A Panel Study on Lung Function and Bronchial Inflammation among Children Exposed to Ambient SO₂ from an Oil Refinery

Asthma, COPD, Respiratory, and Allergic Health Effects in an Adult Population Living near an Italian Refinery: A Cross-Sectional Study

BACKGROUND AND AIM

Asthma and chronic obstructive pulmonary disease (COPD) are leading causes of morbidity and mortality worldwide. Globally, 545 million people suffer from chronic respiratory diseases with a wide geographical variability. Risk factors for asthma are both genetic and related to several environmental factors (internal and external pollutants); these also have an important role in the occurrence of COPD. The aim of this study was to describe the prevalence of asthma, COPD, and asthma/COPD overlap (ACO) in an adult population living in two municipalities located in the Po Valley.

METHODS

A standardized questionnaire on respiratory symptoms and sociodemographic characteristics was self-administered to a random sample of the adult population aged 20-64 years, living near a refinery in Northern Italy during the period between 2016 and 2019. Logistic and multinomial regression were implemented to explore factors associated with asthma, COPD, and ACO.

RESULTS

In total, 1108 subjects filled out the questionnaire, the mean age was 48.02 ± 12.34 years (range 21-68), and 53% of the respondents/participants were female. Half of the responders were non-smokers, but the frequency of current and former smokers was significantly greater in men than in women (p < 0.001). The likelihood of being a probable case of asthma decreased with increasing age and increased for smokers. Tobacco smoke was associated with the presence of COPD and ACO.

CONCLUSION

Respiratory diseases such as asthma and COPD are common in the general population, with differences among countries worldwide. Our findings show, on the basis of the main confirmed risk factor, namely smoking, that it is useful to plan target programs and actions in order to reduce smoking, thus improving the quality of life in public health.

Social determinants of health and asthma

PURPOSE OF REVIEW

Social determinants of health play a major role in healthcare utilization and outcomes in patients with asthma. Continuing to understand how these complex and interwoven relationships interact to impact patient care will be crucial to creating innovative programmes that address these disparities.

RECENT FINDINGS

The current literature continues to support the association of substandard housing, urban and rural neighbourhoods, and race/ethnicity with poor asthma outcomes. Targeted interventions with community health workers (CHWs), telemedicine and local environmental rectifications can help improve outcomes.

SUMMARY

The link between social determinants and poor asthma outcomes continues to be supported by recent literature. These factors are both nonmodifiable and consequences of institutionalized racist policies that require innovative ideas, technologic equity and funding for groups most at risk for poorer outcomes.

Environmental justice and allergic disease: A Work Group Report of the AAAAI Environmental Exposure and Respiratory Health Committee and the Diversity, Equity and Inclusion Committee

Environmental justice is the concept that all people have the right to live in a healthy environment, to be protected against environmental hazards, and to participate in decisions affecting their communities. Communities of color and low-income populations live, work, and play in environments with disproportionate exposure to hazards associated with allergic disease. This unequal distribution of hazards has contributed to health disparities and is largely the result of systemic racism that promotes segregation of neighborhoods, disinvestment in predominantly racial/ethnic minority neighborhoods, and discriminatory housing, employment, and lending practices. The AAAAI Environmental Exposure and Respiratory Health Committee and Diversity, Equity and Inclusion Committee jointly developed this report to improve allergy/immunology specialists' awareness of environmental injustice, its roots in systemic racism, and its impact on health disparities in allergic disease. We present evidence supporting the relationship between exposure to environmental hazards, particularly at the neighborhood level, and the disproportionately high incidence and poor outcomes from allergic diseases in marginalized populations. Achieving environmental justice requires investment in at-risk communities to increase access to safe housing, clean air and water, employment opportunities, education, nutrition, and health care. Through policies that promote environmental justice, we can achieve greater health equity in allergic disease.

Associations of air pollution with peripheral inflammation and cardiac autonomic physiology in children

Climate change-related disasters have drawn increased attention to the impact of air pollution on health. 122 children ages 9-11 years old, M(SD) = 9.91(.56), participated. Levels of particulate matter (PM2.5) near participants' homes were obtained from the Environmental Protection Agency. Cytokines were assayed from 100 child serum samples: IL-6, IL-8, IL-10, and TNFα. Autonomic physiology was indexed by pre-ejection period (PEP), respiratory sinus arrhythmia (RSA), cardiac autonomic regulation (CAR), and cardiac autonomic balance (CAB). IL-6 was positively related to daily PM2.5 (r = .26, p = .009). IL-8 was negatively associated with monthly PM2.5 (r = -.23, p = .02). PEP was positively related to daily (r = .29, p = .001) and monthly PM2.5 (r = .18, p = .044). CAR was negatively associated with daily PM2.5 (r = -.29, p = .001). IL-10, TNFα, RSA, and CAB were not associated with PM2.5. Air pollution may increase risk of inflammation in children.

Effects of air pollution and green spaces on impaired lung function in children: a case-control study

The occurrences of impaired lung function during childhood could substantially influence the health states of the respiratory system in adults. So, the effects of air pollution and green spaces on impaired lung function in children were investigated in this study. The lung function of each student was tested every year from 2015 to 2017 and the method of case-control study was applied. 2087 students aged from 9 to 11 years old of primary schools in Tianjin were ultimately included in this study. The method of propensity score matching (PSM) was performed to minimize the confounding bias and the conditional logistic regression model was carried out to evaluate the effects of indoor and outdoor environmental risk factors on the occurrences of impaired lung function in children. For every interquartile range (IQR) increase in the mixture of six air pollutants at the lag1, lag2, and lag3 periods, the risks of getting impaired lung function were increased by 53.4%, 34.7%, and 16.9%, respectively. The protective effect of greenness at lag2 period (odds ratios (OR)) = 0.022 (95% confidence interval (CI): 0.008-0.035)) was stronger than that at lag1and lag3 periods, respectively. Separate and combined effects of most air pollutants at different lag periods exerted hazardous effects on the lung function of students. Exposure to greenness had protective effects on the lung health of children.

Association of short-term fine particulate matter exposure with pulmonary function in populations at intermediate to high-risk of cardiovascular disease: A panel study in three Chinese cities

BACKGROUND

Decline in pulmonary function contributes to increasing cardiovascular disease (CVD) risk. Although adverse effects of short-term exposure to fine particulate matter (PM_2.5) on pulmonary function have been recognized in healthy people or patients with respiratory disease, these results were not well illustrated among people with elevated CVD risk.

MATERIALS AND METHODS

A panel study was conducted in three Chinese cities with three repeated visits among populations at intermediate to high-risk of CVD, defined as treated hypertension patients or those with blood pressure ≥ 130/80 mmHg, who met any of the three conditions including abdominal obesity, dyslipidemia, and diabetes mellitus. Individualized PM_2.5 exposure and pulmonary function were measured during each seasonal visit. Linear mixed-effect models were applied to analyze the associations of PM_2.5 concentrations with pulmonary function indicators, including forced expiratory volume in 1 s (FEV₁), FEV₁/forced vital capacity (FVC), maximal mid-expiratory flow (MMF), and peak expiratory flow (PEF).

RESULTS

Short-term PM_2.5 exposure was significantly associated with decreased pulmonary function and an increment of 10 μg/m³ in PM_2.5 concentrations during lag 12-24 hour was associated with declines of 41.7 ml/s (95% confidence interval [CI]: 7.7-75.7), 0.35% (95% CI: 0.01, 0.69), and 20.9 ml/s (95% CI: 0.5-41.3) for PEF, FEV₁/FVC, and MMF, respectively. Results from stratified and sensitivity analyses were generally similar with the overall findings, while the adverse effects of PM_2.5 on pulmonary functions were more pronounced in those who were physically inactive.

CONCLUSIONS

This study first identified short-term exposure to PM_2.5 was associated with impaired pulmonary function and physical activity might attenuate the adverse effects of PM_2.5 among populations at intermediate to high-risk of CVD. These findings provide new robust evidence on health effects of air pollution and call for effective prevention measures among people at CVD risk.

Systematic Review of Ozone Effects on Human Lung Function, 2013 through 2020

Background

Ozone effects on lung function are particularly important to understand in the context of the air pollution-health outcomes epidemiologic literature, given the complex relationships between ozone and other air pollutants with known lung function effects.

Research Question

What has been learned about the association between ozone exposures and lung function from epidemiology studies published from 2013 through 2020?

Study Design and Methods

On March 18, 2018, and September 8, 2020, PubMed was searched using the terms health AND ozone, filtering to articles in English and about humans, from 2013 or later. An additional focused review searching for ozone AND (lung function OR FEV₁OR FVC) was performed June 26, 2021. Articles were selected for this review if they reported a specific relationship between a lung function outcome and ozone exposure.

Results

Of 3,271 articles screened, 53 ultimately met criteria for inclusion. A systematic review with assessment of potential for bias was conducted, but a meta-analysis was not carried out because of differences in exposure duration and outcome quantification. Consistent evidence exists of small decreases in children’s lung function, even associated with very low levels of short-term ozone exposure. The effects on adult lung function from exposure to low-level, short-term ozone are less clear, although ozone-associated decrements may occur in the elderly. Finally, long-term ozone exposure decreases both lung function and lung function growth in children, although few new studies have examined long-term ozone and lung function in adults.

Interpretation

Much of this literature involves concentrations below the current US Environmental Protection Agency’s National Ambient Air Quality Standard of 70 parts per billion over an 8-h averaging time, suggesting that this current standard may not protect children adequately from ozone-related decrements in lung function.

Impact of a pollution breach at a coke oven factory on asthma control in nearby vulnerable adults

BACKGROUND

Previous studies have related sulfur dioxide (SO₂) exposure to asthma exacerbations. We utilized the University of Pittsburgh Asthma Institute registry to study associations of asthma exacerbations between 2 geographically distinct populations of adults with asthma.

OBJECTIVE

Our objective was to examine whether asthma symptoms worsened following a significant fire event that destroyed pollution control equipment at the largest coke works in the United States.

METHODS

Two groups of patients with asthma, namely, those residing within 10 miles of the coke works fire (the proximal group [n = 39]) and those residing beyond that range (the control group [n = 44]), were geocoded by residential address. Concentrations of ambient air SO₂ were generated by using local University of Pittsburgh Asthma Institute registry air monitoring data. Factory emissions were also evaluated. Data from a patient historical acute exposure survey and in-person follow-up data were evaluated. Inferential statistics were used to compare the groups.

RESULTS

In the immediate postfire period (6-8 weeks), the level of emissions of SO₂ from the factory emissions increased to 25 times more than the typical level. Following the pollution control breach, the proximal cohort self-reported an increase in medication use (risk ratio = 1.76; 95% CI = 1.1-2.8; P < .01) and more exacerbations. In a small subset of the follow-up cohort of those who completed the acute exposure survey only, asthma control metrics improved.

CONCLUSIONS

Real-world exposure to a marked increase in ambient levels of SO₂ from a pollution control breach was associated with worsened asthma control in patients proximal to the event, with the worsened control improving following repair of the controls. Improved spatial resolution of air pollutant measurements would enable better examination of exposures and subsequent health impacts.

Adverse Health Impacts of Living Near an Oil Refinery in Jordan

INTRODUCTION

Air pollution can adversely affect the health of communities and manifest as a variety of symptoms.

OBJECTIVE

This study aimed at assessing health symptoms among populations living near an oil refinery in Jordan.

METHODS

A cross-sectional survey study was conducted utilizing convenient random sampling at Al-Hashimeya town (where the refinery is located) and Bal'ma town (about 12 km further away from refinery). A total of 486 participants were recruited for the study. The data were checked, coded, and entered to excel sheet and exported to the Statistical Package for Social Science (SPSS) Version 20 for further analysis. Both bivariate and multivariate logistic regressions were used to identify associated factors. Variables having a P ⩽ 0.25 were fitted to multivariate logistic regression so as to assess the presence and strength of associations between socio-demographic characteristics and health symptoms and outcomes. A P value < 0.05 was considered for statistical significance.

RESULTS

In the cross tabulation analysis, there were significant differences in the reported respiratory health problems and history of abortions in the family between residents in the 2 towns (P < 0.05). Only 4.7% of Al-Hashimeya residents were extremely enjoying their town compared to 32.9% among Bal'ma residents (P < 0.001). In addition, residents of Al-Hashimeya were at several folds higher risk to have phlegm and about 3 times more likely to have skin problems compared to participants from Bal'ma (P < 0.001). Furthermore, reporting asthma was substantially higher among Al-Hashimeya residents (odds ratio [OR] = 5.20; 95% confidence interval [CI]: 2.11-12.84), and they were more likely to perceive the neighboring oil refinery industry as the leading cause of their health problems than Bal'ma residents (OR = 86.40; 95%CI: 45.95-162.44).

CONCLUSION

Residents living close to the oil refinery industry in Jordan report adverse impacts on their health, including respiratory problems, skin diseases, and perception of poor health.

Risk of temperature, humidity and concentrations of air pollutants on the hospitalization of AECOPD

AIM

To investigate the effect of temperature, humidity and the concentration of ambient air pollution on the hospitalization of AECOPD.

METHOD

Hospitalization record was obtained from Shenyang Medical Insurance Bureau, concluding patient's age, gender, income hospital time, outcome hospital; Generalized additive model was used to analyze the relationship between temperature, humidity, the concentration of ambient air pollution and the hospitalization of AECOPD.

RESULT

The effect of ozone on admission rate in male group was higher than that in female group. Ambient air pollution had a weak influence on age≤50 group. It was found that the optimal lag day for daily relative 40 humidity to age≤50 group, 50<age≤60, 60<age≤70 group and age>70 group was on lag5, lag4, lag4 and lag5, respectively.

CONCLUSION

Air pollution, relative humidity and temperature can increase the risk of admission for acute exacerbation of COPD, and in this process there was a lag effect.

Impact of Coal-fired Power Plant Emissions on Children's Health: A Systematic Review of the Epidemiological Literature

Coal-based energy production is the most utilized method of electricity production worldwide and releases the highest concentration of gaseous, particulate, and metallic pollutants. This article aims to systematically review the public health impact of coal-fired power plant emissions on children’s health. PubMed, Web of Science, and Toxline databases were queried for the past 20 years. Inclusion criteria included original scientific articles with (a) coal-fired power plant exposure assessment, (b) at least one primary pediatric health outcome, and (c) assessment of potential sources of confounding and bias. Only morbidity and mortality studies were included; economic analysis and risk assessment studies without a primary health outcome were not included. Of 513 articles initially retrieved, 17 epidemiological articles were included in the final systematic review after screening and eligibility. The articles reviewed showed a statistically significant adverse effect on pediatric neurodevelopment; birth weight and pediatric respiratory morbidity was associated with exposure to coal-fired power plant emissions, primarily particulate matter and polyaromatic hydrocarbon exposure. There is a lack of consistency of exposure assessment and inadequate control of significant potential confounders such as social economic status. Future research should focus on improving exposure assessment models with an emphasis on source-apportionment and geographic information system methods to model power plant-specific emissions.