Article

Outdoor air pollution and uncontrolled asthma in the San Joaquin Valley, California

February 2010
Journal of Epidemiology and Community Health 64(2):142-7

DOI:10.1136/jech.2009.083576

Source
PubMed

Authors:

Rudolph P Rull

Naval Health Research Center

Christina A Lombardi

University of California, Los Angeles

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The San Joaquin Valley (SJV) in California ranks among the worst in the USA in terms of air quality, and its residents report some of the highest rates of asthma symptoms and asthma-related emergency department (ED) visits and hospitalisations in California. Using California Health Interview Survey data, the authors examined associations between air pollution and asthma morbidity in this region. Eligible subjects were SJV residents (2001 California Health Interview Survey) who reported physician-diagnosed asthma (n=1502, 14.6%). The authors considered two outcomes indicative of uncontrolled asthma: (1) daily or weekly asthma symptoms and (2) asthma-related ED visits or hospitalisation in the past year. Based on residential zip code, subjects were assigned annual average concentrations of ozone, PM(10) and PM(2.5) for the 1-year period prior to the interview date from their closest government air monitoring station within an 8 km (5 miles) radius. Adjusting for age, gender, race/ethnicity, poverty level and insurance status, the authors observed increased odds of experiencing daily or weekly asthma symptoms for ozone, PM(10) and PM(2.5) (OR(ozone) 1.23, 95% CI 0.94 to 1.60 per 10 ppb; OR(PM10) 1.29, 95% CI 1.05 to 1.57 per 10 microg/m(3); and OR(PM2.5) 1.82; 95% CI 1.11 to 2.98 per 10 microg/m(3)). The authors also observed increased odds of asthma-related ED visits or hospitalisations for ozone (OR 1.49, 95% CI 1.05 to 2.11 per 10 ppb) and a 29% increase in odds for PM(10) (OR 1.29, 95% CI 0.99 to 1.69 per 10 microg/m(3)). Overall, these findings suggest that individuals with asthma living in areas of the SJV with high ozone and particulate pollution levels are more likely to have frequent asthma symptoms and asthma-related ED visits and hospitalisations.

Influence of Particulate Matter on Asthma Control in Adult Asthma

Article

Full-text available

Feb 2023

No clear evidence shows the association between particulate matter (PM) with an aerodynamic diameter < 10 µm (PM10) and asthma control. Therefore, the objective of this study was to determine the association between PM10 and asthma control. A retrospective observational study was conducted at the Airway Clinic, Chiang Mai University Hospital, Chiang Mai, Thailand, between January 2010 and April 2013. Various values of asthma control test (ACT) scores between high and low PM10 periods were analyzed. The association of an increased monthly average PM10 level and ACT score was analyzed using a time series analysis. There were a total of 1180 visits from 236 asthmatic patients. The monthly average ACT score was significantly lower in the high PM10 period compared with the low PM10 period. Every 10 µg/m3 increment of monthly average PM10 resulted in a significantly decreased ACT score at lag zero and one month, with an adjusted coefficient of –0.101 (95% CI; –0.165, –0.037), p-value = 0.002 and –0.079 (95% CI; –0.147, –0.012), p-value = 0.021, respectively. Monthly average PM10 significantly affected asthma control in asthmatic patients. During the air pollution period, the serial assessments of ACT should be measured for early detection of worsening asthma control.

: Short-term effects of exposure to particulate matter on hospital admissions for asthma and chronic obstructive pulmonary disease

Article

Full-text available

Sep 2022
MEDICINE

We investigated the effects of particulate matter (PM) factors on hospitalization rates for asthma and chronic obstructive pulmonary disease (COPD). We obtained data on pollutants—PM10, PM2.5—in Seoul, South Korea. We also investigated data for asthma and COPD exacerbation that required hospitalization from 2006 to 2016. We used a time-stratified case-crossover design and generalized additive models with log transformation to assess adjusted risk, and conditional logistic regression was performed to analyze these data. Our study showed that PM10 and PM2.5, on different best lag days, were associated with increased risks of COPD or asthma hospitalization. The odds ratios (ORs) for each per-unit increase in PM10 and PM2.5 were higher in patients with male asthma (PM10: OR, 1.012; 95% confidence interval [CI], 1.008–1.016 and PM2.5: OR, 1.015; 95% CI, 1008–1.023), preschool asthma (PM10: OR, 1.015; 95% CI, 1.006–1.015 and PM2.5: OR, 1.015; 95% CI, 1.009–1.024), male COPD (PM10: OR, 1.012; 95% CI, 1.005–1.019 and PM2.5: OR, 1.013; 95% CI, 1.000–1.026), and senior COPD (PM10: OR, 1.016; 95% CI, 1.008–1.024 and PM2.5: OR, 1.022; 95% CI, 1.007–1.036). Increasing PM levels increased hospitalizations for asthma and COPD. Additionally, the consequences may be different according to age and sex, and PM2.5 may have a more significant effect on airway disease patients than PM10.

The Joint Effect of Ambient Air Pollution and Agricultural Pesticide Exposures on Lung Function among Children with Asthma

Article

Jul 2020

Background Ambient environmental pollutants have been shown to adversely affect respiratory health in susceptible populations. However, the role of simultaneous exposure to multiple diverse environmental pollutants is poorly understood. Objective We applied a multidomain, multipollutant approach to assess the association between pediatric lung function measures and selected ambient air pollutants and pesticides. Methods Using data from the US EPA and California Pesticide Use Registry, we reconstructed three months prior exposure to ambient air pollutants ((ozone (O3), nitrogen dioxide (NO2), particulate matter with a median aerodynamic diameter < 2.5μm (PM2.5) and < 10μm (PM10)) and pesticides (organophosphates (OP), carbamates (C) and methyl bromide (MeBr)) for 153 children with mild intermittent or mild persistent asthma from the San Joaquin Valley of California, USA. We implemented Bayesian kernel machine regression (BKMR) to estimate the association between simultaneous exposures to air pollutants and pesticides and lung function measures (forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), and forced expiratory flow between 25% and 75% of vital capacity (FEF25–75)). Results In BKMR analysis, the overall effect of mixtures (pollutants and pesticides) was associated with reduced FEV1 and FVC, particularly when all the environmental exposures were above their 60th percentile. For example, the effect of the overall mixture at the 70th percentile (compared to the median) was a -0.12SD (-50mL, 95% CI: -180mL, 90mL) change in the FEV1 and a -0.18SD (-90mL, 95% CI: -240mL, 60mL) change in the FVC. However, 95% credible intervals around all of the joint effect estimates contained the null value. Conclusion At this agricultural-urban interface, we observed results from multipollutant analyses, suggestive of adverse effects on some pediatric lung function measures following a cumulative increase in ambient air pollutants and agricultural pesticides. Given the uncertainty in effect estimates, this approach should be explored in larger studies.

Satellite NO2 trends reveal pervasive impacts of wildfire and soil emissions across California landscapes

Article

Full-text available

Aug 2023
ENVIRON RES LETT

Nitrogen dioxide (NO2) plays a pivotal role in the production of secondary pollutants, most importantly ozone (O3) and particulate matter (PM). Regulatory controls have greatly reduced NO2 in cities, where most of the surface monitoring occurs, but the change in rural environments is less certain. Here, we present summertime (June–September) spatio-temporal patterns of NO2 concentrations using satellite and ground observations across California from 2009–2020, quantifying the differences in NO2 trends for 5 distinct land cover classes: urban, forests, croplands, scrublands (shrublands, savannas, and grasslands), and barren (minimally vegetated) lands. Over urban environments, NO2 columns exhibited continued but weakening downward trends (–3.7 ± 0.3%a–1), which agree fairly well with contemporaneous trends estimated from the surface air quality network (–4.5 ± 0.5%a–1). In rural (i.e., non-urban) parts of the state, however, secular trends are insignificant (0.0 to 0.4 ± 0.4%a–1) or in the case of remote forests are rapidly on the rise (+4.2 ± 1.2%a–1). Sorting the NO2 columns by air temperature and soil moisture reveals relationships that are commensurate with extant parameterizations but do indicate a stronger temperature dependence. We further find that rapidly rising temperatures and, to a lesser extent, decreasing precipitation in response to climate change are acting to increase soil NOx emissions, explaining about one-third of the observed NO2 rise in non-urban regions across California. Finally, we show that these trends, or their absence, can be attributed predominantly to the dramatic rise in wildfire frequency, especially since the turn of the 21st century.

Air pollution and pediatric respiratory hospital admissions in Bursa, Turkey: A time series study

Article

Full-text available

Oct 2021
INT J ENVIRON HEAL R

We aimed to investigate the relation between air pollution and the number of daily hospitalizations due to pneumonia, asthma, bronchitis in children aged 0-18 in Bursa city of Turkey, between the years 2013-2018. The daily values of air pollutants (PM10, SO2, NO2, NOx, CO, and O3) from 2013 until 2018, were obtained. Adjusted Quasi-Poisson regression models including distributed lags, controlled for climate variables were used for data analysis. Increases in SO2, ozone, PMs, and nitrogen oxides were associated with pneumonia hospitalizations, increases in SO2 NOx and PMs were associated with asthma hospitalizations, and increases in SO2 and ozone were associated with bronchitis hospitalizations. Male hospitalization was related with SO2, ozone, and NOx; while female hospitalization was only related with SO2. This study showed that short-term exposure to air pollution is associated with an increased risk of pneumonia, asthma, and bronchitis hospitalization among children in Bursa.

Effect of PM2.5 Levels on Respiratory Pediatric ED Visits in a Semi-Urban Greek Peninsula

Article

Full-text available

Jun 2021
Int J Environ Res Publ Health

Ambient air pollution accounts for an estimated 4.2 million deaths worldwide. Particulate matter (PM)2.5 particles are believed to be the most harmful, as when inhaled they can penetrate deep into the lungs. The aim of this study was to examine the relationship between PM2.5 daily air concentrations and pediatric emergency department (ED) visits for respiratory diseases in a Greek suburban area. All pediatric ED visits for asthma-, pneumonia- and upper respiratory infection (URI)-related complaints were recorded during the one-year period. The 24-h PM2.5 air pollution data were prospectively collected from twelve fully automated air quality monitoring stations. The mean annual concentration of PM2.5 was 30.03μg/m3 (World Health Organization (WHO) Air Quality Guidelines (AQG) Annual mean concentration: 10 μg/m3). PM2.5 levels rose above the WHO Air Quality Guidelines (AQG) 24-h concentrations (25 μg/m3)), 178 times (48.6% of the study period). When PM2.5 levels were above the daily limit, an increase of 32.44% (p < 0.001) was observed in daily pediatric ED visits for respiratory diseases and the increase was much higher during spring (21.19%, p = 0.018). A 32% (p < 0.001) increase was observed in URI-related visits, when PM2.5 levels were ≥ 25 μg/m3, compared to the mean daily visits when PM2.5 levels were < 25 μg/m3. Air pollution levels were associated with increased pediatric ED visits for respiratory-related diseases.

Association of air pollutants, airborne occupational exposures, and chronic rhinosinusitis disease severity

Article

Oct 2019

Background: Previous work has shown that chronic rhinosinusitis (CRS) severity may be associated with particulate maer 2.5 (PM2.5) and black carbon (BC) in CRS patients without nasal polyps (CRSsNP). Data regarding occupational exposures, however, are lacking. We assessed the impact of PM2.5, BC, as well as occupational airborne exposure on CRS disease severity. Methods: Patients with CRS with nasal polyps (CRSwNP), CRSsNP, and aspirin-exacerbated respiratory disease (AERD) were identified from an institution wide database. Spatial modeling from 37 pollutant monitoring sites in Allegheny County was used to estimate exposures. Patient occupations using the 2010 Standard Occupation Classification (SOC10) and airborne occupation exposures to vapors, gases, dusts, fumes, fibers and mists (VGDFFiM) or diesel fumes were recorded. Disease severity was measured by modified Lund-Mackay score (LMS), systemic corticosteroid therapy, and incidence of functional endoscopic sinus surgery (FESS). Results: Two hundred thirty-four patients were included (CRSwNP, n = 113; CRSsNP, n = 96; AERD, n = 25). The prevalence of AERD among those with CRSwNP was 18%. Patients exposed to VGDFFiM or diesel fumes required higher steroid doses vs nonexposed patients (p = 0.015 and p = 0.03, respectively); patients with VGDFFiM levels>5% were more likely to undergo FESS vs nonexposed patients (p = 0.0378). There was no difference in PM2.5 and BC with regard to disease severity and FESS between CRSwNP, CRSsNP, and AERD patients. Steroid use was significantly higher in CRSwNP and AERD vs CRSsNP (p = 0.001). LMS was significantly higher in AERD as compared with CRSwNP and CRSsNP (p = 0.001). Conclusion: Occupational airborne exposure to VGDFFiM correlated with increased prevalence of FESS and need for corticosteroids in CRS patients. There was no difference in PM2.5 and BC levels and disease severity outcome measures between CRS subtypes in this subset.

Relationship between air quality and asthma-related emergency hospital admissions in Mexico City 2017–2019

Article

Full-text available

Nov 2023

Background Previous studies found exposure to air pollution leads to exacerbations of asthma in paediatric and adult patients and increases asthma-related emergency hospital admissions (AREHA). Methods AREHAs and levels of air pollutants (PM 10 , PM 2.5 and NO 2 ) were obtained from Mexico City for the period 2017–2019. A time-series approach was used to explore the relationship between air pollutants and AREHA. Relative risks of AREHA were estimated using a negative binomial regression in young children (less than 5 years) and adults (greater than 18 years). Results There was a positive association between AREHA and PM 10 , PM 2.5 and NO 2 in adults, which remained after mutual adjustment for these pollutants. The relative risk (RR) of admission in adults increased by 3% (95% CI 1% to 4%) for a 10 µg/m ³ increase in PM 10 , 1% (0.03% to 3%) for a 5 µg/m ³ increase in PM 2.5 and by 1% (0.06% to 2%) for a 5 µg/m ³ increase in NO 2 . In contrast, in young children, AREHAs were negatively associated with PM 10 after adjustment for NO 2 (RR 0.97 (0.95 to 0.99) for a 10 µg/m ³ and with NO 2 after adjustment for PM 10 and PM 2.5 (RR 0.98 (0.96 to 0.99) and 0.97 (0.96 to 0.99), respectively, for a 5 µg/m ³ increase in NO 2 ). AREHAs in children were not associated with PM 2.5 after adjustment for NO 2 . Conclusions Ambient air pollution, within the previous week, was associated with emergency hospital admissions for asthma to public hospitals in adults in Mexico City. The relationship in children was less consistent. Further work is needed to explore why differences between adults and children exist to inform appropriate interventions to benefit public health.

The Impact of Air Pollution on the Incidence of Asthma: A Comparative Analysis of Regional Factors

Article

Full-text available

Sep 2023

Lu Wang

Air quality is closely related to human health and has attracted the attention of governments and people around the world. This paper aims to study whether there is a concrete link between the development of asthma and air pollution. By adopting comparative analysis, it examines three regions (Seoul, Sydney, and San Joaquin Valley) in terms of how different sources of air pollution affect the incidence of asthma. The results indicate that agricultural and industrial pollution cause asthma outbreaks worst in certain areas. The implication of this paper is that the local governments should develop programs to train public health professionals through public health networks. These health networks provide practical training in epidemiology and strategic planning, and help achieve effectively Communication with other health professionals and the public through public speaking, academic reports and scientific investigations, while advocating for other community managers for improved community health. In the meanwhile, it is crucial to improve local air quality through reasonable environmental regulation.

Ambient particulate matter associates with asthma in high altitude region: A population-based study

Article

Full-text available

May 2023

Background: Exposure to particulate matter (PM) has been a major public health threat, but the potentially differential effects on asthma of PM remain largely unknown in high altitude settings. We evaluated the effects of ambient PM on asthma in high altitude settings. Methods: The study recruited a representative sample from high altitude settings using a multistage stratified sampling procedure. Asthma was defined by a self-reported history of diagnosis by a physician or by wheezing symptoms in the preceding 12 months. The annual mean PM2.5 and PM10 concentrations were calculated for each grid cell at 1-km spatial resolution based on the geographical coordinates. Results: We analyzed data for participants (mean age 39.1 years, 51.4% female) and 183 (3.7%, 95% confidence interval (CI): 3.2-4.2) of the participants had asthma. Prevalence was higher in women (4.3%, 95% CI 3.5-5.1) than in men (3.1%, 2.4-3.8) and increasing with higher concentration of PM exposures. For an interquartile range (IQR) difference (8.77 μg/m3) in PM2.5 exposure, the adjusted odds ratio (OR) was 1.64 (95% CI 1.46-1.83, P < 0.001) for risk of asthma. For PM10, there was evidence for an association with risk of asthma (OR 2.34, 95% CI: 1.75-3.15, P < 0.001 per IQR of 43.26 μg/m3). Further analyses showed that household mold or damp exposure may aggravate PM exposure associated risks of asthma. Conclusions: This study identified that PM exposure could be a dominate environmental risk factor for asthma but largely unconsidered in the high-altitude areas. The association between PM exposure and asthma should be of interest for planners of national policies and encourage programs for prevention of asthma in residents living at high altitudes.

Association between exposure to particulate matter and school absences in Korean asthmatic adolescents

Article

Full-text available

Aug 2022

Background: Because particulate matter (PM) and asthma are closely related, the prevalence of school absence among adolescents with asthma can be affected by the concentration of PM. We aimed to investigate the relationship between school absences due to asthma and the total number of days that the PM concentration exceeded the standard. Methods: We used the data from the 16th Korea Youth Risk Behavior Survey and the PM levels of 17 metropolitan cities and provinces gathered from the AirKorea. Information on the characteristics of asthmatic adolescents and the prevalence of school absence was obtained using a questionnaire, while the PM levels based on the total number of days with poor and very poor PM grades were collected from the AirKorea website. Both χ2 test and logistic regression analysis were performed using the weights presented in the original dataset. Results: In the case of particulate matter of 10 microns in diameter or smaller (PM10), the odds ratio (OR) after adjusting for confounders (sex, school year, body mass index, smoking history, diagnosis of allergic rhinitis, diagnosis of atopic dermatitis and city size) was 1.07 (95% confidence interval [CI]: 1.01-1.13) for absents due to asthma when the total days of poor and very poor grades of PM10 (81 μg/m3 or higher) increased by 1 day. In the analysis of particulate matter of 2.5 microns in diameter or smaller (PM2.5), the OR after adjusting for confounders was 1.01 (95% CI: 1.00-1.03) for absents due to asthma when the total number of days with poor and very poor PM2.5 grades (36 μg/m3 or higher) increased by 1 day. Conclusions: A significant association was observed between the total number of days of poor and very poor PM10 and PM2.5 grades and school absence due to asthma; PM can cause asthma exacerbation and affect the academic life.

The superposition effects of air pollution on government health expenditure in China— spatial evidence from GeoDetector

Article

Full-text available

Jul 2022
BMC PUBLIC HEALTH

Background As the fifth-largest global mortality risk factor, air pollution has caused nearly one-tenth of the world’s deaths, with a death toll of 5 million. 21% of China’s disease burden was related to environmental pollution, which is 8% higher than the US. Air pollution will increase the demand and utilisation of Chinese residents’ health services, thereby placing a greater economic burden on the government. This study reveals the spatial impact of socioeconomic, health, policy and population factors combined with environmental factors on government health expenditure. Methods Spearman’s correlation coefficient and GeoDetector were used to identify the determinants of government health expenditure. The GeoDetector consist of four detectors: factor detection, interaction detection, risk detection, and ecological detection. One hundred sixty-nine prefecture-level cities in China are studied. The data sources are the 2017 data from China’s Economic and Social Big Data Research Platform and WorldPOP gridded population datasets. Results It is found that industrial sulfur dioxide attributed to government health expenditure, whose q value (explanatory power of X to Y) is 0.5283. The interaction between air pollution factors and other factors will increase the impact on government health expenditure, the interaction value (explanatory power of × 1∩× 2 to Y) of GDP and industrial sulfur dioxide the largest, whose values is 0.9593. There are 96 simple high-risk areas in these 169 areas, but there are still high-risk areas affected by multiple factors. Conclusion First, multiple factors influence the spatial heterogeneity of government health expenditure. Second, health and socio-economic factors are still the dominant factors leading to increased government health expenditure. Third, air pollution does have an important impact on government health expenditure. As a catalytic factor, combining with other factors, it will strengthen their impact on government health expenditure. Finally, an integrated approach should be adopted to synergisticly governance the high-risk areas with multi-risk factors.

Visualizing the Knowledge Base and Research Hotspot of Public Health Emergency Management: A Science Mapping Analysis-Based Study

Article

Full-text available

Jun 2022

Public health emergency management has been one of the main challenges of social sustainable development since the beginning of the 21st century. Research on public health emergency management is becoming a common focus of scholars. In recent years, the literature associated with public health emergency management has grown rapidly, but few studies have used a bibliometric analysis and visualization approach to conduct deep mining and explore the characteristics of the public health emergency management research field. To better understand the present status and development of public health emergency management research, and to explore the knowledge base and research hotspots, the bibliometric method and science mapping technology were adopted to visually evaluate the knowledge structure and research trends in the field of public health emergency management studies. From 2000 to 2020, a total of 3723 papers related to public health emergency management research were collected from the Web of Science Core Collection as research data. The five main research directions formed are child prevention, mortality from public health events, public health emergency preparedness, public health emergency management, and coronavirus disease 2019 (COVID-19). The current research hotspots and frontiers are climate change, COVID-19 and related coronaviruses. Further research is needed to focus on the COVID-19 and related coronaviruses. This study intends to contribute inclusive support to related academia and industry in the aspects of public health emergency management and public safety research, as well as research hotspots and future research directions.

Effect of maternal ozone exposure before and during pregnancy on wheezing risk in offspring: A birth cohort study in Guangzhou, China

Article

May 2022
ENVIRON RES

Ozone (O3) exposure may lead to the development and exacerbation of asthma or wheezing in postnatal children; however, it has rarely been studied before and during pregnancy. Wheezing is one of the most common symptoms when diagnosing of asthma; thus, we investigated the associations of O3 exposure before and during pregnancy with wheezing in preschool children and the potential susceptible exposure windows from a heavily polluted city in China. This population-based birth cohort study, which included 3725 mother-child pairs from Guangzhou, began in 2016, and the follow-up period ended on July 31, 2020. We used a spatiotemporal land-use-regression model combined with activity patterns to estimate the daily O3 exposure levels during the pre-pregnancy period and each trimester, and wheezing was recorded by reviewing medical records. We used the Cox proportional hazard model to quantify the effects of O3 exposure on childhood wheezing adjusted for potential confounders. No significant association was detected between pre-pregnancy exposure to O3 and childhood wheezing. However, increased ambient O3 exposures throughout pregnancy and in the second trimester were positively associated with the risk of childhood wheezing, with hazard ratios (HRs) and 95% confident intervals (CIs) per interquartile range (IQR) increment of 1.22 (95% CI: 1.04–1.44) and 1.31 (95% CI: 1.09–1.58), respectively. The effects of maternal O3 exposure on childhood wheezing risk was stronger when the exposure occurred in the warm conception season (P < 0.05). Significant childhood wheezing risk could be attributable to maternal O3 exposure, especially during the second trimester and with warm-season conception in Guangzhou. Further cohorts of children, particularly school age children who have more robust asthma diagnoses, should be investigated in the future.

Associations between Daily Ambient Air Pollution and Pulmonary Function, Asthma Symptom Occurrence, and Quick-Relief Inhaler Use among Asthma Patients

Article

Full-text available

Apr 2022
Int J Environ Res Publ Health

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.

DIURNAL TREND OF PARTICULATE MATTER CONCENTRATION AT INDUSTRIAL AREA USING MULTIVARIATE ANALYSIS

Article

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Mar 2022

Current status of herbal medicine research for respiratory diseases induced by particulate matter: a protocol for a scoping review

Article

Full-text available

Mar 2022

Background Particulate matter (PM) is an important environmental risk factor for the initiation and exacerbation of respiratory disease. Various herbal medicines have exhibited a reduction in symptoms of respiratory diseases induced by PM in animal models. However, the types and characteristics of studies on herbal medicine for respiratory diseases by PM have not been reviewed. This scoping review will focus on the currents status and research gap of herbal medicines for respiratory diseases caused by PM. Methods We will follow the scoping review framework developed by Arksey and O’Malley. MEDLINE (via PubMed), EMBASE, and the Cochrane Central Register of Controlled Trials will be searched for relevant English-language publications, and only peer-reviewed, controlled comparative in vivo/in-vitro/human studies examining the effects of herbs on respiratory disease induced by PM will be included. The basic characteristics, research methods, detailed regimens, possible mechanisms, outcomes, and results will be extracted using a predefined standardized data extraction form. Outcomes will be presented in the following categories: pulmonary function, inflammatory markers, reactive oxygen species, histology and mechanisms, and adverse events. Two researchers will independently perform the study selection, data extraction, and quality assessment. We will also present the research map and implications for further study. Ethics and dissemination Ethical approval is not required because individual patient data will not be included. The findings will be disseminated through peer-reviewed publications or conference presentations. Systematic review registration This review protocol has been registered with the Open Science Framework on February 12, 2021 (https://osf.io/s7uvk/)

Role of Environmental Air Pollution in Chronic Rhinosinusitis

Article

Full-text available

Aug 2021
CURR ALLERGY ASTHM R

Purpose of Review Chronic rhinosinusitis (CRS) is a highly prevalent disease with large social and financial burdens. The pathophysiology is multifactorial. Environmental pollutants have been suggested to play a role in the inflammatory component of the disease process. Recent Findings Recent work has focused on exposure to various pollutants, primarily particulate matter (PM). Exposure to environmental pollutants leads to upregulation of inflammatory markers and ciliary dysfunction at the cellular level. Mouse models suggest a role for epithelial barrier dysfunction contributing to inflammatory changes after pollutant exposure. Clinical studies support the role of pollutants contributing to disease severity in certain populations, but the role in CRS incidence or prevalence is less clear. Research is limited by the retrospective nature of most studies. Summary This review focuses on recent advancements in our understanding of the impact of environmental pollutants in CRS, limitations of the available data, and potential opportunities for future studies.

Proximity to coal-fired power plants and neurobehavioral symptoms in children

Article

Full-text available

Jan 2022
J EXPO SCI ENV EPID

Coal-fired power plants are a major source of air pollution that can impact children’s health. Limited research has explored if proximity to coal-fired power plants contributes to children’s neurobehavioral disorders. This community-based study collected primary data to investigate the relationships of residential proximity to power plants and neurobehavioral problems in children. 235 participants aged 6–14 years who lived within 10 miles of two power plants were recruited. Exposure to particulate matter ≤10 μm (PM10) was measured in children’s homes using personal modular impactors. Neurobehavioral symptoms were assessed using the Child Behavior Checklist (CBCL). Multiple regression models were performed to test the hypothesized associations between proximity/exposure and neurobehavioral symptoms. Geospatial statistical methods were used to map the spatial patterns of exposure and neurobehavioral symptoms. A small proportion of the variations of neurobehavioral problems (social problems, affective problems, and anxiety problems) were explained by the regression models in which distance to power plants, traffic proximity, and neighborhood poverty was statistically associated with the neurobehavioral health outcomes. Statistically significant hot spots of participants who had elevated levels of attention deficit hyperactivity disorder, anxiety, and social problems were observed in the vicinity of the two power plants. Results of this study suggest an adverse impact of proximity to power plants on children’s neurobehavioral health. Although coal-fired power plants are being phased out in the US, health concern about exposure from coal ash storage facilities remains. Furthermore, other countries in the world are increasing coal use and generating millions of tons of pollutants and coal ash. Findings from this study can inform public health policies to reduce children’s risk of neurobehavioral symptoms in relation to proximity to power plants.

Spatial variation in the joint effect of extreme heat events and ozone on respiratory hospitalizations in California

Article

Jun 2021

Significance Projections show that extreme heat events and high ozone days are expected to increase under climate change. Both exposures are harmful to human health, but warning systems, typically implemented separately, do not consider the joint effects of these exposures. In this study, we propose a method to address spatial differences of the joint effects of extreme heat events and ozone peaks on respiratory hospitalizations at the zip code level in California. Zip codes with low median income and high unemployment rates are at increased risk for these joint effects. Results identified zip codes with increased vulnerability, demonstrating the importance of going beyond average measures to prioritize areas for joint warning systems and protect population health.

Semantic Standards of External Exposome Data

Article

Full-text available

Apr 2021
ENVIRON RES

An individual's health and conditions are associated with a complex interplay between the individual's genetics and his or her exposures to both internal and external environments. Much attention has been placed on characterizing of the genome in the past; nevertheless, genetics only account for about 10% of an individual's health conditions, while the remaining appears to be determined by environmental factors and gene-environment interactions. To comprehensively understand the causes of diseases and prevent them, environmental exposures, especially the external exposome, need to be systematically explored. However, the heterogeneity of the external exposome data sources (e.g., same exposure variables using different nomenclature in different data sources, or vice versa, two variables have the same or similar name but measure different exposures in reality) increases the difficulty of analyzing and understanding the associations between environmental exposures and health outcomes. To solve the issue, the development of semantic standards using an ontology-driven approach is inevitable because ontologies can (1) provide a unambiguous and consistent understanding of the variables in heterogeneous data sources, and (2) explicitly express and model the context of the variables and relationships between those variables. We conducted a review of existing ontology for the external exposome and found only four relevant ontologies. Further, the four existing ontologies are limited: they (1) often ignored the spatiotemporal characteristics of external exposome data, and (2) were developed in isolation from other conceptual frameworks (e.g., the socioecological model and the social determinants of health). Moving forward, the combination of multi-domain and multi-scale data (i.e., genome, phenome and exposome at different granularity) and different conceptual frameworks is the basis of health outcomes research in the future.

Risk Factors for Acute Urticaria in Central California

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Apr 2021
Int J Environ Res Publ Health

At least 15–20% of the population in the world suffers from urticaria. Allergy triggers contribute to the development of urticaria. Not much is known about the demographic and environmental risk factors that contribute to the occurrence of acute urticaria. Methods: We utilized emergency department data on acute urticaria-related visits managed by the California Office of Statewide Planning and Operations for 201 zip codes located in southern central California (San Joaquin Valley) collected during the years 2016 and 2017. Census data from the same zip codes were considered as a population at risk. Socioeconomic and environmental parameters using CalEnviroScreen (Office of Environmental Health Hazard Assessment, Sacramento, CA, USA) database for the zip codes were evaluated as risk factors. Results: The incidence rate of acute urticaria in San Joaquin Valley during 2016–2017 was 1.56/1000 persons (n = 14,417 cases). Multivariate Poisson analysis revealed that zip codes with high population density (RR = 2.81), high percentage of farm workers (RR = 1.49), and the composite of those with high and medium percentage of poverty and those with high and medium percentage of non-white residents (RR = 1.59) increased the likelihood of the occurrence of acute urticaria. Conclusion: High population density, farm work, poverty and minority status is associated with a high risk of having acute urticaria.

Efficacy, Mechanism, and Safety of Herbal Medicine for Respiratory Disease Induced by Particulate Matter: a Protocol for a Scoping Review

Preprint

Full-text available

Mar 2021

Background: Particulate matter (PM) is an important environmental risk factor in the initiation and exacerbation of respiratory disease. Various herbal medicines have exhibited a reduction in symptoms of respiratory diseases induced by PM in animal models; however, their efficacy, mechanism, and safety have not been reviewed. This review will evaluate the efficacy, safety, and mechanism of action of herbal medicines in respiratory diseases caused by PM. Methods: We will follow the scoping review framework developed by Arksey and O’Malley. MEDLINE (via PubMed), EMBASE, and the Cochrane Central Register of Controlled Trials will be searched for relevant English-language publications, and only peer-reviewed, controlled comparative in-vivo/in-vitro studies examining the effects of herbs in animal models of respiratory disease induced by PM will be included. The basic characteristics, research method, possible mechanism, and results will be extracted. The primary outcome will be pulmonary function; secondary outcomes will be inflammatory markers, reactive oxygen species, histology and mechanisms, and adverse events. Two researchers will independently perform the study selection, data extraction, and quality assessment. RevMan software (version 5.3) will be used for the quantitative data synthesis. When appropriate, data will be pooled for meta-analysis using fixed or random effects models; otherwise, evidence will be summarized qualitatively. Ethics and Dissemination: Ethical approval is not required because individual patient data will not be included. The findings will be disseminated through peer-reviewed publications or conference presentations. Registration number: This review protocol has been registered with the Open Science Framework on February 12, 2021 (https://osf.io/s7uvk/)

Source-specific contributions of particulate matter to asthma-related pediatric emergency department utilization

Article

Full-text available

Mar 2021

Ambient particulate matter smaller than 2.5 μm (PM2.5) is associated with different chronic diseases. It is crucial to identify the sources of ambient particulate matter to reduce the impact on health. Still, only a few studies have been linked with specific ambient particulate matter sources. In this study, we estimated the contributions of sources of PM2.5 and examined their association with daily asthma hospital utilization in Cincinnati, Ohio, USA. We used a model-based clustering method to group days with similar source-specific contributions into six distinct clusters. Specifically, elevated PM2.5 concentrations occurring on days characterized by low coal combustion contributions showed a significantly reduced risk of hospital utilization for asthma (rate ratio: 0.86, 95% CI: [0.77, 0.95]) compared to other clusters. Reducing coal combustion contribution to PM2.5 levels could be an effective intervention for lowering asthma-related hospital utilization. Supplementary information: The online version contains supplementary material available at 10.1007/s13755-021-00141-z.

Metabolomics analysis of maternal serum exposed to high air pollution during pregnancy and risk of autism spectrum disorder in offspring

Article

Feb 2021

Background Previously, numerous epidemiologic studies reported an association, between autism spectrum disorder (ASD) and exposure to air pollution during pregnancy. However, there have been no metabolomics studies investigating the impact of pregnancy pollution exposure to ASD risk in offspring. Objectives To identify differences in maternal metabolism that may reflect a biological response to exposure to high air pollution in pregnancies of offspring who later did or did not develop ASD. Methods We obtained stored mid-pregnancy serum from 214 mothers who live in California’s Central Valley, showing worst air quality. We estimated each woman’s average traffic-related air pollution exposure (carbon monoxide, nitric oxides, and particulate matter <2.5μm) during the first trimester using the California Line Source Dispersion Model, version 4 (CALINE4). By utilizing liquid chromatography-high resolution mass spectrometry, we identified the metabolic profiles of maternal serum for 116 mothers with offspring who later develop ASD and 98 control mothers. Partial least squares discriminant analysis (PLS-DA) was employed to select metabolic features associated with air pollution exposure or autism risk in offspring. We also conducted extensive pathway enrichment analysis to elucidate potential ASD-related changes in metabolome of pregnant women. Results We extracted 4022 and 4945 metabolic features from maternal serum samples in hydrophilic interaction (HILIC) chromatography (positive ion mode) and C18 (negative ion mode) columns, respectively. After controlling for potential confounders, we identified 167 and 222 discriminative features (HILIC and C18, respectively). Pathway enrichment analysis to discriminate metabolic features associated with ASD risk indicated that various metabolic pathway perturbations linked to the tricarboxylic acid (TCA) cycle and mitochondrial function, including carnitine shuttle, amino acid metabolism, bile acid metabolism, and vitamin A metabolism. Conclusion Using HRM, we identified several metabolic pathways disturbed in mothers with ASD offspring among women under high exposure to traffic-related air pollution during pregnancy associated with mitochondrial dysfunction. These findings provide us a better understanding of metabolic disturbance involved in the development of ASD under adverse environmental conditions.

Empowering Surgeons, Anesthesiologists, and Obstetricians to Incorporate Environmental Sustainability in the Operating Room

Article

Full-text available

Jan 2021

Objective: We review the existing research on environmentally sustainable surgical practices to enable SAO to advocate for improved environmental sustainability in operating rooms across the country. Summary of background data: Climate change refers to the impact of greenhouse gases emitted as a byproduct of human activities, trapped within our atmosphere and resulting in hotter and more variable climate patterns. As of 2013, the US healthcare industry was responsible for 9.8% of the country's emissions; if it were itself a nation, US healthcare would rank 13th globally in emissions. As one of the most energy-intensive and wasteful areas of the hospital, ORs drive this trend. ORs are 3 to 6 times more energy intensive than clinical wards. Further, ORs and labor/delivery suites produce 50%-70% of waste across the hospital. Due to the adverse health impacts of climate change, the Lancet Climate Change Commission (2009) declared climate change "the biggest global health threat of the 21 century" and predicted it would exacerbate existing health disparities for minority groups, children and low socioeconomic patients. Methods/results: We provide a comprehensive narrative review of published efforts to improve environmental sustainability in the OR while simultaneously achieving cost-savings and highlight resources for clinicians interested in pursuing this work. Conclusion: Climate change adversely impacts patient health, and disproportionately impacts the most vulnerable patients. SAO contribute to the problem through their resource-intensive work in the OR and are uniquely positioned to lead efforts to improve the environmental sustainability of the OR.

R E V I E W Spotlight on microRNAs in allergy and asthma

Article

Nov 2020

In past 10 years, microRNAs (miRNAs) have gained scientific attention due to their importance in the pathophysiology of allergic diseases and their potential as biomarkers in liquid biopsies. They act as master post-transcriptional regulators that control most cellular processes. As one miRNA can target several mRNAs, often within the same pathway, dysregulated expression of miRNAs may alter particular cellular responses and contribute, or lead, to the development of various diseases. In this review, we give an overview of the current research on miRNAs in allergic diseases, including atopic dermatitis, allergic rhinitis, and asthma. Specifically, we discuss how individual miRNAs function in the regulation of immune responses in epithelial cells and specialized immune cells in response to different environmental factors and respiratory viruses. In addition, we review insights obtained from experiments with murine models of allergic airway and skin inflammation and offer an overview of studies focusing on miRNA discovery using profiling techniques and bioinformatic modeling of the network effect of multiple miRNAs. In conclusion, we highlight the importance of research into miRNA function in allergy and asthma to improve our knowledge of the molecular mechanisms involved in the pathogenesis of this heterogeneous group of diseases.

R E V I E W: Spotlight on microRNAs in allergy and asthma

Article

Full-text available

Nov 2020

Media Reporting on Air Pollution: Health Risk and Precautionary Measures in National and Regional Newspapers

Article

Full-text available

Sep 2020
Int J Environ Res Publ Health

Exposure to air pollution is one of the primary global health risk factors, yet individuals lack the knowledge to engage in individual risk mitigation and the skills to mobilize for the change necessary to reduce such risks. News media is an important tool for influencing individual actions and support for public policies to reduce environmental threats; thus, a lack of news coverage of such issues may exacerbate knowledge deficits. This study examines the reporting of health risks and precautionary measures regarding air pollution in national and regional print news. We conducted a content analysis of two national and two local newspapers covering the USA's most polluted region during a 5-year period. Coders identified information on threat, self-efficacy, protective measures and information sources. Nearly 40% of air pollution news articles mentioned human health risks. Fewer than 10% of news stories about air pollution provided information on the precautionary measures necessary for individuals to take action to mitigate their risk. Local newspapers did not report more threat (Χ2 = 1.931, p = 0.165) and efficacy (Χ2 = 1.118, p = 0.209) information. Although air pollution levels are high and continue to rise at alarming rates, our findings suggest that news media reporting is not conducive to raising environmental health literacy.

Shaping Land Use Change and Ecosystem Restoration in a Water-Stressed Agricultural Landscape to Achieve Multiple Benefits

Article

Full-text available

Aug 2020

Irrigated agriculture has grown rapidly over the last 50 years, helping food production keep pace with population growth, but also leading to significant habitat and biodiversity loss globally. Now, in some regions, land degradation and overtaxed water resources mean historical production levels may need to be reduced. We demonstrate how analytically supported planning for habitat restoration in stressed agricultural landscapes can recover biodiversity and create co-benefits during transitions to sustainability. We apply our approach in California's San Joaquin Valley where groundwater regulations are driving significant land use change. We link agricultural-economic and land use change models to generate plausible landscapes with different cropping patterns, including temporary fallowing and permanent retirement. We find that a large fraction of the reduced cultivation is met through temporary fallowing, but still estimate over 86,000 hectares of permanent retirement. We then apply systematic conservation planning to identify optimized restoration solutions that secure at least 10,000 hectares of high quality habitat for each of five representative endangered species, accounting for spatially varying opportunity costs specific to each plausible future landscape. The analyses identified consolidated areas common to all land use scenarios where restoration could be targeted to enhance habitat by utilizing land likely to be retired anyway, and by shifting some retirement from regions with low habitat value to regions with high habitat value. We also show potential co-benefits of retirement (derived from avoided nitrogen loadings and soil carbon sequestration), though these require careful consideration of additionality. Our approach provides a generalizable means to inform multi-benefit adaptation planning in response to agricultural stressors.

Spotlight on microRNAs in allergy and asthma

Preprint

Oct 2020

2020.11.20- This publication has now been accepted and published in Allergy. This article has been accepted for publication and undergone full peer review but has not been through the proofreading process, which may lead to differences between this version and the Version of Record.

Air Pollution Levels Related to Peak Expiratory Flow Rates among Adult Asthmatics in Lampang, Thailand

Article

Jan 2020

Asthmatics may suffer harmful health effects from air pollution. This year-long study, which was conducted from November 2015 till October 2016 and resulted in 12,045 data points from 33 participants, assessed the relationships (with a 95% confidence interval [CI]) between measured air pollutant (CO, NO2, O3, SO2, PM2.5 and PM10) concentrations and peak expiratory flow rates (PEFRs) among adults with asthma in the district of Mae Moh in Lampang, Thailand. A positive correlation was found between the mean daily concentration of NO2 from 4 days prior (“lag 4”) and the PEFR upon waking (“morning PEFR”), with an increase of 1 ppb in the former being associated with an increase of 1.34 L min–1 (95% CI: 0.25, 2.44) in the latter. Also, the interaction between NO2 (lag 4) and PM10 (lag 6) was multiplicatively associated with a decrease of –0.015 L min–1 in the morning PEFR, which was also negatively associated with the maximum daily concentration (“max”) of NO2 (lag 2) and that of PM10 (lag 6), with coefficients of –0.07 and –0.013, respectively. Furthermore, when including PM2.5 max in the generalized estimating equation model, only NO2 max (lag 2) and CO max (lag 6) were negatively associated with the morning PEFR, displaying coefficients of –0.08 and –1.71, respectively. O3 max (lag 3) and PM2.5 max exhibited positive relationships with the PEFR before sleeping (“evening PEFR”), with coefficients of 0.078 and 0.029, respectively. Additionally, the average daily PEFR was positively associated with the average daily concentration of NO2 (lag 4), with a coefficient of 0.15, but negatively associated with that of SO2, with a coefficient of –0.47. We also observed a negative relationship between the average daily PEFR and NO2 max (lag 2), with a coefficient of –0.05, but a positive one between the former and O3 max (lag 3), with a coefficient of 0.06. Our results indicate that the delayed—and, in some cases, negative—effects of these pollutants on PEFRs must be considered in health forecasting and that preventative measures should be implemented to control certain emissions at the source.

The association of exposure to PM10 with the quality of life in adult asthma patients

Article

Full-text available

Mar 2020

Objectives: Air pollution has become a critical environmental issue, which severely threatens the well-being of asthma patients. The quality of life of these patients, when exposed to air pollutants such as particulate matter 10 (PM10), has been poorly studied. The current research examined the association between the concentration of PM10 in the air and the quality of life of patients with asthma. Material and methods: The study group consisted of 300 adult asthma patients treated in 2 allergy outpatient clinics in Kraków, who declared they would not leave the city in the 14-day study period. Daily concentrations of PM10 from air monitoring stations were recorded over a period of 2 weeks, following which the patients filled out the standardized Asthma Quality of Life Questionnaire (AQLQ) regarding the monitored period to assess the total quality of life and its 4 domains (symptoms, limitation of activity, emotional functioning and environmental stimuli). Results: The average PM10 exposure was 65.2 μg/m3 and only 30% of the patients were exposed to values of ≤50 μg/m3, i.e., the highest 24-h threshold value considered acceptable by the World Health Organization. The observed effect of an increased level of exposure to airborne PM10 was associated with reduced scores in AQLQ from 0.40 at the medium level to 0.46 at the high level, in comparison to the low level. The total score of the asthma-related quality of life and its domains showed poorer outcomes as the concentration of PM10 was increasing (every 0.08 pt per a 10 μg/m3 increase). Conclusions: The increase in the concentration of PM10 in the air impacts on the overall quality of life and its particular domains in people with exceptional predispositions, such as patients with bronchial asthma. Physicians taking care of asthma patients should pay special attention to the quality of patient's life in response to the course and control of that illness, in relation to air pollution.

The contribution of particulate matter to respiratory allergy: A review of current evidence

Article

Full-text available

Feb 2020

Background: Air pollution contributes to an estimated six million deaths per year. Epidemiological and experimental studies show an association between air pollutant exposure and respiratory allergy. Objective: We aimed to write a narrative review of the epidemiology of air pollution-related respiratory-related allergic disorders (including asthma and allergic rhinitis) and the effects of air pollutants - with an emphasis on the particulate matter - on respiratory allergy-related health. Methods: PubMed Medline was searched, and representative epidemiologic and controlled-exposure studies were selected by using terms for air pollutants, particulate matter, and respiratory allergy including asthma and allergic rhinitis. Results: Epidemiological studies showed methodologic heterogeneity, including variability in study populations, geographical regions, types and sources of pollutants, methods for exposure estimation, approaches to controlling for confounding, and case definitions. This heterogeneity affected measures of association between studies. There is strong evidence to support an association between exposure to particulate matter and asthmatic exacerbations. Although data are inconclusive, several studies suggest exposure to particulate matter contributes to the development of asthma, allergic sensitization, and allergic rhinitis. Experimental studies, such as controlled-exposure studies, support a causal association between particulate matter and adverse health effects. Conclusions: Particulate matter exposure can exacerbate pre-existing asthma and may contribute to developing asthma, allergic rhinitis, and aeroallergen sensitization. Short-term and long-term strategies are needed to reduce disease severity and prevent new-onset disease development. Additional research is needed to identify effective avoidance strategies and therapeutic approaches.

Association of Long-term Ambient Ozone Exposure With Respiratory Morbidity in Smokers

Article

Dec 2019

Importance Few studies have investigated the association of long-term ambient ozone exposures with respiratory morbidity among individuals with a heavy smoking history. Objective To investigate the association of historical ozone exposure with risk of chronic obstructive pulmonary disease (COPD), computed tomography (CT) scan measures of respiratory disease, patient-reported outcomes, disease severity, and exacerbations in smokers with or at risk for COPD. Design, Setting, and Participants This multicenter cross-sectional study, conducted from November 1, 2010, to July 31, 2018, obtained data from the Air Pollution Study, an ancillary study of SPIROMICS (Subpopulations and Intermediate Outcome Measures in COPD Study). Data analyzed were from participants enrolled at 7 (New York City, New York; Baltimore, Maryland; Los Angeles, California; Ann Arbor, Michigan; San Francisco, California; Salt Lake City, Utah; and Winston-Salem, North Carolina) of the 12 SPIROMICS clinical sites. Included participants had historical ozone exposure data (n = 1874), were either current or former smokers (≥20 pack-years), were with or without COPD, and were aged 40 to 80 years at baseline. Healthy persons with a smoking history of 1 or more pack-years were excluded from the present analysis. Exposures The 10-year mean historical ambient ozone concentration at participants’ residences estimated by cohort-specific spatiotemporal modeling. Main Outcomes and Measures Spirometry-confirmed COPD, chronic bronchitis diagnosis, CT scan measures (emphysema, air trapping, and airway wall thickness), 6-minute walk test, modified Medical Research Council (mMRC) Dyspnea Scale, COPD Assessment Test (CAT), St. George’s Respiratory Questionnaire (SGRQ), postbronchodilator forced expiratory volume in the first second of expiration (FEV1) % predicted, and self-report of exacerbations in the 12 months before SPIROMICS enrollment, adjusted for demographics, smoking, and job exposure. Results A total of 1874 SPIROMICS participants were analyzed (mean [SD] age, 64.5 [8.8] years; 1479 [78.9%] white; and 1013 [54.1%] male). In adjusted analysis, a 5-ppb (parts per billion) increase in ozone concentration was associated with a greater percentage of emphysema (β = 0.94; 95% CI, 0.25-1.64; P = .007) and percentage of air trapping (β = 1.60; 95% CI, 0.16-3.04; P = .03); worse scores for the mMRC Dyspnea Scale (β = 0.10; 95% CI, 0.03-0.17; P = .008), CAT (β = 0.65; 95% CI, 0.05-1.26; P = .04), and SGRQ (β = 1.47; 95% CI, 0.01-2.93; P = .048); lower FEV1% predicted value (β = −2.50; 95% CI, −4.42 to −0.59; P = .01); and higher odds of any exacerbation (odds ratio [OR], 1.37; 95% CI, 1.12-1.66; P = .002) and severe exacerbation (OR, 1.37; 95% CI, 1.07-1.76; P = .01). No association was found between historical ozone exposure and chronic bronchitis, COPD, airway wall thickness, or 6-minute walk test result. Conclusions and Relevance This study found that long-term historical ozone exposure was associated with reduced lung function, greater emphysema and air trapping on CT scan, worse patient-reported outcomes, and increased respiratory exacerbations for individuals with a history of heavy smoking. The association between ozone exposure and adverse respiratory outcomes suggests the need for continued reevaluation of ambient pollution standards that are designed to protect the most vulnerable members of the US population.

Health effects of PM2.5 sources on children's allergic and respiratory symptoms in Fukuoka, Japan

Article

Dec 2019
SCI TOTAL ENVIRON

Exposure to fine particulate matter (PM2.5) is a potential aggravating factor for respiratory and allergic diseases. However, which PM2.5 sources are associated with such diseases remains unclear. This study aimed to investigate the association of PM2.5 sources with allergic and respiratory symptoms in schoolchildren. PM2.5 samples were collected in Fukuoka during the spring in 2014 and 2015. Asian dust was observed in 2014. Ion components, elemental components, and organic components were analyzed. Positive matrix factorization (PMF) was conducted to calculate PM2.5 concentrations from each source. Mixed logistic regression analysis with a random intercept for each schoolchild was performed to evaluate the association of components and sources with symptoms. Among 2317 schoolchildren, the mean prevalence was 28.9%, 23.6%, 11.2%, and 11.4% for lower respiratory, nasal, ocular, and skin symptoms, respectively. PMF identified the following six PM2.5 sources "Secondary sulfate and coal combustion", "Secondary nitrate", "Heavy oil combustion", "Sea salt", "Soil" and "Traffic emission". An interquartile range of PM2.5 mass was associated with nasal (Odds ratios 1.08, 95% confidence interval [1.03, 1.13]), ocular (1.10, [1.04, 1.16]), and skin symptoms (1.13, [1.06, 1.20]). Among the source factors, "Heavy oil combustion" was significantly associated with nasal symptom (1.11, [1.05, 1.18]) while "Sea salt" was associated with nasal (1.06, [1.02, 1.11]) and skin (1.073, [1.01, 1.14]) symptoms. We found "Soil", which might be affected by Asian dust, was associated with ocular (1.07, [1.03, 1.10]) and skin (1.05, [1.01, 1.08]) symptoms. Further studies in other seasons or places are needed to clarify the influence of PM2.5 sources on children's health.

Next-Generation Community Air Quality Sensors for Identifying Air Pollution Episodes

Article

Full-text available

Sep 2019
Int J Environ Res Publ Health

Conventional regulatory air quality monitoring sites tend to be sparsely located. The availability of lower-cost air pollution sensors, however, allows for their use in spatially dense community monitoring networks, which can be operated by various stakeholders, including concerned residents, organizations, academics, or government agencies. Networks of many community monitors have the potential to fill the spatial gaps between existing government-operated monitoring sites. One potential benefit of finer scale monitoring might be the ability to discern elevated air pollution episodes in locations that have not been identified by government-operated monitoring sites, which might improve public health warnings for populations sensitive to high levels of air pollution. In the Imperial Air study, a large network of low-cost particle monitors was deployed in the Imperial Valley in Southeastern California. Data from the new monitors is validated against regulatory air monitoring. Neighborhood-level air pollution episodes, which are defined as periods in which the PM2.5 (airborne particles with sizes less than 2.5 μm in diameter) hourly average concentration is equal to or greater than 35 μg m−3, are identified and corroborate with other sites in the network and against the small number of government monitors in the region. During the period from October 2016 to February 2017, a total of 116 episodes were identified among six government monitors in the study region; however, more than 10 times as many episodes are identified among the 38 community air monitors. Of the 1426 episodes identified by the community sensors, 723 (51%) were not observed by the government monitors. These findings suggest that the dense network of community air monitors could be useful for addressing current limitations in the spatial coverage of government air monitoring to provide real-time warnings of high pollution episodes to vulnerable populations.

The first pollution investigation of road sediment in Gary, Indiana: Anthropogenic metals and possible health implications for a socioeconomically disadvantaged area

Article

Full-text available

Jul 2019
ENVIRON INT

An investigation of road sediment in Gary, Indiana revealed high levels of various trace metals such as Zn, Mn, and Cr, often exceeding those of background reference concentrations as shown through geoaccumulation indices and contamination factors. The hazard index (HI) value for Mn in children was > 1 (1.7), suggesting possible long-term non-carcinogenic health risk. Mn HI for children is even higher for the five samples closest to a US Steel facility, with an HI of 2.8. Through SEM-EDS analysis, the prevalence of small particulates (PM 2.5 and PM 2.5-10) containing potentially harmful elements such as Mn and Pb illustrate a health risk through direct inhalation or ingestion. The small nature of particulates in general may also pose an increased health risk for respiratory diseases such as asthma. Mn concentrations in the road sediment were particularly high, with 30 out of 32 samples exceeding 1800 ppm. Mn and V concentrations show a strong spatial trend of decreasing concentration away from a US Steel facility. These spatial trends along with correlation plots of the bulk chemistry suggest that industrial steel manufacturing, particularly US Steel in Gary, is a major contributing source of Mn and V. Fe and Cr show a moderate decrease in concentrations away from the US Steel facility, which suggests some sourcing from the steel facility when coupled with bulk chemistry plots. Zn and Cu do not show much evidence of sourcing from the US Steel facility, likely due to increased mixing from other sources. Further work constraining anthropogenic sources, the bioaccessible fraction of metals, and analysis of direct atmospheric particulates can help with remedial activity and risk assessment.

Air Pollution Contributes to Asthma Deaths

Article

Full-text available

Mar 2019

Paloma I Beamer

In-use NOx and black carbon emissions from heavy-duty freight diesel vehicles and near-zero emissions natural gas vehicles in California's San Joaquin Air Basin

Article

Oct 2023
SCI TOTAL ENVIRON

The Change of Comprehensive Air-Quality Index and Health Effects According to the Seasonal PM2.5 Management

Article

Aug 2023

The role of murine models in the study of the respiratory tract immune response induced by particulate matter

Article

Full-text available

Oct 2022

Environmental air pollution is a global problem. Among the main types of air pollutants that harm human health are ozone, particulate matter (PM), nitrogen, carbon dioxide, sulfur dioxide, and carbon monoxide. These have a significant effect on human health across the world. PM can penetrate the respiratory tract, induce inflammation, and cause permanent damage. In addition, correlations have been found between PM inhalation and the development of cardiovascular diseases, various types of cancer, asthma, and lower respiratory infections. Murine models provide us with the experimental tools to understand the immunoinflammatory response to the inhalation of PM and develop preventive measures that can be extrapolated to humans. Here, we present an overview of the current understanding of the PM immune response and discuss the different experimental strategies used in research on this subject with murine models.

Factors affecting seedling recruitment of the desert shrub Atriplex polycarpa (Torr.) S. Watson (Chenopodiaceae) in the San Joaquin Valley of California

Thesis

Full-text available

Nov 2017

Mitchell Coleman

UNIVERSITY STUDENTS’ PERCEPTION ON CITY’S AIR QUALITY: A TALE OF THREE CITIES IN BANGLADESH

Article

Full-text available

Mar 2022

The underlying endeavor of this paper is to understand the air pollution situation, particularly PM 2.5, in the major three cities of Bangladesh through the lenses of university students. In order to achieve this aim, a structured questionnaire was developed and scheduled interview was performed with the students from three universities of Bangladesh, namely Khulna University, Chittagong University, and Dhaka University. Data was collected on three categories: demographic, seasonal variation and consequences, and lastly some prevention perceptions. Accumulated data were analyzed by deploying descriptive statistics. Multinomial logistic regression, Pearson correlation along with PCA and cluster analysis were performed to understand the prevention perceptions. The result shows that air pollution has adverse effects on participants and air quality is most deteriorated during summer season. Statistically, pollution in Dhaka city is the most while least was found in Khulna city. Participants witness and bear the consequences of air pollution, but they think individual prevention measures are not at work. This study unveils the air quality problem in three major cities in Bangladesh and pollution problem is out of individual control. Further studies are encouraged to understand individual pollution control measures and policies.

Review of Ground-Level Ozone Impact in Respiratory Health Deterioration for the Past Two Decades

Article

Full-text available

Mar 2022

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.

Media Reporting on Air Pollution: Health risk and precautionary measures in national and regional newspapers

Preprint

Full-text available

Mar 2020

Background Exposure to air pollution is one of the primary global health risk factors, yet individuals lack the knowledge to engage in individual risk mitigation and the skills to mobilize for change necessary to reduce such risks. The news media are an important tool for influencing individual actions and support for public policies to reduce environmental threats; thus, a lack of news coverage of such issues may exacerbate knowledge deficits. This study examines the reporting of health risk and precautionary measures regarding air pollution in national and regional print news using an environmental health literacy perspective. Methods We conducted a content analysis of two national (New York Times and Washington Post) and two local newspapers (Fresno Bee and Bakersfield Californian) newspapers covering the country’s most polluted region, California’s San Joaquin Valley, during a 5-year period (2011-2015). Using a constructed week sampling approach, 276 newspaper articles were coded for information on threat, efficacy information, and information sources. Results News coverage of air pollution mostly failed to mention human health risks. Moreover, fewer than 10 percent of news stories about air pollution provided information on the precautionary measures necessary for individuals to take action to mitigate their risk. Despite being located in one of the most polluted areas in the US, local newspapers did not report significantly more threat and efficacy information. News coverage of air pollution consistently missed opportunities to raise environmental health literacy. Conclusions Although air pollution levels are high and continue to rise at alarming rates, our findings suggest that news media reporting is not conducive to raising environmental health literacy. Public health advocates and health promotion experts must develop more effective strategies for disseminating information about the health risks of air pollution, balancing the need for recognizing the structural causes of poor air quality and the actions individuals and communities can take to reduce air pollution related morbidity and mortality. National and local news media may be useful partners for such dissemination.

Perceptions about air quality of individuals who work outdoors in the San Joaquin Valley, California

Article

Apr 2020
APR

The San Joaquin valley (SJV) is known for having poor air quality and high rates of respiratory illnesses including asthma. This study was aimed to assess the perceptions about air quality of individuals who work outdoors in the San Joaquin Valley, California. Surveys were conducted with SJV residents (n=198) to understand attitudes, perceptions of air quality, and behaviors related to air pollution of individuals who work outdoors. The results suggest that people who worry more about air quality tend to check air quality more often. It was found that individuals who suffer from asthma are more likely to check air quality when working and exercising outdoors. In addition, the differences on how people utilize informational sources regarding air quality were observed. Conclusion: Therefore, there is a need to further study attitudes and perceptions about air quality among populations who work outdoors.

Estimating mortality impacts from vehicle emission reduction efforts: The Tune In and Tune Up program in the San Joaquin Valley

Article

Dec 2019
TRANSPORT RES D-TR E

As a response to profoundly poor air quality and associated environmental justice concerns in the San Joaquin Valley region in California, the Tune In & Tune Up (TI&TU) program provides residents with free vehicle emissions testing and vouchers for smog repair. We used data on approximately 19,000 repaired TI&TU vehicles from 2012 to 2018, and several estimation techniques, to quantify a range of nitrogen oxides (NOX) emissions prevented as a result of the program. We then calculated resulting mortality impacts from reduced exposure to fine particulate matter (PM2.5) in the form of secondary nitrates. After applying a novel smog repair emissions abatement depreciation function, we find that six years of operation of the TI&TU program has reduced NOX emissions by approximately 53–302 tons by the end of 2018. Using a concentration response function for ambient PM2.5, we found that between 0.055 and 0.31 premature deaths have also been avoided. We present multiple methods for assessing public health impacts, which can be used as guidance for evaluating similar transportation-based emission reduction programs.

PM 2.5 and pediatric asthma

Article

Full-text available

Jan 2019

Longitudinal effect of ambient air pollution and pollen exposure on asthma control: the PROMIS® Pediatric Asthma Study

Article

May 2019

Objective: Although exposure to air pollution and pollen is associated with asthma exacerbation and increased health care use, longitudinal effects of fine particulate matter 2.5 (PM2.5), ozone (O3), and pollen exposure on asthma control status in pediatric patients are understudied. This study investigated effects of exposure to PM2.5, O3, and pollen on asthma control status among pediatric patients with asthma. Methods: A total of 229 dyads of pediatric patients with asthma and their parents were followed for 15 months. The Asthma Control and Communication Instrument was used to measure asthma control, which was reported weekly by parents during a 26-week period. PM2.5 and O3 data were collected from the US Environmental Protection Agency Air Quality System. Pollen data were obtained from Intercontinental Marketing Services Health. Mean air pollutant and pollen exposures within 7 days before the reporting of asthma control were used to estimate weekly exposures for each participant. Linear mixed-effects models were performed to test associations of PM2.5, O3, and pollen exposure with asthma control status. Sensitivity analyses were performed to evaluate the robustness of findings by different exposure monitoring days per week and distances between monitoring sites and participants' residences. Results: Elevated PM2.5 concentration and pollen severity were associated with poorer asthma control status (P < .05), yet elevated O3 concentration was marginally associated with better asthma control (P < .1). Conclusions: Poorer asthma control status was associated with elevated PM2.5 and pollen severity. Reducing harmful outdoor environmental ambient exposure may improve asthma outcomes in children and adolescents.

Environmental Public Health Tracking of Childhood Asthma Using California Health Interview Survey, Traffic, and Outdoor Air Pollution Data

Article

Full-text available

Oct 2008

Despite extensive evidence that air pollution affects childhood asthma, state-level and national-level tracking of asthma outcomes in relation to air pollution is limited. Our goals were to evaluate the feasibility of linking the 2001 California Health Interview Survey (CHIS), air monitoring, and traffic data; estimate associations between traffic density (TD) or outdoor air pollutant concentrations and childhood asthma morbidity; and evaluate the usefulness of such databases, linkages, and analyses to Environmental Public Health Tracking (EPHT). We estimated TD within 500 feet of residential cross-streets of respondents and annual average pollutant concentrations based on monitoring station measurements. We used logistic regression to examine associations with reported asthma symptoms and emergency department (ED) visits/hospitalizations. Assignment of TD and air pollution exposures for cross-streets was successful for 82% of children with asthma in Los Angeles and San Diego, California, Counties. Children with asthma living in high ozone areas and areas with high concentrations of particulate matter < 10 microm in aerodynamic diameter experienced symptoms more frequently, and those living close to heavy traffic reported more ED visits/hospitalizations. The advantages of the CHIS for asthma EPHT include a large and representative sample, biennial data collection, and ascertainment of important socio-demographic and residential address information. Disadvantages are its cross-sectional design, reliance on parental reports of diagnoses and symptoms, and lack of information on some potential confounders. Despite limitations, the CHIS provides a useful framework for examining air pollution and childhood asthma morbidity in support of EPHT, especially because later surveys address some noted gaps. We plan to employ CHIS 2003 and 2005 data and novel exposure assessment methods to re-examine the questions raised here.

Exacerbations of Childhood Asthma and Ozone Pollution in Atlanta

Article

Full-text available

May 1994

Asthma prevalence and mortality due to asthma have been increasing during the last decade, and both the rates and the increases in rates have been higher for blacks than whites and higher for children than adults. Whether environmental factors such as air pollution contribute to these increases is unknown. The purpose of this study was to examine the relationship between emergency visits to a hospital for childhood asthma and exposure to ozone in an indigent, predominantly black population. Data were collected by abstracting clinical records for all children with asthma or reactive airway disease in one public hospital during the summer of 1990. From June 1, 1990, to August 31, 1990, 609 visits were made by children aged 1 to 16 years to an emergency clinic for treatment of asthma or reactive airway disease. Monitoring data indicated that maximum ozone levels equalled or exceeded 0.11 ppm on 6 days during the study period. The average number of visits for asthma or reactive airway disease was 37% higher on the days after those 6 days (from 6:00 PM to 6:00 PM the next day) than on other days (95% CI, RR = 1.02-1.73). The results of the study suggest that among black children from low-income families, asthma may be exacerbated following periods of high ozone pollution.

Long-term ambient air pollution and respiratory symptoms in adults (SAPALDIA Study)

Article

Full-text available

May 1999

The association between long-term exposure to ambient air pollution and respiratory symptoms was investigated in a cross-sectional study in random population samples of adults (aged 18 to 60 yr, n = 9,651) at eight study sites in Switzerland. Information on respiratory symptoms was obtained with an extended version of the European Community Respiratory Health Survey questionnaire. The impact of annual mean concentrations of air pollutants was analyzed separately for never-, former, and current smokers. After controlling for age, body mass index, gender, parental asthma, parental atopy, low education, and foreign citizenship, we found positive associations between annual mean concentrations of NO2, total suspended particulates, and particulates of less than 10 micrometers in aerodynamic diameter (PM10) and reported prevalences of chronic phlegm production, chronic cough or phlegm production, breathlessness at rest during the day, breathlessness during the day or at night, and dyspnea on exertion. We found no associations with wheezing without cold, current asthma, chest tightness, or chronic cough. Among never-smokers, the odds ratio (95% confidence interval) for a 10 micrograms/ m3 increase in the annual mean concentration of PM10 was 1. 35 (1.11 to 1.65) for chronic phlegm production, 1.27 (1.08 to 1.50) for chronic cough or phlegm production, 1.48 (1.23 to 1.78) for breathlessness during the day, 1.33 (1.14 to 1.55) for breathlessness during the day or at night, and 1.32 (1.18 to 1.46) for dyspnea on exertion. No associations were found with annual mean concentrations of O3. Similar associations were also found for former and current smokers, except for chronic phlegm production. The observed associations remained stable when further control was applied for environmental tobacco smoke exposure, past and current occupational exposures, atopy, and early childhood respiratory infections when restricting the analysis to long-term residents and to non- alpine areas, and when excluding subjects with physician-diagnosed asthma. The high correlation between the pollutants makes it difficult to sort out the effect of one single pollutant. This study provides further evidence that long-term exposure to air pollution of rather low levels is associated with higher prevalences of respiratory symptoms in adults.

Impact of Changes in Transportation and Commuting Behaviors During the 1996 Summer Olympic Games in Atlanta on Air Quality and Childhood Asthma

Article

Full-text available

Mar 2001

Vehicle exhaust is a major source of ozone and other air pollutants. Although high ground-level ozone pollution is associated with transient increases in asthma morbidity, the impact of citywide transportation changes on air quality and childhood asthma has not been studied. The alternative transportation strategy implemented during the 1996 Summer Olympic Games in Atlanta, Ga, provided such an opportunity. To describe traffic changes in Atlanta, Ga, during the 1996 Summer Olympic Games and concomitant changes in air quality and childhood asthma events. Ecological study comparing the 17 days of the Olympic Games (July 19-August 4, 1996) to a baseline period consisting of the 4 weeks before and 4 weeks after the Olympic Games. Children aged 1 to 16 years who resided in the 5 central counties of metropolitan Atlanta and whose data were captured in 1 of 4 databases. Citywide acute care visits and hospitalizations for asthma (asthma events) and nonasthma events, concentrations of major air pollutants, meteorological variables, and traffic counts. During the Olympic Games, the number of asthma acute care events decreased 41.6% (4.23 vs 2.47 daily events) in the Georgia Medicaid claims file, 44.1% (1.36 vs 0.76 daily events) in a health maintenance organization database, 11.1% (4.77 vs 4.24 daily events) in 2 pediatric emergency departments, and 19.1% (2.04 vs 1.65 daily hospitalizations) in the Georgia Hospital Discharge Database. The number of nonasthma acute care events in the 4 databases changed -3.1%, +1.3%, -2.1%, and +1.0%, respectively. In multivariate regression analysis, only the reduction in asthma events recorded in the Medicaid database was significant (relative risk, 0.48; 95% confidence interval, 0.44-0.86). Peak daily ozone concentrations decreased 27.9%, from 81.3 ppb during the baseline period to 58.6 ppb during the Olympic Games (P<.001). Peak weekday morning traffic counts dropped 22.5% (P<.001). Traffic counts were significantly correlated with that day's peak ozone concentration (average r = 0.36 for all 4 roads examined). Meteorological conditions during the Olympic Games did not differ substantially from the baseline period. Efforts to reduce downtown traffic congestion in Atlanta during the Olympic Games resulted in decreased traffic density, especially during the critical morning period. This was associated with a prolonged reduction in ozone pollution and significantly lower rates of childhood asthma events. These data provide support for efforts to reduce air pollution and improve health via reductions in motor vehicle traffic.

Concentration and Size Distribution of Ultrafine Particles Near a Major Highway

Article

Full-text available

Sep 2002

Motor vehicle emissions usually constitute the most significant source of ultrafine particles (diameter <0.1 microm) in an urban environment, yet little is known about the concentration and size distribution of ultrafine particles in the vicinity of major highways. In the present study, particle number concentration and size distribution in the size range from 6 to 220 nm were measured by a condensation particle counter (CPC) and a scanning mobility particle sizer (SMPS), respectively. Measurements were taken 30, 60, 90, 150, and 300 m downwind, and 300 m upwind, from Interstate 405 at the Los Angeles National Cemetery. At each sampling location, concentrations of CO, black carbon (BC), and particle mass were also measured by a Dasibi CO monitor, an aethalometer, and a DataRam, respectively. The range of average concentration of CO, BC, total particle number, and mass concentration at 30 m was 1.7-2.2 ppm, 3.4-10.0 microg/m3, 1.3-2.0 x 10(5)/cm3, and 30.2-64.6 microg/m3, respectively. For the conditions of these measurements, relative concentrations of CO, BC, and particle number tracked each other well as distance from the freeway increased. Particle number concentration (6-220 nm) decreased exponentially with downwind distance from the freeway. Data showed that both atmospheric dispersion and coagulation contributed to the rapid decrease in particle number concentration and change in particle size distribution with increasing distance from the freeway. Average traffic flow during the sampling periods was 13,900 vehicles/hr. Ninety-three percent of vehicles were gasoline-powered cars or light trucks. The measured number concentration tracked traffic flow well. Thirty meters downwind from the freeway, three distinct ultrafine modes were observed with geometric mean diameters of 13, 27, and 65 nm. The smallest mode, with a peak concentration of 1.6 x 10(5)/cm3, disappeared at distances greater than 90 m from the freeway. Ultrafine particle number concentration measured 300 m downwind from the freeway was indistinguishable from upwind background concentration. These data may be used to estimate exposure to ultrafine particles in the vicinity of major highways.

National Environmental Public Health Tracking Program: Bridging the Information Gap

Article

Full-text available

Nov 2004

In January 2001 the Pew Environmental Health Commission called for the creation of a coordinated public health system to prevent disease in the United States by tracking and combating environmental health threats. In response, the Centers for Disease Control and Prevention initiated the Environmental Public Health Tracking (EPHT) Program to integrate three distinct components of hazard monitoring and exposure and health effects surveillance into a cohesive tracking network. Uniform and acceptable data standards, easily understood case definitions, and improved communication between health and environmental agencies are just a few of the challenges that must be addressed for this network to be effective. The nascent EPHT program is attempting to respond to these challenges by drawing on a wide range of expertise from federal agencies, state health and environmental agencies, nongovernmental organizations, and the program's academic Centers of Excellence. In this mini-monograph, we present innovative strategies and methods that are being applied to the broad scope of important and complex environmental public health problems by developing EPHT programs. The data resulting from this program can be used to identify areas and populations most likely to be affected by environmental contamination and to provide important information on the health and environmental status of communities. EPHT will develop valuable data on possible associations between the environment and the risk of noninfectious health effects. These data can be used to reduce the burden of adverse health effects on the American public.

Airborne Particles of the California Central Valley Alter the Lungs of Healthy Adult Rats

Article

Full-text available

Jul 2003

Epidemiologic studies have shown that airborne particulate matter (PM) with a mass median aerodynamic diameter < 10 microm (PM10) is associated with an increase in respiratory-related disease. However, there is a growing consensus that particles < 2.5 microm (PM2.5), including many in the ultrafine (< 0.1 microm) size range, may elicit greater adverse effects. PM is a complex mixture of organic and inorganic compounds; however, those components or properties responsible for biologic effects on the respiratory system have yet to be determined. During the fall and winter of 2000-2001, healthy adult Sprague-Dawley rats were exposed in six separate experiments to filtered air or combined fine (PM2.5) and ultrafine portions of ambient PM in Fresno, California, enhanced approximately 20-fold above outdoor levels. The intent of these studies was to determine if concentrated fine/ultrafine fractions of PM are cytotoxic and/or proinflammatory in the lungs of healthy adult rats. Exposures were for 4 hr/day for 3 consecutive days. The mean mass concentration of particles ranged from 190 to 847 microg/m3. PM was enriched primarily with ammonium nitrate, organic and elemental carbon, and metals. Viability of cells recovered by bronchoalveolar lavage (BAL) from rats exposed to concentrated PM was significantly decreased during 4 of 6 weeks, compared with rats exposed to filtered air (p< 0.05). Total numbers of BAL cells were increased during 1 week, and neutrophil numbers were increased during 2 weeks. These observations strongly suggest exposure to enhanced concentrations of ambient fine/ultrafine particles in Fresno is associated with mild, but significant, cellular effects in the lungs of healthy adult rats.

Outdoor air pollution and emergency department visits for asthma among children and adults: A case-crossover study in northern Alberta, Canada

Article

Full-text available

Feb 2007
ENVIRON HEALTH-GLOB

Recent studies have observed positive associations between outdoor air pollution and emergency department (ED) visits for asthma. However, few have examined the possible confounding influence of aeroallergens, or reported findings among very young children. A time stratified case-crossover design was used to examine 57,912 ED asthma visits among individuals two years of age and older in the census metropolitan area of Edmonton, Canada between April 1, 1992 and March 31, 2002. Daily air pollution levels for the entire region were estimated from three fixed-site monitoring stations. Similarly, daily levels of aeroallergens were estimated using rotational impaction sampling methods for the period between 1996 and 2002. Odds ratios and their corresponding 95% confidence intervals were estimated using conditional logistic regression with adjustment for temperature, relative humidity and seasonal epidemics of viral related respiratory disease. Positive associations for asthma visits with outdoor air pollution levels were observed between April and September, but were absent during the remainder of the year. Effects were strongest among young children. Namely, an increase in the interquartile range of the 5-day average for NO2 and CO levels between April and September was associated with a 50% and 48% increase, respectively, in the number of ED visits among children 2 - 4 years of age (p < 0.05). Strong associations were also observed with these pollutants among those 75 years of age and older. Ozone and particulate matter were also associated with asthma visits. Air pollution risk estimates were largely unchanged after adjustment for aeroallergen levels. Our findings, taken together, suggest that exposure to ambient levels of air pollution is an important determinant of ED visits for asthma, particularly among young children and the elderly.

Dispersion of Car Emissions in the Vicinity of a Highway

Chapter

Jan 1988

Emissions from highways are said to contribute to forest damage. Measurements of air quality at highways performed so far were mostly confined to distances close to the lanes. Relatively few is known for the range of several hundred metres away from the lanes, where emissions from the highway are expected to be still predominant. Therefore the state of Lower Saxony and Volkswagen run a joined project to investigate the dispersion of exhaust emissions from a motorway in a rural surrounding. Measurements are performed by the “Fraunhofer-Institut für Toxikologie und Aerosolforschung” in Hannover. NOx, CO, and O3 are continuously monitored at different distances up to 600 m togehter with meteorological data. A single SO2 monitor indicates if pollution from more distant stationary sources occurs. Diurnal variations of excess concentrations of NOx und CO were found to correlate well with traffic density. Measurements at different heights frequently showed the existence of vertical gradients indicating deposition of NO2 and SO2. For Ozone, reduced levels were found on the leeward side of the highway. The applicability of different dispersion models for describing the dispersion of car exhaust emissions and fitting the measured concentrations is discussed.

Comparison of response to an asthma symptom questionnaire (ISACC core question) completed by adolescents and their parents. SCARPOL-Team. Swiss Study on Childhool Allergy and Respiratory Symptoms with Repsect to Air Polluation

Article

Mar 1998
PEDIATR PULM

The primary objective of the study was to determine the impact of the identity of the respondent (parents versus adolescents) on prevalence estimates of asthma symptoms in Swiss adolescents. In addition, factors influencing agreement between parents' and adolescents' responses to the same questions were analysed. One thousand three hundred and seventy-four (78.4%) adolescents, aged 14 years, self-completed a questionnaire at school based on the International Study of Asthma and Allergy in Childhood (ISAAC) core questions on wheezing and asthma. The same questions were incorporated into a questionnaire to be completed by the parents at home. The adolescents' self- reported prevalence rates of current asthma symptoms and 'asthma ever' were significantly higher than those obtained from the parental questionnaires. 856 (62.6%) parental questionnaires were filled in by parents without the help of the adolescents, 460 (37.4%) were completed by parents and adolescents and 51 (3.7%) were completed by the adolescents without the parents. Prevalence rates were higher when parents and adolescents completed the questionnaire jointly than when questionnaires were completed by parents alone. The level of agreement between parental and self-completed questionnaires was moderate to low (kappa coefficients 0.22-0.68). Agreement between parental and adolescents reports of asthma symptoms was best when questionnaires were completed jointly by parents and adolescents, when the adolescent was a girl, when a family history of asthma was recorded, when the adolescent was a non-smoker, and when the parental education was high. We conclude that the higher reporting of prevalence rates of current asthma symptoms by adolescents compared to reporting by their parents demonstrates the need to take the respondent to a questionnaire into account when comparisons are made between prevalence studies. The results also suggest that factors related to the family milieu influence symptom reporting.

Altered pulmonary function in children with asthma associated with highway traffic near residence

Article

May 2009
INT J ENVIRON HEAL R

Cross-sectional analyses were conducted to evaluate the effects of exposure to highway traffic on pulmonary function in Fresno, California. Traffic and spirometry data were available for 214 children (enrollment ages six to 11 years). Multiple linear regression was used to evaluate the relations between pulmonary function and traffic parameters. Heavy-duty vehicle count was used as a surrogate measure for diesel-related exposures. Pulmonary function was non-significantly associated with longer distance-to-road and non-significantly associated with higher traffic intensity. Evaluation of effect modification by FEF(25-75)/FVC (a measure of intrinsic airway size) showed that all pulmonary function measures of flow were significantly inversely related to a traffic metric that incorporates traffic intensity and roadway proximity. The results indicate that residence proximity to highway traffic is associated with lower pulmonary function among children with asthma, and smaller airway size is an important modifier of the effect of traffic exposure on pulmonary function and a marker of increased susceptibility.

Summertime haze air pollution and children with asthma

Article

Mar 1997

In order to investigate associations between summertime haze air pollution and asthma at an individual level, 52, 58, and 56 children (ages 7 to 13) attending a summer "asthma camp" were followed during the last week of June in 1991, 1992, and 1993, respectively. Most of the subjects had moderate to severe asthma. Daily records were kept of the environmental conditions, as well as of subject medication use, lung function, and medical symptoms. Air pollution was found to be significantly and consistently correlated with acute asthma exacerbations, chest symptoms, and lung function decrements. The pollutant most consistently associated with adverse health consequences was ozone (O3), although associations with sulfates and hydrogen ion suggest a possible role by fine particles as well. Effects were found to be roughly monotonic as a function of O3 concentration. Regression of morning (8:00 A.M.) to afternoon (5:00 P.M.) peak flow change on O3 indicated pulmonary function reductions similar to those previously reported for more active children without asthma. Moreover, analyses also indicated an increased risk of an asthma exacerbation and of experiencing chest symptoms of approximately 40% on the highest pollution day, relative to the mean. Based on these relative risk estimates, a rise in the 1-h daily maximal O3 from 84 ppb to 160 ppb was associated in this group with an increase from 20 to 28 (+/- 2) in the expected number of unscheduled medications administered/day, and from 29 to 41 (+/- 3) in the expected total number of chest symptoms/day. Thus, air pollution can be a major contributor to the respiratory problems experienced by children with asthma during the summer months.

Comparison of responses to an asthma symptom questionnaire (ISAAC core questions) completed by adolescents and their parents. SCARPOL-Team. Swiss Study on Childhood Allergy and Respiratory Symptoms with respect to Air Pollution

Article

Apr 1998

The primary objective of the study was to determine the impact of the identity of the respondent (parents versus adolescents) on prevalence estimates of asthma symptoms in Swiss adolescents. In addition, factors influencing agreement between parents' and adolescents' responses to the same questions were analysed. One thousand three hundred and seventy-four (78.4%) adolescents, aged 14 years, self-completed a questionnaire at school based on the International Study of Asthma and Allergy in Childhood (ISAAC) core questions on wheezing and asthma. The same questions were incorporated into a questionnaire to be completed by the parents at home. The adolescents' self-reported prevalence rates of current asthma symptoms and "asthma ever" were significantly higher than those obtained from the parental questionnaires. 856 (62.6%) parental questionnaires were filled in by parents without the help of the adolescents, 460 (37.4%) were completed by parents and adolescents and 51 (3.7%) were completed by the adolescents without the parents. Prevalence rates were higher when parents and adolescents completed the questionnaire jointly than when questionnaires were completed by parents alone. The level of agreement between parental and self-completed questionnaires was moderate to low (kappa coefficients 0.22-0.68). Agreement between parental and adolescents reports of asthma symptoms was best when questionnaires were completed jointly by parents and adolescents, when the adolescent was a girl, when a family history of asthma was recorded, when the adolescent was a non-smoker, and when the parental education was high. We conclude that the higher reporting of prevalence rates of current asthma symptoms by adolescents compared to reporting by their parents demonstrates the need to take the respondent to a questionnaire into account when comparisons are made between prevalence studies. The results also suggest that factors related to the family milieu influence symptom reporting.

Air Pollution and Asthma — Fact or Artifact? A Plea for Inclusion of Objective Measures in Environmental Epidemiology

Article

Jun 1998

Erika von Mutius

Underdiagnosis of asthma: is the doctor or the patient to blame? The DIMCA project

Article

Aug 2000

It is important to diagnose asthma at an early stage as early treatment may improve the prognosis in the long term. However, many patients do not present at an early stage of the condition so the physician may have difficulty with the diagnosis. A study was therefore undertaken to compare the proportion of patients who underpresented their respiratory symptoms with the proportion of underdiagnosed cases of asthma by the general practitioner (GP). A secondary aim was to investigate whether bad perception of dyspnoea by the patient was a determining factor in the underpresentation of asthma symptoms to the GP. A random sample of 1155 adult subjects from the general population in the eastern part of the Netherlands was screened for respiratory symptoms and lung function and the results were compared with the numbers of asthma related consultations registered in the medical files of the GP. In subjects with reduced lung function the ability to perceive dyspnoea was investigated during a histamine provocation test in subjects who did and did not report their symptoms to their GP. Of the random sample of 1155 subjects 86 (7%) had objective airflow obstruction (forced expiratory volume in one second (FEV(1)) below the reference value corrected for age, length, and sex minus 1.64SD on two occasions) and had symptoms suggestive of asthma. Of these 86 subjects only 29 (34%) consulted the GP, which indicates underpresentation by 66% of patients. Of all subjects with objective airflow obstruction who presented to their GP with respiratory symptoms, 23 (79%) were recorded in the medical files as having asthma, indicating underdiagnosis by the GP in 21% of cases. Of the subjects with objective airflow obstruction who visited the GP with respiratory symptoms 6% had bad perception of dyspnoea compared with 26% of those who did not present to the GP in spite of airflow obstruction (chi(2) = 3.02, p = 0.08). Underpresentation to GPs of respiratory symptoms by asthmatic patients contributes significantly to the problem of underdiagnosis of asthma. Underdiagnosis by the GP seems to play a smaller role. Furthermore, there are indications that underpresentation of symptoms by the patient is at least partly explained by a worse perception of dyspnoea.

Air Pollution and Health in Urban Areas

Article

Jan 2000

Dietrich Schwela

In this paper, recent reviews of the World Health Organization, other review papers, and more recent literature on the human health effects of current air pollution trends in urban areas are reviewed and summarized as follows: Sulphur dioxide. Some studies, but not others, found associations between sulphur dioxide (SO2) exposure and daily mortality and morbidity. Single-pollutant correlations sometimes disappeared when other pollutants, especially suspended particulate matter (SPM), were included. Cross-sectional studies with asthmatics revealed significant, non-threshold relations between SO2 and decrements of the forced expiratory volume in 1 second (FEV1). Nitrogen dioxide. Weak associations between short-term nitrogen dioxide (NO2) exposure from gas cooking and respiratory symptoms and a decrement in lung function parameters were found in children, but not consistently in exposed women. With long-term exposure, children, but not adults, exhibit increased respiratory symptoms, decreased lung function, and increased incidences of chronic cough, bronchitis, and conjunctivitis. A causal relationship between NO2 exposure and adverse health effects has not yet been established. Carbon monoxide. Binding of CO in the lungs with hemoglobin in the blood forms carboxyhemoglobin (COHb), which impairs the transport of oxygen. The health effects of CO include hypoxia, neurological deficits and neurobehavioral changes, and increases in daily mortality and hospital admissions for cardiovascular diseases. The latter persists even at very low CO levels, indicating no threshold for the onset of these effects. Whether the relation between daily mortality and exposure to CO are causal or whether CO might act as a proxy for SPM is still an open question. Ambient CO may have even more serious health consequences than does COHb formation and at lower levels than that mediated through elevated COHb levels. Ozone. Short-term acute effects of O3 include pulmonary function decrements, increased airway responsiveness and airway inflammation, aggravation of pre-existing respiratory diseases like asthma, increases in daily hospital admissions and emergency department visits for respiratory causes, and excess mortality. Exposure-response relations are non-linear for the respective associations between O3 and FEV1, inflammatory changes, and changes in hospital admissions, whereas the relation between percent change in symptom exacerbation among adults and asthmatics is linear. Single-pollutant associations between O3 exposure and daily mortality and hospital admissions for respiratory diseases is statistically significant, even in multi-pollutant models. Suspended particulate matter. Associations between SPM concentrations and mortality and morbidity rates are significant. The acute health effects of SPM, even at short-term low levels of exposure, include increased daily mortality and hospital admission rates for exacerbation of respiratory disease, fluctuations in the prevalence of bronchodilator use, and cough and peak flow reductions, as well as long-term effects with respect to mortality and respiratory morbidity. Such effects depend on particle size and concentration and can fluctuate with daily fluctuations in PM10 or PM2.5 levels. The relation between PM10 or PM2.5 exposure and acute health effects is linear at concentrations below 100 micrograms/m3. Currently no threshold has been reported below which no effects occur. The influence of co-polluting gaseous pollutants could explain part of the observed variance in short-term health effects and reduce the contribution of SPM. Lead. The biological effects of lead can be related to blood lead levels, the best indicator of internal exposure. The potential effects of lead in adults and children include encephalopathic signs and symptoms, central nervous system symptoms, cognitive effects, increased blood pressure, and reduced measures of child intelligence. (ABSTRACT TRUNCATED)

Ambient Air Pollution and Respiratory Emergency Department Visits

Article

Apr 2005
EPIDEMIOLOGY

A number of emergency department studies have corroborated findings from mortality and hospital admission studies regarding an association of ambient air pollution and respiratory outcomes. More refined assessment has been limited by study size and available air quality data. Measurements of 5 pollutants (particulate matter [PM10], ozone, nitrogen dioxide [NO2], carbon monoxide [CO], and sulfur dioxide [SO2]) were available for the entire study period (1 January 1993 to 31 August 2000); detailed measurements of particulate matter were available for 25 months. We obtained data on 4 million emergency department visits from 31 hospitals in Atlanta. Visits for asthma, chronic obstructive pulmonary disease, upper respiratory infection, and pneumonia were assessed in relation to air pollutants using Poisson generalized estimating equations. In single-pollutant models examining 3-day moving averages of pollutants (lags 0, 1, and 2): standard deviation increases of ozone, NO2, CO, and PM10 were associated with 1-3% increases in URI visits; a 2 microg/m increase of PM2.5 organic carbon was associated with a 3% increase in pneumonia visits; and standard deviation increases of NO2 and CO were associated with 2-3% increases in chronic obstructive pulmonary disease visits. Positive associations persisted beyond 3 days for several of the outcomes, and over a week for asthma. The results of this study contribute to the evidence of an association of several correlated gaseous and particulate pollutants, including ozone, NO2, CO, PM, and organic carbon, with specific respiratory conditions.

The role of air pollution in asthma and other pediatric morbidities

Article

Apr 2005
J ALLERGY CLIN IMMUN

A growing body of research supports the role of outdoor air pollutants in acutely aggravating chronic diseases in children, and suggests that the pollutants may have a role in the development of these diseases. This article reviews the biologic basis of children's unique vulnerability to highly prevalent outdoor air pollutants, with a special focus on ozone, respirable particulate matter (PM 2.5 [<2.5 microm in diameter] and PM 10 [<10 microm in diameter]), lead, sulfur dioxide, carbon monoxide, and nitrogen oxides. We also summarize understanding regarding health effects and molecular mechanisms of action. Practitioners can significantly reduce morbidity in children and other vulnerable populations by advising families to minimize pollutant exposures to children with asthma, or at a broader level by educating policymakers about the need to act to reduce pollutant emissions. Management of children with asthma must expand beyond preventing exposures to agents that directly cause allergic reactions (and therefore can be diagnosed by means of skin tests) and must focus more attention on agents that cause a broad spectrum of nonspecific, generalized inflammation, such as air pollution.

The relationship of air pollution to ED visits for asthma differ between children and adults

Article

Nov 2006
AM J EMERG MED

The purpose of this study was to evaluate the relationship between air pollution and asthma exacerbation in children and adults. Pearson analysis was used to establish correlations between air pollutants-sulfur dioxide, nitrogen dioxide, ozone, carbon monoxide, and particles with an aerodynamic diameter of 10 microm or less (PM(10))--and ED visits for asthma in 2004. Among children, there were significant positive correlations between nitrogen dioxide (r = 0.72), carbon monoxide (r = 0.65), and PM(10) (r = 0.63) and ED visits for asthma. Among adults, only weakly positive, non significant correlations between all air pollution measures and ED visits for asthma were found. This study suggests that air pollution plays a role in acute exacerbation of asthma in children but not in adults.

The Asthma Epidemic

Article

Dec 2006
NEW ENGL J MED

This review surveys the data on the increase in the prevalence of asthma in recent decades and finds evidence of a plateau in many Western countries. The authors examine the evidence of possible causal relations to factors such as air pollution, obesity, diet, and exposure to infections, antibiotics, and allergens, including exposures at very young ages. The most strongly supported preventive measure is the avoidance of passive and active exposure to smoke.

Traffic and outdoor air pollution levels near residences and poorly controlled asthma in adults

Article

Jun 2007
ANN ALLERG ASTHMA IM

Air pollution may exacerbate asthma. To investigate associations between traffic and outdoor air pollution levels near residences and poorly controlled asthma among adults diagnosed as having asthma in Los Angeles and San Diego counties, California. We estimated traffic density within 500 ft of 2001 California Health Interview Survey respondents' reported residential cross-street intersections. Additionally, we assigned annual average concentrations of ozone, nitrogen dioxide, particulate matter 2.5 and 10 micrometers or less in diameter, and carbon monoxide measured at government monitoring stations within a 5-mile radius of the reported residential cross-street intersections. We observed a 2-fold increase in poorly controlled asthma (odds ratio [OR], 2.11; 95% confidence interval [CI], 1.38-3.23) among asthmatic adults in the highest quintile of traffic density after adjusting for age, sex, race, and poverty. Similar increases were seen for nonelderly adults, men, and women, although associations seemed strongest in elderly adults (OR, 3.00; 95% CI, 1.13-7.91). Ozone exposures were associated with poorly controlled asthma among elderly adults (OR, 1.70; 95% CI, 0.91-3.18 per 1 pphm) and men (OR, 1.76; 95% CI, 1.05-2.94 per 1 pphm), whereas particulate matter 10 micrometers or less seemed to affect primarily women (OR, 2.06; 95% CI, 1.17-3.61), even at levels below the national air quality standard. Heavy traffic and high air pollution levels near residences are associated with poorly controlled asthma.

Characterization of ambient PM10 and PM2.5 in California

Jan 2006

Carb

CARB. Characterization of ambient PM10 and PM2.5 in California. 2005. http://www. arb.ca.gov/pm/pmmeasures/pmch05/sjv05.pdf (accessed 2 Dec 2009).

National environmental public health tracking program: bridging the information gap California Health Interview Survey. CHIS 2001 methodology series: report 2ddata collection methods

Jan 2001

Ma Mcgeehin
Jr
Niskar
As

McGeehin MA, Qualters JR, Niskar AS. National environmental public health tracking program: bridging the information gap. Environ Health Perspect 2004;112:1409e13. 6. CHIS 2001 Methodology. California Health Interview Survey. CHIS 2001 methodology series: report 2ddata collection methods. Los Angeles: UCLA Center for Health Policy Research, 2002.

Characterization of ambient PM 10 and PM2.5 in California

Jan 2001

Phr Velasco

Velasco PHR. Characterization of ambient PM 10 and PM2.5 in California. Technical Report, Air Resources Board 2001.

weekly symptomsy Emergency department/ hospitalisation Ozone (32 yes, 215 no) (29 yes, 221 no) (161 yes, 344 no) (49 yes, 460 no) Continuous (per 10 ppb) 0

222-253

Daily

Daily/weekly symptomsy Emergency department/ hospitalisation Daily/weekly symptomsy Emergency department/ hospitalisation Ozone (32 yes, 215 no) (29 yes, 221 no) (161 yes, 344 no) (49 yes, 460 no) Continuous (per 10 ppb) 0.76 (0.42 to 1.38) 1.63 (0.95 to 2.81) 1.40 (1.02 to 1.91) 1.43 (0.87 to 2.34) PM 10 (36 yes, 222 no) (31 yes, 230 no) (162 yes, 347 no) (48 yes, 465 no)

Department of Health Services, Environmental Health Investigations Branch

Jan 2007

Milet Mt
S Eatherton
M Flattery
J Kreutzer

Milet Mt S, Eatherton M, Flattery J, Kreutzer R. The burden of asthma in California: a surveillance report. Richmond, California: Department of Health Services, Environmental Health Investigations Branch, 2007.

083576 REFERENCES 1. CARB. The California almanac of emissions and air quality

Jan 2004

J Epidemiol Community Health 2010;64:142e147. doi:10.1136/jech.2009.083576 REFERENCES 1. CARB. The California almanac of emissions and air quality. 2003. http://www.arb.ca. gov/aqd/almanac/almanac03/almanac03.htm (accessed 2 Dec 2009).

California Health Interview Survey. CHIS 2001 methodology series: report 2ddata collection methods

Jan 2001
Meth Eur J Res Meth Behav Soc Sci

CHIS 2001 Methodology. California Health Interview Survey. CHIS 2001 methodology series: report 2ddata collection methods. Los Angeles: UCLA Center for Health Policy Research, 2002.

Outdoor air pollution and uncontrolled asthma in the San Joaquin Valley, California

Abstract

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