The Impact of Air Pollution, Including Asian Sand Dust, on Respiratory Symptoms and Health-related Quality of Life in Outpatients With Chronic Respiratory Disease in Korea: A Panel Study

Association Between Asian Dust Exposure and Pneumonia Hospitalization in Western Japan: A Case-Crossover Study

Epidemiological studies have reported that Asian dust (AD), a type of desert dust, has harmful effects on human health. This study aimed to examine the association between AD exposure and hospitalization due to pneumonia. Data on patients in Western Japan admitted for pneumonia were included from a real-world database derived from electronic medical records. We used the meteorological observatory data of the most populous city in each prefecture, in which AD event was defined as a loss of visibility from a distance ≤10 km. A case-crossover design and conditional logistic regression model were used. Overall, 12 938 patients were included, and AD exposure events were observed for 557 days. Exposure to an AD event five days prior to hospitalization was significantly associated with hospitalization for pneumonia after adjusting for weather variables (odds ratio = 1.17; 95% confidence interval = [1.01, 1.36]). These findings suggest that AD exposure is associated with an increased rate of admission for pneumonia in Western Japan.

Fine particulate matter aggravates smoking induced lung injury via NLRP3/caspase-1 pathway in COPD

BACKGROUND

Exposure to noxious particles, including cigarette smoke and fine particulate matter (PM2.5), is a risk factor for chronic obstructive pulmonary disease (COPD) and promotes inflammation and cell death in the lungs. We investigated the combined effects of cigarette smoking and PM2.5 exposure in patients with COPD, mice, and human bronchial epithelial cells.

METHODS

The relationship between PM2.5 exposure and clinical parameters was investigated in patients with COPD based on smoking status. Alveolar destruction, inflammatory cell infiltration, and pro-inflammatory cytokines were monitored in the smoking-exposed emphysema mouse model. To investigate the mechanisms, cell viability and death and pyroptosis-related changes in BEAS-2B cells were assessed following the exposure to cigarette smoke extract (CSE) and PM2.5.

RESULTS

High levels of ambient PM2.5 were more strongly associated with high Saint George's respiratory questionnaire specific for COPD (SGRQ-C) scores in currently smoking patients with COPD. Combined exposure to cigarette smoke and PM2.5 increased mean linear intercept and TUNEL-positive cells in lung tissue, which was associated with increased inflammatory cell infiltration and inflammatory cytokine release in mice. Exposure to a combination of CSE and PM2.5 reduced cell viability and upregulated NLRP3, caspase-1, IL-1β, and IL-18 transcription in BEAS-2B cells. NLRP3 silencing with siRNA reduced pyroptosis and restored cell viability.

CONCLUSIONS

PM2.5 aggravates smoking-induced airway inflammation and cell death via pyroptosis. Clinically, PM2.5 deteriorates quality of life and may worsen prognosis in currently smoking patients with COPD.

The effects of Pycnogenol, a pine bark extract on pulmonary inflammation by Asian sand dust in mice

Asian sand dust (ASD), also called China dust or yellow dust, mainly occurs in East Asia during spring and autumn. Because ASD enters the body mainly through the respiratory system, it can cause respiratory disorders or worsen underlying diseases. Because of this, it has become an important health concern that threatens the well-being of humans and animals. In this study, we investigated the effects of 15 and 30 mg/kg of Pycnogenol (PYC15 and 30 groups), a pine bark extract, on ASD-induced pulmonary inflammation in mice. We evaluated the inflammatory cell counts, inflammatory cytokines, and matrix-metalloproteinase (MMP)-9 expression in animal models. PYC administration significantly decreased inflammatory cell infiltration into lung tissue; this was accompanied by a reduction in the levels of proinflammatory mediators including interleukin (IL)-1β (P < 0.01), IL-6 (P < 0.01) and tumour necrosis factor-α (P < 0.01) in bronchoalveolar lavage fluids of ASD-exposed mice (ASD group). Histological analysis revealed that PYC suppressed ASD-induced pulmonary inflammation. Moreover, PYC suppressed the levels of matrix-metalloproteinase (MMP)-9 in the lung tissue of ASD-exposed mice, indicating that PYC reduced ASD-induced pulmonary inflammation by suppressing MMP-9. Together, these results indicate that PYC as the potential to treat ASD-driven pulmonary inflammation.

Ambient air pollution and the health-related quality of life of older adults: Evidence from Shandong China

Ambient air pollution is a major public health concern impacting all aspects of human health. There is a lack of studies on the impact of ambient air pollution on health-related quality of life (HRQoL) of older Chinese adults. Our study answers two questions: How concentrations of ambient air pollutants are associated with HRQoL among older adults in China and, second, what are the possible mechanisms through which ambient air pollution affects HRQoL. From the 2018 National Health Service Survey, we sampled 5717 aged 65 years or older residents for the eastern province of Shandong, China. Data on individual exposures to PM_2.5 and PM₁₀ (particulate matter with diameter less than or equal to 2.5 μm and 10 μm) and sulfur dioxide (SO₂) were collected from the ChinaHighAirPollutants (CHAP) datasets. Mixed-effects Tobit regression models and mixed-effects ordered Probit regression models were employed to examine the associations of long-term exposure to ambient air pollution with the European Quality of Life 5 Dimensions 3 Level Version (EQ-5D-3L) scale comprising mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. Socioeconomic, demographic and behavioral factors relating to HRQoL were also examined. The results show that for each 1 μg/m³ increase, EQ-5D-3L scores fell 0.002 for PM_2.5; 0.001 for PM₁₀ and 0.002 for SO₂. Long term exposure to PM_2.5, PM₁₀ and SO₂ were also associated with increased prevalence of pain/discomfort and anxiety/depression. The reduced HRQoL effects of ambient air pollution were exacerbated by higher socioeconomic status (affluent, urban and higher level of education). Our findings suggested that HRQoL of older Chinese adults was not only associated with demographic, socioeconomic, and health-related factors, but also negatively correlated with air pollution, especially through increased pain/discomfort and anxiety/depression. The paper proposes policy recommendations.

Ambient PM Concentrations as a Precursor of Emergency Visits for Respiratory Complaints: Roles of Deep Learning and Multi-Point Real-Time Monitoring

Despite ample evidence that high levels of particulate matter (PM) are associated with increased emergency visits related to respiratory diseases, little has been understood about how prediction processes could be improved by incorporating real-time data from multipoint monitoring stations. While previous studies use traditional statistical models, this study explored the feasibility of deep learning algorithms to improve the accuracy of predicting daily emergency hospital visits by tracking their spatiotemporal association with PM concentrations. We compared the predictive accuracy of the models based on PM datasets collected between 1 December 2019 and 31 December 2021 from a single but more accurate air monitoring station in each district (Air Korea) and multiple but less accurate monitoring sites (Korea Testing & Research Institute; KTR) within Guro District in Seoul, South Korea. We used MLP (multilayer perceptron) to integrate PM data from multiple locations and then LSTM (long short-term memory) models to incorporate the intrinsic temporal PM trends into the learning process. The results reveal evidence that predictive accuracy is improved from 1.67 to 0.79 in RMSE when spatial variations of air pollutants from multi-point stations are incorporated in the algorithm as a 9-day time window. The findings suggest guidelines on how environmental and health policymakers can arrange limited resources for emergency care and design ambient air monitoring and prevention strategies.

Roles of the physical environment in health-related quality of life in patients with chronic obstructive pulmonary disease

RATIONALE

Many clinical and psychological factors are known to influence the health-related quality of life (HRQL) in chronic obstructive pulmonary disease (COPD). However, research on whether environmental factors, such as air pollution, noise, temperature, and blue/green spaces also influence HRQL in COPD has not been systematically investigated.

OBJECTIVE

To assess the relationship between air pollution, road traffic noise, temperature, and distance to blue/green spaces and respiratory-specific HRQL in COPD.

METHODS

We used cross-sectional data from a multicenter study in 407 stable mild-to-very severe COPD patients from Barcelona (Catalonia). Patients answered the COPD Assessment Test (CAT) and Clinical COPD Questionnaire (CCQ). Individual residential exposure to air pollutants (nitrogen dioxide [NO₂] and particulate matters of varying aerodynamic diameters [PM_2.5, PM₁₀, and PM_{2.5absorbance}]), road traffic noise (L_den), and land surface temperature were estimated using long-term averages from land-use regression models, 24-h noise maps, and land surface temperature maps, respectively. We measured residential distances to blue/green spaces from the Urban Atlas. We used mixed-effect negative binomial (for CAT) and linear (for CCQ) regression models, adjusted for potential confounders, with a random effect by center.

RESULTS

Of those patients, 85 % were male and had a mean (SD) age of 69 (9) years, CAT score of 12 (7), CCQ-total score of 1.4 (1.0), and post-bronchodilator forced expiratory volume in 1 s (FEV₁) of 57 (18) %predicted. We found that NO₂ and PM_{2.5absorbance} were associated with worsened CAT and CCQ-mental scores, e.g., 0.15-unit change in CAT score [regression coefficient (β) = 0.15; 95 % confidence interval (CI) = 0.03, 0.26] per interquartile range in NO₂ [13.7 μg/m³]. Greater distances to blue/green spaces were associated with worsened CCQ-mental scores [0.08; 0.002, 0.15].

CONCLUSIONS

Our study showed that increased air pollution, particularly NO₂ and PM_{2.5absorbance} and greater distances to blue/green spaces negatively influence HRQL in COPD patients. These findings have important implications for the WHO promotion to develop healthy cities for our future.

Effects of exposure to ambient air pollution on pulmonary function impairment in South Korea: Korea National Health and Nutritional Examination Survey

OBJECTIVES

This study aimed to investigate the association between pulmonary function and air pollution using 2007–2017 data from the Korea National Health and Nutrition Examination Survey, a nationwide cross-sectional representative survey.

METHODS

A total of 27,378 participants that had sampling weights from a complex sample survey were included in this study. Using the data for forced expiratory volume in 1 second and forced vital capacity, the participants with pulmonary function impairment were classified according to the criteria of restrictive lung disease and chronic obstructive pulmonary disease (COPD). Exposure to ambient air pollution was estimated using the Community Multiscale Air Quality model. Multivariate linear and logistic regression analyses with complex samples were used to determine the associations between pulmonary function and air pollution after adjusting for covariates.

RESULTS

In total, 13.2% of the participants aged >40 years had COPD, and 10.7% were classified as being in the restrictive lung disease group. According to the multivariate logistic regression model, the odds ratios for the fourth quartiles of particulate matter less than 10 μm in diameter (PM₁₀), particulate matter less than 2.5 μm in diameter (PM_2.5) and carbon monoxide (CO) with a 2-year lag period were 1.203 (95% confidence interval [CI], 1.036 to 1.396), 1.283 (95% CI, 1.101 to1.495), and 1.292 (95% CI, 1.110 to 1.504), respectively, using the restrictive lung disease group as an event after adjusting for covariates in the complex sample.

CONCLUSIONS

Long-term exposure to PM₁₀, PM_2.5, and CO was significantly associated with pulmonary function, especially restrictive lung disease.

Temporal-spatial variation and environmental risk assessment of pharmaceuticals in tributaries of the Han River watershed, South Korea

Eight compounds from three categories of pharmaceuticals [5 antibiotics, 2 non-steroidal anti-inflammatory drugs, and 1 anti-epileptics] were monitored at 24 sites in the tributaries of the Han River watershed in South Korea, 2016. The seasonal occurrence, temporal-spatial variation, potential compound source(s), and a risk assessment of this watershed, which is the largest drinking water source in the country, were investigated. Clarithromycin was detected most frequently (72.2%) with the greatest median concentration (0.151 ± 0.072 μg L^-1), followed by carbamazepine and sulfamethoxazole. The seasonality of the pharmaceuticals was observed, with higher concentrations and detection frequencies in spring than in summer and autumn; this was possibly caused by lower levels of microbial activities associated with lower water temperatures than other seasons. In terms of geographical variation, urban areas had higher pharmaceutical concentrations than rural areas, which was attributed to the former's high population density and largest wastewater treatment plants (WWTPs) regardless of season. The total concentration and detection frequency of WWTPs were 12.4 and 2.5 times higher in downstream sites than upstream sites, thereby conveying that WWTPs were the main source for the presence of pharmaceuticals in tributaries. According to the results produced from calculations of the risk quotient (RQ) of aquatic organisms, clarithromycin and sulfamethazine were identified as posing relatively high ecological risk (RQ > 1) during the spring that was identified for this study. This study can provide policymakers with scientific support for prioritizing pollutant management and collections of global data on emerging pollutants.

Impact of the COVID-19 Outbreak on Air Quality in Korea

The COVID-19 pandemic has led countries to take action, which has included practicing social distancing or lockdown. Many cities are experiencing air quality improvements due to human activity restrictions. The purpose of this study was to compare the air quality between 2020 and the previous three years, focusing on the two cities (Seoul and Daegu) where coronavirus is spreading the fastest in Korea. Significant decreases in PM2.5, PM10, CO, and NO2 were observed in both cities. In particular, compared to the same period of 2017-2019, in March 2020, PM2.5 showed remarkable reductions of 36% and 30% in Seoul and Daegu, respectively. The effects of social distancing have maximized improvements in air quality due to reduced transboundary pollutants. The PM2.5/PM10 ratio was significantly reduced after social distancing, indicating that the contribution of traffic-related PM2.5 declined. Air quality improved overall from January to July, and the most noticeable drop in the air quality index (AQI) was observed in April. These findings indicate that relatively weak social distancing measures compared to a COVID-19 lockdown can help reduce air pollutant levels. At the same time, however, changes in air quality in the neighboring countries caused by COVID-19 control action are affecting Korea.

Perspectives on chronic cough in Korea

Chronic cough is a common condition, and generally affects about 3% of Korean adults with a significant influence on quality of life (QoL). Despite continued clinical and academic efforts, there are unmet needs for chronic cough prevention and management in Korea. Epidemiologically, there are two major challenges: an aging population and air pollution. Korea is one of the most rapidly aging countries, and the relative proportion of elderly to younger people is expected to double within the next two decades. Air pollution is a major concern, but there is very limited evidence on the effects of air pollutant on cough in Korean patients. Clinically, upper and lower airway diseases, such as rhinitis/rhinosinusitis and cough variant asthma/eosinophilic bronchitis, are reported to account for about 75% of chronic cough in Korean adults, which formed the basis in formulating clinical practice guidelines. However, further studies are warranted to resolve clinical uncertainty, particularly for the evaluation and treatment of upper airway conditions in chronic cough. The prevalence of gastroesophageal reflux disease (GERD) is increasing, thus its relevance to cough among Koreans may warrant re-evaluation. Infection-associated chronic cough, such as tuberculosis, is another continuing concern. The proportion of chronic refractory or unexplained cough is assumed to be 10–20% among patients visiting referral clinics for chronic cough. This review presents our perspectives on current epidemiological and clinical issues of chronic cough in Korea, and addresses major knowledge gaps and future research priorities.

Distribution of Viable Bacteria in the Dust-Generating Natural Source Area of the Gobi Region, Mongolia

The Gobi Desert is a major source of dust events, whose frequency of occurrence and damage caused have recently significantly increased. In the present study, we investigated the types of live bacteria present in the surface soil of the Gobi Desert in Mongolia, and determined their genetic identification as well as their geographical distribution. During the survey, four different topographies (dry lake bed, wadi, well, and desert steppe) were selected, and land characteristics were monitored for moisture and temperature. The surface soil was aerobically cultured to isolate bacterial colonies, and their 16s rDNA regions were sequenced. The sequence data were identified through NCBI-BLAST analysis and generated phylogenetic trees. The results revealed two phyla and seven families of isolates from the sample points. Each isolate was characterized by their corresponding sample site. The characteristics of land use and soil surface bacteria were compared. Most of the bacteria originated from the soil, however, animal-derived bacteria were also confirmed in areas used by animals. Our findings confirmed the existence of live bacteria in the dust-generating area, suggesting that their presence could affect animal and human health. Therefore, it is necessary to further investigate dust microbes based on the One Health concept.

Associations Between Dust Storms and Intensive Care Unit Admissions in the United States, 2000-2015

Anthropogenic climate change is influencing the incidence of dust storms and associated human exposure to coarse particulate matter (PM2.5-10) in the United States. Studies have found adverse health consequences related to dust exposure. These consequences include respiratory disease exacerbations and premature mortality, resulting in increased health care utilization. However, the impact of dust storms on critical care demand has not been studied in the United States. We seek to quantify the relationship between dust storms and surges in critical care demand by investigating the association between dust storms and intensive care unit (ICU) admissions at nearby hospitals from 2000 to 2015. ICU data were acquired from Premier, Inc. and encompass 15-20% of all ICU admissions in the United States. Dust storm, meteorology, and air pollutant data were downloaded from the U.S. National Weather Service, the U.S. National Climatic Data Center, and the U.S. Environmental Protection Agency websites, respectively. Associations between ICU admission and dust storms, controlling for temperature, dew point temperature, ambient PM2.5 and ozone, as well as seasonally varying confounders, were estimated using a distributed lag conditional Poisson model with overdispersion. We found a 4.8% (95% CI: 0.4, 9.4; p = 0.033) increase in total ICU admissions on the day of the dust storm (Lag 0) and a 9.2% (95% CI: 1.8, 17.0; p = 0.013) and 7.5% (95% CI: 0.3, 15.2; p = 0.040) increase in respiratory admissions at Lags 0 and 5. North American dust storms are associated with increases in same day and lagged demand for critical care services at nearby hospitals.

Associations between perceived environmental pollution and health-related quality of life in a Chinese adult population

BACKGROUND

Health-related quality of life (HRQoL) measures are being used in increasingly diverse populations. However, there have no known studies to date to examine the associations between perceived environmental pollution and HRQoL in a Chinese population. This study aimed to report the associations between air, water, noise pollution and HRQoL among Chinese adult population.

METHODS

A cross-sectional survey data was used from East Asian Social Survey 2010 with a sample of 3866 Chinese populations regarding environmental pollution. HRQoL was computed by SF-12 and reflected by physical and mental component summary score (PCS & MCS). Ordinary least regression analyses were used to examine associations between perceived environmental pollution and PCS and MCS scores. Models in SPSS PROCESS were selected to demonstrate the moderating and mediating effects.

RESULTS

Only considering one pollutant, perceived air pollution and perceived water pollution had significant associations with PCS and MCS scores. Perceived noise pollution had significant associations with PCS scores. Perceived air×noise, air×water, noise×water, and air×noise×water pollution had significant associations with PCS and MCS scores. Conditional (moderated) mediation showed that there were no moderating effects and mediating effects of perceived one pollutant on another pollutant.

CONCLUSIONS

Co-occurring perceived environmental pollution were mainly associated with progressive increase in PCS and MCS scores among the Chinese adult population. These results suggested that some effective policies should be carried out to improve environmental quality in Chinese adult population.

Association of air pollution with outpatient visits for respiratory diseases of children in an ex-heavily polluted Northwestern city, China

BACKGROUND

A great number of studies have confirmed that children are a particularly vulnerable population to air pollution.

METHODS

In the present study, 332,337 outpatient visits of 15 hospitals for respiratory diseases among children (0-13 years), as well as the simultaneous meteorological and air pollution data, were obtained from 2014 to 2016 in Lanzhou, China. The generalized additive model was used to examine the effects of air pollutants on children's respiratory outpatient visits, including the stratified analysis of age, gender and season.

RESULTS

We found that PM_2.5, NO₂ and SO₂ were significantly associated with the increased total respiratory outpatient visits. The increments of total respiratory outpatient visits were the highest in lag 05 for NO₂ and SO₂, a 10 μg/m³ increase in NO₂ and SO₂ was associated with a 2.50% (95% CI: 1.54, 3.48%) and 3.50% (95% CI: 1.51, 5.53%) increase in total respiratory outpatient visits, respectively. Those associations remained stable in two-pollutant models. Through stratification analysis, all air pollutants other than PM₁₀ were significantly positive associated with the outpatients of bronchitis and upper respiratory tract infection. Besides, both NO₂ and SO₂ were positively related to the pneumonia outpatient visits. PM_2.5 and SO₂ were significantly related to the outpatient visits of other respiratory diseases, while only NO₂ was positively associated with the asthma outpatients. We found these associations were stronger in girls than in boys, particularly in younger (0-3 years) children. Interestingly, season stratification analysis indicated that these associations were stronger in the cold season than in the transition or the hot season for PM₁₀, PM_2.5 and SO₂.

CONCLUSIONS

Our results indicate that the air pollution exposure may account for the increased risk of outpatient visits for respiratory diseases among children in Lanzhou, particularly for younger children and in the cold season.

Health Effects of Asian Dust: A Systematic Review and Meta-Analysis

BACKGROUND

Potential adverse health effects of Asian dust exposure have been reported, but systematic reviews and quantitative syntheses are lacking.

OBJECTIVE

We reviewed epidemiologic studies that assessed the risk of mortality, hospital admissions, and symptoms/dysfunction associated with exposure to Asian dust.

METHODS

We performed a systematic search of PubMed and Web of Science to identify studies that reported the association between Asian dust exposure and human health outcomes. We conducted separate meta-analyses using a random-effects model for mortality and hospital admissions for a specific health outcome and assessed pooled estimates for each lag when at least three studies were available for a specific lag.

RESULTS

We identified 89 studies that met our inclusion criteria for the systematic review, and 21 studies were included in the meta-analysis. The pooled estimates (percentage changes) of mortality from circulatory and respiratory causes for Asian dust days vs. non-Asian dust days were 2.33% [95% confidence interval (CI): 0.76, 3.93] increase at lag 0 and 3.99% (95% CI: 0.08, 8.06) increase at lag 3, respectively. The increased risk for hospital admissions for respiratory disease, asthma, and pneumonia peaked at lag 3 by 8.85% (95% CI: 0.80, 17.55), 14.55% (95% CI: 6.74, 22.94), and 8.51% (95% CI: 2.89, 14.44), respectively. Seven of 12 studies reported reduced peak expiratory flow, and 16 of 21 studies reported increased respiratory symptoms associated with Asian dust exposure. There were substantial variations between the studies in definitions of Asian dust, study designs, model specifications, and confounder controls.

DISCUSSION

We found evidence of increased mortality and hospital admissions for circulatory and respiratory events. However, the number of studies included in the meta-analysis was not large and further evidences are merited to strengthen our conclusions. Standardized protocols for epidemiological studies would facilitate interstudy comparisons. https://doi.org/10.1289/EHP5312.

Asian Sand Dust Particles Increased Pneumococcal Biofilm Formation in vitro and Colonization in Human Middle Ear Epithelial Cells and Rat Middle Ear Mucosa

INTRODUCTION

Air pollutants such as Asian sand dust (ASD) and Streptococcus pneumoniae are risk factors for otitis media (OM). In this study, we evaluate the role of ASD in pneumococcal in vitro biofilm growth and colonization on human middle ear epithelium cells (HMEECs) and rat middle ear using the rat OM model.

METHODS

S. pneumoniae D39 in vitro biofilm growth in the presence of ASD (50-300 μg/ml) was evaluated in metal ion-free BHI medium using CV-microplate assay, colony-forming unit (cfu) counts, resazurin staining, scanning electron microscopy (SEM), and confocal microscopy (CF). Biofilm gene expression analysis was performed using real-time RT-PCR. The effects of ASD or S. pneumoniae individually or on co-treatment on HMEECs were evaluated by detecting HMEEC viability, apoptosis, and reactive oxygen species (ROS) production. In vivo colonization of S. pneumoniae in the presence of ASD was evaluated using the rat OM model, and RNA-Seq was used to evaluate the alterations in gene expression in rat middle ear mucosa.

RESULTS

S. pneumoniae biofilm growth was significantly (P < 0.05) elevated in the presence of ASD. SEM and CF analysis revealed thick and organized pneumococcal biofilms in the presence of ASD (300 μg/ml). However, in the absence of ASD, bacteria were unable to form organized biofilms, the cell size was smaller than normal, and long chain-like structures were formed. Biofilms grown in the presence of ASD showed elevated expression levels of genes involved in biofilm formation (luxS), competence (comA, comB, ciaR), and toxin production (lytA and ply). Prior exposure of HMEECs to ASD, followed by treatment for pneumococci, significantly (P < 0.05) decreased cell viability and increased apoptosis, and ROS production. In vivo experiment results showed significantly (P < 0.05) more than 65% increased bacteria colonization in rat middle ear mucosa in the presence of ASD. The apoptosis, cell death, DNA repair, inflammation and immune response were differentially regulated in three treatments; however, number of genes expressed in co-treatments was higher than single treatment. In co-treatment, antimicrobial protein/peptide-related genes (S100A family, Np4, DEFB family, and RATNP-3B) and OM-related genes (CYLD, SMAD, FBXO11, and CD14) were down regulated, and inflammatory cytokines and interleukins, such as IL1β, and TNF-related gene expression were elevated.

CONCLUSION

ASD presence increased the generation of pneumococcal biofilms and colonization.

Effects of temperature, humidity, and diurnal temperature range on influenza incidence in a temperate region

Background

The effect of temperature and humidity on the incidence of influenza may differ by climate region. In addition, the effect of diurnal temperature range on influenza incidence is unclear, according to previous study findings.

Objectives

The aim of this study was to analyze the effects of temperature, humidity, and diurnal temperature range on the incidence of influenza in Seoul, Republic of Korea, which is located in a temperate region.

Methods

We used Korean National Health insurance data to assess the weekly influenza incidence between 2010 and 2016, and used meteorological data from Seoul. To investigate the effect of temperature, relative humidity, and diurnal temperature range levels on influenza incidence, we used a distributed lag non‐linear model.

Results

The risk of influenza incidence was significantly increased with low daily temperatures of 0‐5°C and low (30%–40%) or high (70%) relative humidity. We found a positive significant association between diurnal temperature range and influenza incidence in this study.

Conclusions

Influenza incidence increased with low temperature and low/high humidity in a temperate region. Influenza incidence also increased with high diurnal temperature range, after considering temperature and humidity.

Acceptance of Illness Associates with Better Quality of Life in Patients with Nonmalignant Pulmonary Diseases

Chronic nonmalignant pulmonary diseases impose a heavy burden on patients, generate health-care costs, and contribute to poor health-related quality of life. It has been found that a wide range of factors negatively affects quality of life, but the role of acceptance of illness needs to be further investigated. The aim of the study was to evaluate the relationship between acceptance of illness and quality of life in patients with chronic nonmalignant pulmonary diseases. The study encompassed 200 patients of the mean age 58 ± 16 years who were mainly diagnosed with asthma (n = 72; 36%), COPD (n = 52; 26%), and obstructive sleep apnea (n = 38; 19%). The patients answered the Acceptance of Illness Scale (AIS) and the St. George's Respiratory Questionnaire (SGRQ). Sociodemographical and clinical data were collected. The level of acceptance of illness significantly associated with each of the SGRQ domains. The greater the acceptance of illness, the lowest was the SGRQ score. The mean total score of SGRQ was 44.6 ± 24.9 and that of AIS was 26.1 ± 8.2. Higher AIS scores significantly associated with lower SGRQ scores, i.e., with better quality of life (p < 0.001 for each domain). We conclude that in patients with chronic nonmalignant pulmonary diseases, acceptance of illness plays an important role and is closely related to the general level of quality of life. Interventions aimed at improving acceptance of illness may be considered to improve quality of life.

Progression of physical inactivity in COPD patients: the effect of time and climate conditions - a multicenter prospective cohort study

Purpose

Longitudinal data on the effect of time and environmental conditions on physical activity (PA) among COPD patients are currently scarce, but this is an important factor in the design of trials to test interventions that might impact on it. Thus, we aimed to assess the effect of time and climate conditions (temperature, day length and rainfall) on progression of PA in a cohort of COPD patients.

Patients and methods

This is a prospective, multicenter, cohort study undertaken as part of the EU/IMI PROactive project, in which we assessed 236 COPD patients simultaneously wearing two activity monitors (Dynaport MiniMod and Actigraph GT3X). A multivariable generalized linear model analysis was conducted to describe the effect of the explanatory variables on PA measures, over three time points (baseline, 6 and 12 months).

Results

At 12 months (n=157; FEV₁% predicted=57.7±21.9) there was a significant reduction in all PA measures (Actigraph step count (4284±3533 vs 3533±293)), Actigraph moderate- to vigorous-intensity PA ratio (8.8 (18.8) vs 6.1 (15.7)), Actigraph vector magnitude units (374,902.4 (265,269) vs 336,240 (214,432)), MiniMod walking time (59.1 (34.9) vs 56.9 (38.7) mins) and MiniMod PA intensity (0.183 (0) vs 0.181 (0)). Time had a significant, negative effect on most PA measures in multivariable analysis, after correcting for climate factors, study center, age, FEV₁% predicted, 6MWD and other disease severity measures. Rainfall was the only climate factor with a negative effect on most PA parameters.

Conclusion

COPD patients demonstrate a significant decrease in PA over 1 year follow-up, which is further affected by hours of rainfall, but not by other climate considerations.

Association between ambient temperature and chronic obstructive pulmonary disease: a population-based study of the years of life lost

Limited evidence on the burden of chronic obstructive pulmonary disease (COPD) attributable to ambient temperature. We aim to explore the association between ambient temperature and years of life lost (YLL), and to get a more intuitive understanding of the dangers of COPD in China. Death and meteorological data of 31 Chinese provincial capital cities during 2008-2013 was analyzed in this study. Distributed Lag Non-linear Model (DLNM) was used to estimate the association between ambient temperature and mortality. The attributable fraction (AF) to cold effect ranged from 8.19 (95%CI: -8.52,19.38) to 28.98 (95%CI: -64.78,67.59), while the AF to heat effect varied from 0.02 (95%CI: -0.13,0.05) to 5.73 (95%CI: 0.31,10.22). Cold effect was higher than heat effect on COPD in women and elderly, heat effect was higher in men and younger. Low temperature can cause more serious disease burden of COPD than high temperature.

Influence of Particulate Matter during Seasonal Smog on Quality of Life and Lung Function in Patients with Chronic Obstructive Pulmonary Disease

The impact of outdoor air pollution on the quality of life (QoL) of chronic obstructive pulmonary disease (COPD) patients, as measured by the COPD assessment test (CAT) questionnaire, is limited. The aim of this study was to determine the impact of a short-term increase in outdoor particulate matter in which the particles are less than 10 microns in diameter (PM₁₀) during a seasonal smog period on QoL, symptoms, and lung function in COPD patients. This prospective observational study was conducted at Chiang Dao Hospital, Chiang Mai, Thailand between March and August 2016. Measurement of QoL, severity of dyspnea, forced vital capacity (FVC), and forced expiratory volume in the first second (FEV₁) were performed at both high and low PM₁₀ periods. Fifty-nine patients met the inclusion criteria for enrollment into the study, with the mean age being 71.5 ± 8.0 years. Total CAT score, but not mMRC score, was statistically higher during the high PM₁₀ period. The two lung function parameters, FVC and FEV₁, were significantly lower at the high PM₁₀ compared to the low PM₁₀ period. We concluded that exposure to PM₁₀ during the seasonal smog period resulted in short-term negative impact on the quality of life and lung function in COPD patients.