Epidemiological time series studies of PM2.5 and daily mortality and hospital admissions: a systematic review and meta-analysis

Influence of air quality on the results of in vitro fertilization attempts: A retrospective study

OBJECTIVE

To assess the influence of air quality on the results of IVF.

STUDY DESIGN

We performed a retrospective study on 292 patients who have undergone an IVF attempt from April 2012 to December 2015 in our French university hospital. Patients were included in the study if data on the air quality at home and at work were available and if they haven't been gone for more than 4days in a month. Data were recorded during the 3 months before oocyte collection and 1 month after embryo transfer. Air quality measurements were obtained from the Observatoire Régional de l'Air en Midi-Pyrénées (ORAMIP) and concerned the levels of nitrogen dioxide (NO₂), ozone (O₃), particulate matter PM10 and SO₂ measured every day.

RESULTS

Acute exposures to high levels NO₂ or PM10 were associated with lower results of IVF (ovarian response to stimulation, number of top embryos) while these parameters were enhanced when patients were exposed to high levels of O₃ during the first 2 months of folliculogenesis. These effects were found even for a short exposure (1day).

CONCLUSIONS

Air quality has an impact on global health and also on the reproductive function and public and authorities must be aware of environmental protection.

Major air pollutants and risk of COPD exacerbations: a systematic review and meta-analysis

Background

Short-term exposure to major air pollutants (O₃, CO, NO₂, SO₂, PM₁₀, and PM_2.5) has been associated with respiratory risk. However, evidence on the risk of chronic obstructive pulmonary disease (COPD) exacerbations is still limited. The present study aimed at evaluating the associations between short-term exposure to major air pollutants and the risk of COPD exacerbations.

Methods

After a systematic search up until March 30, 2016, in both English and Chinese electronic databases such as PubMed, EMBASE, and CNKI, the pooled relative risks and 95% confidence intervals were estimated by using the random-effects model. In addition, the population-attributable fractions (PAFs) were also calculated, and a subgroup analysis was conducted. Heterogeneity was assessed by I².

Results

In total, 59 studies were included. In the single-pollutant model, the risks of COPD were calculated by each 10 μg/m³ increase in pollutant concentrations, with the exception of CO (100 μg/m³). There was a significant association between short-term exposure and COPD exacerbation risk for all the gaseous and particulate pollutants. The associations were strongest at lag0 and lag3 for gaseous and particulate air pollutants, respectively. The subgroup analysis not only further confirmed the overall adverse effects but also reduced the heterogeneities obviously. When 100% exposure was assumed, PAFs ranged from 0.60% to 4.31%, depending on the pollutants. The adverse health effects of SO₂ and NO₂ exposure were more significant in low-/middle-income countries than in high-income countries: SO₂, relative risk: 1.012 (95% confidence interval: 1.001, 1.023); and NO₂, relative risk: 1.019 (95% confidence interval: 1.014, 1.024).

Conclusion

Short-term exposure to air pollutants increases the burden of risk of COPD acute exacerbations significantly. Controlling ambient air pollution would provide benefits to COPD patients.

Association between exposure to ambient particulate matter and chronic obstructive pulmonary disease: results from a cross-sectional study in China

Objective

The association between exposure to ambient particles with a median aerodynamic diameter less than 10/2.5 µm (particulate matter, PM₁₀/_2.5) and COPD remains unclear. Our study objective was to examine the association between ambient PM₁₀/_2.5 concentrations and lung functions in adults.

Methods

A cross-sectional study was conducted in southern China. Seven clusters were randomly selected from four cities across Guangdong province. Residents aged ≥20 years in the participating clusters were randomly recruited; all eligible participants were examined with a standardised questionnaire and spirometry. COPD was defined as a post-bronchodilator FEV₁/FVC less than 70%. Atmosphere PM sampling was conducted across the clusters along with our survey.

Results

Of the subjects initially recruited, 84.4% (n=5993) were included for analysis. COPD prevalence and atmosphere PM concentration varied significantly among the seven clusters. COPD prevalence was significantly associated with elevated PM concentration levels: adjusted OR 2.416 (95% CI 1.417 to 4.118) for >35 and ≤75 µg/m³ and 2.530 (1.280 to 5.001) for >75 µg/m³ compared with the level of ≤35 µg/m³ for PM_2.5; adjusted OR 2.442 (95% CI 1.449 to 4.117) for >50 and ≤150 µg/m³ compared with the level of ≤50 µg/m³ for PM₁. A 10 µg/m³ increase in PM_2.5 concentrations was associated with a 26 mL (95% CI −43 to −9) decrease in FEV₁, a 28 mL (−49 to −8) decrease in FVC and a 0.09% decrease (−0.170 to −0.010) in FEV₁/FVC ratio. The associations of COPD with PM₁₀ were consistent with PM_2.5 but slightly weaker.

Conclusions

Exposure to higher PM concentrations was strongly associated with increased COPD prevalence and declined respiratory function.

Trial registration number

ChiCTR-OO-14004264; Post-results.

Mortality and emergency hospitalizations associated with atmospheric particulate matter episodes across the UK in spring 2014

Exposure to particulate air pollution is known to have negative impacts on human health. Long-term exposure to anthropogenic particulate matter is associated with the equivalent of around 29,000 deaths a year in the UK. However, short-lived air pollution episodes on the order of a few days are also associated with increased daily mortality and emergency hospital admissions for respiratory and cardiovascular conditions. The UK experienced widespread high levels of particulate air pollution in March-April 2014; observations of hourly mean PM_2.5 concentrations reached up to 83μgm^-3 at urban background sites. We performed an exposure and health impact assessment of the spring air pollution, focusing on two episodes with the highest concentrations of PM_2.5 (12-14 March and 28 March-3 April 2014). Across these two episodes of elevated air pollution, totalling 10days, around 600 deaths were brought forward from short-term exposure to PM_2.5, representing 3.9% of total all-cause (excluding external) mortality during these days. Using observed levels of PM_2.5 from other years, we estimate that this is 2.0 to 2.7 times the mortality burden associated with typical urban background levels of PM_2.5 at this time of year. Our results highlight the potential public health impacts and may aid planning for health care resources when such an episode is forecast.

Differential health effects of short-term exposure to source-specific particles in London, U.K

BACKGROUND

There is ample evidence of adverse associations between short-term exposure to ambient particle mass concentrations and health but little is known about the relative contribution from various sources.

METHODS

We used air particle composition and number networks in London between 2011 and 2012 to derive six source-related factors for PM₁₀ and four factors for size distributions of ultrafine particles (NSD). We assessed the associations of these factors, at pre-specified lags, with daily total, cardiovascular (CVD) and respiratory mortality and hospitalizations using Poisson regression. Relative risks and 95% confidence intervals (CI) were expressed as percentage change per interquartile range increment in source-factor mass or number concentration. We evaluated the sensitivity of associations to adjustment for multiple other factors and by season.

RESULTS

We found no evidence of associations between PM₁₀ or NSD source-related factors and daily mortality, as the direction of the estimates were variable with 95% CI spanning 0%. Traffic-related PM₁₀ and NSD displayed consistent associations with CVD admissions aged 15-64years (1.01% (95%CI: 0.03%, 2.00%) and 1.04% (95%CI: -0.62%, 2.72%) respectively) as did particles from background urban sources (0.36% for PM₁₀ and 0.81% for NSD). Most sources were positively associated with pediatric (0-14years) respiratory hospitalizations, with stronger evidence for fuel oil PM₁₀ (3.43%, 95%CI: 1.26%, 5.65%). Our results did not suggest associations with cardiovascular admissions in 65+ or respiratory admissions in 15+ age groups. Effect estimates were generally robust to adjustment for other factors and by season.

CONCLUSIONS

Our findings are broadly consistent with the growing evidence of the toxicity of traffic and combustion particles, particularly in relation to respiratory morbidity in children and cardiovascular morbidity in younger adults.

The effects for PM2.5 exposure on non-small-cell lung cancer induced motility and proliferation

Background

Increasing urbanization and associated air pollution, including elevated levels of particulate matter (PM), are strongly correlated with the development of various respiratory diseases. In particular, PM2.5 has been implicated in promoting lung cancer initiation, growth and progression. Cell migration and proliferation are crucial for the progression of cancer. However, the molecular signatures and biological networks representing the distinct and shared features of non-small cell lung cancer (NSCLC) after PM2.5 exposure are unknown.

Results

Functional assays demonstrated higher proliferation, migration and invasion of cancer cells stimulated with PM2.5. To investigate the complicated mechanisms, we performed global transcriptome profiling of the A549 cell line. Particularly, transcriptome sequencing revealed invasive characteristics reminiscent of cancer cells. By comparing the transcriptomes, we identified distinct molecular signatures and cellular processes defining the invasive and proliferative properties of PM2.5-exposed cells, respectively. Interestingly, under the PM2.5-stimulated condition, the A549 and H1299 cells strengthened obviously properties in motility and proliferation. Based on the network model reconstructing the shared protein–protein interactions, we selected the two most up-regulated genes, interleukin-1β (IL1β) and matrix metalloprotease 1 (MMP1), as key regulators responsible for the effects of PM2.5 exposure. Notably, IL1β and MMP1 expression was elevated in independent assays, which was further enhanced by PM2.5.

Conclusion

Taken together, our systems approach to investigating PM2.5 exposure provides a basis to identify key regulators responsible for the pathological features of NSCLC.

Associations among plasma metabolite levels and short-term exposure to PM2.5 and ozone in a cardiac catheterization cohort

RATIONALE

Exposure to ambient particulate matter (PM) and ozone has been associated with cardiovascular disease (CVD). However, the mechanisms linking PM and ozone exposure to CVD remain poorly understood.

OBJECTIVE

This study explored associations between short-term exposures to PM with a diameter <2.5μm (PM_2.5) and ozone with plasma metabolite concentrations.

METHODS AND RESULTS

We used cross-sectional data from a cardiac catheterization cohort at Duke University, North Carolina (NC), USA, accumulated between 2001 and 2007. Amino acids, acylcarnitines, ketones and total non-esterified fatty acid plasma concentrations were determined in fasting samples. Daily concentrations of PM_2.5 and ozone were obtained from a Bayesian space-time hierarchical model, matched to each patient's residential address. Ten metabolites were selected for the analysis based on quality criteria and cluster analysis. Associations between metabolites and PM_2.5 or ozone were analyzed using linear regression models adjusting for long-term trend and seasonality, calendar effects, meteorological parameters, and participant characteristics. We found delayed associations between PM_2.5 or ozone and changes in metabolite levels of the glycine-ornithine-arginine metabolic axis and incomplete fatty acid oxidation associated with mitochondrial dysfunction. The strongest association was seen for an increase of 8.1μg/m³ in PM_2.5 with a lag of one day and decreased mean glycine concentrations (-2.5% [95% confidence interval: -3.8%; -1.2%]).

CONCLUSIONS

Short-term exposures to ambient PM_2.5 and ozone is associated with changes in plasma concentrations of metabolites in a cohort of cardiac catheterization patients. Our findings might help to understand the link between air pollution and cardiovascular disease.

Population exposure to hazardous air quality due to the 2015 fires in Equatorial Asia

Vegetation and peatland fires cause poor air quality and thousands of premature deaths across densely populated regions in Equatorial Asia. Strong El-Niño and positive Indian Ocean Dipole conditions are associated with an increase in the frequency and intensity of wildfires in Indonesia and Borneo, enhancing population exposure to hazardous concentrations of smoke and air pollutants. Here we investigate the impact on air quality and population exposure of wildfires in Equatorial Asia during Fall 2015, which were the largest over the past two decades. We performed high-resolution simulations using the Weather Research and Forecasting model with Chemistry based on a new fire emission product. The model captures the spatio-temporal variability of extreme pollution episodes relative to space- and ground-based observations and allows for identification of pollution sources and transport over Equatorial Asia. We calculate that high particulate matter concentrations from fires during Fall 2015 were responsible for persistent exposure of 69 million people to unhealthy air quality conditions. Short-term exposure to this pollution may have caused 11,880 (6,153-17,270) excess mortalities. Results from this research provide decision-relevant information to policy makers regarding the impact of land use changes and human driven deforestation on fire frequency and population exposure to degraded air quality.

Mortality and emergency room visits associated with ambient particulate matter constituents in metropolitan Taipei

OBJECTIVE

To evaluate the elderly mortality and all population emergency room visits (ERV) associated with exposing to particulate matter (PM) ≤10μm in aerodynamic diameter (PM10), PM2.5, and PM constituents in Taipei, Taiwan.

METHODS

This study used a distributed lag nonlinear model with Poisson distribution to estimate cumulative 6-day (lags 0-5) relative risks (RRs) and confidence intervals (CIs) of mortality and ERV of all causes, circulatory diseases, and respiratory diseases associated with daily concentrations of PM10, PM2.5 and PM constituents (organic carbon (OC), elemental carbon (EC), nitrate and sulfate).

RESULTS

Mortality and ERVs were associated with PM concentrations and its constituents. The elderly all-cause mortality was significantly associated with nitrate concentrations (RR=1.12 (95% CI: 1.02, 1.23) at 1μg/m(3)) and OC higher than 15μg/m(3); and mortality from circulatory diseases was significantly associated with PM10 (RR=1.13 (95% CI: 1.02, 1.25) at 50μg/m(3)), PM2.5 (RR=1.16 (95% CI: 1.01, 1.34) at 30μg/m(3)), nitrate higher than 8μg/m(3), and sulfate (RR=1.31 (95% CI: 1.12, 1.54) at 7μg/m(3)). An increase in PM2.5 from 5μg/m(3) to 30μg/m(3) was associated with increased ERV risk of all causes and respiratory diseases with cumulative 6-day RRs of 1.12 (95% CI: 1.06, 1.18) and 1.27 (95% CI: 1.10, 1.46), respectively. All-cause ERV was significantly associated with concentrations of OC (RR=1.03 (95% CI: 1.00, 1.06) at 4μg/m(3)), EC (RR=1.08 (95% CI: 1.05, 1.12) at 2μg/m(3)), nitrate higher than 6μg/m(3), and sulfate higher than 8μg/m(3).

CONCLUSIONS

Ambient air quality management should regularly evaluate PM constituents and related health effects.

Mortality burden of ambient fine particulate air pollution in six Chinese cities: Results from the Pearl River Delta study

BACKGROUND

Epidemiological studies have reported significant association between ambient fine particulate matter air pollution (PM_2.5) and mortality, however, few studies have investigated the relationship of mortality with PM_2.5 and associated mortality burden in China, especially in a multicity setting.

METHODS

We investigated the PM_2.5-mortality association in six cities of the Pearl River Delta region from 2013 to 2015. We used generalized additive Poisson models incorporating penalized smoothing splines to control for temporal trend, temperature, and relative humidity. We applied meta-analyses using random-effects models to pool the effect estimates in the six cities. We also examined these associations in stratified analyses by sex, age group, education level and location of death. We further estimated the mortality burden (attributable fraction and attributable mortality) due to ambient PM_2.5 exposures.

RESULTS

During the study period, a total of 316,305 deaths were recorded in the study area. The analysis revealed a significant association between PM_2.5 and mortality. Specifically, a 10μg/m³ increase in 4-day averaged (lag₀₃) PM_2.5 concentration corresponded to a 1.76% (95% confidence interval (CI): 1.47%, 2.06%) increase in total mortality, 2.19% (95% CI: 1.80%, 2.59%) in cardiovascular mortality, and 1.68% (95% CI: 1.00%, 2.37%) in respiratory mortality. The results were generally robust to model specifications and adjustment of gaseous air pollutants. We estimated that 0.56% (95% CI: 0.47%, 0.66%) and 3.79% (95% CI: 3.14%, 4.45%) of all-cause mortalities were attributable to PM_2.5 using China's and WHO's air quality standards as the reference, corresponding to 1661 (95% CI: 1379, 1946) and 11,176 (95% CI: 9261, 13,120) attributable premature mortalities, respectively.

CONCLUSION

This analysis adds to the growing body of evidence linking PM_2.5 with daily mortality, and mortality burdens, particularly in one Chinese region with high levels of air pollution.

A review on recent progress in observations, sources, classification and regulations of PM2.5 in Asian environments

Natural and human activities generate a significant amount of PM_2.5 (particles ≤2.5 μm in aerodynamic diameter) into the surrounding atmospheric environments. Because of their small size, they can remain suspended for a relatively longer time in the air than coarse particles and thus can travel long distances in the atmosphere. PM_2.5 is one of the key indicators of pollution and known to cause numerous types of respiratory and lung-related diseases. Due to poor implementation of regulations and a time lag in introducing the vehicle technology, levels of PM_2.5 in most Asian cities are much worse than those in European environments. Dedicated reviews on understanding the characteristics of PM_2.5 in Asian urban environments are currently missing but much needed. In order to fill the existing gaps in the literature, the aim of this review article is to describe dominating sources and their classification, followed by current status and health impact of PM_2.5, in Asian countries. Further objectives include a critical synthesis of the topics such as secondary and tertiary aerosol formation, chemical composition, monitoring and modelling methods, source apportionment, emissions and exposure impacts. The review concludes with the synthesis of regulatory guidelines and future perspectives for PM_2.5 in Asian countries. A critical synthesis of literature suggests a lack of exposure and monitoring studies to inform personal exposure in the household and rural areas of Asian environments.

Effects of long-range transported air pollution from vegetation fires on daily mortality and hospital admissions in the Helsinki metropolitan area, Finland

INTRODUCTION

Fine particulate matter (PM_2.5) emissions from vegetation fires can be transported over long distances and may cause significant air pollution episodes far from the fires. However, epidemiological evidence on health effects of vegetation-fire originated air pollution is limited, particularly for mortality and cardiovascular outcomes.

OBJECTIVE

We examined association between short-term exposure to long-range transported PM_2.5 from vegetation fires and daily mortality due to non-accidental, cardiovascular, and respiratory causes and daily hospital admissions due to cardiovascular and respiratory causes in the Helsinki metropolitan area, Finland.

METHODS

Days significantly affected by smoke from vegetation fires between 2001 and 2010 were identified using air quality measurements at an urban background and a regional background monitoring station, and modelled data on surface concentrations of vegetation-fire smoke. Associations between daily PM_2.5 concentration and health outcomes on i) smoke-affected days and ii) all other days (i.e. non-smoke days) were analysed using Poisson time series regression. All statistical models were adjusted for daily temperature and relative humidity, influenza, pollen, and public holidays.

RESULTS

On smoke-affected days, 10µg/m³ increase in PM_2.5 was associated with a borderline statistically significant increase in cardiovascular mortality among total population at a lag of three days (12.4%, 95% CI -0.2% to 26.5%), and among the elderly (≥65 years) following same-day exposure (13.8%, 95% CI -0.6% to 30.4%) and at a lag of three days (11.8%, 95% CI -2.2% to 27.7%). Smoke day PM_2.5 was not associated with non-accidental mortality or hospital admissions due to cardiovascular causes. However, there was an indication of a positive association with hospital admissions due to respiratory causes among the elderly, and admissions due to chronic obstructive pulmonary disease or asthma among the total population. In contrast, on non-smoke days PM_2.5 was generally not associated with the health outcomes, apart from suggestive small positive effects on non-accidental mortality at a lag of one day among the elderly and hospital admissions due to all respiratory causes following same-day exposure among the total population.

CONCLUSIONS

Our research provides suggestive evidence for an association of exposure to long-range transported PM_2.5 from vegetation fires with increased cardiovascular mortality, and to a lesser extent with increased hospital admissions due to respiratory causes. Hence, vegetation-fire originated air pollution may have adverse effects on public health over a distance of hundreds to thousands of kilometres from the fires.

Lung function reductions associated with motor vehicle density in chronic obstructive pulmonary disease: a cross-sectional study

Background

Motor vehicle-related air pollution can potentially impair lung function. The effect of pollution in people with compromised pulmonary function such as in COPD has not been previously investigated. To examine the association of lung function with motor vehicle density in people with spirometrically determined COPD in a cross-sectional study.

Methods

In 2004–06, The North West Adelaide Health Study (NWAHS), a biomedical cohort of adults assessed pre and post-bronchodilator spirometry (n = 3,103). Traffic density, obtained from the motor vehicle inventory maintained by the South Australian Environment Protection Authority, was expressed as the daily numbers of vehicles travelling within a 200 m diameter zone around participants’ geocoded residences.

Results

In subjects with COPD (FEV₁/FVC <0.7, n = 221, 7.1 %), increasing daily vehicle density was associated with statistically significant decreases in lung function parameters after adjustment for smoking and socio-economic variables. Mean (95 % CI) post-bronchodilator % predicted FEV₁ was 81 % (76–87) in the low (≤7179/day) compared with 71 % (67–75) in the high (≥15,270/day) vehicle exposure group (p < 0.05). Linear regression analysis in all subjects with COPD showed significant decrements in post-bronchodilator FEV₁/FVC ratio and % predicted FEV₁ of 0.03 and 0.05 % respectively per daily increase in 1000 vehicles. In men with COPD (n = 150), the corresponding reductions were 0.03 and 0.06 %. Smaller, non-significant decrements were seen in females. No difference was seen in those without COPD.

Conclusions

Vehicle traffic density was associated with significant reductions in lung function in people with COPD. Urban planning should consider the health impacts for those with pre-existing respiratory conditions.

Electronic supplementary material

The online version of this article (doi:10.1186/s12931-016-0451-3) contains supplementary material, which is available to authorized users.

Effects of air pollution and seasonality on the respiratory symptoms and health-related quality of life (HR-QoL) of outpatients with chronic respiratory disease in Ulaanbaatar: pilot study for the comparison of the cold and warm seasons

Background

This study was performed to investigate the effects of air pollution and seasonality on the respiratory symptoms and health-related quality of life (HR-QoL) of outpatients with respiratory diseases in Ulaanbaatar, Mongolia. Subjects were outpatients who visited the hospital with chronic obstructive pulmonary diseases (COPD) or bronchial asthma (BA) in March. Their symptoms and HR-QoL were evaluated using a questionnaire including the SF-36v2 and COOP/WONCA charts in March, May and July. PM2.5 was sampled in March and July in Ulaanbaatar, and its composition was analyzed.

Results

Patients with COPD or BA showed higher prevalence of respiratory symptoms than the control subjects in each month. For HR-QoL, all subscales worsened in the patients than in the control group in March. Although the HR-QoL of the COPD and control groups were not significantly changed through the surveys, some subscales of the BA group showed remarkable improvement in July as compared to March. Daily means of PM2.5 in March were significantly higher than those in July. Carbon and ionic component concentrations, except for magnesium and calcium ions, were significantly higher in March than July. Mass concentrations of some metallic components were also significantly higher in March than July. The percentage of nitrate ion in PM2.5 was significantly higher in March when compared to that in July.

Conclusions

These results suggested that the symptoms in the COPD and BA groups were caused by the disease, and the association with air pollution or seasonality remained unclear. However, the effects of air pollution and seasonality on the HR-QoL were significant in the patients with BA.

Electronic supplementary material

The online version of this article (doi:10.1186/s40064-016-3481-x) contains supplementary material, which is available to authorized users.

Exposure to metal oxide nanoparticles administered at occupationally relevant doses induces pulmonary effects in mice

In spite of the great promises that the development of nanotechnologies can offer, concerns regarding potential adverse health effects of occupational exposure to nanoparticle (NP) is raised. We recently identified metal oxide NP in lung tissue sections of welders, located inside macrophages infiltrated in fibrous regions. This suggests a role of these NP in the lung alterations observed in welders. We therefore designed a study aimed to investigate the pulmonary effects, in mice, of repeated exposure to NP administered at occupationally relevant doses. We therefore chose four metal oxide NPs representative of those found in the welder's lungs: Fe₂O₃, Fe₃O₄, MnFe₂O₄ and CrOOH. These NPs were administered weekly for up to 3 months at two different doses: 5 μg, chosen as occupationally relevant to welding activity, and 50 μg, chosen as occupationally relevant to the context of an NP-manufacturing facility. Our results show that 3 month-repeated exposures to 5 μg NP induced limited pulmonary effects, characterized by the development of a mild peribronchiolar fibrosis observed for MnFe₂O₄ and CrOOH NP only. This fibrotic event was further extended in terms of intensity and localization after the repeated administration of 50 μg NP: all but Fe₂O₃ NP induced the development of peribronchiolar, perivascular and alveolar fibrosis, together with an interstitial inflammation. Our data demonstrate for the first time a potential risk for respiratory health posed by repeated exposure to NP at occupationally relevant doses. Given these results, the development of occupational exposure limits (OELs) specifically dedicated to NP exposure might therefore be an important issue to address.

Association between fine particulate matter chemical constituents and airway inflammation: A panel study among healthy adults in China

BACKGROUND

Ambient fine particulate matter (PM2.5) air pollution has been associated with increased airway inflammation, but the roles of various PM2.5 constituents remain to be determined.

OBJECTIVES

To investigate the acute effects of PM2.5 constituents on fractional exhaled nitric oxide (FeNO), a well-established biomarker of respiratory inflammation.

METHODS

A longitudinal panel study was performed among 32 healthy young adults in Shanghai, China from January 12th to February 6th, 2015. FeNO was repeatedly measured, 6-8 times per subject. Real-time mass concentration of ambient PM2.5 and chemical constituents were obtained from a nearby monitoring station. Linear mixed-effect models were applied to evaluate the association between FeNO and PM2.5 constituents, with the adjustment of age, gender, body mass index, temperature, relative humidity and day of week. The robustness of constituents' effects was also evaluated.

RESULTS

A total of 234 effective measurements of FeNO were obtained with a geometric mean of 13.1 ppb. The PM2.5-FeNO associations were strongest at lags of 0-6h and diminished at lags longer than 12h. An interquartile range increase in PM2.5 constituents (NH4(+), NO3(-), K(+), SO4(2-) and elemental carbon) at lags of 0-6h were significantly associated with increments in FeNO by 12.3%, 11.3%, 11.1%, 9.6% and 10.7%, respectively. After controlling for PM2.5 total mass and the colinearity, only elemental carbon remained significant.

CONCLUSION

Several chemical constituents of PM2.5 may impact FeNO following acute exposure. Elemental carbon in particular may be the primary component responsible for increased airway inflammation.

Short-term exposure to ambient particulate matter and emergency ambulance dispatch for acute illness in Japan

Short-term exposure to air pollution may be linked to negative health outcomes that require an emergency medical response. However, few studies have been undertaken on this phenomenon to date. The aim of this study therefore was to examine the association between short-term exposure to ambient suspended particulate matter (SPM) and emergency ambulance dispatches (EADs) for acute illness in Japan. Daily EAD data, daily mean SPM and meteorological data were obtained for four prefectures in the Kanto region of Japan for the period from 2007 to 2011. The area-specific association between daily EAD for acute illness and SPM was explored using generalized linear models while controlling for ambient temperature, relative humidity, seasonality, long-term trends, day of the week and public holidays. Stratified analyses were conducted to evaluate the modifying effects of age, sex and medical conditions. Area-specific estimates were combined using meta-analyses. For the total study period the mean level of SPM was 23.7μg/m(3). In general, higher SPM was associated with a significant increase in EAD for acute illness [estimated pooled relative risk (RR): 1.008, 95% CI: 1.007 to 1.010 per 10μg/m(3) increase in SPM at lag 0-1]. The effects of SPM on EAD for acute illness were significantly greater for moderate/mild medical conditions (e.g. cases that resulted in <3weeks hospitalization or no hospitalization) when compared to severe medical conditions (e.g. critical cases, and cases that led to >3weeks hospitalization or which resulted in death). Using EAD data, this study has shown the adverse health effects of ambient air pollution. This highlights the importance of reducing the level of air pollution in order to maintain population health and well-being.

Indoor particulate matter exposure is associated with increased black carbon content in airway macrophages of former smokers with COPD

INTRODUCTION

Exposure to fine particulate matter (PM2.5) is associated with worse morbidity in individuals with COPD. Inhaled PM is phagocytosed by airway macrophages (AM), and black carbon measured in AM may serve as a biomarker of air pollution exposure. As there is little data on how indoor PM exposure may influence AM black carbon content in those with respiratory disease, we investigated the association of indoor PM2.5 concentration to AM black carbon content in adults with COPD.

METHODS

Former smokers (>10 pack-years smoking history, quit date >1 year prior to enrollment) older than 40 years of age with moderate-severe COPD were eligible. Indoor air PM2.5 concentrations were measured over 5-7 days at baseline, 3 month, and 6 month intervals. Sputum induction was performed during clinic visits concordant with home monitoring. A total of 50 macrophages per sputum specimen were photographed and quantified using appropriate software by trained staff blinded to PM concentrations. Longitudinal analyses using generalized estimating equations were used to assess the relationship between indoor PM exposure and AM black carbon content.

RESULTS

Participants (n=20) were older (mean (SD) age 67 (4) years), predominantly Caucasian (85%) and male (70%), with an average smoking history of 52 pack-years and mean (SD) quit date of 13 (9) years prior to enrollment. The majority of daily time was reported to be spent indoors (>23h). Mean indoor PM2.5 concentration was 12.8 (13.5)µg/m(3). The mean area of black carbon quantified in airway macrophages was 1.2 (0.7)µm(2). In multivariate cross-sectional and longitudinal analyses, each 10µg/m(3) increase in indoor PM2.5 was significantly associated with a 0.26µm(2) and 0.19µm(2) increase in airway macrophage black carbon total area, respectively (p<0.05).

CONCLUSION

Higher indoor PM2.5 concentration is associated with an increase in black carbon content of AM in individuals with COPD. These data support the potential for AM black carbon content to be a useful non-invasive biomarker of exposure to indoor PM.

Exposure to coarse particulate matter during gestation and birth weight in the U.S

Few studies have explored the relationship between coarse particles (PM10-2.5) and adverse birth outcomes. We examined associations between gestational exposure of PM10-2.5 and birth weight. U.S. birth certificates data (1999-2007) were acquired for 8,017,865 births. Gestational and trimester exposures of PM10-2.5 were estimated using co-located PM10 and PM2.5 monitors ≤35km from the population-weighted centroid of mothers' residential counties. A linear regression model was applied, adjusted by potential confounders. As sensitivity analyses, we explored alternative PM10-2.5 estimations, adjustment for PM2.5, and stratification by regions. Gestational exposure to PM10-2.5 was associated with 6.6g (95% Confidence Interval: 5.9, 7.2) lower birth weight per interquartile range increase (7.8μg/m(3)) in PM10-2.5 exposures. All three trimesters showed associations. Under different exposure methods for PM10-2.5, associations remained consistent but with different magnitudes. Results were robust after adjusting for PM2.5, and regional analyses showed associations in all four regions with larger estimates in the South. Our results suggest that PM10-2.5 is associated with birth weight in addition to PM2.5. Regional heterogeneity may reflect differences in population, measurement error, region-specific emission pattern, or different chemical composition within PM10-2.5. Most countries do not set health-based standards for PM10-2.5, but our findings indicate potentially important health effects of PM10-2.5.

Effect of the shape of the exposure-response function on estimated hospital costs in a study on non-elective pneumonia hospitalizations related to particulate matter

OBJECTIVE

We used log-linear and log-log exposure-response (E-R) functions to model the association between PM2.5 exposure and non-elective hospitalizations for pneumonia, and estimated the attributable hospital costs by using the effect estimates obtained from both functions.

METHODS

We used hospital discharge data on 3519 non-elective pneumonia admissions from UZ Brussels between 2007 and 2012 and we combined a case-crossover design with distributed lag models. The annual averted pneumonia hospitalization costs for a reduction in PM2.5 exposure from the mean (21.4μg/m(3)) to the WHO guideline for annual mean PM2.5 (10μg/m(3)) were estimated and extrapolated for Belgium.

RESULTS

Non-elective hospitalizations for pneumonia were significantly associated with PM2.5 exposure in both models. Using a log-linear E-R function, the estimated risk reduction for pneumonia hospitalization associated with a decrease in mean PM2.5 exposure to 10μg/m(3) was 4.9%. The corresponding estimate for the log-log model was 10.7%. These estimates translate to an annual pneumonia hospital cost saving in Belgium of €15.5 million and almost €34 million for the log-linear and log-log E-R function, respectively.

DISCUSSION

Although further research is required to assess the shape of the association between PM2.5 exposure and pneumonia hospitalizations, we demonstrated that estimates for health effects and associated costs heavily depend on the assumed E-R function. These results are important for policy making, as supra-linear E-R associations imply that significant health benefits may still be obtained from additional pollution control measures in areas where PM levels have already been reduced.

Respiratory medication sales and urban air pollution in Brussels (2005 to 2011)

BACKGROUND

We investigated the associations between daily sales of respiratory medication and air pollutants in the Brussels-Capital Region between 2005 and 2011.

METHODS

We used over-dispersed Poisson Generalized Linear Models to regress daily individual reimbursement data of prescribed asthma and COPD medication from the social security database against each subject's residential exposure to outdoor particulate matter (PM10) or NO2 estimated, by interpolation from monitoring stations. We calculated cumulative risk ratios (RR) and their 95% confidence intervals (CI) for interquartile ranges (IQR) of exposure for different windows of past exposure for the entire population and for seven age groups.

RESULTS

Median daily concentrations of PM10 and NO2 were 25μg/m(3) (IQR=17.1) and 38μg/m(3) (IQR=20.5), respectively. PM10 was associated with daily medication sales among individuals aged 13 to 64y. For NO2, significant associations were observed among all age groups except >84y. The highest RR were observed for NO2, among adolescents, including three weeks lags (RR=1.187 95%CI: 1.097-1.285).

CONCLUSION

The associations found between temporal changes in exposure to air pollutants and daily sales of respiratory medication in Brussels indicate that urban air pollution contributes to asthma and COPD morbidity in the general population.

Time series analysis of temporal trends in the pertussis incidence in Mainland China from 2005 to 2016

Short-term forecast of pertussis incidence is helpful for advanced warning and planning resource needs for future epidemics. By utilizing the Auto-Regressive Integrated Moving Average (ARIMA) model and Exponential Smoothing (ETS) model as alterative models with R software, this paper analyzed data from Chinese Center for Disease Control and Prevention (China CDC) between January 2005 and June 2016. The ARIMA (0,1,0)(1,1,1)₁₂ model (AICc = 1342.2 BIC = 1350.3) was selected as the best performing ARIMA model and the ETS (M,N,M) model (AICc = 1678.6, BIC = 1715.4) was selected as the best performing ETS model, and the ETS (M,N,M) model with the minimum RMSE was finally selected for in-sample-simulation and out-of-sample forecasting. Descriptive statistics showed that the reported number of pertussis cases by China CDC increased by 66.20% from 2005 (4058 cases) to 2015 (6744 cases). According to Hodrick-Prescott filter, there was an apparent cyclicity and seasonality in the pertussis reports. In out of sample forecasting, the model forecasted a relatively high incidence cases in 2016, which predicates an increasing risk of ongoing pertussis resurgence in the near future. In this regard, the ETS model would be a useful tool in simulating and forecasting the incidence of pertussis, and helping decision makers to take efficient decisions based on the advanced warning of disease incidence.

Distinguishing the associations between daily mortality and hospital admissions and nitrogen dioxide from those of particulate matter: a systematic review and meta-analysis

OBJECTIVES

To quantitatively assess time-series studies of daily nitrogen dioxide (NO2) and mortality and hospital admissions which also controlled for particulate matter (PM) to determine whether or to what extent the NO2 associations are independent of PM.

DESIGN

A systematic review and meta-analysis.

METHODS

Time-series studies-published in peer-reviewed journals worldwide, up to May 2011-that reported both single-pollutant and two-pollutant model estimates for NO2 and PM were ascertained from bibliographic databases (PubMed, EMBASE and Web of Science) and reviews. Random-effects summary estimates were calculated globally and stratified by different geographical regions, and effect modification was investigated.

OUTCOME MEASURES

Mortality and hospital admissions for various cardiovascular or respiratory diseases in different age groups in the general population.

RESULTS

60 eligible studies were identified, and meta-analysis was conducted on 23 outcomes. Two-pollutant model study estimates generally showed that the NO2 associations were independent of PM mass. For all-cause mortality, a 10 µg/m(3) increase in 24-hour NO2 was associated with a 0.78% (95% CI 0.47% to 1.09%) increase in the risk of death, which reduced to 0.60% (0.33% to 0.87%) after control for PM. Heterogeneity between geographical region-specific estimates was removed by control for PM (I(2) from 66.9% to 0%). Estimates of PM and daily mortality assembled from the same studies were greatly attenuated after control for NO2: from 0.51% (0.29% to 0.74%) to 0.18% (-0.11% to 0.47%) per 10 µg/m(3) PM10 and 0.74% (0.34% to 1.14%) to 0.54% (-0.25% to 1.34%) for PM2.5.

CONCLUSIONS

The association between short-term exposure to NO2 and adverse health outcomes is largely independent of PM mass. Further studies should attempt to investigate whether this is a generic PM effect or whether it is modified by the source and physicochemical characteristics of PM. This finding strengthens the argument for NO2 having a causal role in health effects.

Monitoring the effect of air pollution episodes on health care consultations and ambulance call-outs in England during March/April 2014: A retrospective observational analysis

There is an increasing body of evidence illustrating the negative health effects of air pollution including increased risk of respiratory, cardiac and other morbid conditions. During March and April 2014 there were two air pollution episodes in England that occurred in close succession. We used national real-time syndromic surveillance systems, including general practitioner (GP) consultations, emergency department attendances, telehealth calls and ambulance dispatch calls to further understand the impact of these short term acute air pollution periods on the health seeking behaviour of the general public. Each air pollution period was comparable with respect to particulate matter concentrations (PM10 and PM2.5), however, the second period was longer in duration (6 days vs 3 days) and meteorologically driven 'Sahara dust' contributed to the pollution. Health surveillance data revealed a greater impact during the second period, with GP consultations, emergency department attendances and telehealth (NHS 111) calls increasing for asthma, wheeze and difficulty breathing indicators, particularly in patients aged 15-64 years. Across regions of England there was good agreement between air quality levels and health care seeking behaviour. The results further demonstrate the acute impact of short term air pollution episodes on public health and also illustrate the potential role of mass media reporting in escalating health care seeking behaviour.

Short-term exposure to air pollution and morbidity of COPD and asthma in East Asian area: A systematic review and meta-analysis

BACKGROUND

The association between short-term exposure to air pollution and morbidity of COPD and asthma has been observed in many studies. However, there is a lack of systematic review of the overall risk ratios in East Asian area to provide scientific evidence for health risk assessment.

METHODS

A systematic literature retrieval was conducted in December 2014. The results from eligible studies were stratified by pollutants, diseases, types of hospital utilization, and age groups of the subject. For each pollutant-outcome pair, meta-analysis was conducted to calculate the pooled risk ratios (RR) with 95% confidence intervals for every 10μg/m(3) increase in pollutants (1mg/m(3) in CO). We also performed meta-regression to explore the source of heterogeneity and funnel plots to detect publication bias.

RESULTS

Based on results from 26 studies, statistically significant pooled RRs of different pollutants and age groups ranged from 1.007 (SO2 in all ages) to 1.028 (O3 in all ages) for COPD general hospital admissions, 1.011 (SO2 in all ages) to 1.028 (O3 in all ages) for COPD emergency hospital admissions, 1.013 (PM10 in all ages) to 1.141 (CO in children) for all-type asthma hospital utilization, 1.010 (PM10 in all ages) to 1.141 (CO in children) for asthma general hospital admissions, and 1.009 (SO2 in all ages) to 1.040 (NO2 in children) for asthma emergency hospital admissions. The association between air pollution and asthma morbidity was generally stronger in children, but not significant in people aged 15-64.

CONCLUSIONS

Evidence was found that short-term exposure to air pollution was associated with increasing risk of hospital utilization for COPD and asthma in the whole population, the elderly and children, but not in people aged 15-64. Children tended to be more susceptible to the effect of air pollution on asthma morbidity.

Ambient air pollution epidemiology systematic review and meta-analysis: A review of reporting and methods practice

BACKGROUND

Systematic review and meta-analysis (SRMA) are increasingly employed in environmental health (EH) epidemiology and, provided methods and reporting are sound, contribute to translating science evidence to policy. Ambient air pollution (AAP) is both among the leading environmental causes of mortality and morbidity worldwide, and of growing policy relevance due to health co-benefits associated with greenhouse gas emissions reductions.

OBJECTIVES

We reviewed the published AAP SRMA literature (2009 to mid-2015), and evaluated the consistency of methods, reporting and evidence evaluation using a 22-point questionnaire developed from available best-practice consensus guidelines and emerging recommendations for EH. Our goal was to contribute to enhancing the utility of AAP SRMAs to EH policy.

RESULTS AND DISCUSSION

We identified 43 studies that used both SR and MA techniques to examine associations between the AAPs PM2.5, PM10, NO2, SO2, CO and O3, and various health outcomes. On average AAP SRMAs partially or thoroughly addressed 16 of 22 questions (range 10-21), and thoroughly addressed 13 of 22 (range 5-19). We found evidence of an improving trend over the period. However, we observed some weaknesses, particularly infrequent formal reviews of underlying study quality and risk-of-bias that correlated with lower frequency of thorough evaluation for key study quality parameters. Several other areas for enhanced reporting are highlighted.

CONCLUSIONS

The AAP SRMA literature, in particular more recent studies, indicate broad concordance with current and emerging best practice guidance. Development of an EH-specific SRMA consensus statement including a risk-of-bias evaluation tool, would be a contribution to enhanced reliability and robustness as well as policy utility.

Titanium dioxide nanoparticles induce the expression of early and late receptors for adhesion molecules on monocytes

BACKGROUND

There is growing evidence that exposure to titanium dioxide nanoparticles (TiO2 NPs) could be harmful. Previously, we have shown that TiO2 NPs induces endothelial cell dysfunction and damage in glial cells. Considering that inhaled particles can induce systemic effects and the evidence that nanoparticles may translocate out of the lungs, we evaluated whether different types of TiO2 NPs can induce the expression of receptors for adhesion molecules on monocytes (U937 cell line). We evaluated the role of reactive oxygen spices (ROS) on these effects.

METHODS

The expression of receptors for early (sLe(x) and PSGL-1) and late (LFA-1, VLA-4 and αVβ3) adhesion molecules was evaluated in U937 cells on a time course (3-24 h) using a wide range of concentrations (0.001-100 μg/mL) of three types of TiO2 NPs (<25 nm anatase, 50 nm anatase-rutile or < 100 nm anatase). Cells exposed to TNFα were considered positive controls, and unexposed cells, negative controls. In some experiments we added 10 μmolar of N-acetylcysteine (NAC) to evaluate the role of ROS.

RESULTS

All tested particles, starting at a concentration of 0.03 μg/mL, induced the expression of receptors for early and late adhesion molecules. The largest increases were induced by the different molecules after 3 h of exposure for sLe(x) and PSGL-1 (up to 3-fold of the positive controls) and after 18 h of exposure for LFA-1, VLA-4 and αVβ3 (up to 2.5-fold of the positive controls). Oxidative stress was observed as early as 10 min after exposure, but the maximum peak was found after 4 h of exposure. Adhesion of exposed or unexposed monocytes to unexposed or exposed endothelial cells was tested, and we observed that monocytes cells adhere in similar amounts to endothelial cells if one of the two cell types, or both were exposed. When NAC was added, the expression of the receptors was inhibited.

CONCLUSIONS

These results show that small concentrations of particles may activate monocytes that attach to endothelial cells. These results suggest that distal effects can be induced by small amounts of particles that may translocate from the lungs. ROS play a central role in the induction of the expression of these receptors.

The Effect of Seasonal Variations in Airborne Particulate Matter on Asthma-Related Airway Inflammation in Mice

This study aimed to investigate the effects of winter and spring particulate matter (PM) on airway inflammation and allergies in a mouse asthma model. PM was collected during 7–28 February 2013 (winter) and during 7–28 April 2013 (spring) in Yonago, Japan. NC/Nga mice were co-sensitized using intranasal instillation of the PMs and Dermatophagoides farinae (Df) for 5 consecutive days, and were subsequently challenged using intranasal Df at 7 days after the last sensitization. At 24 h after the challenge, serum immunoglobulin levels, differential leukocyte counts, and inflammatory cytokines levels were measured in the mice’s bronchoalveolar lavage fluid (BALF). Compared to co-sensitization using spring PM and Df, winter PM and Df induced greater increases in the BALF neutrophil and eosinophil counts and total serum IgE and IgG2a levels. Furthermore, winter PM-sensitized mice exhibited higher BALF levels of interleukin-5, interleukin-13, interleukin-6, and keratinocyte-derived chemokine. Therefore, we observed seasonal variations in the effects of PM on asthma-related airway inflammation. These findings suggest that the compositions of PM vary according to season, and that it is important to evaluate PM compositions in order to understand the associations between asthma and PM.

The pyrohealth transition: how combustion emissions have shaped health through human history

Air pollution from landscape fires, domestic fires and fossil fuel combustion is recognized as the single most important global environmental risk factor for human mortality and is associated with a global burden of disease almost as large as that of tobacco smoking. The shift from a reliance on biomass to fossil fuels for powering economies, broadly described as the pyric transition, frames key patterns in human fire usage and landscape fire activity. These have produced distinct patters of human exposure to air pollution associated with the Agricultural and Industrial Revolutions and post-industrial the Earth global system-wide changes increasingly known as the Anthropocene. Changes in patterns of human fertility, mortality and morbidity associated with economic development have been previously described in terms of demographic, epidemiological and nutrition transitions, yet these frameworks have not explicitly considered the direct consequences of combustion emissions for human health. To address this gap, we propose a pyrohealth transition and use data from the Global Burden of Disease (GBD) collaboration to compare direct mortality impacts of emissions from landscape fires, domestic fires, fossil fuel combustion and the global epidemic of tobacco smoking. Improving human health and reducing the environmental impacts on the Earth system will require a considerable reduction in biomass and fossil fuel combustion.This article is part of the themed issue 'The interaction of fire and mankind'.

Association of EGF Receptor and NLRs signaling with Cardiac Inflammation and Fibrosis in Mice Exposed to Fine Particulate Matter

ЄAmbient fine particulate matter (PM2.5 ) could induce cardiovascular diseases (CVD), but the mechanism remains unknown. To investigate the roles of epidermal growth factor receptor (EGFR) and NOD-like receptors (NLRs) in PM2.5 -induced cardiac injury, we set up a BALB/c mice model of PM2.5 -induced cardiac inflammation and fibrosis with intratracheal instillation of PM2.5 suspension (4.0 mg/kg b.w.) for 5 consecutive days (once per day). After exposure, we found that mRNA levels of CXCL1, interleukin (IL)-6, and IL-18 were elevated, but interestingly, mRNA level of NLRP12 was significant decreased in heart tissue from PM2.5 -induced mice compared with those of saline-treated mice using real-time PCR. Protein levels of phospho-EGFR (Tyr1068), phospho-Akt (Thr308), NLRP3, NF-κB-p52/p100, and NF-κB-p65 in heart tissue of PM2.5 -exposed mice were all significantly increased using immunohistochemistry or Western blotting. Therefore, PM2.5 exposure could induce cardiac inflammatory injury in mice, which may be involved with EGFR/Akt signaling, NLRP3, and NLRP12.

Acute exposure to fine and coarse particulate matter and infant mortality in Tokyo, Japan (2002-2013)

Few studies have evaluated the effect of short-term exposure to particulate matter (PM) less than 2.5μm in diameter (PM2.5) or to coarse particles on infant mortality. We evaluated the association between short-term exposure to PM and infant mortality in Japan and assessed whether adverse health effects were observable at PM concentrations below Japanese air quality guidelines. We used a time-stratified, case-crossover design. The participants included 2086 infants who died in the 23 urbanized wards of the Tokyo Metropolitan Government between January 2002 and December 2013. We obtained measures of PM2.5 and suspended particulate matter (SPM; PM<7μm in diameter) from one general monitoring station. As a measure of coarse particles, we calculated PM7-2.5 by subtracting PM2.5 from SPM. We then used conditional logistic regression to analyze the data. Same-day PM2.5 was associated with increased risks of infant and postneonatal mortality, especially for mortality related to respiratory causes. For a 10μg/m(3) increase in PM2.5, the odds ratios were 1.06 (95% confidence interval: 1.01-1.12) for infant mortality and 1.10 (1.02-1.19) for postneonatal mortality. PM7-2.5 was also associated with an increased risk of postneonatal mortality, independent of PM2.5. Even when PM2.5 and SPM concentrations were below Japanese air quality guidelines, we observed adverse health effects. This study provides further evidence that acute exposure to PM2.5 and coarse particles (PM7-2.5) is associated with an increased risk of infant mortality. Further, rigorous evaluation of air quality guidelines for daily average PM2.5 and larger particles is needed.

Association between Air Pollution and Hemoptysis

Background. The relationship between air pollution and exacerbation of respiratory diseases is well established. Nevertheless, its association with hemoptysis has been poorly investigated. This paper describes the relationship of air pollutants with severe hemoptysis. Methods. All consecutive subjects with severe hemoptysis during a 5-year period were included. The relationship between the contamination measurements and the frequency of embolizations was analyzed using Poisson regressions. In these regressions, the dependent variable was the monthly number of embolizations in a given month and the independent variable was either the concentration of an air contaminant during the same month, the concentration of the air contaminant during the previous month, or the difference between the two. Results. A higher total number of embolizations per month were observed over the months with increases in the concentration of NO. The number of embolizations was 2.0 in the 33 months with no increases in the concentration of NO, 2.1 in the 12 months with small increases, 2.2 in the 5 months with moderate increases, 2.5 in the 4 months with large increases, and 4.0 in the 5 months with very large increases. Conclusion. There is association between hemoptysis and increases in the concentration of atmospheric NO in Badalona (Spain).

Spatiotemporal patterns of particulate matter (PM) and associations between PM and mortality in Shenzhen, China

Background

Most studies on air pollution exposure and its associations with human health in China have focused on the heavily polluted industrial areas and/or mega-cities, and studies on cities with comparatively low air pollutant concentrations are still rare. Only a few studies have attempted to analyse particulate matter (PM) for the vibrant economic centre Shenzhen in the Pearl River Delta. So far no systematic investigation of PM spatiotemporal patterns in Shenzhen has been undertaken and the understanding of pollution exposure in urban agglomerations with comparatively low pollution is still limited.

Methods

We analyze daily and hourly particulate matter concentrations and all-cause mortality during 2013 in Shenzhen, China. Temporal patterns of PM (PM_2.5 and PM₁₀) with aerodynamic diameters of 2.5 (10) μm or less (or less (including particles with a diameter that equals to 2.5 (10) μm) are studied, along with the ratio of PM_2.5 to PM₁₀. Spatial distributions of PM₁₀ and PM_2.5 are addressed and associations of PM₁₀ or PM_2.5 and all-cause mortality are analyzed.

Results

Annual average PM₁₀ and PM_2.5 concentrations were 61.3 and 39.6 μg/m³ in 2013. PM_2.5 failed to meet the Class 2 annual limit of the National Ambient Air Quality Standard. PM_2.5 was the primary air pollutant, with 8.8 % of days having heavy PM_2.5 pollution. The daily PM_2.5/PM₁₀ ratios were high. Hourly PM_2.5 concentrations in the tourist area were lower than downtown throughout the day. PM₁₀ and PM_2.5 concentrations were higher in western parts of Shenzhen than in eastern parts. Excess risks in the number of all-cause mortality with a 10 μg/m³ increase of PM were 0.61 % (95 % confidence interval [CI]: 0.50–0.72) for PM₁₀, and 0.69 % (95 % CI: 0.55–0.83) for PM_2.5, respectively. The greatest ERs of PM₁₀ and PM_2.5 were in 2-day cumulative measures for the all-cause mortality, 2-day lag for females and the young (0–65 years), and L02 for males and the elder (>65 years). PM_2.5 had higher risks on all-cause mortality than PM₁₀. Effects of high PM pollution on mortality were stronger in the elder and male.

Conclusions

Our findings provide additional relevant information on air quality monitoring and associations of PM and human health, valuable data for further scientific research in Shenzhen and for the on-going discourse on improving environmental policies.

Acute effect of fine particulate matter on mortality in three Southeastern states from 2007-2011

Epidemiologic studies on acute effects of air pollution have generally been limited to larger cities, leaving questions about rural populations behind. Recently, we had developed a spatiotemporal model to predict daily PM2.5 level at a 1 km(2) using satellite aerosol optical depth (AOD) data. Based on the results from the model, we applied a case-crossover study to evaluate the acute effect of PM2.5 on mortality in North Carolina, South Carolina, and Georgia between 2007 and 2011. Mortality data were acquired from the Departments of Public Health in the States and modeled PM2.5 exposures were assigned to the zip code of residence of each decedent. We performed various stratified analyses by age, sex, race, education, cause of death, residence, and environmental protection agency (EPA) standards. We also compared results of analyses using our modeled PM2.5 levels and those imputed daily from the nearest monitoring station. 848,270 non-accidental death records were analyzed and we found each 10 μg/m(3) increase in PM2.5 (mean lag 0 and lag 1) was associated with a 1.56% (1.19 and 1.94) increase in daily deaths. Cardiovascular disease (2.32%, 1.57-3.07) showed the highest effect estimate. Blacks (2.19%, 1.43-2.96) and persons with education ≤ 8 year (3.13%, 2.08-4.19) were the most vulnerable populations. The effect of PM2.5 on mortality still exists in zip code areas that meet the PM2.5 EPA annual standard (2.06%, 1.97-2.15). The effect of PM2.5 below both EPA daily and annual standards was 2.08% (95% confidence interval=1.99-2.17). Our results showed more power and suggested that the PM2.5 effects on rural populations have been underestimated due to selection bias and information bias. We have demonstrated that our AOD-based exposure models can be successfully applied to epidemiologic studies. This will add new study populations in rural areas, and will confer more generalizability to conclusions from such studies.

Short-term exposure to traffic-related air pollution and daily mortality in London, UK

Epidemiological studies have linked daily concentrations of urban air pollution to mortality, but few have investigated specific traffic sources that can inform abatement policies. We assembled a database of >100 daily, measured and modelled pollutant concentrations characterizing air pollution in London between 2011 and 2012. Based on the analyses of temporal patterns and correlations between the metrics, knowledge of local emission sources and reference to the existing literature, we selected, a priori, markers of traffic pollution: oxides of nitrogen (general traffic); elemental and black carbon (EC/BC) (diesel exhaust); carbon monoxide (petrol exhaust); copper (tyre), zinc (brake) and aluminium (mineral dust). Poisson regression accounting for seasonality and meteorology was used to estimate the percentage change in risk of death associated with an interquartile increment of each pollutant. Associations were generally small with confidence intervals that spanned 0% and tended to be negative for cardiovascular mortality and positive for respiratory mortality. The strongest positive associations were for EC and BC adjusted for particle mass and respiratory mortality, 2.66% (95% confidence interval: 0.11, 5.28) and 2.72% (0.09, 5.42) per 0.8 and 1.0 μg/m(3), respectively. These associations were robust to adjustment for other traffic metrics and regional pollutants, suggesting a degree of specificity with respiratory mortality and diesel exhaust containing EC/BC.

Short-term exposure to traffic-related air pollution and daily mortality in London, UK

Epidemiological studies have linked daily concentrations of urban air pollution to mortality, but few have investigated specific traffic sources that can inform abatement policies. We assembled a database of >100 daily, measured and modelled pollutant concentrations characterizing air pollution in London between 2011 and 2012. Based on the analyses of temporal patterns and correlations between the metrics, knowledge of local emission sources and reference to the existing literature, we selected, a priori, markers of traffic pollution: oxides of nitrogen (general traffic); elemental and black carbon (EC/BC) (diesel exhaust); carbon monoxide (petrol exhaust); copper (tyre), zinc (brake) and aluminium (mineral dust). Poisson regression accounting for seasonality and meteorology was used to estimate the percentage change in risk of death associated with an interquartile increment of each pollutant. Associations were generally small with confidence intervals that spanned 0% and tended to be negative for cardiovascular mortality and positive for respiratory mortality. The strongest positive associations were for EC and BC adjusted for particle mass and respiratory mortality, 2.66% (95% confidence interval: 0.11, 5.28) and 2.72% (0.09, 5.42) per 0.8 and 1.0 μg/m(3), respectively. These associations were robust to adjustment for other traffic metrics and regional pollutants, suggesting a degree of specificity with respiratory mortality and diesel exhaust containing EC/BC.

Associations between ultrafine and fine particles and mortality in five central European cities - Results from the UFIREG study

BACKGROUND

Evidence on health effects of ultrafine particles (UFP) is still limited as they are usually not monitored routinely. The few epidemiological studies on UFP and (cause-specific) mortality so far have reported inconsistent results.

OBJECTIVES

The main objective of the UFIREG project was to investigate the short-term associations between UFP and fine particulate matter (PM)<2.5μm (PM2.5) and daily (cause-specific) mortality in five European Cities. We also examined the effects of PM<10μm (PM10) and coarse particles (PM2.5-10).

METHODS

UFP (20-100nm), PM and meteorological data were measured in Dresden and Augsburg (Germany), Prague (Czech Republic), Ljubljana (Slovenia) and Chernivtsi (Ukraine). Daily counts of natural and cardio-respiratory mortality were collected for all five cities. Depending on data availability, the following study periods were chosen: Augsburg and Dresden 2011-2012, Ljubljana and Prague 2012-2013, Chernivtsi 2013-March 2014. The associations between air pollutants and health outcomes were assessed using confounder-adjusted Poisson regression models examining single (lag 0-lag 5) and cumulative lags (lag 0-1, lag 2-5, and lag 0-5). City-specific estimates were pooled using meta-analyses methods.

RESULTS

Results indicated a delayed and prolonged association between UFP and respiratory mortality (9.9% [95%-confidence interval: -6.3%; 28.8%] increase in association with a 6-day average increase of 2750particles/cm(3) (average interquartile range across all cities)). Cardiovascular mortality increased by 3.0% [-2.7%; 9.1%] and 4.1% [0.4%; 8.0%] in association with a 12.4μg/m(3) and 4.7μg/m(3) increase in the PM2.5- and PM2.5-10-averages of lag 2-5.

CONCLUSIONS

We observed positive but not statistically significant associations between prolonged exposures to UFP and respiratory mortality, which were independent of particle mass exposures. Further multi-centre studies are needed investigating several years to produce more precise estimates on health effects of UFP.

Associations of acute exposure to fine and coarse particulate matter and mortality among older people in Tokyo, Japan

Recent studies have reported adverse health effects of short-term exposure to coarse particles independent of particulate matter less than 2.5 μm in diameter (PM2.5), but evidence in Asian countries is limited. We therefore evaluated associations between short-term exposure to particulate matter (PM) and mortality among older people in Tokyo, Japan. We used a time-stratified, case-crossover design. Study participants included 664,509 older people (≥65 years old) in the 23 urbanized wards of the Tokyo Metropolitan Government, who died between January 2002 and December 2013. We obtained PM2.5 and suspended particulate matter (SPM; PM<7 μm in diameter) from one general monitoring station. We calculated PM7-2.5 by subtracting PM2.5 from SPM to account for coarse particles. We then used conditional logistic regression to estimate odds ratios (ORs) and 95 confidence intervals (CIs). Same-day PM2.5 and PM7-2.5 were independently associated with all-cause and cause-specific mortality related to cardiovascular and respiratory diseases; for example, both pollutants were positively associated with increased risk of all-cause mortality even after simultaneous adjustment for each pollutant: OR of 1.006 (95% CI: 1.003, 1.009) for PM2.5 and 1.016 (95% CI: 1.011, 1.022) for PM7-2.5. Even below concentrations stipulated by the Japanese air quality guidelines for PM2.5 and SPM (PM7), we observed adverse health effects. This study provides further evidence that acute exposure to PM2.5 and coarse particles is associated with increased risk of mortality among older people. Rigorous evaluation of air quality guidelines for daily average PM2.5 and larger particles should be continued.

A Two-Stage Method to Estimate the Contribution of Road Traffic to PM₂.₅ Concentrations in Beijing, China

BACKGROUND

Fine particulate matters with aerodynamic diameters smaller than 2.5 micrometers (PM2.5) have been a critical environmental problem in China due to the rapid road vehicle growth in recent years. To date, most methods available to estimate traffic contributions to ambient PM2.5 concentration are often hampered by the need for collecting data on traffic volume, vehicle type and emission profile.

OBJECTIVE

To develop a simplified and indirect method to estimate the contribution of traffic to PM2.5 concentration in Beijing, China.

METHODS

Hourly PM2.5 concentration data, daily meteorological data and geographic information were collected at 35 air quality monitoring (AQM) stations in Beijing between 2013 and 2014. Based on the PM2.5 concentrations of different AQM station types, a two-stage method comprising a dispersion model and generalized additive mixed model (GAMM) was developed to estimate separately the traffic and non-traffic contributions to daily PM2.5 concentration. The geographical trend of PM2.5 concentrations was investigated using generalized linear mixed model. The temporal trend of PM2.5 and non-linear relationship between PM2.5 and meteorological conditions were assessed using GAMM.

RESULTS

The medians of daily PM2.5 concentrations during 2013-2014 at 35 AQM stations in Beijing ranged from 40 to 92 μg/m³. There was a significant increasing trend of PM2.5 concentration from north to south. The contributions of road traffic to daily PM2.5 concentrations ranged from 17.2% to 37.3% with an average 30%. The greatest contribution was found at AQM stations near busy roads. On average, the contribution of road traffic at urban stations was 14% higher than that at rural stations.

CONCLUSIONS

Traffic emissions account for a substantial share of daily total PM2.5 concentrations in Beijing. Our two-stage method is a useful and convenient tool in ecological and epidemiological studies to estimate the traffic contribution to PM2.5 concentrations when there is limited information on vehicle number and types and emission profile.

Short-term Exposure to Ambient Fine Particulate Matter Increases Hospitalizations and Mortality in COPD: A Systematic Review and Meta-analysis

BACKGROUND

Many epidemiologic studies have documented variable relationships between ambient particulate matter (PM) and COPD hospitalizations and mortality in cities worldwide.

METHODS

Comprehensive and systematic searches were performed in the electronic reference databases (PubMed, EMBASE, Google Scholar, Ovid, and Web of Science) with specific search terms and selection criteria for relevant studies. Summary ORs and 95% CIs were calculated to evaluate the relationship between short-term exposure to PM with aerodynamic diameters ≤ 2.5 μm (PM2.5) and COPD hospitalizations and mortality. The sources of heterogeneity and the effect of potential confounders were explored using subgroup analyses. Study findings were analyzed using a random effects model and a fixed effects model in COPD hospitalizations and mortality, respectively.

RESULTS

The search yielded 12 studies suitable for meta-analysis of hospitalizations and six studies suitable for the mortality meta-analysis until April 15, 2015. A 10-μg/m(3) increase in daily PM2.5 (lag days 0-7) was associated with a 3.1% (95% CI, 1.6%-4.6%) increase in COPD hospitalizations and a 2.5% (95% CI, 1.5%-3.5%) increase in COPD mortality. Significant publication bias was not found in studies focusing on the relationship between short-term PM2.5 exposure and COPD hospitalizations and mortality.

CONCLUSIONS

Our combined analysis indicated that short-term exposure to a 10-μg/m(3) increment of ambient PM2.5 is associated with increased COPD hospitalizations and mortality. Further study is needed to elucidate to what extent this relationship is causal, together with other factors, and to elucidate the mechanism by which PM2.5 induces activation of cellular processes promoting COPD exacerbations.

The chronic bronchitis phenotype in chronic obstructive pulmonary disease: features and implications

PURPOSE OF REVIEW

Chronic obstructive pulmonary disease (COPD) is a major public health problem that is projected to rank fifth worldwide in terms of disease burden and third in terms of mortality. Chronic bronchitis is associated with multiple clinical consequences, including hastening lung function decline, increasing risk of exacerbations, reducing health-related quality of life, and possibly raising all-cause mortality. Recent data suggest greater elucidation on the risk factors, radiologic characteristics, and treatment regimens. Our goal was to review the literature on chronic bronchitis that has been published in the past few years.

RECENT FINDINGS

A growing body of literature that more carefully describes environmental risk factors, epidemiology, and genetics associated with chronic bronchitis. In addition, as computed tomography technology continues to improve, the radiologic phenotype associated with chronic bronchitis is better understood.

SUMMARY

With these new data, the clinician can recognize the newly described risk factors and the associated phenotype for chronic bronchitis and entertain new treatment options for this high-risk population.