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Fatima M, Ahmad A, Butt I, Arshad S, Kiani B. Geospatial modelling of ambient air pollutants and chronic obstructive pulmonary diseases at regional scale in Pakistan. ENVIRONMENTAL MONITORING AND ASSESSMENT 2024; 196:929. [PMID: 39271595 DOI: 10.1007/s10661-024-13105-z] [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: 03/10/2024] [Accepted: 09/06/2024] [Indexed: 09/15/2024]
Abstract
Pakistan is among the South Asian countries mostly vulnerable to the negative health impacts of air pollution. In this context, the study aimed to analyze the spatiotemporal patterns of chronic obstructive pulmonary disease (COPD) incidence and its relationship with air pollutants including aerosol absorbing index (AAI), carbon monoxide, sulfur dioxide (SO2), and nitrogen dioxide. Spatial scan statistics were employed to identify temporal, spatial, and spatiotemporal clusters of COPD. Generalized linear regression (GLR) and random forest (RF) models were utilized to evaluate the linear and non-linear relationships between COPD and air pollutants for the years 2019 and 2020. The findings revealed three spatial clusters of COPD in the eastern and central regions, with a high-risk spatiotemporal cluster in the east. The GLR identified a weak linear relationship between the COPD and air pollutants with R2 = 0.1 and weak autocorrelation with Moran's index = -0.09. The spatial outcome of RF model provided more accurate COPD predictions with improved R2 of 0.8 and 0.9 in the respective years and a very low Moran's I = -0.02 showing a random residual distribution. The RF findings also suggested AAI and SO2 to be the most contributing predictors for the year 2019 and 2020. Hence, the strong association of COPD clusters with some air pollutants highlight the urgency of comprehensive measures to combat air pollution in the region to avoid future health risks.
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Affiliation(s)
- Munazza Fatima
- Department of Geography, The Islamia University of Bahawalpur, Punjab, 63100, Pakistan.
| | - Adeel Ahmad
- Taylor Geospatial Institute, St. Louis, 63103, USA
- Department of Computer Science & Engineering, Washington University in St. Louis, St. Louis, 63130, USA
- Institute of Geography, University of Punjab Lahore, Lahore, 54590, Pakistan
| | - Ibtisam Butt
- Institute of Geography, University of Punjab Lahore, Lahore, 54590, Pakistan
| | - Sana Arshad
- Department of Geography, The Islamia University of Bahawalpur, Punjab, 63100, Pakistan
| | - Behzad Kiani
- Centre for Clinical Research, The University of Queensland, Brisbane, Australia
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2
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Boura D, Spanakis M, Markakis G, Notas G, Lionis C, Tzanakis N, Paraskakis E. Exploring the Relationship between Wind Patterns and Hospital Admissions Due to Respiratory Symptoms in Children. CHILDREN (BASEL, SWITZERLAND) 2024; 11:717. [PMID: 38929296 PMCID: PMC11201383 DOI: 10.3390/children11060717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 05/31/2024] [Accepted: 06/11/2024] [Indexed: 06/28/2024]
Abstract
Respiratory disorders significantly impact adolescents' health, often resulting in hospital admissions. Meteorological elements such as wind patterns have emerged as potential contributors to respiratory symptoms. However, it remains uncertain whether fluctuations in wind characteristics over extended periods have a tangible impact on respiratory health, particularly in regions characterized by distinct annual wind patterns. Crete is situated in the central-eastern Mediterranean Sea and frequently faces southerly winds carrying Sahara Desert sand from Africa and northerly winds from the Aegean Sea. This retrospective study analyzes long-term wind direction data and their relationship to respiratory symptoms observed in children up to 14 years old admitted at the University Hospital of Heraklion between 2002 and 2010. Symptoms such as headache, dyspnea, dry cough, dizziness, tachypnea, throat ache, and earache were predominantly reported during the presence of southern winds. Fever, productive cough, and chest pain were more frequently reported during northern winds. Cough was the most common symptom regardless of the wind pattern. Southern winds were significantly associated with higher probabilities of productive or non-productive cough, headache, dyspnea, tachypnea, dizziness, earache, and throat ache. Northern winds were related to a higher incidence of productive cough. Rhinitis, asthma, allergies, pharyngitis, and sinusitis were related to southern winds, while bronchiolitis and pneumonia were associated with northern winds. These findings underscore the critical role of local climatic factors, emphasizing their potential impact on exacerbating respiratory conditions in children. Moreover, they point out the need for further research to elucidate the underlying mechanisms and develop targeted interventions for at-risk populations.
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Affiliation(s)
- Despoina Boura
- Department of Respiratory Medicine, University Hospital of Heraklion, School of Medicine, University of Crete, 71003 Heraklion, Greece; (D.B.); (N.T.)
| | - Marios Spanakis
- Department of Forensic Sciences and Toxicology, School of Medicine, University of Crete, 71003 Heraklion, Greece;
- Computational Bio-Medicine Laboratory, Institute of Computer Science, Foundation for Research & Technology–Hellas, 71110 Heraklion, Greece
| | - George Markakis
- Department of Social Work, Faculty of Health Sciences, Hellenic Mediterranean University, 71004 Heraklion, Greece;
| | - George Notas
- Department of Emergency Medicine, University Hospital of Heraklion, School of Medicine, University of Crete, 71003 Heraklion, Greece;
| | - Christos Lionis
- Clinic of Social and Family Medicine, School of Medicine, University of Crete, 71003 Heraklion, Greece;
| | - Nikolaos Tzanakis
- Department of Respiratory Medicine, University Hospital of Heraklion, School of Medicine, University of Crete, 71003 Heraklion, Greece; (D.B.); (N.T.)
| | - Emmanouil Paraskakis
- Paediatric Respiratory Unit, Paediatric Department, University of Crete, 71500 Heraklion, Greece
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3
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Lindsay S, Hsu S, Ragunathan S, Lindsay J. The impact of climate change related extreme weather events on people with pre-existing disabilities and chronic conditions: a scoping review. Disabil Rehabil 2023; 45:4338-4358. [PMID: 36426560 DOI: 10.1080/09638288.2022.2150328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 11/16/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE People with disabilities experience a disproportionate impact of extreme weather events and there is a critical need to better understand the impact that climate change has for them. Most previous reviews focus on the risk of acquiring a new disability or injury after a climate-related event and not the impact on people with pre-existing disabilities or chronic conditions, which is the purpose of this study. METHODS We conducted a scoping review while searching seven international databases that identified 45 studies meeting our inclusion criteria. RESULTS The studies included in our review involved 2 337 199 participants with pre-existing disabilities and chronic conditions across 13 countries over a 20-year period. The findings demonstrated the following trends: (1) the impact on physical and mental health; (2) the impact on education and work; (3) barriers to accessing health and community services (i.e., lack of access to services, lack of knowledge about people with disabilities, communication challenges, lack of adequate housing); and (4) coping strategies (i.e., social supports and connecting to resources) and resilience. CONCLUSIONS Our findings highlight the critical need for rehabilitation clinicians and other service providers to explore opportunities to support their clients in preparing for climate-related emergencies.
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Affiliation(s)
- Sally Lindsay
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
- Department of Occupational Science & Occupational Therapy, University of Toronto, Toronto, Canada
| | - Shaelynn Hsu
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
| | - Sharmigaa Ragunathan
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
| | - John Lindsay
- Department of Geography, Environment & Geomatics, University of Guelph, Guelph, Canada
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4
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Gandhi S, Tonelli R, Murray M, Samarelli AV, Spagnolo P. Environmental Causes of Idiopathic Pulmonary Fibrosis. Int J Mol Sci 2023; 24:16481. [PMID: 38003670 PMCID: PMC10671449 DOI: 10.3390/ijms242216481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 11/06/2023] [Accepted: 11/15/2023] [Indexed: 11/26/2023] Open
Abstract
Idiopathic pulmonary fibrosis (IPF), the most common and severe of the idiopathic interstitial pneumonias, is a chronic and relentlessly progressive disease, which occurs mostly in middle-aged and elderly males. Although IPF is by definition "idiopathic", multiple factors have been reported to increase disease risk, aging being the most prominent one. Several occupational and environmental exposures, including metal dust, wood dust and air pollution, as well as various lifestyle variables, including smoking and diet, have also been associated with an increased risk of IPF, probably through interaction with genetic factors. Many of the predisposing factors appear to act also as trigger for acute exacerbations of the disease, which herald a poor prognosis. The more recent literature on inhalation injuries has focused on the first responders in the World Trade Center attacks and military exposure. In this review, we present an overview of the environmental and occupational causes of IPF and its pathogenesis. While our list is not comprehensive, we have selected specific exposures to highlight based on their overall disease burden.
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Affiliation(s)
- Sheiphali Gandhi
- Division of Occupational and Environmental Medicine, University of California San Francisco, San Francisco, CA 94143-0924, USA; (S.G.); (M.M.)
| | - Roberto Tonelli
- Respiratory Disease Unit, University Hospital of Modena, Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, 42125 Modena, Italy; (R.T.); (A.V.S.)
- Laboratory of Cell Therapies and Respiratory Medicine, Department of Medical and Surgical Sciences for Children & Adults, University of Modena and Reggio Emilia, 41124 Modena, Italy
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, 42121 Modena, Italy
| | - Margaret Murray
- Division of Occupational and Environmental Medicine, University of California San Francisco, San Francisco, CA 94143-0924, USA; (S.G.); (M.M.)
| | - Anna Valeria Samarelli
- Respiratory Disease Unit, University Hospital of Modena, Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, 42125 Modena, Italy; (R.T.); (A.V.S.)
- Laboratory of Cell Therapies and Respiratory Medicine, Department of Medical and Surgical Sciences for Children & Adults, University of Modena and Reggio Emilia, 41124 Modena, Italy
| | - Paolo Spagnolo
- Respiratory Disease Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35128 Padova, Italy
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Sin DD, Doiron D, Agusti A, Anzueto A, Barnes PJ, Celli BR, Criner GJ, Halpin D, Han MK, Martinez FJ, Montes de Oca M, Papi A, Pavord I, Roche N, Singh D, Stockley R, Lopez Varlera MV, Wedzicha J, Vogelmeier C, Bourbeau J. Air pollution and COPD: GOLD 2023 committee report. Eur Respir J 2023; 61:2202469. [PMID: 36958741 DOI: 10.1183/13993003.02469-2022] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 03/04/2023] [Indexed: 03/25/2023]
Abstract
Exposure to air pollution is a major contributor to the pathogenesis of COPD worldwide. Indeed, most recent estimates suggest that 50% of the total attributable risk of COPD may be related to air pollution. In response, the Global Initiative for Chronic Obstructive Lung Disease (GOLD) Scientific Committee performed a comprehensive review on this topic, qualitatively synthesised the evidence to date and proffered recommendations to mitigate the risk. The review found that both gaseous and particulate components of air pollution are likely contributors to COPD. There are no absolutely safe levels of ambient air pollution and the relationship between air pollution levels and respiratory events is supra-linear. Wildfires and extreme weather events such as heat waves, which are becoming more common owing to climate change, are major threats to COPD patients and acutely increase their risk of morbidity and mortality. Exposure to air pollution also impairs lung growth in children and as such may lead to developmental COPD. GOLD recommends strong public health policies around the world to reduce ambient air pollution and for implementation of public warning systems and advisories, including where possible the use of personalised apps, to alert patients when ambient air pollution levels exceed acceptable minimal thresholds. When household particulate content exceeds acceptable thresholds, patients should consider using air cleaners and filters where feasible. Air pollution is a major health threat to patients living with COPD and actions are urgently required to reduce the morbidity and mortality related to poor air quality around the world.
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Affiliation(s)
- Don D Sin
- Centre for Heart Lung Innovation, St Paul's Hospital and University of British Columbia Division of Respiratory Medicine, Vancouver, BC, Canada
| | - Dany Doiron
- McGill University Health Centre, McGill University, Montreal, QC, Canada
| | - Alvar Agusti
- Respiratory Institute, Hospital Clinic, IDIBAPS, University of Barcelona and CIBERES, Barcelona, Spain
| | - Antonio Anzueto
- South Texas Veterans Health Care System, University of Texas, San Antonio, TX, USA
| | - Peter J Barnes
- National Heart and Lung Institute, Imperial College London, London, UK
| | | | | | - David Halpin
- University of Exeter Medical School, College of Medicine and Health, University of Exeter, Exeter, UK
| | | | - Fernando J Martinez
- Weill Cornell Medical Center/New York-Presbyterian Hospital, New York, NY, USA
| | - Maria Montes de Oca
- Hospital Universitario de Caracas, Universidad Central de Venezuela, Centro Médico de Caracas, Caracas, Venezuela
| | - Alberto Papi
- Respiratory Medicine, University of Ferrara, Ferrara, Italy
| | - Ian Pavord
- Respiratory Medicine Unit and Oxford Respiratory NIHR Biomedical Research Centre, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Nicolas Roche
- Service de Pneumologie, Hôpital Cochin, AP-HP, Université Paris Cité, UMR 1016, Institut Cochin, Paris, France
| | - Dave Singh
- University of Manchester, Manchester, UK
| | | | | | - Jadwiga Wedzicha
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Claus Vogelmeier
- Department of Medicine, Pulmonary and Critical Care Medicine, University Hospital Giessen and Marburg, German Center for Lung Research (DZL), University of Marburg, Marburg, Germany
| | - Jean Bourbeau
- McGill University Health Centre, McGill University, Montreal, QC, Canada
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6
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Neira M, Erguler K, Ahmady-Birgani H, Al-Hmoud ND, Fears R, Gogos C, Hobbhahn N, Koliou M, Kostrikis LG, Lelieveld J, Majeed A, Paz S, Rudich Y, Saad-Hussein A, Shaheen M, Tobias A, Christophides G. Climate change and human health in the Eastern Mediterranean and Middle East: Literature review, research priorities and policy suggestions. ENVIRONMENTAL RESEARCH 2023; 216:114537. [PMID: 36273599 PMCID: PMC9729515 DOI: 10.1016/j.envres.2022.114537] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 09/29/2022] [Accepted: 10/06/2022] [Indexed: 05/17/2023]
Abstract
Human health is linked to climatic factors in complex ways, and climate change can have profound direct and indirect impacts on the health status of any given region. Susceptibility to climate change is modulated by biological, ecological and socio-political factors such as age, gender, geographic location, socio-economic status, occupation, health status and housing conditions, among other. In the Eastern Mediterranean and Middle East (EMME), climatic factors known to affect human health include extreme heat, water shortages and air pollution. Furthermore, the epidemiology of vector-borne diseases (VBDs) and the health consequences of population displacement are also influenced by climate change in this region. To inform future policies for adaptation and mitigation measures, and based on an extensive review of the available knowledge, we recommend several research priorities for the region. These include the generation of more empirical evidence on exposure-response functions involving climate change and specific health outcomes, the development of appropriate methodologies to evaluate the physical and psychological effects of climate change on vulnerable populations, determining how climate change alters the ecological determinants of human health, improving our understanding of the effects of long-term exposure to heat stress and air pollution, and evaluating the interactions between adaptation and mitigation strategies. Because national boundaries do not limit most climate-related factors expected to impact human health, we propose that adaptation/mitigation policies must have a regional scope, and therefore require collaborative efforts among EMME nations. Policy suggestions include a decisive region-wide decarbonisation, the integration of environmentally driven morbidity and mortality data throughout the region, advancing the development and widespread use of affordable technologies for the production and management of drinking water by non-traditional means, the development of comprehensive strategies to improve the health status of displaced populations, and fostering regional networks for monitoring and controlling the spread of infectious diseases and disease vectors.
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Affiliation(s)
- Marco Neira
- Climate and Atmosphere Research Center (CARE-C), The Cyprus Institute, Nicosia, Cyprus.
| | - Kamil Erguler
- Climate and Atmosphere Research Center (CARE-C), The Cyprus Institute, Nicosia, Cyprus
| | | | | | - Robin Fears
- European Academies Science Advisory Council (EASAC), Halle (Saale), Germany
| | | | - Nina Hobbhahn
- European Academies Science Advisory Council (EASAC), Halle (Saale), Germany
| | - Maria Koliou
- University of Cyprus Medical School, Nicosia, Cyprus
| | - Leondios G Kostrikis
- Department of Biological Sciences, University of Cyprus, Nicosia, Cyprus; Cyprus Academy of Sciences, Letters, and Arts, Nicosia, Cyprus
| | - Jos Lelieveld
- Climate and Atmosphere Research Center (CARE-C), The Cyprus Institute, Nicosia, Cyprus; Max Planck Institute for Chemistry, Mainz, Germany
| | - Azeem Majeed
- Department of Primary Care & Public Health, Imperial College London, London, United Kingdom
| | - Shlomit Paz
- Department of Geography and Environmental Studies, University of Haifa, Haifa, Israel
| | - Yinon Rudich
- Department of Earth and Planetary Sciences, The Weismann Institute of Science, Rehovot, Israel
| | - Amal Saad-Hussein
- Environment and Climate Change Research Institute, National Research Centre, Cairo, Egypt
| | - Mohammed Shaheen
- Damour for Community Development - Research Department, Palestine
| | - Aurelio Tobias
- Institute of Environmental Assessment and Water Research (IDAEA), Spanish Council for Scientific Research (CSIC), Barcelona, Spain
| | - George Christophides
- Climate and Atmosphere Research Center (CARE-C), The Cyprus Institute, Nicosia, Cyprus; Department of Life Sciences, Imperial College London, London, United Kingdom.
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Monteiro A, Basart S, Kazadzis S, Votsis A, Gkikas A, Vandenbussche S, Tobias A, Gama C, García-Pando CP, Terradellas E, Notas G, Middleton N, Kushta J, Amiridis V, Lagouvardos K, Kosmopoulos P, Kotroni V, Kanakidou M, Mihalopoulos N, Kalivitis N, Dagsson-Waldhauserová P, El-Askary H, Sievers K, Giannaros T, Mona L, Hirtl M, Skomorowski P, Virtanen TH, Christoudias T, Di Mauro B, Trippetta S, Kutuzov S, Meinander O, Nickovic S. Multi-sectoral impact assessment of an extreme African dust episode in the Eastern Mediterranean in March 2018. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 843:156861. [PMID: 35750162 DOI: 10.1016/j.scitotenv.2022.156861] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 06/17/2022] [Accepted: 06/17/2022] [Indexed: 06/15/2023]
Abstract
In late March 2018, a large part of the Eastern Mediterranean experienced an extraordinary episode of African dust, one of the most intense in recent years, here referred to as the "Minoan Red" event. The episode mainly affected the Greek island of Crete, where the highest aerosol concentrations over the past 15 yeas were recorded, although impacts were also felt well beyond this core area. Our study fills a gap in dust research by assessing the multi-sectoral impacts of sand and dust storms and their socioeconomic implications. Specifically, we provide a multi-sectoral impact assessment of Crete during the occurrence of this exceptional African dust event. During the day of the occurrence of the maximum dust concentration in Crete, i.e. March 22nd, 2018, we identified impacts on meteorological conditions, agriculture, transport, energy, society (including closing of schools and cancellation of social events), and emergency response systems. As a result, the event led to a 3-fold increase in daily emergency responses compare to previous days associated with urban emergencies and wildfires, a 3.5-fold increase in hospital visits and admissions for Chronic Obstructive Pulmonary Disease (COPD) exacerbations and dyspnoea, a reduction of visibility causing aircraft traffic disruptions (eleven cancellations and seven delays), and a reduction of solar energy production. We estimate the cost of direct and indirect effects of the dust episode, considering the most affected socio-economic sectors (e.g. civil protection, aviation, health and solar energy production), to be between 3.4 and 3.8 million EUR for Crete. Since such desert dust transport episodes are natural, meteorology-driven and thus to a large extent unavoidable, we argue that the efficiency of actions to mitigate dust impacts depends on the accuracy of operational dust forecasting and the implementation of relevant early warning systems for social awareness.
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Affiliation(s)
- Alexandra Monteiro
- CESAM & Department of Environment and Planning, University of Aveiro, Aveiro, Portugal.
| | - Sara Basart
- Barcelona Supercomputing Center (BSC), Barcelona, Spain
| | - Stelios Kazadzis
- Physikalisch-Meteorologisches Observatorium Davos, World Radiation Center, Switzerland
| | - Athanasios Votsis
- Dept. of Governance and Technology for Sustainability, University of Twente, Enschede, Netherlands; Climate Change and Society, Finnish Meteorological Institute, Helsinki, Finland
| | - Antonis Gkikas
- IAASARS, National Observatory of Athens, 15236 Athens, Greece
| | | | - Aurelio Tobias
- Institute of Environmental Assessment and Water Research (IDAEA), Spanish Council for Scientific Research (CSIC), Barcelona, Spain; School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Carla Gama
- CESAM & Department of Environment and Planning, University of Aveiro, Aveiro, Portugal
| | - Carlos Pérez García-Pando
- Barcelona Supercomputing Center (BSC), Barcelona, Spain; ICREA, Catalan Institution for Research and Advanced Studies, Barcelona, Spain
| | | | - George Notas
- School of Medicine and University Hospital, Department of Emergency Medicine, University of Crete, 70013 Heraklion, Greece
| | - Nick Middleton
- St Anne's College, University of Oxford, Oxford OX2 6HS, United Kingdom
| | - Jonilda Kushta
- Climate and Atmosphere Research Center (CARE-C), The Cyprus Institute, Nicosia 2121, Cyprus
| | | | - Kostas Lagouvardos
- Institute of Environmental Research and Sustainable Development, National Observatory of Athens (IERSD/NOA), Greece
| | - Panagiotis Kosmopoulos
- Institute of Environmental Research and Sustainable Development, National Observatory of Athens (IERSD/NOA), Greece
| | - Vasiliki Kotroni
- Institute of Environmental Research and Sustainable Development, National Observatory of Athens (IERSD/NOA), Greece
| | - Maria Kanakidou
- Environmental Chemical Processes Laboratory, Chemistry Department, University of Crete, 70013 Heraklion, Greece
| | - Nikos Mihalopoulos
- Institute of Environmental Research and Sustainable Development, National Observatory of Athens (IERSD/NOA), Greece; Environmental Chemical Processes Laboratory, Chemistry Department, University of Crete, 70013 Heraklion, Greece
| | - Nikos Kalivitis
- IAASARS, National Observatory of Athens, 15236 Athens, Greece; Environmental Chemical Processes Laboratory, Chemistry Department, University of Crete, 70013 Heraklion, Greece
| | - Pavla Dagsson-Waldhauserová
- Agricultural University of Iceland, Keldnaholt, 112 Reykjavik, Iceland; Faculty of Environmental Sciences, Czech University of Life Sciences, Prague 165 21, Czech Republic
| | - Hesham El-Askary
- Schmid College of Science and Technology, Chapman University, Orange, CA, 92866, USA; Department of Environmental Sciences, Faculty of Science, Alexandria University, Alexandria 21522, Egypt
| | - Klaus Sievers
- ZAMG - Zentralanstalt für Meteorologie und Geodynamik, Wien, Austria
| | - T Giannaros
- Institute of Environmental Research and Sustainable Development, National Observatory of Athens (IERSD/NOA), Greece
| | - Lucia Mona
- Consiglio Nazionale delle Ricerche, Istituto di Metodologie per l'Analisi Ambientale (CNR-IMAA), Tito Scalo (PZ), Italy
| | - Marcus Hirtl
- ZAMG - Zentralanstalt für Meteorologie und Geodynamik, Wien, Austria
| | - Paul Skomorowski
- ZAMG - Zentralanstalt für Meteorologie und Geodynamik, Wien, Austria
| | - Timo H Virtanen
- Finnish Meteorological Institute, Climate Research, 00101 Helsinki, Finland
| | - Theodoros Christoudias
- Climate and Atmosphere Research Center (CARE-C), The Cyprus Institute, Nicosia 2121, Cyprus
| | - Biagio Di Mauro
- Institute of Polar Sciences, National Research Council of Italy, Milano, Italy
| | - Serena Trippetta
- Consiglio Nazionale delle Ricerche, Istituto di Metodologie per l'Analisi Ambientale (CNR-IMAA), Tito Scalo (PZ), Italy
| | - Stanislav Kutuzov
- Dept. of Glaciology, Institute of Geography Russian Academy of Sciences, Russia; Faculty of Geography and Geoinformation Technologies, National Research University Higher School of Economics, Russia
| | - Outi Meinander
- Finnish Meteorological Institute, Climate Research, 00101 Helsinki, Finland
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8
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Celebi Sozener Z, Özbey Yücel Ü, Altiner S, Ozdel Oztürk B, Cerci P, Türk M, Gorgülü Akin B, Akdis M, Yilmaz I, Ozdemir C, Mungan D, Akdis CA. The External Exposome and Allergies: From the Perspective of the Epithelial Barrier Hypothesis. FRONTIERS IN ALLERGY 2022; 3:887672. [PMID: 35873598 PMCID: PMC9304993 DOI: 10.3389/falgy.2022.887672] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 04/29/2022] [Indexed: 01/04/2023] Open
Abstract
Introduction In the last decades, we have seen a rapid increase in the prevalence of allergic diseases such as asthma, allergic rhinitis, atopic dermatitis, and food allergies. The environmental changes caused by industrialization, urbanization and modernization, including dramatic increases in air pollutants such as particulate matter (PM), diesel exhaust, nitrogen dioxide (NO2), ozone (O3), alarming effects of global warming, change and loss of biodiversity, affect both human health and the entire ecosystem. Objective In this review, we aimed to discuss the effects of the external exposome on epithelial barriers and its relationship with the development of allergic diseases by considering the changes in all stakeholders of the outer exposome together, in the light of the recently proposed epithelial barrier hypothesis. Method To reach current, prominent, and comprehensive studies on the subject, PubMed databases were searched. We included the more resounding articles with reliable and strong results. Results Exposure to altered environmental factors such as increased pollution, microplastics, nanoparticles, tobacco smoke, food emulsifiers, detergents, and household cleaners, and climate change, loss and change in microbial biodiversity, modifications in the consumption of dietary fatty acids, the use of emulsifiers, preservatives and the decrease in the antioxidant content of the widely consumed western diet may disrupt the epithelial barriers of the skin, respiratory and gastrointestinal tracts, making us more vulnerable to exogeneous allergens and microbes. Epithelial cell activation, microbial dysbiosis and bacterial translocation disrupt the immune balance and a chronic Th2 inflammation ensues. Conclusion Dramatic increases in air pollution, worrisome effects of global warming, dysbiosis, changing dietary habits and the complex interactions of all these factors affect the epithelial barriers and local and systemic inflammation. We want to draw attention to the emerging health effects of environmental changes and to motivate the public to influence government policies for the well-being of humans and the nature of the earth and the well-being of future generations.
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Affiliation(s)
- Zeynep Celebi Sozener
- Clinic of Immunology and Allergic Diseases, Ankara City Hospital, Ankara, Turkey
- *Correspondence: Zeynep Celebi Sozener ; orcid.org/0000-0003-4188-0959
| | - Ümüs Özbey Yücel
- Department of Nutrition and Diet, Ankara University, Ankara, Turkey
| | - Seda Altiner
- Division of Immunology and Allergic Diseases, Department of Internal Medicine, School of Medicine, Ankara University, Ankara, Turkey
| | - Betül Ozdel Oztürk
- Division of Immunology and Allergic Diseases, Department of Chest Diseases, School of Medicine, Ankara University, Ankara, Turkey
| | - Pamir Cerci
- Clinic of Immunology and Allergic Diseases, Eskisehir City Hospital, Eskisehir, Turkey
| | - Murat Türk
- Clinic of Immunology and Allergic Diseases, Kayseri City Hospital, Kayseri, Turkey
| | - Begüm Gorgülü Akin
- Clinic of Immunology and Allergic Diseases, Ankara City Hospital, Ankara, Turkey
| | - Mübeccel Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
| | - Insu Yilmaz
- Division of Immunology and Allergic Diseases, Department of Chest Diseases, Erciyes University, Kayseri, Turkey
| | - Cevdet Ozdemir
- Department of Pediatric Basic Sciences, Institute of Child Health, Istanbul University, Istanbul, Turkey
- Division of Pediatric Allergy and Immunology, Department of Pediatrics, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Dilsad Mungan
- Division of Immunology and Allergic Diseases, Department of Chest Diseases, School of Medicine, Ankara University, Ankara, Turkey
| | - Cezmi A. Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
- Christine Kühne-Center for Allergy Research and Education (CK-CARE), Davos, Switzerland
- Cezmi A. Akdis ; orcid.org/0000-0001-8020-019X
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9
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Celebi Sozener Z, Ozdel Ozturk B, Cerci P, Turk M, Gorgulu Akin B, Akdis M, Altiner S, Ozbey U, Ogulur I, Mitamura Y, Yilmaz I, Nadeau K, Ozdemir C, Mungan D, Akdis CA. Epithelial barrier hypothesis: Effect of the external exposome on the microbiome and epithelial barriers in allergic disease. Allergy 2022; 77:1418-1449. [PMID: 35108405 PMCID: PMC9306534 DOI: 10.1111/all.15240] [Citation(s) in RCA: 139] [Impact Index Per Article: 69.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 01/25/2022] [Accepted: 01/29/2022] [Indexed: 12/11/2022]
Abstract
Environmental exposure plays a major role in the development of allergic diseases. The exposome can be classified into internal (e.g., aging, hormones, and metabolic processes), specific external (e.g., chemical pollutants or lifestyle factors), and general external (e.g., broader socioeconomic and psychological contexts) domains, all of which are interrelated. All the factors we are exposed to, from the moment of conception to death, are part of the external exposome. Several hundreds of thousands of new chemicals have been introduced in modern life without our having a full understanding of their toxic health effects and ways to mitigate these effects. Climate change, air pollution, microplastics, tobacco smoke, changes and loss of biodiversity, alterations in dietary habits, and the microbiome due to modernization, urbanization, and globalization constitute our surrounding environment and external exposome. Some of these factors disrupt the epithelial barriers of the skin and mucosal surfaces, and these disruptions have been linked in the last few decades to the increasing prevalence and severity of allergic and inflammatory diseases such as atopic dermatitis, food allergy, allergic rhinitis, chronic rhinosinusitis, eosinophilic esophagitis, and asthma. The epithelial barrier hypothesis provides a mechanistic explanation of how these factors can explain the rapid increase in allergic and autoimmune diseases. In this review, we discuss factors affecting the planet's health in the context of the 'epithelial barrier hypothesis,' including climate change, pollution, changes and loss of biodiversity, and emphasize the changes in the external exposome in the last few decades and their effects on allergic diseases. In addition, the roles of increased dietary fatty acid consumption and environmental substances (detergents, airborne pollen, ozone, microplastics, nanoparticles, and tobacco) affecting epithelial barriers are discussed. Considering the emerging data from recent studies, we suggest stringent governmental regulations, global policy adjustments, patient education, and the establishment of individualized control measures to mitigate environmental threats and decrease allergic disease.
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Affiliation(s)
| | - Betul Ozdel Ozturk
- School of MedicineDepartment of Chest DiseasesDivision of Immunology and Allergic DiseasesAnkara UniversityAnkaraTurkey
| | - Pamir Cerci
- Clinic of Immunology and Allergic DiseasesEskisehir City HospitalEskisehirTurkey
| | - Murat Turk
- Clinic of Immunology and Allergic DiseasesKayseri City HospitalKayseriTurkey
| | - Begum Gorgulu Akin
- Clinic of Immunology and Allergic DiseasesAnkara City HospitalAnkaraTurkey
| | - Mubeccel Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF)University of ZurichDavosSwitzerland
| | - Seda Altiner
- Clinic of Internal Medicine Division of Immunology and Allergic DiseasesKahramanmaras Necip Fazil City HospitalKahramanmarasTurkey
| | - Umus Ozbey
- Department of Nutrition and DietAnkara UniversityAnkaraTurkey
| | - Ismail Ogulur
- Swiss Institute of Allergy and Asthma Research (SIAF)University of ZurichDavosSwitzerland
| | - Yasutaka Mitamura
- Swiss Institute of Allergy and Asthma Research (SIAF)University of ZurichDavosSwitzerland
| | - Insu Yilmaz
- Department of Chest DiseasesDivision of Immunology and Allergic DiseasesErciyes UniversityKayseriTurkey
| | - Kari Nadeau
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University School of MedicineDivision of Pulmonary and Critical Care MedicineDepartment of MedicineStanford UniversityStanfordCaliforniaUSA
| | - Cevdet Ozdemir
- Institute of Child HealthDepartment of Pediatric Basic SciencesIstanbul UniversityIstanbulTurkey
- Istanbul Faculty of MedicineDepartment of PediatricsDivision of Pediatric Allergy and ImmunologyIstanbul UniversityIstanbulTurkey
| | - Dilsad Mungan
- School of MedicineDepartment of Chest DiseasesDivision of Immunology and Allergic DiseasesAnkara UniversityAnkaraTurkey
| | - Cezmi A. Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF)University of ZurichDavosSwitzerland
- Christine Kühne‐Center for Allergy Research and Education (CK‐CARE)DavosSwitzerland
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10
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Saers J, Andersson L, Janson C, Sundh J. Respiratory symptoms, lung function, and fraction of exhaled nitric oxide before and after assignment in a desert environment-a cohort study. Respir Med 2021; 189:106643. [PMID: 34653874 DOI: 10.1016/j.rmed.2021.106643] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 09/23/2021] [Accepted: 10/05/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Inhalation of small particulate matter (PM 2.5) may be associated with development of respiratory disease. Increased respiratory symptoms have been reported among military staff after service in countries with recurrent desert storms. OBJECTIVE The aim was to investigate whether an assignment in a desert environment and exposure to desert storms are associated with negative effects on respiratory health. METHODS In two cohorts of Swedish soldiers serving in Mali as part of the United Nations stabilization forces, examination with spirometry, determination of fraction of exhaled nitric oxide (FeNO), and a questionnaire including participant characteristics, symptoms, and exposure was performed before and after service. Ambient air sampling was conducted on-site. Paired t-test was used to compare pre- and post-variables on lung function data, FeNO and symptom level. RESULTS Most indoor and outdoor air measurements of dust and silica were within the Swedish occupational exposure limit for PM2.5 and silica (<0.10-2.7 mg/m3 and <0.002-0.40 mg/m3, respectively) as well as for respirable dust and silica (0.056-0.078 mg/m3and 0.0033-0.025 mg/m3, respectively). In the subgroup of participants with reported exposure to desert storms during the stay in Mali, forced expiratory volume in 1 s (FEV1) was significantly lower after exposure than before the mission (mean litres (SD) 4.21 ± 0.66 vs 4.33 ± 0.72, p = 0.021). CONCLUSION Exposure to a desert storm was associated with a decrease in FEV1. Exposure to small particulate matter may contribute to the development of respiratory disease and thus spirometry should be performed after occupational exposure to desert storms.
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Affiliation(s)
- Johannes Saers
- School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Lena Andersson
- Department of Occupational and Environmental Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Christer Janson
- Department of Medical Sciences, Respiratory, Allergy & Sleep Research, Uppsala University, Uppsala, Sweden
| | - Josefin Sundh
- Department of Respiratory Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
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11
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Sadeghimoghaddam A, Khankeh H, Norozi M, Fateh S, Farrokhi M. Investigating the effects of dust storms on morbidity and mortality due to cardiovascular and respiratory diseases: A systematic review. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2021; 10:191. [PMID: 34250125 PMCID: PMC8249988 DOI: 10.4103/jehp.jehp_1272_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 10/11/2020] [Indexed: 06/13/2023]
Abstract
New epidemiological studies acknowledge the detrimental effects of dust storms on health. The aim of this study was to systematically review the effects of dust storms on the morbidity and mortality rates of cardiovascular and respiratory diseases. The results of this study were obtained based on articles published in English-language journals. For the purpose of this study, all articles published until the end of 2020 based on the search in the "Scopus," "Web of Science," and "PubMed" databases were selected. Articles were searched independently by two trained researchers. Dust storms are the cause of many diseases and health-related complications, of which cardiovascular and respiratory diseases are common. It is necessary to recognize and investigate the harmful effects of dust storms to prevent serious harms to human societies. In the reviewed articles, the impact of dust storms on several diseases, including cardiovascular and respiratory diseases, has been analyzed. Most of these articles acknowledge the effect of dust storms on increasing the incidence and mortality rate of these diseases, although in some articles this effect is not statistically significant. Many studies conducted around the world confirm the harmful effects of dust storms on cardiovascular and respiratory diseases, including increase in the number and duration of hospitalizations, as well as increase in mortality and exacerbation of these diseases. However, some studies do not consider the harmful effects of dust storms on the above diseases to be statistically significant.
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Affiliation(s)
- Ali Sadeghimoghaddam
- Health in Emergency and Disaster Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
- Faculty of Nursing and Midwifery, Dezful University of Medical Sciences, Dezful, Iran
| | - Hamidreza Khankeh
- Health in Emergency and Disaster Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
- Department of Clinical Science and Education, Karolinska Institute, Stockholm, Sweden,
| | - Mehdi Norozi
- Social Determinants of Health Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Shahrokh Fateh
- Health in Emergency and Disaster Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Mehrdad Farrokhi
- Health in Emergency and Disaster Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
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12
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Aghababaeian H, Ostadtaghizadeh A, Ardalan A, Asgary A, Akbary M, Yekaninejad MS, Stephens C. Global Health Impacts of Dust Storms: A Systematic Review. ENVIRONMENTAL HEALTH INSIGHTS 2021; 15:11786302211018390. [PMID: 34103932 PMCID: PMC8150667 DOI: 10.1177/11786302211018390] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 04/27/2021] [Indexed: 05/08/2023]
Abstract
BACKGROUND Dust storms and their impacts on health are becoming a major public health issue. The current study examines the health impacts of dust storms around the world to provide an overview of this issue. METHOD In this systematic review, 140 relevant and authoritative English articles on the impacts of dust storms on health (up to September 2019) were identified and extracted from 28 968 articles using valid keywords from various databases (PubMed, WOS, EMBASE, and Scopus) and multiple screening steps. Selected papers were then qualitatively examined and evaluated. Evaluation results were summarized using an Extraction Table. RESULTS The results of the study are divided into two parts: short and long-term impacts of dust storms. Short-term impacts include mortality, visitation, emergency medical dispatch, hospitalization, increased symptoms, and decreased pulmonary function. Long-term impacts include pregnancy, cognitive difficulties, and birth problems. Additionally, this study shows that dust storms have devastating impacts on health, affecting cardiovascular and respiratory health in particular. CONCLUSION The findings of this study show that dust storms have significant public health impacts. More attention should be paid to these natural hazards to prepare for, respond to, and mitigate these hazardous events to reduce their negative health impacts.Registration: PROSPERO registration number CRD42018093325.
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Affiliation(s)
- Hamidreza Aghababaeian
- Department of Health in Emergencies and Disasters, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- Center for Air Pollution Research (CAPR), Institute for Environmental Research (IER), Tehran University of Medical Sciences, Tehran, Iran
- Department of Nursing and Emergency, Dezful University of Medical Sciences, Dezful, Iran
| | - Abbas Ostadtaghizadeh
- Department of Health in Emergencies and Disasters, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- Center for Air Pollution Research (CAPR), Institute for Environmental Research (IER), Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Ardalan
- Department of Health in Emergencies and Disasters, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Asgary
- Disaster and Emergency Management, School of Administrative Studies, York University, Toronto, Canada
| | - Mehry Akbary
- Department of Climatology, Faculty of Geographical Sciences, Kharazmi University, Tehran, Iran
| | - Mir Saeed Yekaninejad
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Carolyn Stephens
- UCL Bartlett Development Planning Unit, London School of Hygiene & Tropical Medicine, London, UK
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Abstract
Objective To summarize the main updated evidence about the health effects of air pollution, with a special focus on Southern Europe. Data sources Literature was obtained through PubMed Central and the official websites of European Agencies and Scientific Societies. Study selection Recent shreds of evidence about the health effects of air pollution coming from international reports and original research were collected and described in this review. Results Air pollution is an avoidable risk factor that causes a huge burden for society, in terms of death, health disorders, and huge socio-economic costs. The southern European countries face a more threatening problem because they experience the effects of both anthropogenic pollutants and natural dusts (particulate matter [PM]). The European Environment Agency reported the number of premature deaths in the 28 countries of the European Union attributable to air pollutant exposure in the year 2016: 374,000 for PM2.5, 68,000 for nitrogen dioxide, and 14,000 for ozone. In Italy, time series and analytical epidemiological studies showed increased cardio-respiratory hospital admissions and mortality, as well as increased risk of respiratory diseases in people living in urban areas. Conclusions Based on abundant evidence, the World Health Organization, which hosts the Global Alliance against Chronic Respiratory Diseases (GARD), the scientific respiratory societies, and the patients’ associations, as well as others in the health sector, must increase their engagement in advocacy for clean air policies.
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14
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Gayle AV, Quint JK, Fuertes EI. Understanding the relationships between environmental factors and exacerbations of COPD. Expert Rev Respir Med 2021; 15:39-50. [PMID: 32713218 DOI: 10.1080/17476348.2020.1801426] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 07/22/2020] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Exacerbations of chronic obstructive pulmonary disease (COPD) are associated with a significant health burden both for patients and healthcare systems. Exposure to various environmental factors increases the risk of exacerbations. AREAS COVERED We searched PubMed and assessed literature published within the last 10 years to include epidemiological evidence on the relationships between air pollution, temperature and COPD exacerbation risk as well as the implications of extreme weather events on exacerbations. EXPERT OPINION Ongoing climate change is expected to increase air pollution levels, global temperature and the frequency and severity of extreme weather events, all of which are associated with COPD exacerbations. Further research is needed using patient-focused methodological approaches to better understand and quantify these relationships, so that effective mitigation strategies that decrease the risk of exacerbations can be developed.
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Affiliation(s)
- Alicia V Gayle
- Respiratory Epidemiology, Occupational Medicine and Public Health, National Heart and Lung Institute, Imperial College London , London, UK
- Global Real World Evidence, AstraZeneca Plc , Cambridge, UK
| | - Jennifer K Quint
- Respiratory Epidemiology, Occupational Medicine and Public Health, National Heart and Lung Institute, Imperial College London , London, UK
| | - Elaine I Fuertes
- Respiratory Epidemiology, Occupational Medicine and Public Health, National Heart and Lung Institute, Imperial College London , London, UK
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15
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Gutierrez MP, Zuidema P, Mirsaeidi M, Campos M, Kumar N. Association between African Dust Transport and Acute Exacerbations of COPD in Miami. J Clin Med 2020; 9:jcm9082496. [PMID: 32756441 PMCID: PMC7464868 DOI: 10.3390/jcm9082496] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 07/27/2020] [Accepted: 07/29/2020] [Indexed: 12/12/2022] Open
Abstract
Background: Air pollution is increasingly recognized as a risk factor for acute exacerbation of chronic obstructive pulmonary disease (COPD). Changing climate and weather patterns can modify the levels and types of air pollutants. For example, dust outbreaks increase particulate air pollution. Objective: This paper examines the effect of Saharan dust storms on the concentration of coarse particulate matter in Miami, and its association with the risk of acute exacerbation of COPD (AECOPD). Methods: In this prospective cohort study, 296 COPD patients (with 313 events) were followed between 2013 and 2016. We used Light Detection and Ranging (LIDAR) and satellite-based Aerosol Optical Depth (AOD) to identify dust events and quantify particulate matter (PM) exposure, respectively. Exacerbation events were modeled with respect to location- and time-lagged dust and PM exposures, using multivariate logistic regressions. Measurements and main results: Dust duration and intensity increased yearly during the study period. During dust events, AOD increased by 51% and particulate matter ≤2.5 µm in aerodynamic diameter (PM2.5) increased by 25%. Adjusting for confounders, ambient temperature and local PM2.5 exposure, one-day lagged dust exposure was associated with 4.9 times higher odds of two or more (2+ hereto after) AECOPD events (odds ratio = 4.9; 95% CI = 1.8–13.4; p < 0.001). Ambient temperature exposure also showed a significant association with 2+ and 3+ AECOPD events. The risk of AECOPD lasted up to 15 days after dust exposure, declining from 10× higher on day 0 to 20% higher on day 15. Conclusions: Saharan dust outbreaks observed in Miami elevate the concentration of PM and increase the risk of AECOPD in COPD patients with recurring exacerbations.
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Affiliation(s)
| | - Paquita Zuidema
- Rosenstiel School of Marine and Atmospheric Science, University of Miami, Miami, FL 33149, USA;
| | - Mehdi Mirsaeidi
- Pulmonary and Critical Care, Jackson Memorial Hospital, Miami, FL 33136, USA; (M.P.G.); (M.M.)
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, University of Miami School of Medicine, Miami, FL and Miami Veterans Affairs Medical Center, Miami, FL 33136, USA
| | - Michael Campos
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, University of Miami School of Medicine, Miami, FL and Miami Veterans Affairs Medical Center, Miami, FL 33136, USA
- Correspondence: (M.C.); (N.K.); Tel.: +1-305-243-4854 (M.C. & N.K.)
| | - Naresh Kumar
- Environmental Health Division, Department of Public Health Sciences, University of Miami School of Medicine, Miami, FL 33136, USA
- Correspondence: (M.C.); (N.K.); Tel.: +1-305-243-4854 (M.C. & N.K.)
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