Towards a multidisciplinary and integrated strategy in the assessment of adverse health effects related to air pollution: the case study of Cracow (Poland) and asthma

Nasal Septal Deviation and Concha Bullosa - Do They Have an Impact on Maxillary Sinus Volumes and Prevalence of Maxillary Sinusitis?

Background

The aim of the study was to assess if the presence of nasal septal deviation and concha bullosa is connected with the development of sinuses and the incidence of inflammation within them.

Material/Methods

We retrospectively analysed 214 patients who underwent paranasal sinus computed tomography. There were 125 females and 89 males, the mean age being 47.67±16.74 years (range 18–97). Exclusion criteria included: age under 18 years, prior sinonasal surgery and S-shaped septum.

Results

Mean volume of the right maxillary sinus was 17.794 cm³, while for the left one it was 17.713 cm³. Nasal septal deviation was found in 79.9% of computed tomography examinations and concha bullosa was observed in 42.1% of the patients’ examinations. There was an association between the presence of unilateral or dominant concha bullosa and contralateral direction of septal deviation [right-sided (p=0.039), left-sided (p=0.003)]. There was higher incidence of bilateral maxillary sinusitis in patients with septal deviation (p=0.007). Bilateral concha bullosa did not influence the incidence of bilateral maxillary sinusitis (p=0.495). Neither septal deviation (right sided: p=0.962; left-sided: p=0.731), nor unilateral/dominant concha bullosa (right: p=0.512; left: p=0,430) affected the asymmetry in volumes of maxillary sinuses. Bilateral concha bullosa was connected with larger volume of maxillary sinuses (right sinus: p=0.005; left sinus: p=0.048).

Conclusions

Nasal septal deviation, contrary to concha bullosa, has influence on the development of maxillary sinusitis. There is a connection between the presence of concha bullosa and direction of septal deviation. Only bilateral concha bullosa affects maxillary sinus volumes.

Approaches to integrated monitoring for environmental health impact assessment

Although Integrated Environmental Health Monitoring (IEHM) is considered an essential tool to better understand complex environmental health issues, there is no consensus on how to develop such a programme. We reviewed four existing frameworks and eight monitoring programmes in the area of environmental health. We identified the DPSEEA (Driving Force-Pressure-State-Exposure-Effect-Action) framework as most suitable for developing an IEHM programme for environmental health impact assessment. Our review showed that most of the existing monitoring programmes have been designed for specific purposes, resulting in narrow scope and limited number of parameters. This therefore limits their relevance for studying complex environmental health topics. Other challenges include limited spatial and temporal data availability, limited development of data sharing mechanisms, heterogeneous data quality, a lack of adequate methodologies to link disparate data sources, and low level of interdisciplinary cooperation. To overcome some of these challenges, we propose a DPSEEA-based conceptual framework for an IEHM programme that would enable monitoring and measuring the impact of environmental changes on human health. We define IEHM as 'a systemic process to measure, analyse and interpret the state and changes of natural-eco-anthropogenic systems and its related health impact over time at the same location with causative explanations across the various compartments of the cause-effect chain'. We develop a structural work process to integrate information that is based on existing environmental health monitoring programmes. Such a framework allows the development of combined monitoring systems that exhibit a large degree of compatibility between countries and regions.

Assessment of ambient air quality in Eskişehir, Turkey

This paper presents an assessment of air quality of the city Eskişehir, located 230 km southwest to the capital of Turkey. Only five of the major air pollutants, most studied worldwide and available for the region, were considered for the assessment. Available sulphur dioxide (SO(2)), particulate matter (PM), nitrogen dioxide (NO(2)), ozone (O(3)), and non-methane volatile organic carbons (NMVOCs) data from local emission inventory studies provided relative source contributions of the selected pollutants to the region. The contributions of these typical pollution parameters, selected for characterizing such an urban atmosphere, were compared with the data established for other cities in the nation and world countries. Additionally, regional ambient SO(2) and PM concentrations, determined by semi-automatic monitoring at two sites, were gathered from the National Ambient Air Monitoring Network (NAAMN). Regional data for ambient NO(2) (as a precursor of ozone as VOCs) and ozone concentrations, through the application of the passive sampling method, were provided by the still ongoing local air quality monitoring studies conducted at six different sites, as representatives of either the traffic-dense-, or coal/natural gas burning residential-, or industrial/rural-localities of the city. Passively sampled ozone data at a single rural site were also verified with the data from a continuous automatic ozone monitoring system located at that site. Effects of variations in seasonal-activities, newly established railway system, and switching to natural gas usage on the temporal changes of air quality were all considered for the assessment. Based on the comparisons with the national [AQCR (Air Quality Control Regulation). Ministry of Environment (MOE), Ankara. Official Newspaper 19269; 1986.] and a number of international [WHO (World Health Organization). Guidelines for Air Quality. Geneva; 2000. Downloaded in January 2006, website: http://www.who.int/peh/; EU (European Union). Council Directive 1999/30/EC relating to limit values for sulfur dioxide, nitrogen dioxide and lead in ambient air. Of J Eur Communities L 163: 14-30; 29.6.1999; EU (European Union). Council Directive 2002/3/EC relating to ozone in ambient air. Of J Eur Communities. L 67: 14-30; 9.3.2002.; USEPA (U.S. Environmental Protection Agency). National Ambient Air Quality Standards (NAAQS). Downloaded in January 2006, website: http://www.epa.gov/ttn/naaqs/] ambient air standards, among all the pollutants studied, only the annual average SO(2) concentration was found to exceed one specific limit value (EU limit for protection of the ecosystem). A part of the data (VOC/NO(x) ratio), for determining the effects of photochemical interactions, indicated that VOC-limited regime was prevailing throughout the city.

Asthma and air quality

PURPOSE OF REVIEW

There is evidence for an association between asthma and air pollutants, including ozone, NO2 and particulate matter. Since these pollutants are ubiquitous in the urban atmosphere and typically correlated with each other it has been difficult to ascertain the specific sources of air pollution responsible for the observed effects. Similarly, uncertainty in determining a causal agent, or multiple agents, has complicated efforts to identify the mechanisms involved in pollution-mediated asthma events and whether air pollution may cause asthma as well as exacerbate preexisting cases.

RECENT FINDINGS

Numerous studies have examined specific sources of air pollution and their relationship to asthma. This review summarizes recent work conducted, specifically, on traffic pollution and presents results that elucidate several plausible biological mechanisms for the observed effects. Of note are studies linking susceptibility to several genetic polymorphisms. Together, these studies suggest that remaining uncertainties in the asthma-air pollution association may be addressed through enhanced assessment of both exposures and outcomes.

SUMMARY

Air-pollution research is evolving rapidly; in the near future, clinicians and public health agencies may be able to use this new information to provide recommendations for asthmatics that go beyond only paying attention to the air-pollution forecast.