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Zhou X, Wang X, Shen Q, Ma J, Cai X, Liu H, Yan J, Xu H, Wang Y. Short-term exposure to sulfur dioxide and the occurrence of chronic obstructive pulmonary disease: An updated systematic review and meta-analysis based on risk of bias and certainty of evidence. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2024; 284:116888. [PMID: 39168082 DOI: 10.1016/j.ecoenv.2024.116888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Revised: 07/09/2024] [Accepted: 08/12/2024] [Indexed: 08/23/2024]
Abstract
Several studies have documented a relationship between short-term exposure to atmospheric sulfur dioxide (SO2) and chronic obstructive pulmonary disease (COPD). However, findings vary across different regions. This meta-analysis employed a random-effects model to calculate the combined risk estimate for each 10-μg/m3 increase in ambient SO2 concentration. Subgroup analysis aimed to identify sources of heterogeneity. To assess potential bias, studies were evaluated using a domain-based assessment tool developed by the World Health Organization. Sensitivity analyses, based on bias risk, explored how model assumptions influenced associations. An evidence certainty framework was used to evaluate overall evidence quality. The study protocol was registered with PROSPERO (CRD42023446823). We thoroughly reviewed 191 full-text articles, ultimately including 15 in the meta-analysis. The pooled relative risk for COPD was 1.26 (95 % CI 0.94-1.70) per 10-μg/m3 increase in ambient SO2. Eleven studies were deemed high risk due to inadequate handling of missing data. Overall evidence certainty was rated as medium. Given SO2's significant public health implications, continuous monitoring is crucial. Future research should include countries in Africa and Oceania to enhance global understanding of atmospheric SO2-related health issues.
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Affiliation(s)
- Xingye Zhou
- Hospital Infection Control Department, The Second Affiliated Hospital of Hainan Medical University, Hainan, China
| | - Xiaoxu Wang
- School of Public Health, Shandong University, Shandong, China
| | - Qianqian Shen
- School of Public Health, Peking University, Beijing, China
| | - Jian Ma
- Department of Science and Education, Huaian Center for Disease Control and Prevention, Huaian, China
| | - Xiong Cai
- Hospital Infection Control Department, The Second Affiliated Hospital of Hainan Medical University, Hainan, China
| | - Haizhen Liu
- Hospital Infection Control Department, The Second Affiliated Hospital of Hainan Medical University, Hainan, China
| | - Jianhui Yan
- Hospital Infection Control Department, The Second Affiliated Hospital of Hainan Medical University, Hainan, China
| | - Huawen Xu
- Hospital Infection Control Department, The Second Affiliated Hospital of Hainan Medical University, Hainan, China
| | - Yanping Wang
- Hospital Infection Control Department, The Second Affiliated Hospital of Hainan Medical University, Hainan, China.
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Silva Rodriguez ME, Silveyra P. Air Pollution Exposure as a Relevant Risk Factor for Chronic Obstructive Pulmonary Disease Exacerbations in Male and Female Patients. EUROPEAN MEDICAL JOURNAL 2022. [DOI: 10.33590/emj/21-00228] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a multifactorial lung inflammatory disease that affects 174 million people worldwide, with a recently reported increased incidence in female patients. Patients with COPD are especially vulnerable to the detrimental effects of environmental exposures, especially from air particulate and gaseous pollutants; exposure to air pollution severely influences COPD outcomes, resulting in acute exacerbations, hospitalisations, and death. Here, a literature review of the recent work addressing air pollution-induced acute exacerbations of COPD (AECOPD) was conducted in order to determine whether sex was considered as a biological variable in these studies, and whether air pollution exposure affected patients with COPD in a sex-specific manner. It was found that, while the majority of studies enrolled both male and female patients, only a few reported results were disaggregated by sex. Most studies had a higher enrolment of male patients, only four compared AECOPD outcomes between sexes, and only one study identified sex differences in AECOPD, with females displaying higher rates. Overall, this analysis of the literature confirmed that air pollution exposure is a trigger for AECOPD hospitalisations and revealed a significant gap in the knowledge of sex-specific effects of air pollutants on COPD outcomes, highlighting the need for more studies to consider sex as a biological variable.
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Affiliation(s)
| | - Patricia Silveyra
- School of Public Health, Indiana University Bloomington, Indiana, USA
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Valipour A, Aisanov Z, Avdeev S, Koblizek V, Kocan I, Kopitovic I, Lupkovics G, Man M, Bukovskis M, Tudoric N, Vukoja M, Naumnik W, Yanev N. Recommendations for COPD management in Central and Eastern Europe. Expert Rev Respir Med 2022; 16:221-234. [PMID: 35001780 DOI: 10.1080/17476348.2021.2023498] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
INTRODUCTION The Global Initiative for Chronic Obstructive Lung Disease (GOLD) strategy report provides guidance on effective management of chronic obstructive pulmonary disease (COPD) according to local healthcare systems. However, COPD is a heterogenous disease and certain aspects, including prevalence, disease-time course and phenotype distribution, can differ between countries. Moreover, features of clinical practice and healthcare systems for COPD patients can vary widely, even in geographically close and economically similar countries. AREAS COVERED Based on an initial workshop of respiratory physicians from eleven countries across Central and Eastern Europe (CEE) in December 2018 and subsequent discussions, this article offers region-specific insights from clinical practice and healthcare systems in CEE. Taking GOLD 2020 recommendations into account, we suggest approaches to adapt these into national clinical guidelines for COPD management in CEE. EXPERT OPINION Several factors should be considered when optimizing management of COPD in CEE compared with other regions, including differences in smoking status, vaccination uptake, prevalence of tuberculosis and nontuberculous mycobacteria, and variations in healthcare systems. We provide guidance and algorithms for pharmacologic and non-pharmacologic management of COPD for the following scenarios: initial and follow-up treatment, treatment of patients with frequent exacerbations, and withdrawal of inhaled corticosteroids where appropriate.
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Affiliation(s)
- Arschang Valipour
- Department of Respiratory and Critical Care Medicine, Karl-Landsteiner-Institute for Lung Research and Pulmonary Oncology, Vienna Health Care Group, Vienna, Austria
| | - Zaurbek Aisanov
- Department of Pulmonology, Pirogov Russian State National Research Medical University, Moscow, Russia
| | - Sergey Avdeev
- Pulmonology Department, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Vladimir Koblizek
- Department of Pneumology, Faculty of Medicine in Hradec Kralove, Charles University Hospital, Hradec Kralove, Czech Republic
| | - Ivan Kocan
- University Hospital Martin, Jessenius Faculty of Medicine, Commenius University, Martin, Slovakia
| | - Ivan Kopitovic
- Department for Respiratory Pathophysiology and Sleep Disordered Breathing, The Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia.,Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Gergely Lupkovics
- Adult Pulmonary Department, Institute for Pulmonary Diseases, Törökbálint, Hungary
| | - Milena Man
- Pulmonology Department, Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Maris Bukovskis
- Department of Internal Diseases, Faculty Medicine, University of Latvia, Riga, Latvia
| | - Neven Tudoric
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Marija Vukoja
- Department for Respiratory Pathophysiology and Sleep Disordered Breathing, The Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia.,Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Wojciech Naumnik
- First Department of Lung Diseases and Chemotherapy of Respiratory Neoplasms, Medical University of Bialystok, Bialystok, Poland
| | - Nikolay Yanev
- Department of Pulmonary Diseases, Medical University of Sofia, Sofia, Bulgaria
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Associated factors, assessment, management, and outcomes of patients who present to the emergency department for acute exacerbation of chronic obstructive pulmonary disease: A scoping review. Respir Med 2022; 193:106747. [DOI: 10.1016/j.rmed.2022.106747] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 01/11/2022] [Accepted: 01/17/2022] [Indexed: 12/24/2022]
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Gao J, Xu X, Ying Z, Jiang L, Zhong M, Wang A, Chen LC, Lu B, Sun Q. Post-Effect of Air Quality Improvement on Biomarkers for Systemic Inflammation and Microparticles in Asthma Patients After the 2008 Beijing Olympic Games: a Pilot Study. Inflammation 2018; 40:1214-1224. [PMID: 28444548 DOI: 10.1007/s10753-017-0564-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
This study's aim was to investigate the post-effect of an air quality improvement on systemic inflammation and circulating microparticles in asthmatic patients during, and 2 months after, the Beijing Olympics 2008. We measured the levels of circulating inflammatory cytokines and microparticles in the peripheral blood from asthma patients and healthy controls during (phase 1), and 2 months after (phase 2) the Beijing 2008 Olympic Games. The concentrations of circulating cytokines (including TNFα, IL-6, IL-8, and IL-10) were still seen reduced in phase 2 when compared with those in phase 1. The number of circulating endothelial cell-derived microparticles was significantly lower during the phase 2 than that during phase 1 in asthma patients. The level of plasma lipopolysaccharide-binding protein (LBP) was significantly decreased in asthmatics in phase 2. The level of norepinephrine was significantly higher in phase 2 than that in phase 1 in plasma from both asthma patients and healthy subjects. There were no significant differences in the gene profile for the toll-like receptor (TLR) signaling from peripheral blood mononuclear cells. In vitro, microvesicles from patients with asthma impaired the relaxation to bradykinin and contraction to acetylcholine, whereas microparticles from healthy subjects did not. These data suggested that reduction in systemic pro-inflammatory responses and circulating LBP and increased level of norepinephrine in asthma patients persisted even after 2 months of the air pollution intervention. These changes were independent of the TLR signaling pathway. Circulating microparticles might be associated with airway smooth muscle dysfunction.
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Affiliation(s)
- Jinming Gao
- Department of Respiratory Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China.
| | - Xiaohua Xu
- Division of Environmental Health Sciences, The Ohio State University, Columbus, OH, USA
| | - Zhekang Ying
- Davis Heart and Lung Research Institute, The Ohio State University, Columbus, OH, USA
| | - Lei Jiang
- Department of Respiratory Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Mianhua Zhong
- Department of Environmental Medicine, New York University School of Medicine, Tuxedo, NY, USA
| | - Aixia Wang
- Davis Heart and Lung Research Institute, The Ohio State University, Columbus, OH, USA
| | - Lung-Chi Chen
- Department of Environmental Medicine, New York University School of Medicine, Tuxedo, NY, USA
| | - Bo Lu
- Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Qinghua Sun
- Division of Environmental Health Sciences, The Ohio State University, Columbus, OH, USA
- Davis Heart and Lung Research Institute, The Ohio State University, Columbus, OH, USA
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Global Associations between Air Pollutants and Chronic Obstructive Pulmonary Disease Hospitalizations. A Systematic Review. Ann Am Thorac Soc 2017; 13:1814-1827. [PMID: 27314857 DOI: 10.1513/annalsats.201601-064oc] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
RATIONALE Exacerbations are key events in chronic obstructive pulmonary disease (COPD), affecting lung function decline and quality of life. The effect of exposure to different air pollutants on COPD exacerbations is not clear. OBJECTIVES To carry out a systematic review, examining associations between air pollutants and hospital admissions for COPD exacerbations. METHODS MEDLINE, Embase, BIOSIS, Science Citation Index, and the Air Pollution Epidemiology Database were searched for publications published between 1980 and September 2015. Inclusion criteria were focused on studies presenting solely a COPD outcome defined by hospital admissions and a measure of gaseous air pollutants and particle fractions. The association between each pollutant and COPD admissions was investigated in metaanalyses using random effects models. Analyses were stratified by geographical clusters for investigation of the consistency of the evidence worldwide. MEASUREMENTS AND MAIN RESULTS Forty-six studies were included, and results for all the pollutants under investigation showed marginal positive associations; however, the number of included studies was small, the studies had high heterogeneity, and there was evidence of small-study bias. Geographical clustering of the effects of pollution on COPD hospital admissions was evident and reduced heterogeneity significantly. CONCLUSIONS The most consistent association was between a 1-mg/m3 increase in carbon monoxide level and COPD-related admissions (odds ratio, 1.02; 95% confidence interval, 1.01-1.03). The heterogeneity was moderate, and there was a consistent positive association in both Europe and North America, although levels were clearly below World Health Organization guideline values. There is mixed evidence on the effects of environmental pollution on COPD exacerbations. Limitations of previous studies included the low spatiotemporal resolution of pollutants, inadequate control for confounding factors, and the use of aggregated health data that ignored personal characteristics. The need for more targeted exposure estimates in a large number of geographical locations is evident.
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Li J, Sun S, Tang R, Qiu H, Huang Q, Mason TG, Tian L. Major air pollutants and risk of COPD exacerbations: a systematic review and meta-analysis. Int J Chron Obstruct Pulmon Dis 2016; 11:3079-3091. [PMID: 28003742 PMCID: PMC5161337 DOI: 10.2147/copd.s122282] [Citation(s) in RCA: 152] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Short-term exposure to major air pollutants (O3, CO, NO2, SO2, PM10, and PM2.5) has been associated with respiratory risk. However, evidence on the risk of chronic obstructive pulmonary disease (COPD) exacerbations is still limited. The present study aimed at evaluating the associations between short-term exposure to major air pollutants and the risk of COPD exacerbations. Methods After a systematic search up until March 30, 2016, in both English and Chinese electronic databases such as PubMed, EMBASE, and CNKI, the pooled relative risks and 95% confidence intervals were estimated by using the random-effects model. In addition, the population-attributable fractions (PAFs) were also calculated, and a subgroup analysis was conducted. Heterogeneity was assessed by I2. Results In total, 59 studies were included. In the single-pollutant model, the risks of COPD were calculated by each 10 μg/m3 increase in pollutant concentrations, with the exception of CO (100 μg/m3). There was a significant association between short-term exposure and COPD exacerbation risk for all the gaseous and particulate pollutants. The associations were strongest at lag0 and lag3 for gaseous and particulate air pollutants, respectively. The subgroup analysis not only further confirmed the overall adverse effects but also reduced the heterogeneities obviously. When 100% exposure was assumed, PAFs ranged from 0.60% to 4.31%, depending on the pollutants. The adverse health effects of SO2 and NO2 exposure were more significant in low-/middle-income countries than in high-income countries: SO2, relative risk: 1.012 (95% confidence interval: 1.001, 1.023); and NO2, relative risk: 1.019 (95% confidence interval: 1.014, 1.024). Conclusion Short-term exposure to air pollutants increases the burden of risk of COPD acute exacerbations significantly. Controlling ambient air pollution would provide benefits to COPD patients.
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Affiliation(s)
- Jinhui Li
- Shenzhen Institute of Research and Innovation, Nanshan, The University of Hong Kong, Shenzhen, People's Republic of China; School of Public Health, The University of Hong Kong, Pok Fu Lam, Hong Kong Special Administrative Region
| | - Shengzhi Sun
- Shenzhen Institute of Research and Innovation, Nanshan, The University of Hong Kong, Shenzhen, People's Republic of China; School of Public Health, The University of Hong Kong, Pok Fu Lam, Hong Kong Special Administrative Region
| | - Robert Tang
- Shenzhen Institute of Research and Innovation, Nanshan, The University of Hong Kong, Shenzhen, People's Republic of China; School of Public Health, The University of Hong Kong, Pok Fu Lam, Hong Kong Special Administrative Region
| | - Hong Qiu
- School of Public Health, The University of Hong Kong, Pok Fu Lam, Hong Kong Special Administrative Region
| | - Qingyuan Huang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Minhang, Shanghai, People's Republic of China
| | - Tonya G Mason
- School of Public Health, The University of Hong Kong, Pok Fu Lam, Hong Kong Special Administrative Region
| | - Linwei Tian
- Shenzhen Institute of Research and Innovation, Nanshan, The University of Hong Kong, Shenzhen, People's Republic of China; School of Public Health, The University of Hong Kong, Pok Fu Lam, Hong Kong Special Administrative Region
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DeVries R, Kriebel D, Sama S. Outdoor Air Pollution and COPD-Related Emergency Department Visits, Hospital Admissions, and Mortality: A Meta-Analysis. COPD 2016; 14:113-121. [PMID: 27564008 DOI: 10.1080/15412555.2016.1216956] [Citation(s) in RCA: 108] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
A systematic literature review was performed to identify all peer-reviewed literature quantifying the association between short-term exposures of particulate matter <2.5 microns (PM2.5), nitrogen dioxide (NO2), and sulfur dioxide (SO2) and COPD-related emergency department (ED) visits, hospital admissions (HA), and mortality. These results were then pooled for each pollutant through meta-analyses with a random effects model. Subgroup meta-analyses were explored to study the effects of selected lag/averaging times and health outcomes. A total of 37 studies satisfied our inclusion criteria, contributing to a total of approximately 1,115,000 COPD-related acute events (950,000 HAs, 80,000 EDs, and 130,000 deaths) to our meta-estimates. An increase in PM2.5 of 10 ug/m3 was associated with a 2.5% (95% CI: 1.6-3.4%) increased risk of COPD-related ED and HA, an increase of 10 ug/m3 in NO2 was associated with a 4.2% (2.5-6.0%) increase, and an increase of 10 ug/m3 in SO2 was associated with a 2.1% (0.7-3.5%) increase. The strength of these pooled effect estimates, however, varied depending on the selected lag/averaging time between exposure and outcome. Similar pooled effects were estimated for each pollutant and COPD-related mortality. These results suggest an ongoing threat to the health of COPD patients from both outdoor particulates and gaseous pollutants. Ambient outdoor concentrations of PM2.5, NO2, and SO2 were significantly and positively associated with both COPD-related morbidity and mortality.
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Affiliation(s)
| | - David Kriebel
- a Department of Work Environment , University of Massachusetts Lowell , Lowell , Massachusetts , USA
| | - Susan Sama
- a Department of Work Environment , University of Massachusetts Lowell , Lowell , Massachusetts , USA
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Liu Y, Yan S, Poh K, Liu S, Iyioriobhe E, Sterling DA. Impact of air quality guidelines on COPD sufferers. Int J Chron Obstruct Pulmon Dis 2016; 11:839-72. [PMID: 27143874 PMCID: PMC4846081 DOI: 10.2147/copd.s49378] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Background COPD is one of the leading causes of morbidity and mortality in both high- and low-income countries and a major public health burden worldwide. While cigarette smoking remains the main cause of COPD, outdoor and indoor air pollution are important risk factors to its etiology. Although studies over the last 30 years helped reduce the values, it is not very clear if the current air quality guidelines are adequately protective for COPD sufferers. Objective This systematic review was to summarize the up-to-date literature on the impact of air pollution on the COPD sufferers. Methods PubMed and Google Scholar were utilized to search for articles related to our study’s focus. Search terms included “COPD exacerbation”, “air pollution”, “air quality guidelines”, “air quality standards”, “COPD morbidity and mortality”, “chronic bronchitis”, and “air pollution control” separately and in combination. We focused on articles from 1990 to 2015. We also used articles prior to 1990 if they contained relevant information. We focused on articles written in English or with an English abstract. We also used the articles in the reference lists of the identified articles. Results Both short-term and long-term exposures to outdoor air pollution around the world are associated with the mortality and morbidity of COPD sufferers even at levels below the current air quality guidelines. Biomass cooking in low-income countries was clearly associated with COPD morbidity in adult nonsmoking females. Conclusion There is a need to continue to improve the air quality guidelines. A range of intervention measures could be selected at different levels based on countries’ socioeconomic conditions to reduce the air pollution exposure and COPD burden.
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Affiliation(s)
- Youcheng Liu
- Department of Environmental and Occupational Health Sciences, School of Public Health, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Shuang Yan
- Department of Endocrinology and Metabolism, Fourth Affiliated Hospital, Harbin Medical University, Harbin, Heilongjiang Province, People's Republic of China
| | - Karen Poh
- Department of Environmental and Occupational Health Sciences, School of Public Health, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Suyang Liu
- Epidemiology, Human Genetics & Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Emanehi Iyioriobhe
- Department of Environmental and Occupational Health Sciences, School of Public Health, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - David A Sterling
- Department of Environmental and Occupational Health Sciences, School of Public Health, University of North Texas Health Science Center, Fort Worth, TX, USA
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Wanka ER, Bayerstadler A, Heumann C, Nowak D, Jörres RA, Fischer R. Weather and air pollutants have an impact on patients with respiratory diseases and breathing difficulties in Munich, Germany. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2014; 58:249-262. [PMID: 24091656 DOI: 10.1007/s00484-013-0730-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2012] [Revised: 08/27/2013] [Accepted: 09/02/2013] [Indexed: 06/02/2023]
Abstract
This study determined the influence of various meteorological variables and air pollutants on airway disorders in general, and asthma and/or chronic obstructive pulmonary disease in particular, in Munich, Bavaria, during 2006 and 2007. This was achieved through an evaluation of the daily frequency of calls to medical and emergency call centres, ambulatory medical care visits at general practitioners, and prescriptions of antibiotics for respiratory diseases. Meteorological parameters were extracted from data supplied by the European Centre for Medium Range Weather Forecast. Data on air pollutant levels were extracted from the air quality database of the European Environmental Agency for different measurement sites. In addition to descriptive analyses, a backward elimination procedure was performed to identify variables associated with medical outcome variables. Afterwards, generalised additive models (GAM) were used to verify whether the selected variables had a linear or nonlinear impact on the medical outcomes. The analyses demonstrated associations between environmental parameters and daily frequencies of different medical outcomes, such as visits at GPs and air pressure (-27 % per 10 hPa change) or ozone (-24 % per 10 μg/m(3) change). The results of the GAM indicated that the effects of some covariates, such as carbon monoxide on consultations at GPs, or humidity on medical calls in general, were nonlinear, while the type of association varied between medical outcomes. These data suggest that the multiple, complex effect of environmental factors on medical outcomes should not be assumed homogeneous or linear a priori and that different settings might be associated with different types of associations.
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Affiliation(s)
- E R Wanka
- Institute for Emergency Medicine and Management in Medicine, University Hospital of Munich, Ludwig-Maximilians-University, Schillerstr. 53, 80336, Munich, Germany,
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Cengiz MA, Terzi Y. Comparing models of the effect of air pollutants on hospital admissions and symptoms for chronic obstructive pulmonary disease. Cent Eur J Public Health 2013; 20:282-6. [PMID: 23441395 DOI: 10.21101/cejph.a3757] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
There is an increasing interest in the use of hospital admission for Chronic obstructive pulmonary disease (COPD) in studies of short-term exposure effects attributed to air pollutants. However, little is known about the effect of air pollutants on COPD symptoms. This study was undertaken to determine whether there was an association between air pollutant levels and both hospital admissions and symptoms for COPD. For model comparison, we present Generalized Linear Model, Generalized Additive Model and a general approach for Bayesian inference via Markov chain Monte Carlo in generalized additive model. Furthermore, for comparing the predictive accuracy, Artificial Neural Networks (ANN) approach is given.
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Affiliation(s)
- Mehmet Ali Cengiz
- Department of Statistics, University of Ondokuz Mayis, Samsun, Turkey.
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