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Kim SH, Kim SP, Song JI, Kim Z, Kim JY, Yoon HJ. Causal relationship between asthma outpatient visits and air pollution with instrumental variable approach. Allergy 2023; 78:3007-3009. [PMID: 37357713 DOI: 10.1111/all.15791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 06/06/2023] [Accepted: 06/13/2023] [Indexed: 06/27/2023]
Affiliation(s)
- Su Hwan Kim
- Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea
| | - Seong Pyo Kim
- Interdisciplinary Program of Medical Informatics, Seoul National University College of Medicine, Seoul, South Korea
- Integrated Major in Innovative Medical Science, Seoul National University Graduate School, Seoul, South Korea
| | - Jae-In Song
- Department of Future & Smart Construction Research, Korea Institute of Civil Engineering and Building Technology (KICT), Goyang-si, South Korea
| | - Zio Kim
- Interdisciplinary Program of Bioengineering, Seoul National University College of Engineering, Seoul, South Korea
| | - Jin Youp Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Ilsan Hospital, Dongguk University, Goyang, South Korea
| | - Hyung-Jin Yoon
- Interdisciplinary Program of Medical Informatics, Seoul National University College of Medicine, Seoul, South Korea
- Integrated Major in Innovative Medical Science, Seoul National University Graduate School, Seoul, South Korea
- Interdisciplinary Program of Bioengineering, Seoul National University College of Engineering, Seoul, South Korea
- Medical Big Data Research Center, Seoul National University College of Medicine, Seoul, Korea
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Aslam R, Sharif F, Baqar M, Nizami AS, Ashraf U. Role of ambient air pollution in asthma spread among various population groups of Lahore City: a case study. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2023; 30:8682-8697. [PMID: 35220536 DOI: 10.1007/s11356-022-19086-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 02/02/2022] [Indexed: 06/14/2023]
Abstract
Air pollution levels rise as a result of industrial and vehicular emissions, epidemiological issues such as asthma become more prevalent in Lahore, Punjab, Pakistan and cause adverse public health effects. Many studies explored the association between air pollutants and frequency of asthma hospital visits, although their effects are unclear. This study examined the link between air pollution, asthma, and socioeconomic and demographic factors. A questionnaire survey was administered among four age groups (15-25, 25-45, 45-60, and over 60 years old) in public and private hospitals of Lahore city. Daily average concentrations of five air pollutants including carbon monoxide (CO), nitrogen dioxide (NO2), sulfur dioxide (SO2), ozone (O3), and particulate matter (PM2.5 and PM10) were recorded at ten fixed air monitoring sites in Lahore city. There were favorable connections between outpatient department (OPD) asthma visits (64%) and levels of outdoor air quality during winter season throughout the study period. The correlation between 1, 29, and 370 asthma patients and average daily air pollution levels found that the condition was more prevalent in females (53%) than males (47%). There was a significant correlation between PM10 exposure and asthma OPD visits in the city (p 0.001), as well as the elevated PM10 levels were substantially linked with OPD asthma visits over the winter season in the city. The hazard index (HI) for all adult population was estimated 0.001132. The study's findings indicate that exposure to ambient air pollution is a significant predictor of asthma hospital visits, particularly among the elderly. Strategies can be developed by policymakers in response to the worrying situation of allergic disease asthma in industrial cities due to air pollution.
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Affiliation(s)
- Rabia Aslam
- Sustainable Development Study Center, Government College University, Lahore, 54000, Pakistan.
| | - Faiza Sharif
- Sustainable Development Study Center, Government College University, Lahore, 54000, Pakistan
| | - Mujtaba Baqar
- Sustainable Development Study Center, Government College University, Lahore, 54000, Pakistan
| | - Abdul-Sattar Nizami
- Sustainable Development Study Center, Government College University, Lahore, 54000, Pakistan
| | - Uzma Ashraf
- Department of Environmental Science and Policy, Lahore School of Economics, Lahore, 53200, Pakistan
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Park Y, Kim SH, Kim SP, Ryu J, Yi J, Kim JY, Yoon HJ. Spatial autocorrelation may bias the risk estimation: An application of eigenvector spatial filtering on the risk of air pollutant on asthma. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 843:157053. [PMID: 35780885 DOI: 10.1016/j.scitotenv.2022.157053] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 06/14/2022] [Accepted: 06/25/2022] [Indexed: 06/15/2023]
Abstract
Air pollutants are major risk factors for respiratory diseases, particularly asthma, socially and spatially correlated. Many existing environment-asthma-related studies, however, have evaluated the impact of crude trends at the largest district level, which accounts only for temporal effects and may produce biased results with spatial autocorrelation. This study aimed to investigate how the spatial autocorrelation affects the air pollution effect estimations (sulfur dioxide [SO2], nitrogen dioxide [NO2], carbon monoxide [CO], and particulate matter [PM10]) on daily asthma emergency department (ED) visits in two metropolitan areas in Korea (Seoul Metropolitan Area [SMA] and Busan Metropolitan City, Ulsan Metropolitan City, Gyeongsangnamdo [BUG]). We applied eigenvector spatial filter (ESF) to the spatio-temporal model to remove spatial autocorrelation and distributed lag nonlinear model (DLNM) to explore nonlinear patterns between air pollutant concentration and lagged days on the three models including aggregated model (a temporal model), spatial model without ESF, and spatial model with ESF (both are spatio-temporal models). The effect of SO2 was not statistically significant for asthma ED visits in the aggregated model for SMA (cumulative relative risks [CRR] = 0.99, confidence intervals [CI]: 0.93-1.05), while the effect was statistically significant in the spatial model with ESF (CRR = 1.10, CI: 1.08-1.12). NO2 and CO were positively correlated to asthma ED visits in the spatial model without ESF (CRR = 0.84, CI: 0.81-0.86; 0.91, 0.89-0.94, respectively), but the spatial model with ESF showed significant risks (CRR = 1.21, CI: 1.18-1.24; 1.13, 1.11-1.16). Moreover, the spatial model with ESF successfully removed spatial autocorrelation (P-values for Moran's I 0.83-0.98) and demonstrated the highest model fit (McFadden's pseudo R2 0.42-0.43 for SMA and 0.26-0.27 for BUG) among the three models. Our findings demonstrate how ESF can be introduced into spatial correlation to remove bias and construct more reliable models.
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Affiliation(s)
- Yujin Park
- Department of Biomedical Engineering, Seoul National University College of Medicine, Seoul, South Korea
| | - Su Hwan Kim
- Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
| | - Seong Pyo Kim
- Interdisciplinary Program of Medical Informatics, Seoul National University College of Medicine, Seoul, South Korea
| | - Jiwon Ryu
- Department of Biomedical Engineering, Seoul National University College of Medicine, Seoul, South Korea; Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi, Republic of Korea
| | - Jinyeong Yi
- Department of Health Science and Technology, Seoul National University, Seoul, South Korea
| | - Jin Youp Kim
- Interdisciplinary Program of Medical Informatics, Seoul National University College of Medicine, Seoul, South Korea; Department of Otorhinolaryngology-Head and Neck Surgery, Ilsan Hospital, Dongguk University, Goyang, Gyeonggi, South Korea
| | - Hyung-Jin Yoon
- Department of Biomedical Engineering, Seoul National University College of Medicine, Seoul, South Korea; Interdisciplinary Program of Medical Informatics, Seoul National University College of Medicine, Seoul, South Korea; Medical Big Data Research Center, Seoul National University Medical Research Center, Seoul National University College of Medicine, Seoul, Republic of Korea.
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Ścibor M, Balcerzak B, Galbarczyk A, Jasienska G. Associations between Daily Ambient Air Pollution and Pulmonary Function, Asthma Symptom Occurrence, and Quick-Relief Inhaler Use among Asthma Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19084852. [PMID: 35457717 PMCID: PMC9028503 DOI: 10.3390/ijerph19084852] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 04/13/2022] [Accepted: 04/14/2022] [Indexed: 12/04/2022]
Abstract
Particulate matter (PM) is harmful to human health, especially for people with asthma. The goal of this study was to enhance the knowledge about the short-term effects of daily air concentrations of PM on health outcomes among asthma patients. The novelty of this study was the inclusion of a homogeneous group of patients (N = 300) with diagnosed and partly controlled asthma. Patients recorded their symptoms, asthma quick-relief inhaler use, and peak expiratory flow (PEF) measurements in a diary for two weeks. Data on particulate air pollution were obtained from stationary monitoring stations. We have shown that particulate pollutants (PM10 and PM2.5) are associated with significant deterioration of PEF and an increase in the frequency of early asthma symptoms, as well as asthma quick-relief inhaler use. These effects are observed not only on the day of exposure, but also on the following day. For public health practice, these results support the rationale for using peak-flow meters as necessary devices for proper asthma self-management and control, especially in locations where the air is polluted with particles. This may decrease the number of asthma patients seeking medical help.
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Review of Ground-Level Ozone Impact in Respiratory Health Deterioration for the Past Two Decades. ATMOSPHERE 2022. [DOI: 10.3390/atmos13030434] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background: Ground-level ozone has been gaining notoriety with increasing evidence of its nefarious effects on health, especially respiratory diseases. Where do we stand on the solidity of this data and is there room for improvement? Objectives: Evaluate this evidence for incongruities or heterogeneity in this field of research. How is the exposure assessment conducted, where does Portugal stand in this field, and what can be improved? Health deterioration concerning asthma, chronic obstructive pulmonary disease (COPD), and acute respiratory distress syndrome (ARDS) are analysed. Methods: A review of 1735 studies was conducted through PubMed and Google Scholar engines for the past two decades. We identified 59 eligible studies and included an array of variables, including O3 measurements, number of air-quality monitoring stations used, relative risks, odds ratios, hazard ratios, number of hospital admissions, visits, or mortality, and size of population dataset used. Results: Approximately 83% of data in this review presents significant correlations of ozone with asthma, COPD, and ARDS. Studies that report negative or not significant associations mention a lack of data or topographic differences as the main issue with these divergent results. Studies consistently report summer as a period of particular concern. Portuguese data in this field is lacking. Conclusions: This research field is growing in interest and there is evidence that ozone plays a non-negligible role in health deterioration. The few Portuguese studies in this field seem aligned with the literature reviewed but more research is needed. Suggested improvements are more and better data through denser air-quality networks to accurately depict personal exposure to ozone. Homogenization of the exposure assessment concerning averaging times of ozone to daily maximum 8 h averages whenever possible. Risk increments based on 10 ppb instead of interquartile ranges. Lastly, contrary to some studies in this review, the topographic effect on concentrations and health deterioration should not be underestimated and seasonality should always be checked.
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DZIARZHYNSKAYA NADZEYA, HINDZIUK ANDREY, HINDZIUK LARISA, SYSOEVA IRINA, KRUPSKAYA DARYA, URBAN ULIA, CHERNIAVSKAYA NATALYA, VISHNEVSKAYA ALEXANDRA, MAKAROVA ELENA, ERMAK SVETLANA, HINDZIUK NELLI. Airborne chemical pollution and children's asthma incidence rate in Minsk. JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2022; 62:E871-E878. [PMID: 35603254 PMCID: PMC9104677 DOI: 10.15167/2421-4248/jpmh2021.62.4.1568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 10/28/2021] [Indexed: 11/12/2022]
Abstract
Introduction Asthma manifestations are closely connected with air pollution. Discovering interconnection between concentrations of air pollutants and asthma incidence rate among children provides information for developing effective measures to reduce air pollution and improve population health. Study purpose was to carry out hygienic analysis of the influence of atmospheric air quality on the incidence rate of bronchial asthma of children in Minsk in 2009-2018. Methods During 2019 retrospective health cohort study was conducted, data from stationary air quality monitoring posts were collected. Correlation analysis was conducted by determining the Pearson coefficient. Results Ten-year levels of asthma incidence rate had a moderate downward trend; the highest levels were registered among 5-9-year-old children. 74.7% of all cases of asthma were registered among children under 10 years: 33,61% among 1-4-year-old and 41.09% - among 5-9-year-old. Results of the study showed that concentrations of ammonia, particulate matter (dust/aerosol undifferentiated in composition) and lead in Minsk were characterized by downward trend, carbon oxide and nitrogen dioxide concentrations remained unstable, elevated levels of formaldehyde remained near highways with heavy traffic. Strong evidence was found for concentrations of particulate matter (dust/aerosol undifferentiated in composition) (R = 0.76-0.85, p < 0.05), lead (R = 0.69-0.97, p < 0.05), ammonia (R = 0.64-0.72, p < 0.05) nitrogen dioxide (R = 0.63-0.8, p < 0.05) and children's asthma incidence rate. Conclusions Obtained results indicate that particulate matter, lead, ammonia and nitrogen dioxide concentrations hesitation causes changes in children's asthma incidence levels. Not being the initial cause of the disease, they influence epidemic process and can be the target for preventive measures.
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Affiliation(s)
- NADZEYA DZIARZHYNSKAYA
- Belarusian State Medical University, Minsk, Belarus
- Correspondence: Nadzeya Dziarzhynskaya, Belarusian State Medical University, Minsk, Belarus; 2 Minsk City Center of Hygiene and Epidemiology, Minsk, Belarus - E-mail:
| | | | | | | | - DARYA KRUPSKAYA
- Minsk City Center of Hygiene and Epidemiology, Minsk, Belarus
| | - ULIA URBAN
- Minsk City Center of Hygiene and Epidemiology, Minsk, Belarus
| | | | | | - ELENA MAKAROVA
- Minsk City Center of Hygiene and Epidemiology, Minsk, Belarus
| | - SVETLANA ERMAK
- Minsk City Center of Hygiene and Epidemiology, Minsk, Belarus
| | - NELLI HINDZIUK
- Minsk City Center of Hygiene and Epidemiology, Minsk, Belarus
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Lee EH, Ryu D, Hong NS, Kim JY, Park KD, Lee WJ, Lee SJ, Kim SH, Do Y, Jang YH. Defining the Relationship between Daily Exposure to Particulate Matter and Hospital Visits by Psoriasis Patients. Ann Dermatol 2022; 34:40-45. [PMID: 35221594 PMCID: PMC8831302 DOI: 10.5021/ad.2022.34.1.40] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 08/04/2021] [Accepted: 09/08/2021] [Indexed: 12/02/2022] Open
Abstract
Background Although particulate matter likely provokes inflammatory reactions in those with chronic skin disorders like atopic dermatitis, no study has examined the relationship between particulate matter and psoriasis exacerbation. Objective This study evaluated possible associations between particulate matter and hospital visits for psoriasis patients in 7 major cities in South Korea. Methods We investigated the relationship between psoriasis and particulate matter. To do this, we used psoriasis patient data from the Korean National Health Insurance Service database. In addition, PM10 and PM2.5 concentration data spanning a 3-year time frame were obtained from the Korea Environment Corporation. Results A pattern analysis generated by the sample cross-correlation function and time series regression showed a correlation between particulate matter concentration and the number of hospital visits by psoriasis patients. However, the prewhitening method, which minimizes the effects of other variables besides particulate matter, revealed no correlation between the two. Conclusion This study suggests that particulate matter has no impact on hospital visit frequency among psoriasis patients in South Korean urban areas.
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Affiliation(s)
- Eun Hye Lee
- Department of Dermatology, School of Medicine, Bio-Medical Research Institute, Kyungpook National University, Daegu, Korea
| | - Daesick Ryu
- Department of Mathematics, KNU-Center for Nonlinear Dynamics, Kyungpook National University, Daegu, Korea
| | - Nam-Soo Hong
- Department of Preventive Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Jun Young Kim
- Department of Dermatology, School of Medicine, Bio-Medical Research Institute, Kyungpook National University, Daegu, Korea
| | - Kyung Duck Park
- Department of Dermatology, School of Medicine, Bio-Medical Research Institute, Kyungpook National University, Daegu, Korea
| | - Weon Ju Lee
- Department of Dermatology, School of Medicine, Bio-Medical Research Institute, Kyungpook National University, Daegu, Korea
| | - Seok-Jong Lee
- Department of Dermatology, School of Medicine, Bio-Medical Research Institute, Kyungpook National University, Daegu, Korea
| | - Sang-Hyun Kim
- Department of Pharmacology, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Younghae Do
- Department of Mathematics, KNU-Center for Nonlinear Dynamics, Kyungpook National University, Daegu, Korea
| | - Yong Hyun Jang
- Department of Dermatology, School of Medicine, Bio-Medical Research Institute, Kyungpook National University, Daegu, Korea
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Zhou Y, Liu J, Jiang C, Chen J, Feng X, Chen W, Zhang J, Dong H, Zhang W. A traditional herbal formula, Deng-Shi-Qing-Mai-Tang, regulates TLR4/NF-κB signaling pathway to reduce inflammatory response in PM2.5-induced lung injury. PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2021; 91:153665. [PMID: 34403878 DOI: 10.1016/j.phymed.2021.153665] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 07/02/2021] [Accepted: 07/12/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Studies revealed that particulate matter 2.5 (PM2.5) enters the lung through the respiratory tract and can damage lung tissue resulting in lung injury primarily via imbalance between pro-inflammatory and anti-inflammatory responses. Moreover, TLR4/NF-κB signaling pathways are reported to play a role in PM2.5-induced inflammation and lung injury, which is closely related to the inflammatory responses. Therefore, the traditional herbal formula, Deng-Shi-Qing-Mai-Tang (DSQMT), has been applied to improve patients' clinical symptoms with lung injury induced by PM2.5. It can reduce inflammatory reactions in lung injury and relieve cough and phlegm. However, the underlying mechanism of DSQMT treatment is still exclusive. PURPOSE To clarify the preventive and therapeutic effects of DSQMT on PM2.5-induced lung injury and explore its underlying mechanism. STUDY DESIGN PM2.5-induced lung injury rat model was established, and DSQMT was administered. METHODS First, PM2.5 was collected, and PM2.5 suspension was prepared. Then, a rat model with PM2.5-induced lung injury was established, and the effects of DSQMT were evaluated in vivo. Finally, the roles of DSQMT in inhibiting the TLR4/NF-κB signaling pathway were investigated in vitro using the NR8383 cell line via Western blot analysis, real-time PCR, electrophoretic mobility shift assay (EMSA), and immunofluorescence staining, respectively and analyzed. RESULTS We found that DSQMT significantly attenuated pathological lung tissue damage and inflammatory responses in PM2.5-induced lung injury. We also found that after PM2.5 stimulation in vitro, DSQMT regulates the expression of TLR4, MyD88, IKK, IκB-α, NF-κB p65 in the TLR4/NF-κB signaling pathway. It also constrains activated NF-κB entry into the nucleus and further limits its binding to target DNA. In addition, we revealed that DSQMT down-regulated interleukin (IL)-1β, IL-6, IL-10, THF-α, NO, PGE2 to reduce the inflammatory response. CONCLUSION We demonstrated that DSQMT has preventive and therapeutic effects on PM2.5-induced lung injury by down-regulation of the TLR4/NF-κB signaling pathway. Therefore, the efficacy of traditional Chinese medicine (TCM) in PM2.5 lung injury can be taken into consideration and may be improved in the future through further researches.
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Affiliation(s)
- You Zhou
- State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, Guangdong, China
| | - Jianbo Liu
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Cheng Jiang
- Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Jiaming Chen
- Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Xilian Feng
- Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Weiyan Chen
- Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Jiechun Zhang
- Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Hongzhen Dong
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Wei Zhang
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China.
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Association with Ambient Air Pollutants and School Absence Due to Sickness in Schoolchildren: A Case-Crossover Study in a Provincial Town of Japan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18126631. [PMID: 34203021 PMCID: PMC8296492 DOI: 10.3390/ijerph18126631] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 06/17/2021] [Accepted: 06/19/2021] [Indexed: 11/16/2022]
Abstract
The effect of ambient air pollutants and Asian dust (AD) on absence from school due to sickness has not been well researched. By conducting a case-crossover study, this study investigated the influence of ambient air pollutants and desert sand dust particles from East Asia on absence from school due to sickness. From November 2016 to July 2018, the daily cases of absence due to sickness were recorded in five elementary schools in Matsue, Japan. During the study period, a total of 16,915 absence cases were recorded, which included 4865 fever cases and 2458 cough cases. The relative risk of overall absence in a 10-μg/m3 increment of PM2.5 and a 0.1-km-1 of desert sand dust particles from East Asia were found with 1.28 (95%CI: 1.15-1.42) and 2.15 (1.04-4.45) at lag0, respectively. The significant influence of PM2.5 persisted at lag5 and that of desert sand dust particles at lag2. NO2 had statistically significant effects at lag2, lag3, and lag4. However, there was no evidence of a positive association of Ox and SO2 with absence from school. These results suggested that PM2.5, NO2, and AD increased the risk of absence due to sickness in schoolchildren.
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Huang W, Schinasi LH, Kenyon CC, Moore K, Melly S, Hubbard RA, Zhao Y, Diez Roux AV, Forrest CB, Maltenfort M, De Roos AJ. Effects of ambient air pollution on childhood asthma exacerbation in the Philadelphia metropolitan Region, 2011-2014. ENVIRONMENTAL RESEARCH 2021; 197:110955. [PMID: 33676951 DOI: 10.1016/j.envres.2021.110955] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 01/22/2021] [Accepted: 03/01/2021] [Indexed: 06/12/2023]
Abstract
Fine particulate matter (PM2.5) and ozone (O3) air pollutants are known risk factors for asthma exacerbation. We studied the association of these air pollutants with pediatric asthma exacerbation in the Philadelphia metropolitan region, and evaluated potential effect modification by children's characteristics (e.g., race/ethnicity, atopic conditions) and environmental factors (e.g., neighborhood tree canopy, meteorological factors, aeroallergens). We conducted a time-stratified case-crossover study of 54,632 pediatric (age ≤18 years) asthma exacerbation cases occurring from 2011 to 2014, identified through electronic health records (EHR) of the Children's Hospital of Philadelphia (CHOP) health system. We applied conditional logistic regression to estimate associations between air pollution and asthma exacerbation, using daily census-tract level pollutant concentrations estimated from the EPA Fused Air Quality Surface Using Downscaling (FAQSD) files. The associations were estimated within warm (Apr-Sep) and cold (Oct-Mar) months for unlagged exposure and for cumulative effects up to 5 days after exposure, with adjustment for temperature, relative humidity, and holidays. We found small increases in odds of asthma exacerbation with higher pollutant concentrations, with positive associations (OR, comparing concentrations of 75th to 25th percentile) observed for PM2.5 during both warm (1.03, 95% CI: 0.98-1.08) and cold months (1.05, 95% CI: 1.02-1.07), and for O3 during cold months (1.08, 95% CI: 1.02-1.14). The exposure-response relationship with PM2.5 during the cold months was essentially linear, whereas thresholds of effect were observed for the other associations at low-medium pollutant concentrations. Results were robust to multi-pollutant modeling and adjustment for additional covariates. We found no effect modification by most children's characteristics, while effect sizes were higher on days with detected tree and grass pollens during warm months. Our results suggest that even small decreases in pollutant concentrations could potentially reduce risk of childhood asthma exacerbation - an important finding, given the high burden of childhood asthma and known disparities in asthma control.
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Affiliation(s)
- Wanyu Huang
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA.
| | - Leah H Schinasi
- Department of Environmental and Occupational Health, Dornsife School of Public Health, Drexel University, PA, USA; Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Chén C Kenyon
- PolicyLab, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Kari Moore
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Steven Melly
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Rebecca A Hubbard
- Department of Biostatistics, Epidemiology & Informatics, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Yuzhe Zhao
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Ana V Diez Roux
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA; Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Christopher B Forrest
- The Applied Clinical Research Center, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Mitchell Maltenfort
- The Applied Clinical Research Center, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Anneclaire J De Roos
- Department of Environmental and Occupational Health, Dornsife School of Public Health, Drexel University, PA, USA; Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
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Oh SJ, Yoon D, Park JH, Lee JH. Effects of Particulate Matter on Healthy Skin: A Comparative Study between High- and Low-Particulate Matter Periods. Ann Dermatol 2021; 33:263-270. [PMID: 34079186 PMCID: PMC8137329 DOI: 10.5021/ad.2021.33.3.263] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 12/21/2020] [Accepted: 01/18/2021] [Indexed: 11/21/2022] Open
Abstract
Background The influence of airborne particulate matter (PM) on skin has primarily been studied in patients with skin diseases such as atopic dermatitis. Recently, the effect of PM on healthy human skin has gained attention. Objective To evaluate the relationship between PM concentration and objective skin changes in healthy subjects. Methods This prospective study enrolled 25 healthy volunteers without any skin disease. Data regarding daily meteorological parameters and air pollution were collected during a high-PM period and a low-PM period for 14 days. Environmental and lifestyle factors that might influence skin conditions of subjects were also collected during the study period. Biophysical parameters of the skin such as transepidermal water loss (TEWL), hydration, erythema index, and melanin index were measured. Pores, wrinkles, sebum, and skin tone were evaluated using a facial analysis system. Results Mean TEWL value during the high-PM period was significantly higher than that during the low-PM period (10.16 g/m2/h vs. 5.99 g/m2/h; p=0.0005). Mean erythema index was significantly higher in the high-PM period than that in the low-PM period (4.3 vs. 3.42; p=0.038). For facial analysis system indices, uniformity of skin tone was higher in the low-PM period than that in the high-PM period (p<0.0001). In addition, with increasing PM10 and PM2.5, TEWL also showed increase when other environmental components were constant (regression coefficient [RC]=0.1529, p<0.0001 for PM10; RC=0.2055, p=0.0153 for PM2.5). Conclusion Increased PM concentrations may contribute to disturbed barrier function, increased facial erythema, and uneven skin tone even in healthy human skin.
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Affiliation(s)
- Se Jin Oh
- Department of Dermatology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dokyoung Yoon
- Department of Dermatology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ji-Hye Park
- Department of Dermatology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jong Hee Lee
- Department of Dermatology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Department of Medical Device Management & Research, Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University, Seoul, Korea
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12
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van de Wetering C, Elko E, Berg M, Schiffers CHJ, Stylianidis V, van den Berge M, Nawijn MC, Wouters EFM, Janssen-Heininger YMW, Reynaert NL. Glutathione S-transferases and their implications in the lung diseases asthma and chronic obstructive pulmonary disease: Early life susceptibility? Redox Biol 2021; 43:101995. [PMID: 33979767 PMCID: PMC8131726 DOI: 10.1016/j.redox.2021.101995] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 04/23/2021] [Accepted: 04/24/2021] [Indexed: 01/01/2023] Open
Abstract
Our lungs are exposed daily to airborne pollutants, particulate matter, pathogens as well as lung allergens and irritants. Exposure to these substances can lead to inflammatory responses and may induce endogenous oxidant production, which can cause chronic inflammation, tissue damage and remodeling. Notably, the development of asthma and Chronic Obstructive Pulmonary Disease (COPD) is linked to the aforementioned irritants. Some inhaled foreign chemical compounds are rapidly absorbed and processed by phase I and II enzyme systems critical in the detoxification of xenobiotics including the glutathione-conjugating enzymes Glutathione S-transferases (GSTs). GSTs, and in particular genetic variants of GSTs that alter their activities, have been found to be implicated in the susceptibility to and progression of these lung diseases. Beyond their roles in phase II metabolism, evidence suggests that GSTs are also important mediators of normal lung growth. Therefore, the contribution of GSTs to the development of lung diseases in adults may already start in utero, and continues through infancy, childhood, and adult life. GSTs are also known to scavenge oxidants and affect signaling pathways by protein-protein interaction. Moreover, GSTs regulate reversible oxidative post-translational modifications of proteins, known as protein S-glutathionylation. Therefore, GSTs display an array of functions that impact the pathogenesis of asthma and COPD. In this review we will provide an overview of the specific functions of each class of mammalian cytosolic GSTs. This is followed by a comprehensive analysis of their expression profiles in the lung in healthy subjects, as well as alterations that have been described in (epithelial cells of) asthmatics and COPD patients. Particular emphasis is placed on the emerging evidence of the regulatory properties of GSTs beyond detoxification and their contribution to (un)healthy lungs throughout life. By providing a more thorough understanding, tailored therapeutic strategies can be designed to affect specific functions of particular GSTs.
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Affiliation(s)
- Cheryl van de Wetering
- Department of Respiratory Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands; Department of Pathology and Laboratory Medicine, University of Vermont College of Medicine, Burlington, VT, USA
| | - Evan Elko
- Department of Pathology and Laboratory Medicine, University of Vermont College of Medicine, Burlington, VT, USA
| | - Marijn Berg
- Pathology and Medical Biology, GRIAC Research Institute, University of Groningen, University Medical Center Groningen (UMCG), Groningen, the Netherlands
| | - Caspar H J Schiffers
- Department of Respiratory Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands; Department of Pathology and Laboratory Medicine, University of Vermont College of Medicine, Burlington, VT, USA
| | - Vasili Stylianidis
- Department of Respiratory Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Maarten van den Berge
- Pulmonology, GRIAC Research Institute, University of Groningen, University Medical Center Groningen (UMCG), Groningen, the Netherlands
| | - Martijn C Nawijn
- Pathology and Medical Biology, GRIAC Research Institute, University of Groningen, University Medical Center Groningen (UMCG), Groningen, the Netherlands
| | - Emiel F M Wouters
- Department of Respiratory Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands; Ludwig Boltzmann Institute for Lung Health, Vienna, Austria
| | - Yvonne M W Janssen-Heininger
- Department of Pathology and Laboratory Medicine, University of Vermont College of Medicine, Burlington, VT, USA.
| | - Niki L Reynaert
- Department of Respiratory Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands.
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13
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Baek JO, Cho J, Roh JY. Associations between ambient air pollution and medical care visits for atopic dermatitis. ENVIRONMENTAL RESEARCH 2021; 195:110153. [PMID: 32926890 DOI: 10.1016/j.envres.2020.110153] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 08/17/2020] [Accepted: 08/22/2020] [Indexed: 05/22/2023]
Abstract
BACKGROUND Previous studies have reported numerous environmental factors for atopic dermatitis (AD), such as allergens and chemical stimulants. However, few studies have addressed the relationship between ambient air pollution and AD at a population level. OBJECTIVE To evaluate the effect of air pollutants on medical care visits for AD and to identify susceptible populations. METHODS In this time-series study conducted on 513,870 medical care visits for AD from 2012 to 2015 identified by reviewing national health insurance claim data in Incheon, Republic of Korea. Treating daily number of medical care visits for AD as a dependent variable, generalized additive models with Poisson distributions were constructed, which included air pollutant levels, ambient temperature, relative humidity, day of the week, national holiday, and season. Risks were expressed as relative risks (RR) with 95% confidence intervals (95% CIs) per interquartile range increase of each air pollutant. RESULTS Higher levels of particulate matter of diameter ≤10 μm (PM10) (RR, 1.009; 95% CI, 1.007-1.012), ozone (1.028; 1.023-1.033), and sulfur dioxide (1.033; 1.030-1.037) were significantly associated with increased risk of medical care visits for AD on same days. In all age and sex groups, ozone was associated with a significantly higher risk of medical care visits, with the greatest risk among 13- to 18-year-old males (RR, 1.127; 95% CI, 1.095-1.159). CONCLUSION This study suggests relationships of ambient PM10, ozone, and sulfur dioxide levels with medical care visits for AD.
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Affiliation(s)
- Jin-Ok Baek
- Department of Dermatology, Gil Medical Center, Gachon University, Incheon, Republic of Korea
| | - Jaelim Cho
- Department of Dermatology, Gil Medical Center, Gachon University, Incheon, Republic of Korea.
| | - Joo-Young Roh
- Department of Dermatology, Gil Medical Center, Gachon University, Incheon, Republic of Korea.
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14
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Abstract
Globally, exposure to ambient air pollutants is responsible for premature mortality and is implicated in the development and exacerbation of several acute and chronic lung disease across all ages. In this article, we discuss the source apportionment of ambient pollutants and the respiratory health effects in humans. We specifically discuss the evidence supporting ambient pollution in the development of asthma and chronic obstructive pulmonary disease and acute exacerbations of each condition. Practical advice is given to health care providers in how to promote a healthy environment and advise patients with chronic conditions to avoid unsafe air quality.
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Affiliation(s)
- Gary Adamkiewicz
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
| | - Jahred Liddie
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
| | - Jonathan M Gaffin
- Division of Pulmonary Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA.
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15
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Park S, Ra SW, Kang SY, Kim HC, Lee SW. Effect of particulate matter exposure on patients with COPD and risk reduction through behavioural interventions: the protocol of a prospective panel study. BMJ Open 2020; 10:e039394. [PMID: 33168558 PMCID: PMC7654133 DOI: 10.1136/bmjopen-2020-039394] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION Patients with chronic obstructive pulmonary disease (COPD) are vulnerable to particulate matter (PM) exposure which can increase acute exacerbations and hospitalisation. Interventions to avoid PM exposure are important but evidence-based guidance is lacking. This study aims to assess the impact of PM on lung function, quality of life and exacerbations in patients with COPD using a panel design study; it will also provide evidence for interventional measures to reduce harm from PM exposure. METHODS AND ANALYSIS A prospective panel study of patients with COPD aged ≥40 years will be conducted. Patients will be required to have a forced expiratory volume in one second <80% of the predicted value at enrolment. A total of 120 patients from three different regions will be enrolled, 60 from the metropolitan area, 30 from an industrialised area and 30 from a clean rural area. Clinical outcomes will be assessed through COPD assessment test scores, the St. George's Respiratory Questionnaire for patients with COPD and pulmonary function testing. Indoor and outdoor PM in the patients' environments will be measured using gravimetric and light scattering platforms. To estimate the individual dose of PM exposure, a time-activity diary, Geographic Information System and land use regression model will be combined in every season for 1 year. The correlation between PM exposure and the health status of patients with COPD will be evaluated. In addition, 40 patients with the lowest score of life behaviour score to reduce environmental PM exposure will be randomised to a control or intervention group, who will receive in-depth education on risk-reducing behaviours. ETHICS AND DISSEMINATION This study was approved by the Institutional Review Board of each site. The participants received comprehensive information and provided informed consent. The result of this study will be discussed in the form of conference presentations and peer-reviewed publications. TRIAL REGISTRATION NUMBER NCT04020237.
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Affiliation(s)
- Shinhee Park
- Pulmonary, Allergy and Critical Care medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Republic of Korea
| | - Seung Won Ra
- Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Sung Yoon Kang
- Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Republic of Korea
| | - Hwan-Cheol Kim
- Department of Occupational and Environmental Medicine, Inha University College of Medicine, Incheon, Republic of Korea
| | - Sei Won Lee
- Department of Pulmonology and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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16
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Chang Q, Liu S, Chen Z, Zu B, Zhang H. Association between air pollutants and outpatient and emergency hospital visits for childhood asthma in Shenyang city of China. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2020; 64:1539-1548. [PMID: 32388688 DOI: 10.1007/s00484-020-01934-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 04/30/2020] [Indexed: 06/11/2023]
Abstract
Effects of air pollution on asthma vary in different study areas, and long-term time series research on the effects of air pollution on asthma outpatients and emergency hospital visits has not been conducted in Northeast China. We assessed the impact of air pollutants on the risk of asthma outpatients and emergency hospital visits in Shenyang, China. A distributed lag non-linear model with a Poisson regression was used to assess the short-term effects of air pollutants on asthma outpatient and emergency hospital visits between January 1, 2013 and December 31, 2017. Confounding factors were adjusted using natural cubic splines. Ozone (O3), carbon monoxide (CO), and suspended particulates < 10 μm in aerodynamic diameter (PM10) were positively associated with the number of asthma hospital visits. The largest cumulative effects of O3, CO, and PM10 on hospital visits were on lag day 2 (RR = 1.163, 95% CI 1.051-1.287) for 0-5-year-old childhood asthma, on lag day 3 (RR = 1.386, 95% CI 1.136-1.69) for asthma in winter, and on lag day 10 (RR = 1.148, 95% CI 0.942-1.399) for female asthma, respectively. The cumulative effect of air pollution represented by the air quality index (AQI) was largest on lag day 10 for 0-5-year-old childhood asthma with an increase of 28.6% (95% CI 6.5-55.4) hospital visits every IQR increment of the AQI. CO, O3, and PM10 were the main air pollutants in Shenyang city. Children with bronchitis asthma were more vulnerable to air pollution during the cold season.
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Affiliation(s)
- Qing Chang
- Clinical Research Center, Shengjing Hospital of China Medical University, Huaxiang Road, No. 39, Tiexi District, Shenyang, China
| | - Shu Liu
- Department of Atmospheric Environment Monitoring Office, Environmental Monitoring Experiment Center of Liaoning Province, Shuang Road, No. 30 A3, Hunnan District, Shenyang, China
| | - Zongjiao Chen
- Department of Atmospheric Environment Monitoring Office, Environmental Monitoring Experiment Center of Liaoning Province, Shuang Road, No. 30 A3, Hunnan District, Shenyang, China
| | - Biao Zu
- Department of Atmospheric Environment Monitoring Office, Environmental Monitoring Experiment Center of Liaoning Province, Shuang Road, No. 30 A3, Hunnan District, Shenyang, China
| | - Hehua Zhang
- Clinical Research Center, Shengjing Hospital of China Medical University, Huaxiang Road, No. 39, Tiexi District, Shenyang, China.
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17
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Rosenquist NA, Metcalf WJ, Ryu SY, Rutledge A, Coppes MJ, Grzymski JJ, Strickland MJ, Darrow LA. Acute associations between PM 2.5 and ozone concentrations and asthma exacerbations among patients with and without allergic comorbidities. JOURNAL OF EXPOSURE SCIENCE & ENVIRONMENTAL EPIDEMIOLOGY 2020; 30:795-804. [PMID: 32094459 DOI: 10.1038/s41370-020-0213-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 01/10/2020] [Accepted: 01/21/2020] [Indexed: 05/21/2023]
Abstract
Acute effects of outdoor air pollution on asthma exacerbations may vary by asthma phenotype (allergic vs nonallergic). Associations of ambient PM2.5 and ozone concentrations with acute asthma visits (office, urgent, emergency, and hospitalization) were investigated using electronic medical records. International Classification of Disease codes were used to identify asthmatics, and classify them based on the presence or absence of an allergic comorbidity in their medical records. Daily 24-h average PM2.5, 8-h maximum ozone, and mean temperature were obtained from a centralized monitor. Using a time-stratified case-crossover approach, pollutant concentrations were modeled using moving averages and distributed lag nonlinear models (lag 0-6) to examine lag associations and nonlinear concentration-response. The adjusted odds ratios for a 10 µg/m3 increase in 3-day moving average (lag 0-2) PM2.5 in the two-pollutant models among patients with and without allergic comorbidities were 1.10 (95% confidence interval [CI]: 1.07, 1.13) and 1.05 (95% CI: 1.02, 1.09), respectively; and for a 20 ppb increase in 3-day moving average (lag 0-2) ozone were 1.08 (95% CI: 1.02, 1.14) and 1.00 (95% CI: 0.95, 1.05), respectively. Estimated odds ratios among patients with allergic comorbidities were consistently higher across age, sex, and temperature categories. Asthmatics with an allergic comorbidity may be more susceptible to ambient PM2.5 and ozone.
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Affiliation(s)
| | - William J Metcalf
- Renown Institute for Health Innovation, Reno, NV, USA
- Desert Research Institute, Reno, NV, USA
| | - So Young Ryu
- School of Community Health Sciences, University of Nevada, Reno, NV, USA
| | - Aida Rutledge
- University of Nevada School of Medicine, Reno, NV, USA
| | - Max J Coppes
- Renown Institute for Health Innovation, Reno, NV, USA
- University of Nevada School of Medicine, Reno, NV, USA
- Renown Children's Hospital, Reno, NV, USA
| | - Joe J Grzymski
- Renown Institute for Health Innovation, Reno, NV, USA
- Desert Research Institute, Reno, NV, USA
| | - Matthew J Strickland
- School of Community Health Sciences, University of Nevada, Reno, NV, USA
- University of Nevada School of Medicine, Reno, NV, USA
| | - Lyndsey A Darrow
- School of Community Health Sciences, University of Nevada, Reno, NV, USA
- University of Nevada School of Medicine, Reno, NV, USA
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18
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Slama A, Śliwczyński A, Woźnica-Pyzikiewicz J, Zdrolik M, Wiśnicki B, Kubajek J, Turżańska-Wieczorek O, Studnicki M, Wierzba W, Franek E. The short-term effects of air pollution on respiratory disease hospitalizations in 5 cities in Poland: comparison of time-series and case-crossover analyses. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2020; 27:24582-24590. [PMID: 32356054 PMCID: PMC7326830 DOI: 10.1007/s11356-020-08542-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 03/23/2020] [Indexed: 05/30/2023]
Abstract
Very few publications have compared different study designs investigating the short-term effects of air pollutants on healthcare visits and hospitalizations for respiratory tract diseases. This study describes, using two different study designs (a case-crossover design and a time-series analysis), the association of air pollutants and respiratory disease hospitalizations. The study has been conducted on 5 cities in Poland on a timeline of almost 4 years. DLNM and regression models were both used for the assessment of the short-term effects of air pollution peaks on respiratory hospitalizations. Both case-crossover and time-series studies equally revealed a positive association between air pollution peaks and hospitalization occurrences. Results were provided in the form of percentage increase of a respiratory visit/hospitalization, for each 10-μg/m3 increment in single pollutant level for both study designs. The most significant estimated % increases of hospitalizations linked to increase of 10 μg/m3 of pollutant have been recorded in general with particulate matter, with highest values for 24 h PM2.5 in Warsaw (6.4%, case-crossover; 4.5%, time series, respectively) and in Białystok (5.6%, case-crossover; 4.5%, time series, respectively). The case-crossover analysis results have shown a larger CI in comparison to the results of the time-series analysis, while the lag days were easier to identify with the case-crossover design. The trends and the overlap of the results occurring from both methods are good and show applicability of both study designs to air pollution effects on short-term hospitalizations.
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Affiliation(s)
- Alessandro Slama
- Central Clinical Hospital MSWiA in Warsaw, Wołoska 137, 02-507, Warsaw, Poland
| | - Andrzej Śliwczyński
- University of Humanities and Economics in Łodz, Satellite Campus in Warsaw, ul. Wolność 2a, 01-018, Warsaw, Poland
| | | | - Maciej Zdrolik
- Chancellery of the Prime Minister of Poland, al. Ujazdowskie 1/3, 00-001, Warsaw, Poland
| | - Bartłomiej Wiśnicki
- Department of Business Economics, Warsaw School of Economics, Al. Niepodleglosci 162, 02-554, Warsaw, Poland
| | - Jakub Kubajek
- Chancellery of the Prime Minister of Poland, al. Ujazdowskie 1/3, 00-001, Warsaw, Poland
| | | | - Marcin Studnicki
- Warsaw University of Life Sciences, Nowoursynowska 166, 02-787, Warsaw, Poland
| | - Waldemar Wierzba
- University of Humanities and Economics in Łodz, Satellite Campus in Warsaw, ul. Wolność 2a, 01-018, Warsaw, Poland
| | - Edward Franek
- Central Clinical Hospital MSWiA in Warsaw, Wołoska 137, 02-507, Warsaw, Poland.
- Mossakowski Clinical Research Centre, Polish Academy of Sciences, Pawinskiego 5, 02-106, Warsaw, Poland.
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19
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Kim HB, Shim JY, Park B, Lee YJ. Long-term exposure to air pollution and the risk of non-lung cancer: a meta-analysis of observational studies. Perspect Public Health 2019; 140:222-231. [PMID: 31813335 DOI: 10.1177/1757913919891751] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
AIMS Several meta-analyses of observational studies report a long-term correlation between air pollution and the risk of cancer, particularly lung carcinoma. The aim of this study was to review and quantify evidence for an association between air pollution and the risk of developing non-lung cancers. METHODS We searched PubMed, EMBASE, Cochrane Library, and the reference lists of the included studies as well as those recorded in previous meta-analyses conducted before January 2019. A random-effects model was used to derive overall risk estimates per pollutant. RESULTS A total of 20 studies, including 5 case-control and 15 prospective cohort studies, were used in the final analysis. The risk of developing non-lung cancer was 1.09 (95% confidence interval (CI): 1.01-1.18, I2 = 72.9%) per NO2 increases of 10 µg/m3. There was also a significant association between exposure to PM2.5 and PM10 and the risk of non-lung cancer when the male and female populations were combined (pooled odds ratio/relative risk (OR/RR) = 1.22, 95% CI: 1.11-1.34; I2 = 0.0% and pooled OR/RR = 1.26, 95% CI: 1.05-1.52; I2 = 43.9%, respectively). Regarding the type of cancer, significant harmful effects of PM2.5 were observed for liver cancer populations (pooled OR/RR = 1.21, 95% CI: 1.10-1.32; I2 = 0.0%). Different types of cancer were positively associated with the incidence of non-lung cancer and PM10 in the random-effect meta-regression analysis. CONCLUSIONS Long-term exposure to air pollutants appears to be associated with an increased risk of non-lung cancer. Care should be taken in interpretation, because the results for specific cancers were restricted.
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Affiliation(s)
- H-B Kim
- Department of Family Medicine, Myongji Hospital, Hanyang University College of Medicine, Goyang, Republic of Korea.,Department of Medicine, Graduate School, Yonsei University, Seoul, Republic of Korea
| | - J-Y Shim
- Department of Medicine, Graduate School, Yonsei University, Seoul, Republic of Korea.,Department of Family Medicine, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea
| | - B Park
- Department of Medicine, Graduate School, Yonsei University, Seoul, Republic of Korea.,Department of Family Medicine, Yongin Severance Hospital, Yongin, Republic of Korea
| | - Y-J Lee
- Department of Medicine, Graduate School, Yonsei University, Seoul, Republic of Korea.,Department of Family Medicine, Gangnam Severance Hospital, Seoul, Republic of Korea
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20
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Lee H, Lee E, Jang IY. Air Pollutants and Frailty in Older Adults: A Geriatrician's Perspective. Ann Geriatr Med Res 2019; 23:212-213. [PMID: 32743314 PMCID: PMC7370762 DOI: 10.4235/agmr.19.0049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Revised: 12/17/2019] [Accepted: 12/17/2019] [Indexed: 11/29/2022] Open
Affiliation(s)
- Heayon Lee
- Division of Geriatrics, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Eunju Lee
- Division of Geriatrics, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Il-Young Jang
- Division of Geriatrics, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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21
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Assessing the impact of air pollution on childhood asthma morbidity: how, when, and what to do. Curr Opin Allergy Clin Immunol 2019; 18:124-131. [PMID: 29493555 DOI: 10.1097/aci.0000000000000422] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW Exposure to air pollutants is linked with poor asthma control in children and represents a potentially modifiable risk factor for impaired lung function, rescue medication use, and increased asthma-related healthcare utilization. Identification of the most relevant pollutants to asthma as well as susceptibility factors and strategies to reduce exposure are needed to improve child health. RECENT FINDINGS The current available literature supports the association between pollutants and negative asthma outcomes. Ethnicity, socioeconomic status, and presence of certain gene polymorphisms may impact susceptibility to the negative health effects of air pollution. Improved air quality standards were associated with better asthma outcomes. SUMMARY The link between air pollution and pediatric asthma morbidity is supported by the recent relevant literature. Continued efforts are needed to identify the most vulnerable populations and develop strategies to reduce exposures and improve air quality.
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22
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Park M, Lee JS, Park MK. The Effects of Air Pollutants on the Prevalence of Common Ear, Nose, and Throat Diseases in South Korea: A National Population-Based Study. Clin Exp Otorhinolaryngol 2019; 12:294-300. [PMID: 30813711 PMCID: PMC6635704 DOI: 10.21053/ceo.2018.00612] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 12/20/2018] [Indexed: 11/22/2022] Open
Abstract
Objectives The effects of air pollutants on upper airway disease development have been seldom studied. In this study, we evaluated the effects of air pollution on the prevalence of ENT diseases. Methods We identified cases of ENT disease occurring in 2009, as recorded by the Korea National Health and Nutrition Examination Survey, and explored their associations with the levels of five air pollutants: sulfur dioxide (SO2), nitrogen dioxide (NO2), ozone (O3), carbon monoxide (CO), and particulate matter (PM10 particles; particulates ≤10 μm in aerodynamic diameter). Subjects diagnosed with at least one of the five studied ENT diseases were included in analysis, but those aged under 19 years were excluded. Linear associations between ENT disease frequency and pollutant levels were evaluated by calculating Spearman correlations. After adjusting for age, gender, and geographic region, multivariate logistic regression was used to obtain odds ratios (OR) with 95% confidence intervals (CI). Results A total of 7,399 subjects with ENT diseases were identified. A linear association was evident between PM10 concentration and the frequency of septal deviation (Spearman coefficient, 0.507; P=0.045). After adjustment, the PM10 level was associated with high odds ratios for chronic rhinosinusitis (1.22; 95% CI, 1.02 to 1.46) and septal deviation (1.43; 95% CI, 1.22 to 1.67). Both of these conditions were more prevalent in males. Conclusion We found that increased ambient concentrations of PM10 particles were clearly associated with increased the risk of chronic rhinosinusitis and septal deviation; the exposure-response relationship was definitive.
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Affiliation(s)
- Mina Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul Medical Center, Seoul, Korea
| | - Ji Sung Lee
- Clinical Research Center, Asan Institute of Life Sciences, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Moo Kyun Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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23
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Hernández-Pellón A, Nischkauer W, Limbeck A, Fernández-Olmo I. Metal(loid) bioaccessibility and inhalation risk assessment: A comparison between an urban and an industrial area. ENVIRONMENTAL RESEARCH 2018; 165:140-149. [PMID: 29704775 DOI: 10.1016/j.envres.2018.04.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 04/04/2018] [Accepted: 04/16/2018] [Indexed: 05/12/2023]
Abstract
The content of metal(loid)s in particulate matter (PM) is of special concern due to their contribution to overall (PM) toxicity. In this study, the bioaccessibility and human health risk of potentially toxic metal(loid)s associated with PM10 were investigated in two areas of the Cantabrian region (northern Spain) with different levels of exposure: an industrial area mainly influenced by a ferromanganese alloy plant; and an urban area consisting mainly of residential and commercial activities, but also affected, albeit to a lesser extent by the ferroalloy plant. Total content and bioaccessible fractions in simulated lung fluids (SLFs) of Fe, Mn, Zn, Ni, Cu, Sb, Mo, Cd and Pb were determined by ICP-MS. Gamble's solution and artificial lysosomal fluid (ALF) were used to mimic different conditions inside the human respiratory system. A health risk assessment was performed based on the United States Environmental Protection Agency's (USEPA) methodology. Most metal(loid)s showed moderate and high bioaccessibility in Gamble's solution and ALF, respectively. Despite the high variability between the samples, metal(loid) bioaccessibility was found to be higher on average at the industrial site, suggesting a greater hazard to human health in the proximity of the main metal(loid) sources. Based on the results of the risk assessment, the non-carcinogenic risk associated with Mn exposure was above the safe limit (HQ> 1) under all the studied scenarios at the industrial site and under some specific scenarios at the urban location. The estimated carcinogenic inhalation risk for Cd exposure at the industrial site was found to be within the range between 1.0 × 10-6 to 1.0 × 10-4 (uncertainty range) under some scenarios. The results obtained in this study indicate that Mn and Cd inhalation exposure occurring in the vicinities of the studied areas may pose a human health risk.
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Affiliation(s)
- A Hernández-Pellón
- Dpto. de Ingenierías Química y Biomolecular, Universidad de Cantabria, Avda. Los Castros s/n, 39005 Santander, Cantabria, Spain.
| | - W Nischkauer
- TU Wien, Institute of Chemical Technologies and Analytics, Getreidemarkt 9/164-IAC, A-1060 Vienna, Austria
| | - A Limbeck
- TU Wien, Institute of Chemical Technologies and Analytics, Getreidemarkt 9/164-IAC, A-1060 Vienna, Austria
| | - I Fernández-Olmo
- Dpto. de Ingenierías Química y Biomolecular, Universidad de Cantabria, Avda. Los Castros s/n, 39005 Santander, Cantabria, Spain
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24
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Park M, Han J, Jang MJ, Suh MW, Lee JH, Oh SH, Park MK. Air pollution influences the incidence of otitis media in children: A national population-based study. PLoS One 2018; 13:e0199296. [PMID: 29953484 PMCID: PMC6023207 DOI: 10.1371/journal.pone.0199296] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Accepted: 06/05/2018] [Indexed: 12/12/2022] Open
Abstract
Background Otitis media (OM) is a major reason for children’s visits to physicians and a major cause of their being treated with antibiotics. It not only causes economic burdens but also influences hearing, speech, and education. To our knowledge, no nationwide population-based study has assessed the association between air pollution and OM. Therefore, this study evaluated the association between air pollution levels and the incidence of OM. Methods We identified cases of OM that occurred in South Korea between January 2011 and December 2012 from the Korea National Health Insurance Service-National Sample Cohort database, and evaluated its relationship with five air pollutants: particulate matter (PM10, particulates ≤10 μm in diameter), nitrogen dioxide (NO2), ozone (O3), sulfur dioxide, and carbon monoxide. Associations between the weekly incidence of OM and the five air pollutants were analyzed using generalized estimating equations. Conditional logistic regression analysis was used to obtain odds ratios (ORs) and their 99.9% Bonferroni-corrected confidence intervals after adjusting for gender, age, season, and region. Results We based our analysis on 160,875 hospital visits for OM by children aged <15 years. Correlations with higher concentrations of the five pollutants showed higher ORs than did the reference values at most time lags. PM10 had the largest influence on the OM incidence at a time lag of 0 weeks, whereas NO2 and O3 had the largest impacts on OM incidence at time lags of 1 and 4 weeks, respectively. Conclusion These findings support the notion that the incidence of OM is associated with ambient air pollution.
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Affiliation(s)
- Mina Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul Medical Center, Seoul, South Korea
| | - Jiyeon Han
- Medical Research Collaborating Center, Seoul National University Hospital, Seoul, South Korea
| | - Myoung-jin Jang
- Medical Research Collaborating Center, Seoul National University Hospital, Seoul, South Korea
| | - Myung-Whan Suh
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea
- Sensory Organ Research Institute, Seoul National University Medical Research Center, Seoul, South Korea
| | - Jun Ho Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea
- Sensory Organ Research Institute, Seoul National University Medical Research Center, Seoul, South Korea
| | - Seung Ha Oh
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea
- Sensory Organ Research Institute, Seoul National University Medical Research Center, Seoul, South Korea
| | - Moo Kyun Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea
- Sensory Organ Research Institute, Seoul National University Medical Research Center, Seoul, South Korea
- * E-mail:
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25
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Eguchi R, Onozuka D, Ikeda K, Kuroda K, Ieiri I, Hagihara A. The relationship between fine particulate matter (PM 2.5) and schizophrenia severity. Int Arch Occup Environ Health 2018; 91:613-622. [PMID: 29682692 DOI: 10.1007/s00420-018-1311-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Accepted: 04/18/2018] [Indexed: 12/20/2022]
Abstract
PURPOSE Although particulate matter (PM) is reported to affect the rate of emergency admissions for schizophrenia, no study has examined the relationship between particulate matter less than 2.5 μm in diameter (PM2.5) and the severity of schizophrenia. METHODS We obtained data on patients with schizophrenia at a psychiatric hospital, and on air pollution in Sakai, Japan between Feb 1, 2013 and April 30, 2016. Multivariate logistic regression analyses were used to estimate the relationship between PM2.5 concentrations and scores on the Brief Psychiatric Rating Scale (BPRS) of schizophrenia patients at admission, with a lag of up to 7 days. RESULTS During the study period, there were 1193 schizophrenia cases. The odds ratio (OR) for a BPRS score ≥ 50 at admission was 1.05 [95% confidence interval 1.00-1.10] and the effect of PM2.5 concentration was significant for lag period of 2 days. The ORs associated with PM2.5 concentration increased substantially for patients over 65 years of age. CONCLUSIONS Ambient PM2.5 concentration was associated with exacerbation of schizophrenia. Our results suggest that protection for several days should be considered for controlling PM2.5-related schizophrenia, especially among elderly patients.
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Affiliation(s)
- Rika Eguchi
- Department of Health Services Management and Policy, Kyushu University Graduate School of Medicine, Higashi-ku, Fukuoka, 812-8582, Japan.,Department of Clinical Pharmacokinetics, Kyushu University Graduate School of Pharmaceutical Science, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Daisuke Onozuka
- Department of Health Services Management and Policy, Kyushu University Graduate School of Medicine, Higashi-ku, Fukuoka, 812-8582, Japan.
| | - Kouji Ikeda
- Hannan Hospital, 277 Handaminamino-cho, Naka-ku, Sakai, Osaka, 599-8263, Japan
| | - Kenji Kuroda
- Hannan Hospital, 277 Handaminamino-cho, Naka-ku, Sakai, Osaka, 599-8263, Japan
| | - Ichiro Ieiri
- Department of Clinical Pharmacokinetics, Kyushu University Graduate School of Pharmaceutical Science, Higashi-ku, Fukuoka, 812-8582, Japan.
| | - Akihito Hagihara
- Department of Health Services Management and Policy, Kyushu University Graduate School of Medicine, Higashi-ku, Fukuoka, 812-8582, Japan.
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26
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Ngoc LTN, Park D, Lee Y, Lee YC. Systematic Review and Meta-Analysis of Human Skin Diseases Due to Particulate Matter. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14121458. [PMID: 29186837 PMCID: PMC5750877 DOI: 10.3390/ijerph14121458] [Citation(s) in RCA: 79] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Revised: 11/22/2017] [Accepted: 11/23/2017] [Indexed: 01/13/2023]
Abstract
This study investigated the effects of particulate matter (PM) on human skin diseases by conducting a systematic review of existing literature and performing a meta-analysis. It considered articles reporting an original effect of PM on human skin. From among 918 articles identified, 13 articles were included for further consideration after manual screening of the articles resulted in the exclusion of articles that did not contain data, review articles, editorials, and also articles in languages other than English. Random-effects models and forest plots were used to estimate the effect of PM on the skin by Meta-Disc analysis. According to people's reports of exposure and negative skin effects (atopic dermatitis (AD), eczema, and skin aging, etc.) due to air pollution, the summary relative risk (odds ratio) of PM10 was determined to be 0.99 (95% confidence interval (CI) 0.89-1.11) whereas PM2.5 was determined to be 1.04 (95% CI 0.96-1.12). Simultaneously, there was a different extent of impact between PM10 and PM2.5 on atopic dermatitis (AD) for those of young age: the odds ratio of PM10 and PM2.5 were 0.96 (95% CI 0.83-1.11; I² = 62.7%) and 1.05 (95% CI 0.95-1.16; I² = 46%), respectively. Furthermore, the results suggest an estimated increase of disease incidence per 10 μg/m³ PM of 1.01% (0.08-2.05) due to PM10 and 1.60% (0.45-2.82) due to PM2.5. Following the results, PM10 and PM2.5 are associated with increased risks of human skin diseases, especially AD, whose risk is higher in infants and school children. With its smaller size and a high concentration of metals, PM2.5 is more closely related to AD in younger people, compared to PM10.
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Affiliation(s)
- Le Thi Nhu Ngoc
- Department of BioNano Technology, Gachon University, 1342 Seongnam, Korea.
| | - Duckshin Park
- Korea Railroad Research Institute (KRRI), 176 Cheoldobakmulkwan-ro, Uiwang-si 16105, Korea.
| | - Yongil Lee
- Korea Railroad Research Institute (KRRI), 176 Cheoldobakmulkwan-ro, Uiwang-si 16105, Korea.
| | - Young-Chul Lee
- Department of BioNano Technology, Gachon University, 1342 Seongnam, Korea.
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Li R, Jiang N, Liu Q, Huang J, Guo X, Liu F, Gao Z. Impact of Air Pollutants on Outpatient Visits for Acute Respiratory Outcomes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14010047. [PMID: 28067786 PMCID: PMC5295298 DOI: 10.3390/ijerph14010047] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Revised: 12/24/2016] [Accepted: 01/03/2017] [Indexed: 12/14/2022]
Abstract
The air pollution in China is a severe problem. The aim of our study was to investigate the impact of air pollutants on acute respiratory outcomes in outpatients. Outpatient data from 2 December 2013 to 1 December 2014 were collected, as well as air pollutant data including ozone (O₃), nitrogen dioxide (NO₂), carbon monoxide (CO), sulfur dioxide (SO₂), and particulate matter (PM2.5 and PM10). We screened six categories of acute respiratory outcomes and analyzed their associations with different air pollutant exposures, including upper respiratory tract infection (URTI), acute bronchitis (AB), community-acquired pneumonia (CAP), acute exacerbation of chronic obstructive pulmonary disease (AECOPD), acute exacerbation of asthma (AE-asthma), and acute exacerbation of bronchiectasis (AEBX). A case-crossover design with a bidirectional control sampling approach was used for statistical analysis. A total of 57,144 patients were enrolled for analysis. PM2.5, PM10, NO₂, SO₂, and CO exposures were positively associated with outpatient visits for URTI, AB, CAP, and AEBX. PM10, SO₂, and CO exposures were positively associated with outpatient visits for AECOPD. Exposure to O₃ was positively associated with outpatient visits for AE-asthma, but negatively associated with outpatient visits for URTI, CAP, and AEBX. In conclusion, air pollutants had acute effects on outpatient visits for acute respiratory outcomes, with specific outcomes associated with specific pollutants.
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Affiliation(s)
- Ran Li
- Department of Respiratory and Critical Care Medicine, Peking University People's Hospital, Beijing 100044, China.
| | - Ning Jiang
- Department of Respiratory and Critical Care Medicine, Peking University People's Hospital, Beijing 100044, China.
| | - Qichen Liu
- School of Public Health, Peking University, Beijing 100871, China.
| | - Jing Huang
- School of Public Health, Peking University, Beijing 100871, China.
| | - Xinbiao Guo
- School of Public Health, Peking University, Beijing 100871, China.
| | - Fan Liu
- Department of Respiratory and Critical Care Medicine, Peking University People's Hospital, Beijing 100044, China.
| | - Zhancheng Gao
- Department of Respiratory and Critical Care Medicine, Peking University People's Hospital, Beijing 100044, China.
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