model, was used to examine the relationship between the monthly asthma attack rate among asthma patients and air pollution (nitrogen oxides; nitrogen dioxide; nitric oxide; Ozone; PM10) while controlling for household smoking. The GEE model demonstrated that air pollution is related to asthma attack rate. Air pollution factors also interacted with weather parameters when related to asthma attack rate.

The avoidable health effects of air pollution in three Latin American cities: Santiago, São Paulo, and Mexico City

Urban centers in Latin American often face high levels of air pollution as a result of economic and industrial growth. Decisions with regard to industry, transportation, and development will affect air pollution and health both in the short term and in the far future through climate change. We investigated the pollution health consequences of modest changes in fossil fuel use for three case study cities in Latin American: Mexico City, Mexico; Santiago, Chile; and São Paulo, Brazil. Annual levels of ozone and particulate matter were estimated from 2000 to 2020 for two emissions scenarios: (1) business-as-usual based on current emissions patterns and regulatory trends and (2) a control policy aimed at lowering air pollution emissions. The resulting air pollution levels were linked to health endpoints through concentration-response functions derived from epidemiological studies, using local studies where available. Results indicate that the air pollution control policy would have vast health benefits for each of the three cities, averting numerous adverse health outcomes including over 156,000 deaths, 4 million asthma attacks, 300,000 children's medical visits, and almost 48,000 cases of chronic bronchitis in the three cities over the 20-year period. The economic value of the avoided health impacts is roughly 21 to 165 billion Dollars (US). Sensitivity analysis shows that the control policy yields significant health and economic benefits even with relaxed assumptions with regard to population growth, pollutant concentrations for the control policy, concentration-response functions, and economic value of health outcomes. This research demonstrates the health and economic burden from air pollution in Latin American urban centers and the magnitude of health benefits from control policies.

Effects of ambient air pollutants on asthma medication use and wheezing among fourth-grade school children from 12 Southern California communities enrolled in The Children's Health Study

To investigate the effects of 12 monthly average air pollution levels on monthly prevalence of respiratory morbidity, the authors examined retrospective questionnaire data on 2034 4th-grade children from 12 Southern California communities that were enrolled in The Children's Health Study. Wheezing during the spring and summer months was associated with community levels of airborne particulate matter with a diameter < or = 10 microm (PM10) (odds ratio (OR) = 2.91; 95% confidence interval (CI) = 1.46-5.80), but was not associated with community levels of ozone, nitrogen dioxide, PM2.5 (diameter < or = 2.5), nitric acid, or formic acid. Logistic regression was performed on data stratified into two seasonal groups, spring/summer and fall/winter. Among asthmatics, the monthly prevalence of asthma medication use was associated with monthly levels of ozone, nitric acid, and acetic acid (OR = 1.80 [95%CI = 1.19-2.70]; OR = 1.80 [95%CI = 1.23-2.65]; OR = 1.57 [95% CI = 1.11-2.21]; respectively). Asthma medication use was more prevalent among children who spent more time outdoors--with consequential exposure to ozone--than among children who spent more time indoors (OR = 3.07 [95%CI = 1.61-5.86]; OR = 1.31 [95%CI = 0.47-2.71]; respectively). The authors concluded that monthly variations in some ambient air pollutants were associated with monthly respiratory morbidity among school children.

Predicting premature mortality from new power plant development in Virginia

The authors estimated the number of premature deaths from particulate matter less than 2.5 microm (PM2.5) that would result from making 29 proposed fossil fuel power plants in Virginia operational. We used a U.S. Environmental Protection Agency air quality model (Climatological Regional Dispersion model) to calculate changes in ambient concentrations of PM2.5 and Cox proportional hazard modeling to calculate the resulting premature mortality. The model predicted that if all 29 plants were operational, PM2.5 concentrations would rise in 271 counties across 19 states 5 and increased average annual PM2.5 concentrations would result in a rate of 17 deaths per 37,900,026 people aged 30 yr and older (0.45 deaths per million, 95% confidence interval = 0.31, 0.59) per year by the end of 2004, increasing thereafter. Over a 6 yr period, 104 cumulative excess deaths would occur due to operations of these proposed plants. The authors recommend that precautionary principles be considered when policy decisions related to energy production from fossil fuels are made.

Environmental risk factors and allergic bronchial asthma

The prevalence of allergic respiratory diseases such as bronchial asthma has increased in recent years, especially in industrialized countries. A change in the genetic predisposition is an unlikely cause of the increase in allergic diseases because genetic changes in a population require several generations. Consequently, this increase may be explained by changes in environmental factors, including indoor and outdoor air pollution. Over the past two decades, there has been increasing interest in studies of air pollution and its effects on human health. Although the role played by outdoor pollutants in allergic sensitization of the airways has yet to be clarified, a body of evidence suggests that urbanization, with its high levels of vehicle emissions, and a westernized lifestyle are linked to the rising frequency of respiratory allergic diseases observed in most industrialized countries, and there is considerable evidence that asthmatic persons are at increased risk of developing asthma exacerbations with exposure to ozone, nitrogen dioxide, sulphur dioxide and inhalable particulate matter. However, it is not easy to evaluate the impact of air pollution on the timing of asthma exacerbations and on the prevalence of asthma in general. As concentrations of airborne allergens and air pollutants are frequently increased contemporaneously, an enhanced IgE-mediated response to aeroallergens and enhanced airway inflammation could account for the increasing frequency of allergic respiratory allergy and bronchial asthma. Pollinosis is frequently used to study the interrelationship between air pollution and respiratory allergy. Climatic factors (temperature, wind speed, humidity, thunderstorms, etc) can affect both components (biological and chemical) of this interaction. By attaching to the surface of pollen grains and of plant-derived particles of paucimicronic size, pollutants could modify not only the morphology of these antigen-carrying agents but also their allergenic potential. In addition, by inducing airway inflammation, which increases airway permeability, pollutants overcome the mucosal barrier and could be able to "prime" allergen-induced responses. There are also observations that a thunderstorm occurring during pollen season can induce severe asthma attacks in pollinosis patients. After rupture by thunderstorm, pollen grains may release part of their cytoplasmic content, including inhalable, allergen-carrying paucimicronic particles.

A new longitudinal design for identifying subgroups of the population who are susceptible to the short-term effects of ambient air pollution

A longitudinal design is proposed to investigate the short-term effects of air pollution on health status. The study design exploits a new statistical methodology developed by Dewanji and Moolgavkar (2000, 2002) that makes use of a Poisson counting process for the incidence of events in a longitudinal cohort study. The methodology allows for modeling of subject-specific baseline hazards of multiple events and time-dependent ecological (i.e., daily levels of air pollution and weather conditions) and individual covariates (e.g., comorbid conditions, indices of declines in health status). The study will determine the association between short-term changes in air pollution and incidence of hospitalization, emergency department visits, "intermediate health conditions" (e.g., changes in health status reflected by changes in filled prescriptions), and mortality. Data from the universal Quebec medicare system are used, including data for residents of Montreal age 65 yr and above. The cohorts include individuals who have at baseline airways disease, chronic coronary artery disease, congestive heart failure, hypertension, cerebrovascular disease, atherosclerosis, dysrhythmias, and diabetes, and these will be followed for the incidence of the already mentioned adverse outcomes, adjusting for time-dependent individual and ecological covariates. This type of study will provide findings that can be used to confirm or refute results of time series analyses. Using a different methodology that includes subject-specific information will greatly increase our understanding as to whether short-term exposures to ambient air pollution cause serious changes in health status among subgroups of the population. These results will also help in understanding mechanisms by identifying groups that are susceptible to the effects of air pollution.

Repeated exposure to ozone increases alveolar macrophage recruitment into asthmatic airways

RATIONALE

Repeated, short-term exposures to ozone (O3) lead to attenuation of the acute lung function and airway inflammatory responses seen after a single exposure in healthy subjects, but it is unclear whether these acute responses also attenuate in subjects with asthma.

OBJECTIVE

To address this question by exposing 14 subjects with asthma to 0.2 ppm O3 for either 4 hours on a single day or 4 hours on 4 consecutive days (multiday [MD]). At least 3 weeks later, subjects underwent the alternate exposure.

METHODS

Spirometry was performed immediately pre- and postexposure and bronchoalveolar lavage (BAL) was obtained 18 hours after each exposure.

MAIN RESULTS

The decrease in FEV1 was greatest across Day 2 of the MD (MD2) exposure and then gradually declined on successive days of the MD exposure (mean +/- SD decrease in FEV1 of 25.4 +/- 18.0% across MD2 compared with 4.2 +/- 6.5% across MD4). Respiratory symptoms followed a similar pattern to that of FEV1. Although the concentration of neutrophils in BAL after the MD4 exposure was not significantly different from that after the single-day exposure (1.7 +/- 1.3 x 10(4) cells/ml vs. 1.2 +/- 0.8 x 10(4) cells/ml, p = 0.20), the concentration of alveolar macrophages did significantly increase in BAL after the MD exposure (19.9 +/- 9.7 x 10(4) cells/ml after MD4 vs. 12.1 +/- 6.4 x 10(4) cells/ml after the single day).

CONCLUSIONS

Alveolar macrophages are recruited to the airways of subjects with asthma with repeated short-term exposures to O3, suggesting a possible role for these cells in the chronic response to oxidant-induced injury.

Effects of particulate matter (PM10) on the pulmonary function of middle-school children

It has been reported that the particulate matter under 10 microm (PM10) has deleterious effects on respiratory health. The purpose of this study was to assess the influence of PM10 upon normal children's lung function. The subjects were 368 middle school students in two areas of Incheon Metropolitan City. One (Incheon) is in the central city and the other (Ganghwa) is in the suburbs. Air pollution data in the vicinities of two participating schools were obtained from monthly report of air quality from Korean Ministry of Environment in 2000. Pulmonary function testing (PFT) was done two times, the first one in March and the second one in December with the same students. We analyzed the relationship between the PM10 levels and pulmonary functions (FEV1, FVC) of the children. The monthly average of the PM10 level between the two areas showed no significant difference (55.3 vs. 52.3 microg/m3). In both regions, the difference of the PM10 level between March and December was statistically significant (64 vs. 56 microg/m3 in Incheon, 64 vs. 54 microg/m3 in Ganghwa). The findings of the PFT values in March were significantly lower than those values found in December for both regions. In conclusion, we suggest that PM10 has some adverse effect on the pulmonary function of normal children.

ESR investigation of the oxidative damage in lungs caused by asbestos and air pollution particles

Exposure to asbestos and air pollution particles can be associated with increased human morbidity and mortality. However, the molecular mechanism of lung injuries remains unknown. It has been postulated that the in vivo toxicity results from the catalysis of free radical generation. Using electron spin resonance (ESR) in conjunction with the spin trap alpha-(4-pyridyl-1-oxide)-N-tert-butylnitrone (4-POBN) we previously investigated in vivo free radical production by rats treated with intratracheal instillation of asbestos (crocidolite fibers) and an emission source air pollution particle (oil fly ash). In this report we compare the effect of two different exposures on the type of free radicals they induce in in vivo animal model. Twenty-four hours after the exposure, ESR spectroscopy of the chloroform extract from lungs of animals exposed to either asbestos or oil fly ash gave a spectrum consistent with a carbon-centered radical adduct (aN = 15.01 G and aH = 2.46 G). To test whether free radical formation occurred in vivo and not in vitro, a number of control experiments were performed. Combinations (both individually and together) of asbestos or oil fly ash and 4-POBN were added to lung homogenate of unexposed rats prior to chloroform extraction. No detectable ESR signal resulted. To exclude the possibility of ex vivo free radical generation, asbestos or oil fly ash was added to lung homogenate of an animal treated with 4-POBN. Also, 4-POBN was added to lung homogenate from rats instilled with asbestos or oil fly ash. Neither system produced radical adducts, indicating that the ESR signal detected in the lung extracts of the treated animals must be produced in vivo and not ex vivo or in vitro. In conclusion, ESR analysis of lung tissue demonstrated that both exposures produce lipid-derived radical metabolites despite their different composition and structure. Analogously, both exposures provide evidence of in vivo enhanced lipid peroxidation. Furthermore, it is concluded that without the presence of a spin-trapping agent, no free radical metabolites could be detected directly by ESR in either exposure.

Particulate air pollution and panel studies in children: a systematic review

BACKGROUND

Panel studies have been used to investigate the short term effects of outdoor particulate air pollution across a wide range of environmental settings.

AIMS

To systematically review the results of such studies in children, estimate summary measures of effect, and investigate potential sources of heterogeneity.

METHODS

Studies were identified by searching electronic databases to June 2002, including those where outcomes and particulate level measurements were made at least daily for > or =8 weeks, and analysed using an appropriate regression model. Study results were compared using forest plots, and fixed and random effects summary effect estimates obtained. Publication bias was considered using a funnel plot.

RESULTS

Twenty two studies were identified, all except two reporting PM10 (24 hour mean) >50 microg x m(-3). Reported effects of PM10 on PEF were widely spread and smaller than those for PM2.5 (fixed effects summary: -0.012 v -0.063 l x min(-1) per microg x m(-3) rise). A similar pattern was evident for symptoms. Random effects models produced larger estimates. Overall, in between-study comparisons, panels of children with diagnosed asthma or pre-existing respiratory symptoms appeared less affected by PM10 levels than those without, and effect estimates were larger where studies were conducted in higher ozone conditions. Larger PM10 effect estimates were obtained from studies using generalised estimating equations to model autocorrelation and where results were derived by pooling subject specific regression coefficients. A funnel plot of PM10 results for PEF was markedly asymmetrical.

CONCLUSIONS

The majority of identified studies indicate an adverse effect of particulate air pollution that is greater for PM2.5 than PM10. However, results show considerable heterogeneity and there is evidence consistent with publication bias, so limited confidence may be placed on summary estimates of effect. The possibility of interaction between particle and ozone effects merits further investigation, as does variability due to analytical differences that alter the interpretation of final estimates.

Air pollution and children's health in São Paulo (1986-1998)

Air pollution in the conurbation of São Paulo, Brazil, with 17 million inhabitants, has been measured from air quality monitoring stations. In three contrasted sample areas, children's respiratory health parameters were collected to assess the role of air pollution in 1986. Twelve years later, in 1998, a similar study was undertaken to evaluate the impact of pollution control programs on the respiratory symptoms of children living in the same neighborhoods previously studied. Results indicated that pollution control programs were in part neutralized by increased number of cars and that the control of a single pollutant was not enough to protect children's health. In the area where both particulate matter and sulfur dioxide levels decreased, there was a reduction in the prevalence of respiratory symptoms.

Bioavailability of iron from coal fly ash: mechanisms of mobilization and of biological effects

Particulate air pollution contains iron that may be involved in the pathological effects after inhalation. This article reviews work demonstrating that ambient particulate samples (Standard Reference Material [SRM] 1648 and SRM 1649, from the National Institute of Science and Technology) contain iron that can be mobilized from the particle in vitro and inside human lung epithelial (A549) cells. The mobilized iron can then catalyze the formation of reactive oxygen species (ROS). Work is also reviewed on the generation and size fractionation of coal fly ash (CFA) from three commercially important coal types, as well as size fractionation of three types of noncombustion particles. The availability of iron from these particles to A549 cells was measured by citrate mobilization in vitro and induction of the iron storage protein ferritin in particle-treated cells. The amount of bioavailable iron decreased with increasing particle size. The ability of particles to induce synthesis of the proinflammatory cytokine interleukin-8 (IL-8) was also determined. As with the bioavailability of iron, there was an inverse correlation with size. Further work showed that iron in CFA is responsible for IL-8 induction. Mössbauer spectroscopy of a CFA sample before and after desferrioxamine B treatment to remove bioavailable iron showed that the bioavailable iron was associated with the glassy aluminosilicate fraction of the particle. In conclusion, this work shows that bioavailable iron is responsible for ROS production by SRMs and IL-8 induction by CFA in A549 cells. The source of this bioavailable iron in CFA is glassy aluminosilicates, which are found at higher levels in smaller sizes of CFA.

Integrating risk assessment and life cycle assessment: a case study of insulation

Increasing residential insulation can decrease energy consumption and provide public health benefits, given changes in emissions from fuel combustion, but also has cost implications and ancillary risks and benefits. Risk assessment or life cycle assessment can be used to calculate the net impacts and determine whether more stringent energy codes or other conservation policies would be warranted, but few analyses have combined the critical elements of both methodologies In this article, we present the first portion of a combined analysis, with the goal of estimating the net public health impacts of increasing residential insulation for new housing from current practice to the latest International Energy Conservation Code (IECC 2000). We model state-by-state residential energy savings and evaluate particulate matter less than 2.5 microm in diameter (PM2.5), NOx, and SO2 emission reductions. We use past dispersion modeling results to estimate reductions in exposure, and we apply concentration-response functions for premature mortality and selected morbidity outcomes using current epidemiological knowledge of effects of PM2.5 (primary and secondary). We find that an insulation policy shift would save 3 x 10(14) British thermal units or BTU (3 x 10(17) J) over a 10-year period, resulting in reduced emissions of 1,000 tons of PM2.5, 30,000 tons of NOx, and 40,000 tons of SO2. These emission reductions yield an estimated 60 fewer fatalities during this period, with the geographic distribution of health benefits differing from the distribution of energy savings because of differences in energy sources, population patterns, and meteorology. We discuss the methodology to be used to integrate life cycle calculations, which can ultimately yield estimates that can be compared with costs to determine the influence of external costs on benefit-cost calculations.

A comparison of the prevalence of respiratory illness and non-specific health symptoms in two Victorian cities

OBJECTIVE

To compare the prevalence of respiratory illness and non-specific health symptoms among adults and children aged 4-15 years living in Portland and Warrnambool, Victoria.

METHODS

A postal survey of 3,903 adults in Portland and Warrnambool systematically selected from the electoral roll was undertaken. Both an adults and children's questionnaire were enclosed in the mailing to each adult. If there were children aged 4-15 years in the household, an adult was asked to complete a questionnaire for the child who would next celebrate a birthday. Questionnaires were returned by 2,111 adults (54%) and for 585 children.

RESULTS

No significant differences in the prevalence of self-reported asthma or wheeze were observed among adults or children residing in Portland and Warrnambool. The likelihood of itchy eyes, skin rash and stuffy nose was significantly higher in Portland adults and children compared with those in Warrnambool. Dry cough at night was increased among Portland children, but not significantly so.

CONCLUSIONS

Higher rates of non-specific symptoms were observed in Portland but from a cross-sectional survey such as this, it is not possible to identify the cause of these higher rates. They may be related to environmental factors such as pollens or emissions from aluminium production, fertiliser production or bulk handling activities on the wharf, or they may be attributable to other factors such as response or recall bias.

Assessing the health benefits of urban air pollution reductions associated with climate change mitigation (2000-2020): Santiago, São Paulo, México City, and New York City

To investigate the potential local health benefits of adopting greenhouse gas (GHG) mitigation policies, we develop scenarios of GHG mitigation for México City, México; Santiago, Chile; São Paulo, Brazil; and New York, New York, USA using air pollution health impact factors appropriate to each city. We estimate that the adoption of readily available technologies to lessen fossil fuel emissions over the next two decades in these four cities alone will reduce particulate matter and ozone and avoid approximately 64,000 (95% confidence interval [CI] 18,000-116,000) premature deaths (including infant deaths), 65,000 (95% CI 22,000-108,000) chronic bronchitis cases, and 46 million (95% CI 35-58 million) person-days of work loss or other restricted activity. These findings illustrate that GHG mitigation can provide considerable local air pollution-related public health benefits to countries that choose to abate GHG emissions by reducing fossil fuel combustion.

Air pollution and exacerbation of asthma in African-American children in Los Angeles

Significant increases in asthma morbidity and mortality in the United States have occurred since the 1970s, particularly among African-Americans. Exposure to various environmental factors, including air pollutants and allergens, has been suggested as a partial explanation of these trends. To examine relations between several air pollutants and asthma exacerbation in African-Americans, we recruited a panel of 138 children in central Los Angeles. We recorded daily data on respiratory symptoms and medication use for 13 weeks and examined these data in conjunction with data on ozone (O3) nitrogen dioxide (NO2), particulate matter (PM10 and PM2.5), meteorological variables, pollens, and molds. Using generalized estimating equations, we found associations between respiratory symptom occurrence and several environmental factors. For example, new episodes of cough were associated with exposure to PM10 (OR = 1.25; 95% CI = 1.12-1.39; interquartile range [IQR] = 17 microg/m3, 24-hour average), PM2.5 (OR = 1.10; 95% CI = 1.03-1.18; IQR = 30 microg/m3, 12-hour average), NO2, and the molds Cladosporium and Alternaria, but not with exposure to O3 or pollen. The factors PM10 and O3 were associated with the use of extra asthma medication. For this population several bioaerosols and air pollutants had effects that may be clinically significant.

Effect of flow rate on particle deposition in a replica of a human nasal airway

Charge-coupled device (CCD) imaging technology was used to observe how the spatial deposition patterns of inhaled aerosols changed as a function of rate of airflow through the airway. This technology allows the experimenter to measure local particle deposition patterns of different sized fluorescent particles at different flow rates in a full-scale multisection replica of a human nasal airway. Total particle deposition efficiencies and particle deposition patterns were measured in the nasal airway for 5.5-microm-diameter particles at constant flow rates of 10, 20, 30, and 40 L/min. Images of fluorescing particles on each plate of the exposed model were taken with a CCD camera and combined to form three-dimensional particle deposition patterns. Total particle deposition efficiency as measured with the model was found to be consistent with in vivo data. Impaction was found to be the dominant mechanism by which 5.5-microm-diameter particles deposit within the model, in agreement with published inhalation data.

Effects of ambient air pollution on symptoms of asthma in Seattle-area children enrolled in the CAMP study

We observed a panel of 133 children (5-13 years of age) with asthma residing in the greater Seattle, Washington, area for an average of 58 days (range 28-112 days) during screening for enrollment in the Childhood Asthma Management Program (CAMP) study. Daily self-reports of asthma symptoms were obtained from study diaries and compared with ambient air pollution levels in marginal repeated measures logistic regression models. We defined days with asthma symptoms as any day a child reported at least one mild asthma episode. All analyses were controlled for subject-specific variables [age, race, sex, baseline height, and FEV(1) PC(20) concentration (methacholine provocative concentration required to produce a 20% decrease in forced expiratory volume in 1 sec)] and potential time-dependent confounders (day of week, season, and temperature). Because of variable observation periods for participants, we estimated both between- and within-subject air pollutant effects. Our primary interest was in the within-subject effects: the effect of air pollutant excursions from typical levels in each child's observation period on the odds of asthma symptoms. In single-pollutant models, the population average estimates indicated a 30% [95% confidence interval (CI), 11-52%] increase for a 1-ppm increment in carbon monoxide lagged 1 day, an 18% (95% CI, 5-33%) increase for a 10-microg/m(3) increment in same-day particulate matter < 1.0 microm (PM(1.0)), and an 11% (95% CI, 3-20%) increase for a 10-microg/m(3) increment in particulate matter < 10 microm (PM(10)) lagged 1 day. Conditional on the previous day's asthma symptoms, we estimated 25% (95% CI, 10-42%), 14% (95% CI, 4-26%), and 10% (95% CI, 3-16%) increases in the odds of asthma symptoms associated with increases in CO, PM(1.0), and PM(10), respectively. We did not find any association between sulfur dioxide (SO(2)) and the odds of asthma symptoms. In multipollutant models, the separate pollutant effects were smaller. The overall effect of an increase in both CO and PM(1. 0) was a 31% (95% CI, 11-55%) increase in the odds of symptoms of asthma. We conclude that there is an association between change in short-term air pollution levels, as indexed by PM and CO, and the occurrence of asthma symptoms among children in Seattle. Although PM effects on asthma have been found in other studies, it is likely that CO is a marker for vehicle exhaust and other combustion by-products that aggravate asthma.

Toxicity of chemical components of ambient fine particulate matter (PM 2.5) inhaled by aged rats

The toxicity of two important chemical components of fine ambient particulate matter (PM 2.5)-ammonium bisulfate (ABS) and elemental carbon (C)-was studied using aged (senescent) rats. The study tested the hypotheses that fine particle exposure can damage lungs and impair host defenses in aged rats and that ozone would potentiate the toxicity of these particles. Ammonium bisulfate aerosols were generated by nebulization of dilute aqueous solutions. Elemental carbon was generated from an aqueous suspension of carbon black. Carbon and ABS mixtures were generated by nebulization of a suspension of carbon black in a dilute aqueous solution of ABS. Rats were exposed, nose-only, for 4 h a day, three consecutive days a week, for 4 weeks. The rats were exposed to one of six atmospheres: (1) purified air; (2) C, 50 microg m(-3), 0.3 microm mass median aerodynamic diameter (MMAD); (3) ABS, 70 microg m(-3), 0.3 microm MMAD; (4) O3, 0.2 ppm; (5) ABS + C, 0.46 microm MMAD; and (6) ABS + C + O3, 0.45 microm MMAD. Data were analyzed using ANOVA and Tukey multiple comparison tests; a two-tailed significance level of 0.05 was used. The nuclei of lung epithelial and interstitial cells were examined to determine the labeling of the DNA of dividing cells by 5-bromo-2-deoxyuridine and to identify the location of injury-repair-related cell replication. Increased labeling of both epithelial and interstitial lung cells occurred following all pollutant exposures. Although epithelial cells are most likely impacted by inhaled particles first, the adjacent interstitial cells were the cells that showed the greatest degree of response. Exposure to the ABS + C + O3 mixture resulted in losses of lung collagen and increases in macrophage respiratory burst and phagocytic activities that were statistically significant. Our results demonstrate that ozone can increase the toxicity of inhaled particles (or vice versa), and suggest that detailed study of mixtures could provide a more comprehensive understanding of the mechanisms by which inhaled pollutants adversely affect human health.

Epidemiology of fine particulate air pollution and human health: biologic mechanisms and who's at risk?

This article briefly summarizes the epidemiology of the health effects of fine particulate air pollution, provides an early, somewhat speculative, discussion of the contribution of epidemiology to evaluating biologic mechanisms, and evaluates who's at risk or is susceptible to adverse health effects. Based on preliminary epidemiologic evidence, it is speculated that a systemic response to fine particle-induced pulmonary inflammation, including cytokine release and altered cardiac autonomic function, may be part of the pathophysiologic mechanisms or pathways linking particulate pollution with cardiopulmonary disease. The elderly, infants, and persons with chronic cardiopulmonary disease, influenza, or asthma are most susceptible to mortality and serious morbidity effects from short-term acutely elevated exposures. Others are susceptible to less serious health effects such as transient increases in respiratory symptoms, decreased lung function, or other physiologic changes. Chronic exposure studies suggest relatively broad susceptibility to cumulative effects of long-term repeated exposure to fine particulate pollution, resulting in substantive estimates of population average loss of life expectancy in highly polluted environments. Additional knowledge is needed about the specific pollutants or mix of pollutants responsible for the adverse health effects and the biologic mechanisms involved.

Criteria air pollutants and toxic air pollutants

This review presents a brief overview of the health effects and exposures of two criteria pollutants--ozone and particulate matter--and two toxic air pollutants--benzene and formaldehyde. These pollutants were selected from the six criteria pollutants and from the 189 toxic air pollutants on the basis of their prevalence in the United States, their physicochemical behavior, and the magnitude of their potential health threat. The health effects data included in this review primarily include results from epidemiologic studies; however, some findings from animal studies are also discussed when no other information is available. Health effects findings for each pollutant are related in this review to corresponding information about outdoor, indoor, and personal exposures and pollutant sources.

Criteria air pollutants and toxic air pollutants

This review presents a brief overview of the health effects and exposures of two criteria pollutants--ozone and particulate matter--and two toxic air pollutants--benzene and formaldehyde. These pollutants were selected from the six criteria pollutants and from the 189 toxic air pollutants on the basis of their prevalence in the United States, their physicochemical behavior, and the magnitude of their potential health threat. The health effects data included in this review primarily include results from epidemiologic studies; however, some findings from animal studies are also discussed when no other information is available. Health effects findings for each pollutant are related in this review to corresponding information about outdoor, indoor, and personal exposures and pollutant sources.

Epidemiology of fine particulate air pollution and human health: biologic mechanisms and who's at risk?

This article briefly summarizes the epidemiology of the health effects of fine particulate air pollution, provides an early, somewhat speculative, discussion of the contribution of epidemiology to evaluating biologic mechanisms, and evaluates who's at risk or is susceptible to adverse health effects. Based on preliminary epidemiologic evidence, it is speculated that a systemic response to fine particle-induced pulmonary inflammation, including cytokine release and altered cardiac autonomic function, may be part of the pathophysiologic mechanisms or pathways linking particulate pollution with cardiopulmonary disease. The elderly, infants, and persons with chronic cardiopulmonary disease, influenza, or asthma are most susceptible to mortality and serious morbidity effects from short-term acutely elevated exposures. Others are susceptible to less serious health effects such as transient increases in respiratory symptoms, decreased lung function, or other physiologic changes. Chronic exposure studies suggest relatively broad susceptibility to cumulative effects of long-term repeated exposure to fine particulate pollution, resulting in substantive estimates of population average loss of life expectancy in highly polluted environments. Additional knowledge is needed about the specific pollutants or mix of pollutants responsible for the adverse health effects and the biologic mechanisms involved.

Soluble components of Utah Valley particulate pollution alter alveolar macrophage function in vivo and in vitro

Water-soluble extracts of Utah Valley dust (UVD) have been found to cause inflammatory injury of the lung in both humans and rodents. The degree of lung damage found correlated with the metal content in the extracts. In the present study, extracts of a set of UVD PM(10) filters collected over a 3-yr span, varying in total metal content with yr 1 = yr 3 > yr 2, were used to assess effects on human alveolar macrophage (AM) function. The phagocytic activity and oxidative response of AM was investigated 24 h after segmental instillation of UVD, or after overnight in vitro culture of the extracts with AM. Using flow cytometry analysis, AM phagocytosis of fluorescently (FITC)-labeled Saccharomyces cerevisiae was inhibited following instillation of UVD1 (61%) but not by yr 2 and 3. Neither baseline oxidant activity nor phorbol ester-induced oxidant generation was affected by the dust extracts in vivo. Overnight culture of AM with UVD1 resulted in a significant decrease in the percentage of AM phagocytizing particles (30%), while no significant effect on this function was found with the other two extracts. Furthermore, only UVD1 caused an immediate oxidative response in AM, although both UVD1 and UVD3 inhibited oxidant activity in AM when the cells were incubated with the extracts overnight. The detrimental effects on AM host defenses could be due to apoptosis, which was evident in cells exposed to the UVD1 and to a much lesser extent with AM exposed to yr 2 and 3. The component(s) responsible for the toxic effects on AM in vitro were removed by pretreatment of the UVD extracts with a polycation chelating resin, chelex-100. However, since yr 1 and 3 are similar in their soluble metal content, but differ in their effects on AM phagocytosis, it is possible that the metals may not be the culprit in effects of particulate matter on AM host defense.

Reanalysis of the effects of air pollution on daily mortality in Seoul, Korea: A case-crossover design

We used the case-crossover design to identify any increase in mortality in Seoul, Korea, when there were higher levels of ambient air pollution on case-days than would be expected solely as a result of chance. This empirical study showed that either unidirectional retrospective (selecting only control days prior to death) or prospective (selecting only control days after death) control sampling could cause risk estimates to be confounded by seasonal waves as well as time trends in air pollution levels. In bidirectional control sampling in which exposures at death were compared with exposures both before and after death, the estimated mortality was resistant to confounding by time patterns of air pollution. Using a bidirectional control sampling approach, the results from a conditional logistic regression model controlling for weather conditions showed that the nonaccidental mortality associated with a 50-ppb increment over a 3-day moving average of SO(2) concentrations, including the concurrent day and preceding 2 days, was 1.023 [95% confidence interval (CI), 1.016-1.084]. The relative risk of death was 1.023 (CI, 0.999-1.048) per 50 ppb for 1-hr maximum O(3) and 1.010 (CI, 0.988-1.032) per 100 microg/m(3 )or total suspended particulates. In conclusion, the findings of this study were 2-fold: given the consistency of the observed association between SO(2) and daily mortality across different analysis methods, the association reported here indicates that air pollution is a probable contributor to premature death; and bidirectional control sampling is needed in a case-crossover design applied to air pollution epidemiologic studies to control confounding by seasonal patterns of air pollution as well as time trends.

Particulate air pollution and asthma: a review of epidemiological and biological studies

The link between exposure to air pollution and exacerbation of asthma symptoms has been investigated by epidemiological study and by direct biological experimentation. In asthmatics, epidemiological studies generally show a positive correlation between the particulate fraction of air pollution and increased morbidity, although roles for other co-pollutants (for example, ozone) are implicated as well. Direct experimentation using air pollutants, especially particles, to investigate their effects on humans or on animal models of asthma provides corroboration of the epidemiology and has begun to identify the pathophysiological mechanisms involved. We begin this review with an overview of air pollution, followed by a survey of the epidemiological and experimental data regarding air pollution particles and asthma. We finish with a discussion of directions for future research.

Diesel exhaust exposure among adolescents in Harlem: a community-driven study

OBJECTIVES

This study sought individual-level data on diesel exhaust exposure and lung function among adolescents in Harlem as part of a community-driven research agenda.

METHODS

High school students administered in-person surveys to seventh grade students to ascertain information on demographics, asthma history, and self-reported and maternal smoking. Urine samples were assayed for 1-hydroxypyrene (1-HP), a marker of diesel exhaust exposure, and cotinine, a marker of tobacco smoke exposure. Computer-assisted spirometry was used to measure lung function.

RESULTS

Three quarters (76%) of the participating students had detectable levels of 1-HP. Three students (13%) had an FEF25-75 of less than or equal to 80% of their predicted measurements, and 4 students (17%) had results between 80% and 90% of the predicted value, all of which are suggestive of possible lung impairment.

CONCLUSIONS

These data suggest that most adolescents in Harlem are exposed to detectable levels of diesel exhaust, a known exacerbator and possible cause of chronic lung disorders such as asthma. Community-driven research initiatives are important for empowering communities to make needed changes to improve their environments and health.

The environment and asthma in U.S. inner cities

The prevalence and severity of asthma has increased in the last 20 years, and the greatest increase has been seen among children and young adults living in U.S. inner cities. The reasons for this increase are obviously complex, but include environmental exposures to allergens and pollutants, changing patterns of medication, and the psychosocial stresses of living in poor inner-city neighborhoods. This paper presents an overview of environmental, immunologic, and genetic factors associated with asthma morbidity and mortality. This overview can be used to provide a framework for designing an interdisciplinary research program to address the complexities of asthma etiology and exacerbation. The strongest epidemiologic association has been found between asthma morbidity and the exposure of immunologically sensitive asthmatic patients to airborne allergens. Our current understanding of the process of sensitization suggests that there is a strong genetic predisposition to form IgE to allergenic proteins on airborne particles. Much of this work has been conducted with animal models, but in a number of instances, specific confirmation has been reported in humans. Sensitized individuals respond to inhaled exposure with immediate mast-cell dependent inflammation that may be augmented by pollutant particles, especially diesel exhaust particles. Relatively little is known about the methods of assessing exposure to airborne pollutants, especially biologically active particulates. However, to examine the relationship of morbidity in genetically predisposed individuals, it will be important to determine the most relevant method of making this assessment.

Long-term ambient ozone concentration and the incidence of asthma in nonsmoking adults: the AHSMOG Study

We conducted a prospective study of a cohort of 3091 nonsmokers, ages 27 to 87 years, to evaluate the association between long-term ambient ozone exposure and development of adult-onset asthma. Over a 15-year period, 3.2% of males and 4.3% of females reported new doctor diagnoses of asthma. For males, we observed a significant relationship between report of doctor diagnosis of asthma and 20-year mean 8-h average ambient ozone concentration (relative risk (RR)=2.09 for a 27 ppb increase in ozone concentration, 95% CI=1.03 to 4.16). We observed no such relationship for females. Other variables significantly related to development of asthma were a history of ever-smoking for males (RR=2.37, 95% CI=1.13 to 4.81), and for females, number of years worked with a smoker (RR=1.21 for a 7-year increment, 95% CI=1.04 to 1.39), age (RR=0.61 for a 16-year increment, 95% CI=0.44 to 0.84), and a history of childhood pneumonia or bronchitis (RR=2.96, 95% CI=1.68 to 5.03). Addition of other pollutants (PM10, SO4, NO2, and SO2) to the models did not diminish the relationship between ozone and asthma for males. These data suggest that long-term exposure to ambient ozone is associated with development of asthma in adult males.

Elevated asthma morbidity in Puerto Rican children: a review of possible risk and prognostic factors

Latino children represent a significant proportion of all US children, and asthma is the most common chronic illness affecting them. Previous research has revealed surprising differences in health among Latino children with asthma of varying countries of family origin. For instance, Puerto Rican children have a higher prevalence of asthma than Mexican American or Cuban American children. In addition, there are important differences in family structure and socioeconomic status among these Latino populations: Cuban Americans have higher levels of education and family income than Mexican-Americans and Puerto Ricans; mainland Puerto Rican children have the highest proportion of households led by a single mother. Our review of past research documents differences in asthma outcomes among Latino children and identifies the possible genetic, environmental, and health care factors associated with these differences. Based on this review, we propose research studies designed to differentiate between mutable and immutable risk and prognostic factors. We also propose that the sociocultural milieus of Latino subgroups of different ethnic and geographic origin are associated with varying patterns of risk factors that in turn lead to different morbidity patterns. Our analysis provides a blue-print for future research, policy development, and the evaluation of multifactorial interventions involving the collaboration of multiple social sectors, such as health care, public health, education, and public and private agencies.

Emergency room visits of asthmatic children, relation to air pollution, weather, and airborne allergens

BACKGROUND

The worldwide increase in the incidence, prevalence, and severity of asthma may suggest that environmental factors play a role in these epidemiologic changes.

OBJECTIVE

To examine the correlations between air pollutants, weather conditions, airborne allergens, and the incidence of emergency room (ER) visits of children with acute asthma attacks.

DESIGN

One-year prospective study. Data of daily concentration of air pollutants, weather conditions, and selective airborne allergens were collected and compared with the number of ER visits of asthmatic children.

SUBJECTS

1076 asthmatic children (aged 1 to 18 years) who presented at the Pediatric ER between January 1 and December 31, 1993.

RESULTS

Correlations between fluctuations in ER visits of asthmatic children and various environmental parameters were more relevant for weekly than for daily values. Emergency room visits correlated positively with concentrations of NOx, SO2 and with high barometric pressure; and negatively with O3 concentration and minimal and maximal temperature. There were no significant correlations with concentrations of particulates, humidity, or airborne pollen and spores. An exceptionally high incidence of ER visits of asthmatic children was observed during September. This peak coincided with the beginning of the school year and the Jewish holidays. The correlations between ER visits and the environmental factors increased significantly when the September peak was excluded, revealing that 61% of the variance in ER visits was explained by NOx, SO2, and 03 concentrations, 46% by weather parameters, 66% by NOx, SO2 and barometric pressure, and 69% by the combination of air pollutants and weather parameters.

CONCLUSION

The major factors found to be associated with ER visits of asthmatic children were high NOx, high SO2, and high barometric pressure. Negative correlation was found between ER visits of asthmatic children and ozone concentrations. The particularly high number of ER visits at the beginning of the school year and the Jewish holidays was probably associated with an increase in the number of viral infections and/or emotional stress.

Symptoms in pediatric asthmatics and air pollution: differences in effects by symptom severity, anti-inflammatory medication use and particulate averaging time

Experimental research in humans and animals points to the importance of adverse respiratory effects from short-term particle exposures and to the importance of proinflammatory effects of air pollutants, particularly O(subscript)3. However, particle averaging time has not been subjected to direct scientific evaluation, and there is a lack of epidemiological research examining both this issue and whether modification of air pollutant effects occurs with differences in asthma severity and anti-inflammatory medication use. The present study examined the relationship of adverse asthma symptoms (bothersome or interfered with daily activities or sleep) to O(3) and particles (less than or equal to)10 micrometer (PM10) in a Southern California community in the air inversion zone (1200-2100 ft) with high O(3) and low PM (R = 0.3). A panel of 25 asthmatics 9-17 years of age were followed daily, August through October 1995 (n = 1,759 person-days excluding one subject without symptoms). Exposures included stationary outdoor hourly PM10 (highest 24-hr mean, 54 microgram/m(3), versus median of 1-hr maximums, 56 microgram/m(3) and O(3) (mean of 1-hr maximums, 90 ppb, 5 days (greater than or equal to)120 ppb). Longitudinal regression analyses utilized the generalized estimating equations (GEE) model controlling for autocorrelation, day of week, outdoor fungi, and weather. Asthma symptoms were significantly associated with both outdoor O(3) and PM(10) in single pollutant- and co-regressions, with 1-hr and 8-hr maximum PM(10) having larger effects than the 24-hr mean. Subgroup analyses showed effects of current day PM(10) maximums were strongest in 10 more frequently symptomatic (MS) children: the odds ratios (ORs) for adverse symptoms from 90th percentile increases were 2.24 [95% confidence interval (CI), 1.46-3.46] for 1-hr PM10 (47 microgram/m(3); 1.82 (CI, 1.18-2.81) for 8-hr PM10 (36 microgram/m(3); and 1.50 (CI, 0.80-2.80) for 24-hr PM10 (25 microgram/m(3). Subgroup analyses also showed the effect of current day O(subscript)3 was strongest in 14 less frequently symptomatic (LS) children: the ORs were 2.15 (CI, 1.04-4.44) for 1-hr O(3) (58 ppb) and 1.92 (CI, 0.97-3.80) for 8-hr O(3) (46 ppb). Effects of 24-hr PM10 were seen in both groups, particularly with 5-day moving averages (ORs were 1.95 for MS and 4. 03 for LS; p(less than or equal to)0.05). The largest effects were in 7 LS children not on anti-inflammatory medications [5-day, 8-hr PM10, 9.66 (CI, 2.80-33.21); current day, 1-hr O(3), 4.14 (CI, 1.71-11.85)]. Results suggest that examination of short-term particle excursions, medication use, and symptom severity in longitudinal studies of asthma yields sensitive measures of adverse respiratory effects of air pollution.

The use of a neural network for studying the relationship between air pollution and asthma-related emergency room visits

To establish the relationship between air pollution levels and bronchial asthma-associated emergency room (ER) visits, we adapted artificial network technology to conduct this study which focused on three different pollutants, sulphur dioxide, nitrogen oxide and ozone. The study population was comprised of adults presenting to the emergency room of a large metropolitan hospital in Israel during a 3-month period with acute exacerbation of bronchial asthma and who had a past history of intermittent airway disease compatible with bronchial asthma. The range of mean daily pollutants levels for the whole period were: O3 = 15-26 micrograms m-3, NOx = 36-108 micrograms m-3, NO = 16-70 micrograms m-3, and SO2 = 11-32 micrograms m-3. The data sets were composed of input air pollution levels and output ER visits. The first 126 data sets used for the training phase showed that maximal ER visits were mainly associated with the highest cumulative values of air pollution and mostly with nitrogen oxide. In phase two, an attempt was made to predict ER visits based on air pollution level in 49 data sets. The study findings demonstrated that ordinary network technology can be used for learning the effect of air pollution ER visits and, although limited in accuracy, to also predict future ER visits.