Respiratory Effects of Exposure to Traffic-Related Air Pollutants During Exercise

Dietary supplementations to mitigate the cardiopulmonary effects of air pollution toxicity: A systematic review of clinical trials

BACKGROUND

There is a consistent association between exposure to air pollution and elevated rates of cardiopulmonary illnesses. As public health activities emphasize the paramount need to reduce exposure, it is crucial to examine strategies like the antioxidant diet that could potentially protect individuals who are unavoidably exposed.

METHODS

A systematic search was performed in PubMed/Medline, EMBASE, CENTRAL, and ClinicalTrials.gov up to March 31, 2023, for clinical trials assessing dietary supplements against cardiovascular (blood pressure, heart rate, heart rate variability, brachial artery diameter, flow-mediated dilation, and lipid profile) or pulmonary outcomes (pulmonary function and airway inflammation) attributed to air pollution exposure.

RESULTS

After reviewing 4681 records, 18 studies were included. There were contradictory findings on the effects of fish oil and olive oil supplementations on cardiovascular outcomes. Although with limited evidence, fish oil offered protection against pulmonary dysfunction induced by pollutants. Most studies on vitamin C did not find protective cardiovascular effects; however, the combination of vitamin C and E offered protective effects against pulmonary dysfunction but showed conflicting results for cardiovascular outcomes. Other supplements like sulforaphane, L-arginine, n-acetylcysteine, and B vitamins showed potential beneficial effects but need further research due to the limited number of existing trials.

CONCLUSIONS

Although more research is needed to determine the efficacy and optimal dose of anti-inflammatory and antioxidant dietary supplements against air pollution toxicity, this low-cost preventative strategy has the potential to offer protection against outcomes of air pollution exposure.

Dynamic and stationary monitoring of air pollutant exposures and dose during marathons

Marathon running significantly increases breathing volumes and, consequently, air pollution inhalation doses. This is of special concern for elite athletes who ventilate at very high rates. However, race organizers and sport governing bodies have little guidance to support events scheduling to protect runners. A key limitation is the lack of hyper-local, high temporal resolution air quality data representative of exposure along the racecourse. This work aimed to understand the air pollution exposures and dose inhaled by athletes, by means of a dynamic monitoring methodology designed for road races. Air quality monitors were deployed during three marathons, monitoring nitrogen dioxide (NO2), ozone (O3), particulate matter (PMx), air temperature, and relative humidity. One fixed monitor was installed at the Start/Finish line and one mobile monitor followed the women elite runner pack. The data from the fixed monitors, deployed prior the race, described daily air pollution trends. Mobile monitors in combination with heatmap analysis facilitated the hyper-local characterization of athletes' exposures and helped identify local hotspots (e.g., areas prone to PM resuspension) which should be preferably bypassed. The estimation of inhaled doses disaggregated by gender and ventilation showed that doses inhaled by last finishers may be equal or higher than those inhaled by first finishers for O3 and PMx, due to longer exposures as well as the increase of these pollutants over time (e.g., 58.2 ± 9.6 and 72.1 ± 23.7 μg of PM2.5 for first and last man during Rome marathon). Similarly, men received significantly higher doses than women due to their higher ventilation rate, with differences of 31-114 μg for NO2, 79-232 μg for O3, and 6-41 μg for PMx. Finally, the aggregated data obtained during the 4 week- period prior the marathon can support better race scheduling by the organizers and provide actionable information to mitigate air pollution impacts on athletes' health and performance.

Effects of Air Pollution on the Health of Older Adults during Physical Activities: Mapping Review

Atmospheric pollutants present environmental threats to health and have been investigated in different environments, such as highways, squares, parks, and gyms. These environments are frequented by older adults, who are considered fragile to the harmful impacts of pollution present in the air. The aim was to analyze the state of the art on the effects of air pollution on the health of older adults during physical activities (PAs) through a mapping review. The search was performed in PubMed, Web of Science, Scopus, and Cinahl databases until June 2022. Of the 10,109 studies initially identified, 58 met the inclusion criteria. The most investigated health outcome was cardiovascular disease, followed by respiratory outcomes. Particulate matter (PM2.5 and PM10), nitrogen dioxide (NO2), and ozone (O3) were the most investigated pollutants. Of the 75 health outcomes investigated, in 29, air pollution had harmful effects on the health of the older adults during the practice of PA, more frequently in cardiovascular diseases. In 25 outcomes, the beneficial effects of PA to the health of the older adults remained, despite exposure to high and low concentrations of pollutants, most often in terms of mental disorders. We conclude that poor air quality is a harmful factor for the health of older adults during the practice of PAs, more frequently in cardiovascular and respiratory diseases. On the other hand, for mental-health-related outcomes (depression and cognition), in most studies, the beneficial effects of PA in older adults were maintained, even after exposure to pollutants.

Traffic-related air pollution is a risk factor in the development of chronic obstructive pulmonary disease

Background

Outdoor traffic-related air pollution has negative effects on respiratory health. In this study, we aimed to explore the effect of outdoor traffic-related air pollution on chronic obstructive pulmonary disease (COPD) in Guangzhou.

Methods

We enrolled 1,460 residents aged 40 years or older between 21 January 2014 and 31 January 2018. We administered questionnaires and spirometry tests. The distance of participants' residences or locations of outdoor activities from busy roads (as indicators of outdoor traffic-related air pollution), indoor air pollution, and smoking history were queried in the questionnaires.

Results

Of the 1,460 residents with valid survey and test results, 292 were diagnosed with COPD, with a detection rate of 20%. Participants who lived and did their outdoor activities near busy roads had a higher detection rate of COPD. Among residents living at distances of <50 meters, 50-199 meters, and more than 200 meters from busy roads, the detection rates were 20.6, 21.2, and 14.8%, respectively; the rates for outdoor activities at these distances were 23.8, 24.5, and 13.7%, respectively (p < 0.05). After adjusting for sex, age, smoking status, family history, and smoking index, the distance of outdoor activities from busy roads was an independent risk factor for COPD. Participants whose outdoor activities were conducted <50 meters and 50-199 meters of main roads had odds ratios of 1.54 (95% confidence interval 1.01-2.36) and 1.84 (95% interval 1.23-2.76) for the risk of COPD in comparison with a distance of more than 200 meters from busy roads.

Conclusions

Residents of Guangzhou whose outdoor activities were close to busy roads had a high risk of COPD. Traffic-related air pollution presents a risk to human health and a risk of COPD.

Risk/benefit tradeoff of habitual physical activity and air pollution on chronic pulmonary obstructive disease: findings from a large prospective cohort study

BACKGROUND

The combined health impact of physical activity (PA) and air pollution on chronic obstructive pulmonary disease (COPD) remains unclear. We investigated the joint effects of habitual PA and long-term fine particulate matter (PM2.5) exposure on COPD incidence in a prospective population-based cohort.

METHODS

A prospective cohort study was conducted using data from the UK Biobank. Incidence of COPD was ascertained through linkage to the UK National Health Services register. Annual mean PM2.5 concentration was obtained using land use regression model. PA was measured by questionnaire and wrist-worn accelerometer. Cox proportional hazard models were applied to examine the associations between PM2.5, PA, and COPD. Additive and multiplicative interactions were examined.

RESULTS

A total of 266,280 participants free of COPD at baseline were included in data analysis with an average follow-up of 10.64 years, contributing to around 2.8 million person-years. Compared with participants with low level of PA, those with higher PA levels had lower risks of COPD incidence [hazard ratio (HR): 0.769, 95% CI: 0.720, 0.820 for moderate level; HR: 0.726, 95% CI: 0.679, 0.776 for high level]. By contrast, PM2.5 was associated with increased risk of COPD (HR per interquartile range increment: 1.065, 95% CI: 1.032, 1.099). Limited evidence of interaction between habitual PA and PM2.5 exposure was found. Similar results were found for accelerometer-measured PA.

CONCLUSIONS

Our study suggests that habitual PA could reduce risk of COPD incidence, and such protective effects were not affected by ambient PM2.5 pollution exposure.

The Acute Effects of Exercising in Air Pollution: A Systematic Review of Randomized Controlled Trials

BACKGROUND

The acute effects of air pollution (AP) exposure during physical activity have been studied. However, comprehensive systematic reviews are lacking, particularly regarding moderate-to-vigorous physical activity (MVPA).

OBJECTIVE

Our objective was to determine the acute health- and exercise-related effects of AP exposure during a bout of MVPA in healthy individuals.

METHODS

We searched for randomized controlled trials in MEDLINE, Embase, Cochrane CENTRAL, SPORTDiscus, Agricultural and Environmental Science Database, ClinicalTrials.gov, International Standard Randomised Controlled Trial Number Registry, and the World Health Organization (WHO) International Clinical Trials Registry Platform up to July 2020 without language or date restrictions. Studies including healthy subjects engaging in a bout of MVPA while exposed to one or more of the following air pollutants were eligible: particulate matter, black carbon, carbon monoxide, nitrogen dioxide, ozone, diesel exhaust, and traffic-related air pollution (TRAP). Main outcome measures were markers of pulmonary function, symptoms, cardiovascular function, cognitive function, systemic inflammation, and exercise response. The evidence was synthesized by vote counting based on direction of effect.

RESULTS

In total, 53 studies were included in the systematic review. Studies employed a heterogeneous mix of exercise protocols, AP interventions, and measured outcomes. Pooled results suggest ozone exposure during MVPA has an adverse effect on pulmonary function (100% [95% confidence interval (CI) 88-100], p < 0.001; high-certainty evidence) and reported symptoms (88% [95% CI 69-96], p < 0.001; low-certainty evidence). The effect of exposure to carbon monoxide, nitrogen dioxide, small engine exhaust, or diesel exhaust during MVPA on health- and exercise-related outcomes is uncertain because of insufficient evidence and the low to very low certainty of available evidence.

DISCUSSION

The evidence is strongest for ozone, exposure to which generally induced a reduction in pulmonary function and increased symptoms during MVPA. The research related to other outcome domains remains inconclusive. Although long-term exposure to AP is proven to be hazardous, the evidence for healthy individuals to forgo MVPA during periods of high (non-ozone) pollution remains weak.

TRIAL REGISTRATION

Retrospectively registered in PROSPERO (CRD42020188280) on 10 July 2020.

The Diamond League athletic series: does the air quality sparkle?

Urban air pollution can have negative short- and long-term impacts on health, including cardiovascular, neurological, immune system and developmental damage. The irritant qualities of pollutants such as ozone (O₃), nitrogen dioxide (NO₂) and particulate matter (PM) can cause respiratory and cardiovascular distress, which can be heightened during physical activity and particularly so for those with respiratory conditions such as asthma. Previously, research has only examined marathon run outcomes or running under laboratory settings. This study focuses on elite 5-km athletes performing in international events at nine locations. Local meteorological and air quality data are used in conjunction with race performance metrics from the Diamond League Athletics series to determine the extent to which elite competitors are influenced during maximal sustained efforts in real-world conditions. The findings from this study suggest that local meteorological variables (temperature, wind speed and relative humidity) and air quality (ozone and particulate matter) have an impact on athletic performance. Variation between finishing times at different race locations can also be explained by the local meteorology and air quality conditions seen during races.

Marathon race performance increases the amount of particulate matter deposited in the respiratory system of runners: an incentive for "clean air marathon runs"

Background

In the last decades, marathon running has become a popular form of physical activity among people around the world. It should be noticed that the main marathon races are performed in large cities, where air quality varies considerably. It is well established that breathing polluted air results in a number of harmful effects to the human body. However, there have been no studies to show the impact of marathon run performance on the amount of the deposition of varied fractions of airborne particulate matter (PM) in the respiratory tract of runners. This is why the present study sought to determine the impact of marathon run performance in the air of varying quality on the deposition of the PM₁, PM_2.5, PM₁₀ in the respiratory tract in humans.

Methods

The PM₁, PM_2.5 and PM₁₀ deposition was determined in an “average runner” (with marathon performance time 4 h: 30 min) and in an “elite marathon runner” (with marathon performance time 2 h: 00 min) at rest, and during a marathon race, based on own measurements of the PM content in the air and the size-resolved DF(d) profile concept.

Results

We have shown that breathing air containing 50 µg m⁻³ PM₁₀ (a borderline value according to the 2006 WHO standard - still valid) at minute ventilation (V_E) equal to 8 L min⁻¹ when at rest, resulted in PM₁₀deposition rate of approximately 9 µg h⁻¹, but a marathon run of an average marathon runner with the V_E = 62 L min⁻¹ increased the deposition rate up to 45 µg h⁻¹. In the elite runner, marathon run with the V_E= 115 L min⁻¹ increased PM₁₀ deposition rate to 83 µg h⁻¹. Interestingly, breathing the air containing 50 µg m⁻³of PM₁₀ at the V_E = 115 L min⁻¹by the elite marathon runner during the race resulted in the same PM₁₀deposition rate as the breathing highly polluted air containing as much as 466 µg m⁻³ of PM₁₀ when at rest. Furthermore, the total PM₁₀ deposition in the respiratory tract during a marathon race in average runners is about 22% greater (203 / 166 = 1.22) than in elite runners. According to our calculations, the concentration of PM₁₀in the air during a marathon race that would allow one not to exceed the PM₁₀ deposition rate of 9 µg h⁻¹should be lower than 10 µg m⁻³ in the case of an average runner, and it should be lower than 5.5 µg m⁻³ in the case of an elite runner.

Conclusions

We conclude that a marathon run drastically increases the rate of deposition of the airborne PM in the respiratory tract of the runners, as a consequence of the huge V_E generated during the race. A decrease of the PM content in the air attenuates this rate. Based on our calculations, we postulate that the PM₁₀ content in the air during a “clean air marathon run”, involving elite marathon runners, should be below 5.5 µg m⁻³.