Assessing the associations of daily respiratory symptoms and lung function in schoolchildren using an Air Quality Index for ozone: Results from the RESPOZE panel study in Athens, Greece

Short-Term Effects of Exposure to Atmospheric Ozone on the Nasal and Respiratory Symptoms in Adolescents

Information regarding the effects of exposure to relatively low ozone (O3) concentrations in daily life is limited. We evaluated the effects of daily O3 exposure on nasal and respiratory symptoms in healthy students. A panel study was conducted with students (39 people) for approximately one month. They were asked to record the presence or absence of any nasal or respiratory symptoms each day. O3 concentrations were continuously measured inside and outside the classrooms, and the maximum 1 h, maximum 8 h average, and 24 h average values were calculated for the 24 h before recording the symptoms. Additionally, personal exposure to O3 was repeatedly measured every 24 h using passive samplers. Mixed-effects models were used to evaluate the association between daily symptoms and various O3 concentrations. Increases in maximum 1 h concentrations of indoor and outdoor O3 were significantly associated with the occurrence of nasal congestion and runny nose, respectively. These associations were more pronounced in those with a history of pollinosis or allergic rhinitis. Personal O3 exposure per 24 h was also associated with sneezing, runny nose, and nasal congestion. This study showed that the assessment of the amount of personal exposure levels is desired to evaluate the health effects of O3 exposure.

Trends of the Global Burden of Disease Linked to Ground-Level Ozone Pollution: A 30-Year Analysis for the Greater Athens Area, Greece

The Greater Athens Area (GAA), situated in the southern part of the European continent (in Greece), has a Mediterranean climate characterized by hot, dry summers and mild, wet winters. As a result of increased sunshine and high temperatures, exceedances in ozone concentrations are often recorded during the hot period. In the present study, the monthly as well as daily variations of O3 concentrations at thirteen stations in the GAA were investigated for the period 1987–2019. Moreover, the impact of O3 on the people’s health in Greece was examined by using data from the Global Burden of Disease (GBD) study with the socio-economic conditions of the country. Ozone concentrations were found to be particularly high during the summer months, especially in suburban stations. Values ranged from 65 μg/m3 to 90 μg/m3 during the night, in contrast to urban areas and remain high for several hours. Comparing estimates from GBD, it was found that exposure to ozone can impair respiratory function, leading to death or susceptibility to respiratory diseases that reduce quality of life, especially for people over 55 years of age. Finally, since 2009, when the economic crisis began in Greece, an upward trend was observed for deaths and disability adjusted life years.

Effects of short-term air pollution exposure on symptoms development in the course of idiopathic pulmonary fibrosis

BACKGROUND

Lately a potential detrimental effect of air pollution to idiopathic pulmonary fibrosis emerged. We aimed to assess the effects of short-term air pollution exposure to the clinical course of IPF.

RESEARCH DESIGN AND METHODS

IPF patients were followed intensively for four nonconsecutive study periods between 13 July 2020 and 5 September 2021. Short-term exposure to O3, NO2 and PM10 concentrations was estimated using spatio-temporal land use regression models. Associations among symptoms, lung function, oxygen saturation, and short-term personal air pollutant exposure were assessed through multiple mixed effects logistic regression models.

RESULTS

Data for up to 24 IPF patients (mean age: 72.2 ± 7.6 years) were analyzed. We detected positive significant associations between cough and a 10 μg/m3 increase in same day mean level of NO2 (OR = 1.59, 95%CI: 1.00-2.53), PM10 (OR = 2.42, 95%CI: 1.54-3.79), and O3 (OR = 1.63, 95%CI: 1.14-2.32). A 10 μg/m3 increase in same day mean level of NO2 was also associated with the risk of appearance of wheezing (OR = 3.01, 95%CI: 1.00-9.04), while exposure to O3 was associated with common cold (OR = 6.30, 95%CI: 3.59-11.07). No significant associations were detected between short-term exposure to air pollutants and forced vital capacity or saturation of oxygen.

CONCLUSIONS

Short-term exposure to increased concentrations of air pollutants is an independent risk factor for IPF symptoms' aggravation.

Association between prenatal exposure to ambient ozone, birth weight, and macrosomia in healthy women

Studies have shown that prenatal ozone exposure is associated with an increased risk of adverse pregnancy outcomes, among which abnormal birth weight is a detrimental factor for diseases in adulthood, but the association between birth weight and ozone is inconclusive. Herein, we conducted this study by enrolling 407 couples of pregnant women and collected their demographical materials, their exposure to ambient ozone was assessed according to the place of their residence. The hourly monitored ozone was first averaged to the daily level, then monthly and whole-gestationally levels. After adjusting confounders, we processed a multivariate generalized addictive analysis to predict the association between prenatal ozone exposure and birth weight. We also divided the cohort into two categories according to whether the infant met the standard of macrosomia, and the occurrence of macrosomia was studied via univariate and multivariate logistic regression analyses as extreme conditions of the effects of ozone exposure on birth weight. We found that the ground-level ozone in Jinan changed with temperature periodically, higher in summer and lower in winter. Over the past 8 years from 2014, the ambient ozone increased by 1.74 μg/m³ per year. Of the 407 singleton-pregnant women, 21 infants were diagnosed with macrosomia. After adjusting confounders, we found that each unit increase in prenatal ozone exposure caused 8.80% [OR_ozone90%CI: 0.912 (0.850, 0.978)] decreased risk of macrosomia, but the splined ambient ozone exposure data was not statistically associated with birth weight, which is probably due to the limited sample size. In conclusion, prenatal ozone exposure is associated with decreased risk of macrosomia but is weakly linked to birth weight.

Impact of acute temperature and air pollution exposures on adult lung function: A panel study of asthmatics

Background

Individuals with respiratory conditions, such as asthma, are particularly susceptible to adverse health effects associated with higher levels of ambient air pollution and temperature. This study evaluates whether hourly levels of fine particulate matter (PM_2.5) and dry bulb globe temperature (DBGT) are associated with the lung function of adult participants with asthma.

Methods and findings

Global positioning system (GPS) location, respiratory function (measured as forced expiratory volume at 1 second (FEV₁)), and self-reports of asthma medication usage and symptoms were collected as part of the Exposure, Location, and Lung Function (ELF) study. Hourly ambient PM_2.5 and DBGT exposures were estimated by integrating air quality and temperature public records with time-activity patterns using GPS coordinates for each participant (n = 35). The relationships between acute PM_2.5, DBGT, rescue bronchodilator use, and lung function collected in one week periods and over two seasons (summer/winter) were analyzed by multivariate regression, using different exposure time frames.

In separate models, increasing levels in PM_2.5, but not DBGT, were associated with rescue bronchodilator use. Conversely DBGT, but not PM_2.5, had a significant association with FEV₁. When DBGT and PM_2.5 exposures were placed in the same model, the strongest association between cumulative PM_2.5 exposures and the use of rescue bronchodilator was identified at the 0–24 hours (OR = 1.030; 95% CI = 1.012–1.049; p-value = 0.001) and 0–48 hours (OR = 1.030; 95% CI = 1.013–1.057; p-value = 0.001) prior to lung function measure. Conversely, DBGT exposure at 0 hours (β = 3.257; SE = 0.879; p-value>0.001) and 0–6 hours (β = 2.885; SE = 0.903; p-value = 0.001) hours before a reading were associated with FEV₁. No significant interactions between DBGT and PM_2.5 were observed for rescue bronchodilator use or FEV₁.

Conclusions

Short-term increases in PM_2.5 were associated with increased rescue bronchodilator use, while DBGT was associated with higher lung function (i.e. FEV₁). Further studies are needed to continue to elucidate the mechanisms of acute exposure to PM_2.5 and DBGT on lung function in asthmatics.

School neighbourhood and compliance with WHO-recommended annual NO2 guideline: A case study of Greater London

Despite several national and local policies towards cleaner air in England, many schools in London breach the WHO-recommended concentrations of air pollutants such as NO₂ and PM_2.5. This is while, previous studies highlight significant adverse health effects of air pollutants on children's health. In this paper we adopted a Bayesian spatial hierarchical model to investigate factors that affect the odds of schools exceeding the WHO-recommended concentration of NO₂ (i.e., 40 μg/m³ annual mean) in Greater London (UK). We considered a host of variables including schools' characteristics as well as their neighbourhoods' attributes from household, socioeconomic, transport-related, land use, built and natural environment characteristics perspectives. The results indicated that transport-related factors including the number of traffic lights and bus stops in the immediate vicinity of schools, and borough-level bus fuel consumption are determinant factors that increase the likelihood of non-compliance with the WHO guideline. In contrast, distance from roads, river transport, and underground stations, vehicle speed (an indicator of traffic congestion), the proportion of borough-level green space, and the area of green space at schools reduce the likelihood of exceeding the WHO recommended concentration of NO₂. We repeated our analysis under a hypothetical scenario in which the recommended concentration of NO₂ is 35 μg/m³ - instead of 40 μg/m³. Our results underscore the importance of adopting clean fuel technologies on buses, installing green barriers, and reducing motorised traffic around schools in reducing exposure to NO₂ concentrations in proximity to schools. Also, our findings highlight the presence of environmental inequalities in the Greater London area. This study would be useful for local authority decision making with the aim of improving air quality for school-aged children in urban settings.

Relationships between Long-Term Ozone Exposure and Allergic Rhinitis and Bronchitic Symptoms in Chinese Children

Numerous studies have demonstrated that exposure to ambient ozone (O₃) could have adverse effects on children's respiratory health. However, previous studies mainly focused on asthma and wheezing. Evidence for allergic rhinitis and bronchitic symptoms (e.g., persistent cough and phlegm) associated with O₃ is limited, and results from existing studies are inconsistent. This study included a total of 59,754 children from the seven northeastern cities study (SNEC), who were aged 2 to 17 years and from 94 kindergarten, elementary and middle schools. Information on doctor-diagnosed allergic rhinitis (AR), persistent cough, and persistent phlegm was collected during 2012-2013 using a standardized questionnaire developed by the American Thoracic Society (ATS). Information for potential confounders was also collected via questionnaire. Individuals' exposure to ambient ozone (O₃) during the four years before the investigation was estimated using a satellite-based random forest model. A higher level of O₃ was significantly associated with increased risk of AR and bronchitic symptoms. After controlling for potential confounders, the OR (95% CI) were 1.13 (1.07-1.18), 1.10 (1.06-1.16), and 1.12 (1.05-1.20) for AR, persistent cough, and persistent phlegm, respectively, associated with each interquartile range (IQR) rise in O₃ concentration. Interaction analyses showed stronger adverse effects of O₃ on AR in children aged 7-17 years than those aged 2-6 years, while the adverse association of O₃ with cough was more prominent in females and children aged 7-12 years than in males and children aged 2-6 and 13-17 years. This study showed that long-term exposure to ambient O₃ was significantly associated with higher risk of AR and bronchitic symptoms in children, and the association varies across age and gender. Our findings contribute additional evidence for the importance of controlling O₃ pollution and protecting children from O₃ exposure.

Ambient exposure of O3 and NO2 and associated health risk in Kuwait

Ozone (O₃) and nitrogen dioxide (NO₂), indissoluble air pollutants in the atmosphere, have been confirmed in various parts of the world to have detrimental health effects on humans. Currently, such information is lacking in Kuwait. The objectives of this study are to investigate the spatial and temporal variations of O₃ and NO₂ concentrations in Kuwait during a 4-year period (2014-2017) and to quantify the associated short- and long-term health effects, including all-cause, respiratory, and cardiovascular mortalities and morbidities during the same study period. Exposure assessment showed that the annual levels (22.5-26.4 ppb), SOMO35, and the 8-hour 4-year mean (38 ppb) of O₃ were very low and below the World Health Organization (WHO) (50 ppb) and Kuwaiti (70 ppb) regulatory limits. The annual mean levels of NO₂ ranged from 30.3 to 43.8 ppb and were significantly higher than both WHO and Kuwait limits (21 ppb). As expected, O₃ and NO₂ levels showed opposing trends, with higher concentrations of NO₂ recorded in early morning and mid-evening, during autumn and winter, and during Saturdays (the so-called weekend effect). Health effects indicated high respiratory diseases due to short-term exposure to NO₂. Contrary to the western countries' pollution levels, Kuwait showed lower O₃ and higher NO₂ levels. There is potential for substantial health improvements in Kuwait by reducing NO₂ pollution through stringent control measures of stationary and mobile sources.

Verification of satellite ozone/temperature profile products and ozone effective height/temperature over Kunming, China

Ozonesonde data from November 2013 to April 2015 over Kunming, China are used to verify ozone and temperature profile retrievals from two spaceborne instruments, the version 4.2 product from the Microwave Limb Sounder (MLS) on the NASA Aura satellite and the version 6.0 product from the Atmospheric Infrared Sounder (AIRS) on the NASA Aqua satellite. We calculated and compared the ozone effective height H_eff and effective temperature T_eff, which are two important parameters in ground-based total ozone retrieval through the use of various profile datasets. This is used to verify the accuracy of the operative values (H_eff(0) = 23 km, T_eff(0) = -46.3 °C (or -45 °C)) from the World Meteorological Organization. The results show that the deviation of MLS and AIRS ozone profiles from ozone sounding data has significant oscillation and scatter in the upper troposphere and lower stratosphere. The average difference of MLS at 82.5 hPa is (80.5 ± 65.1) %, and that of AIRS at 70 and 100 hPa are (105.6 ± 74.9) % and (107.0 ± 67.8) %, respectively. The two satellite temperature profiles have differences within ±3 °C and can effectively describe the vertical distribution and variation of temperature. When calculating the H_eff and T_eff, upper stratospheric data missing from the sounding data must be filled in by the satellite profile data; otherwise the calculated results will show large errors of 3.2 km and 3.3 °C. The H_eff and T_eff at Kunming are respectively 24.36 to 25.51 km and -48.3 to -43.6 °C. The operational H_eff and T_eff used at Kunming ozone observation station clearly do not conform to the actual situation and must be corrected.

The aggravation of urban air quality deterioration due to urbanization, transportation and economic development - Panel models with marginal effect analyses across China

In this paper, panel data models are established to examine the impacts of urban construction, transport facilities, and economic development on the urban air quality. Combined with data from different tiers of Chinese cities for two time series, 2010 and 2015, the variable-intercept model (VIM) is used to determine the parameters and significance of each independent variable. The marginal effects of different categories of independent variables (urbanization, transportation and economy) on the urban air quality are also studied with regard to the results of different VIMs. The results show that transportation factors (such as annual passenger trips, bus numbers and taxi numbers) have the most significant effects on the air quality for all the Chinese cities. Moreover, urbanized area and annual gross value of industrial output also have prominent impacts on the air quality across China. In addition, the marginal effects of the air quality index obtained via VIMs with classified local variables reflect that the influences of urbanization, transportation and economy on urban air quality are substantially different among different tiers of cities. Therefore, based on the findings, we propose measures to improve air quality for different tiers of cities, such as rational use of space resources, optimizing transport modes, and encouraging carpooling.

Development of a Conjunctivitis Outpatient Rate Prediction Model Incorporating Ambient Ozone and Meteorological Factors in South Korea

Ozone (O₃) is a commonly known air pollutant that causes adverse health effects. This study developed a multi-level prediction model for conjunctivitis in outpatients due to exposure to O₃ by using 3 years of ambient O₃ data, meteorological data, and hospital data in Seoul, South Korea. We confirmed that the rate of conjunctivitis in outpatients (conjunctivitis outpatient rate) was highly correlated with O₃ (R² = 0.49), temperature (R² = 0.72), and relative humidity (R² = 0.29). A multi-level regression model for the conjunctivitis outpatient rate was well-developed, on the basis of sex and age, by adding statistical factors. This model will contribute to the prediction of conjunctivitis outpatient rate for each sex and age, using O₃ and meteorological data.