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Suzukawa M, Ohta K, Sugimoto M, Ohshima N, Kobayashi N, Tashimo H, Tanimoto Y, Itano J, Kimura G, Takata S, Nakano T, Yamashita T, Ikegame S, Hyodo K, Abe M, Chibana K, Kamide Y, Sasaki K, Hashimoto H. Identification of exhaled volatile organic compounds that characterize asthma phenotypes: A J-VOCSA study. Allergol Int 2024:S1323-8930(24)00047-9. [PMID: 38658257 DOI: 10.1016/j.alit.2024.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 03/23/2024] [Accepted: 04/03/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Asthma is characterized by phenotypes of different clinical, demographic, and pathological characteristics. Identifying the profile of exhaled volatile organic compounds (VOCs) in asthma phenotypes may facilitate establishing biomarkers and understanding asthma background pathogenesis. This study aimed to identify exhaled VOCs that characterize severe asthma phenotypes among patients with asthma. METHODS This was a multicenter cross-sectional study of patients with severe asthma in Japan. Clinical data were obtained from medical records, and questionnaires were collected. Exhaled breath was sampled and subjected to thermal desorption gas chromatography-mass spectrometry (GC/MS). RESULTS Using the decision tree established in the previous nationwide asthma cohort study, 245 patients with asthma were divided into five phenotypes and subjected to exhaled VOC analysis with 50 healthy controls (HCs). GC/MS detected 243 VOCs in exhaled breath samples, and 142 frequently detected VOCs (50% of all samples) were used for statistical analyses. Cluster analysis assigning the groups with similar VOC profile patterns showed the highest similarities between phenotypes 3 and 4 (early-onset asthma phenotypes), followed by the similarities between phenotypes 1 and 2 (late-onset asthma phenotypes). Comparisons between phenotypes 1-5 and HC revealed 19 VOCs, in which only methanesulfonic anhydride showed p < 0.05 adjusted by false discovery rate (FDR). Comparison of these phenotypes yielded several VOCs showing different trends (p < 0.05); however, no VOCs showed p < 0.05 adjusted by FDR. CONCLUSIONS Exhaled VOC profiles may be useful for distinguishing asthma and asthma phenotypes; however, these findings need to be validated, and their pathological roles should be clarified.
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Affiliation(s)
- Maho Suzukawa
- Clinical Research Center, National Hospital Organization Tokyo National Hospital, Tokyo, Japan.
| | - Ken Ohta
- Clinical Research Center, National Hospital Organization Tokyo National Hospital, Tokyo, Japan; Japan Anti-Tuberculosis Association, JATA Fukujuji Hospital, Tokyo, Japan.
| | - Masahiro Sugimoto
- Institute for Advanced Biosciences, Keio University, Yamagata, Japan; Human Metabolome Technologies, Inc., Yamagata, Japan
| | - Nobuharu Ohshima
- Clinical Research Center, National Hospital Organization Tokyo National Hospital, Tokyo, Japan
| | - Nobuyuki Kobayashi
- Clinical Research Center, National Hospital Organization Tokyo National Hospital, Tokyo, Japan
| | - Hiroyuki Tashimo
- Clinical Research Center, National Hospital Organization Tokyo National Hospital, Tokyo, Japan
| | - Yasushi Tanimoto
- National Hospital Organization Minami-Okayama Medical Center, Okayama, Japan
| | - Junko Itano
- National Hospital Organization Minami-Okayama Medical Center, Okayama, Japan
| | - Goro Kimura
- National Hospital Organization Minami-Okayama Medical Center, Okayama, Japan
| | - Shohei Takata
- National Hospital Organization Fukuokahigashi Medical Center, Fukuoka, Japan
| | - Takako Nakano
- National Hospital Organization Fukuokahigashi Medical Center, Fukuoka, Japan
| | - Takafumi Yamashita
- National Hospital Organization Fukuokahigashi Medical Center, Fukuoka, Japan
| | - Satoshi Ikegame
- National Hospital Organization Fukuokahigashi Medical Center, Fukuoka, Japan
| | - Kentaro Hyodo
- National Hospital Organization Ibarakihigashi National Hospital, Ibaraki, Japan
| | - Masahiro Abe
- National Hospital Organization Ehime Medical Center, Ehime, Japan
| | - Kenji Chibana
- National Hospital Organization Okinawa National Hospital, Okinawa, Japan
| | - Yosuke Kamide
- National Hospital Organization Sagamihara National Hospital, Kanagawa, Japan
| | - Kazunori Sasaki
- Institute for Advanced Biosciences, Keio University, Yamagata, Japan; Human Metabolome Technologies, Inc., Yamagata, Japan
| | - Hiroya Hashimoto
- National Hospital Organization Nagoya Medical Center, Nagoya, Japan
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2
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Marks GB. "Safe air" to breathe: Time for action? Respirology 2023; 28:210-211. [PMID: 36750441 DOI: 10.1111/resp.14469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 01/30/2023] [Indexed: 02/09/2023]
Affiliation(s)
- Guy B Marks
- South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia
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3
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Altman MC, Kattan M, O'Connor GT, Murphy RC, Whalen E, LeBeau P, Calatroni A, Gill MA, Gruchalla RS, Liu AH, Lovinsky-Desir S, Pongracic JA, Kercsmar CM, Khurana Hershey GK, Zoratti EM, Teach SJ, Bacharier LB, Wheatley LM, Sigelman SM, Gergen PJ, Togias A, Busse WW, Gern JE, Jackson DJ. Associations between outdoor air pollutants and non-viral asthma exacerbations and airway inflammatory responses in children and adolescents living in urban areas in the USA: a retrospective secondary analysis. Lancet Planet Health 2023; 7:e33-e44. [PMID: 36608946 PMCID: PMC9984226 DOI: 10.1016/s2542-5196(22)00302-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 10/10/2022] [Accepted: 10/27/2022] [Indexed: 05/25/2023]
Abstract
BACKGROUND Asthma prevalence and severity have markedly increased with urbanisation, and children in low-income urban centres have among the greatest asthma morbidity. Outdoor air pollution has been associated with adverse respiratory effects in children with asthma. However, the mechanisms by which air pollution exposure exacerbates asthma, and how these mechanisms compare with exacerbations induced by respiratory viruses, are poorly understood. We aimed to investigate the associations between regional air pollutant concentrations, respiratory illnesses, lung function, and upper airway transcriptional signatures in children with asthma, with particular focus on asthma exacerbations occurring in the absence of respiratory virus. METHODS We performed a retrospective analysis of data from the MUPPITS1 cohort and validated our findings in the ICATA cohort. The MUPPITS1 cohort recruited 208 children aged 6-17 years living in urban areas across nine US cities with exacerbation-prone asthma between Oct 7, 2015, and Oct 18, 2016, and monitored them during reported respiratory illnesses. The last MUPPITS1 study visit occurred on Jan 6, 2017. The ICATA cohort recruited 419 participants aged 6-20 years with persistent allergic asthma living in urban sites across eight US cities between Oct 23, 2006, and March 25, 2008, and the last study visit occurred on Dec 30, 2009. We included participants from the MUPPITS1 cohort who reported a respiratory illness at some point during the follow-up and participants from the ICATA cohort who had nasal samples collected during respiratory illness or at a scheduled visit. We used air quality index values and air pollutant concentrations for PM2·5, PM10, O3, NO2, SO2, CO, and Pb from the US Environmental Protection Agency spanning the years of both cohorts, and matched values and concentrations to each illness for each participant. We investigated the associations between regional air pollutant concentrations and respiratory illnesses and asthma exacerbations, pulmonary function, and upper airway transcriptional signatures by use of a combination of generalised additive models, case crossover analyses, and generalised linear mixed-effects models. FINDINGS Of the 208 participants from the MUPPITS1 cohort and 419 participants from the ICATA cohort, 168 participants in the MUPPITS1 cohort (98 male participants and 70 female participants) and 189 participants in the ICATA cohort (115 male participants and 74 female participants) were included in our analysis. We identified that increased air quality index values, driven predominantly by increased PM2·5 and O3 concentrations, were significantly associated with asthma exacerbations and decreases in pulmonary function that occurred in the absence of a provoking viral infection. Moreover, individual pollutants were significantly associated with altered gene expression in coordinated inflammatory pathways, including PM2·5 with increased epithelial induction of tissue kallikreins, mucus hypersecretion, and barrier functions and O3 with increased type-2 inflammation. INTERPRETATION Our findings suggest that air pollution is an important independent risk factor for asthma exacerbations in children living in urban areas and is potentially linked to exacerbations through specific inflammatory pathways in the airway. Further investigation of these potential mechanistic pathways could inform asthma prevention and management approaches. FUNDING National Institutes of Health, National Institute of Allergy and Infectious Diseases.
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Affiliation(s)
- Matthew C Altman
- Department of Medicine, University of Washington, Seattle, WA, USA; Systems Immunology Division, Benaroya Research Institute, Seattle, WA, USA.
| | | | - George T O'Connor
- Department of Medicine, Boston University School of Medicine, Boston University, Boston, MA, USA
| | - Ryan C Murphy
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Elizabeth Whalen
- Systems Immunology Division, Benaroya Research Institute, Seattle, WA, USA
| | | | | | | | | | - Andrew H Liu
- Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA
| | | | | | | | | | | | | | - Leonard B Bacharier
- Division of Allergy, Immunology, and Pulmonary Medicine, Washington University, Saint Louis, MO, USA
| | | | | | | | | | - William W Busse
- University of Wisconsin School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - James E Gern
- University of Wisconsin School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Daniel J Jackson
- University of Wisconsin School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
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Lu C, Liu Z, Yang W, Liao H, Liu Q, Li Q, Deng Q. Early life exposure to outdoor air pollution and indoor environmental factors on the development of childhood allergy from early symptoms to diseases. ENVIRONMENTAL RESEARCH 2023; 216:114538. [PMID: 36252839 DOI: 10.1016/j.envres.2022.114538] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 10/05/2022] [Accepted: 10/06/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND The prevalence of childhood allergies has increased during past decades leading to serious hospitalization and heavy burden worldwide, yet the key factors responsible for the onset of early symptoms and development of diagnosed diseases are unclear. OBJECTIVE To explore the role of early life exposure to ambient air pollution and indoor environmental factors on early allergic symptoms and doctor diagnosed allergic diseases. METHODS A retrospective cohort study of 2598 preschool children was conducted at 36 kindergartens in Changsha, China from September of 2011 to February of 2012. A questionnaire was developed to survey each child's early onset of allergic symptoms (wheeze and rhinitis-like symptoms) and doctor diagnosis of allergic diseases (asthma and rhinitis) as well as home environments. Each mother's and child's exposures to ambient air pollutants (PM10, SO2, and NO2) and temperature were estimated for in utero and postnatal periods. The associations of early symptoms and diagnosed diseases with outdoor air pollution and indoor environmental variables were examined by logistic regression models. RESULTS Childhood early allergic symptoms (33.9%) including wheeze (14.7%) and rhinitis-like symptoms (25.4%) before 2 years old were not associated with outdoor air pollution exposure but was significantly associated with maternal exposure of window condensation at home in pregnancy with ORs (95% CI) of 1.33 (1.11-1.59), 1.30 (1.01-1.67) and 1.27 (1.04-1.55) respectively, and was associated with new furniture during first year after birth with OR (95% CI) of 1.43 (1.02-2.02) for early wheeze. Childhood diagnosed allergic diseases (28.4%) containing asthma (6.7%) and allergic rhinitis (AR) (7.2%) were significantly associated with both outdoor air pollutants (mainly for SO2 and NO2) during first 3 years and indoor new furniture, redecoration, and window condensation. We found that sex, age, parental atopy, maternal productive age, environmental tobacco smoke (ETS), antibiotics use, economic stress, early and late introduction of complementary foods, and outdoor air pollution modified the effects of home environmental exposure in early life on early allergic symptoms and diagnosed allergic diseases. CONCLUSION Our study indicates that early life exposure to indoor environmental factors plays a key role in early onset of allergic symptoms in children, and further exposure to ambient air pollution and indoor environmental factors contribute to the later development of asthma and allergic rhinitis.
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Affiliation(s)
- Chan Lu
- XiangYa School of Public Health, Central South University, Changsha, 410078, Hunan, China.
| | - Zijing Liu
- XiangYa School of Public Health, Central South University, Changsha, 410078, Hunan, China.
| | - Wenhui Yang
- XiangYa School of Public Health, Central South University, Changsha, 410078, Hunan, China.
| | - Hongsen Liao
- XiangYa School of Public Health, Central South University, Changsha, 410078, Hunan, China.
| | - Qin Liu
- XiangYa School of Public Health, Central South University, Changsha, 410078, Hunan, China.
| | - Qin Li
- XiangYa School of Public Health, Central South University, Changsha, 410078, Hunan, China.
| | - Qihong Deng
- School of Public Health, Zhengzhou University, Zhengzhou, 450001, Henan, China.
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5
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Lu C, Liu Z, Liao H, Yang W, Li Q, Liu Q. Effects of early life exposure to home environmental factors on childhood allergic rhinitis: Modifications by outdoor air pollution and temperature. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2022; 244:114076. [PMID: 36113271 DOI: 10.1016/j.ecoenv.2022.114076] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 09/08/2022] [Accepted: 09/09/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND There is growing evidence that allergic rhinitis (AR) is associated with indoor environmental factors, but their role in childhood AR during early life remains unclear. OBJECTIVE To investigate the association of preconceptional, prenatal, early postnatal, and current exposure to home environmental factors with childhood AR, and to further explore whether this association can be interacted by outdoor air pollution and temperature. METHODS A retrospective cohort study of 8689 preschool children was conducted during 2019-2020 in Changsha, China. A standard questionnaire was used to collect data on each family's health outcomes and home environments. We considered home environmental exposures during one year before conception, pregnancy, first year of life, and past year. Associations of indoor air pollution and allergens with AR were assessed by multiple logistic regression models. RESULTS Pre-birth exposure to indoor air pollution emitted by new furniture or redecoration and dampness related allergen derived from mold/damp stains and mold/damp clothes or bedding during 1 year before conception and pregnancy was significantly associated with increased AR, with adjusted ORs (95% CI) ranging from 1.35 (1.05-1.75) to 1.87 (1.55-2.27). Childhood AR was also significantly related with post-birth exposure to dampness related indoor allergen including mold/damp stains and mold/damp clothes or bedding in first year and past year and pollen allergen including total and nonflowing plants in past year, with a range of ORs (95% CI) from 1.20 (1.01-1.42) to 1.79 (1.42-2.27). We identified that pre-birth, particularly in utero exposure to both indoor air pollution from renovation and dampness related allergens, played a key role in AR development compared to post-birth exposures, and accumulative effect was observed with the highest risk of AR. High exposure to traffic-related air pollution (TRAP) including outdoor PM2.5, NO2, CO, and O3, as well as living near traffic road not only significantly increased adverse effect of home environmental factors but also decreased protective effect of household dogs on childhood AR. Early life exposure to low temperature in pregnancy and high temperature in first year significantly increased AR risk of home environmental exposure. Sensitivity analysis indicated that some sub-groups were more susceptible to AR risk of home environmental exposure. CONCLUSION Our study suggests that pre-birth exposure to home environmental factors played an important role in AR development and this effect can be interacted by TRAP and temperature, which supports a hypothesis of "(pre)fetal origin of childhood AR".
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Affiliation(s)
- Chan Lu
- XiangYa School of Public Health, Central South University, Changsha, China.
| | - Zijing Liu
- XiangYa School of Public Health, Central South University, Changsha, China.
| | - Hongsen Liao
- XiangYa School of Public Health, Central South University, Changsha, China.
| | - Wenhui Yang
- XiangYa School of Public Health, Central South University, Changsha, China.
| | - Qin Li
- XiangYa School of Public Health, Central South University, Changsha, China.
| | - Qin Liu
- XiangYa School of Public Health, Central South University, Changsha, China.
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Zhao Y, Kong D, Fu J, Zhang Y, Chen Y, Liu Y, Chang Z, Liu Y, Liu X, Xu K, Jiang C, Fan Z. Increased Risk of Hospital Admission for Asthma in Children From Short-Term Exposure to Air Pollution: Case-Crossover Evidence From Northern China. Front Public Health 2022; 9:798746. [PMID: 34976938 PMCID: PMC8718688 DOI: 10.3389/fpubh.2021.798746] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 11/22/2021] [Indexed: 11/23/2022] Open
Abstract
Background: Previous studies suggested that exposure to air pollution could increase risk of asthma attacks in children. The aim of this study is to investigate the short-term effects of exposure to ambient air pollution on asthma hospital admissions in children in Beijing, a city with serious air pollution and high-quality medical care at the same time. Methods: We collected hospital admission data of asthma patients aged ≤ 18 years old from 56 hospitals from 2013 to 2016 in Beijing, China. Time-stratified case-crossover design and conditional Poisson regression were applied to explore the association between risk of asthma admission in children and the daily concentration of six air pollutants [particulate matter ≤ 2.5 μm (PM2.5), particulate matter ≤ 10 μm (PM10), sulfur dioxide (SO2), nitrogen dioxide (NO2), carbon monoxide (CO), and ozone (O3)], adjusting for meteorological factors and other pollutants. Additionally, stratified analyses were performed by age, gender, and season. Results: In the single-pollutant models, higher levels of PM2.5, SO2, and NO2 were significantly associated with increased risk of hospital admission for asthma in children. The strongest effect was observed in NO2 at lag06 (RR = 1.25, 95%CI: 1.06-1.48), followed by SO2 at lag05 (RR = 1.17, 95%CI: 1.05–1.31). The robustness of effects of SO2 and NO2 were shown in two-pollutant models. Stratified analyses further indicated that pre-school children (aged ≤ 6 years) were more susceptible to SO2. The effects of SO2 were stronger in the cold season, while the effects of NO2 were stronger in the warm season. No significant sex-specific differences were observed. Conclusions: These results suggested that high levels of air pollution had an adverse effect on childhood asthma, even in a region with high-quality healthcare. Therefore, it will be significant to decrease hospital admissions for asthma in children by controlling air pollution emission and avoiding exposure to air pollution.
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Affiliation(s)
- Yakun Zhao
- Department of Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Dehui Kong
- Department of Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Jia Fu
- Department of Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Yongqiao Zhang
- Department of Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Yuxiong Chen
- Department of Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Yanbo Liu
- Department of Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Zhen'ge Chang
- Department of Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Yijie Liu
- Department of Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Xiaole Liu
- Department of Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Kaifeng Xu
- Department of Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Chengyu Jiang
- National Key Laboratory of Medical Molecular Biology, Department of Biochemistry, Institute of Basic Medical Sciences, Peking Union Medical Colleges, Chinese Academy of Medical Sciences, Beijing, China
| | - Zhongjie Fan
- Department of Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
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Effect of Candida intermedia LAMAP1790 Antimicrobial Peptides against Wine-Spoilage Yeasts Brettanomyces bruxellensis and Pichia guilliermondii. FERMENTATION 2020. [DOI: 10.3390/fermentation6030065] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Wine spoilage yeasts are one of the main issues in the winemaking industry, and the control of the Brettanomyces and Pichia genus is an important goal to reduce economic loses from undesired aromatic profiles. Previous studies have demonstrated that Candida intermedia LAMAP1790 produces antimicrobial peptides of molecular mass under 10 kDa with fungicide activity against Brettanomyces bruxellensis, without affecting the yeast Saccharomyces cerevisiae. So far, it has not been determined whether these peptides show biocontroller effect in this yeast or other spoilage yeasts, such as Pichia guilliermondii. In this work, we determined that the exposure of B. bruxellensis to the low-mass peptides contained in the culture supernatant of C. intermedia LAMAP1790 produces a continuous rise of reactive oxygen species (ROS) in this yeast, without presenting a significant effect on membrane damage. These observations can give an approach to the antifungal mechanism. In addition, we described a fungicide activity of these peptides fraction against two strains of P. guilliermondii in a laboratory medium. However, carrying out assays on synthetic must, peptides must show an effect on the growth of B. bruxellensis. Moreover, these results can be considered as a start to develop new strategies for the biocontrol of spoilage yeast.
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Cumulative Impact of Environmental Pollution and Population Vulnerability on Pediatric Asthma Hospitalizations: A Multilevel Analysis of CalEnviroScreen. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16152683. [PMID: 31357578 PMCID: PMC6696276 DOI: 10.3390/ijerph16152683] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 07/19/2019] [Accepted: 07/25/2019] [Indexed: 12/14/2022]
Abstract
The CalEnviroScreen created by the Office of Environmental Health Hazard Assessment, Sacramento, USA, is a place-based dataset developed to measure environmental and social indicators that are theorized to have cumulative health impacts on populations. The objective of this study was to examine the extent to which the composite scores of the CalEnviroScreen tool are associated with pediatric asthma hospitalization. This was a retrospective analysis of California hospital discharge data from 2010 to 2012. Children who were hospitalized for asthma-related conditions, were aged 0–14 years, and resided in California were included in analysis. Rates of hospitalization for asthma-related conditions among children residing in California were calculated. Poisson multilevel modeling was used to account for individual- and neighborhood-level risk factors. Every unit increase in the CalEnviroScreen Score was associated with an increase of 1.6% above the mean rate of pediatric asthma hospitalizations (rate ratio (RR) = 1.016, 95% confidence interval (CI) = 1.014–1.018). Every unit increase in racial/ethnic segregation and diesel particulate matter was associated with an increase of 1.1% and 0.2% above the mean rate of pediatric asthma, respectively (RR = 1.011, 95% CI = 1.010–1.013; RR = 1.002, 95% CI = 1.001–1.004). The CalEnviroScreen is a unique tool that combines socioecological factors and environmental indicators to identify vulnerable communities with major health disparities, including pediatric asthma hospital use. Future research should identify mediating factors that contribute to community-level health disparities.
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de Miguel-Díez J, Hernández-Vázquez J, López-de-Andrés A, Álvaro-Meca A, Hernández-Barrera V, Jiménez-García R. Analysis of environmental risk factors for chronic obstructive pulmonary disease exacerbation: A case-crossover study (2004-2013). PLoS One 2019; 14:e0217143. [PMID: 31120946 PMCID: PMC6532877 DOI: 10.1371/journal.pone.0217143] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Accepted: 05/07/2019] [Indexed: 12/14/2022] Open
Abstract
Purpose We aim to assess if air pollution levels and climatological factors are associated with hospital admissions for exacerbation of chronic obstructive pulmonary disease (COPD) in Spain from 2004 to 2013. Methods We conducted a retrospective study. Information on pollution level and climatological factors were obtained from the Spanish Meteorological Agency and hospitalizations from the Spanish hospital discharge database. A case-crossover design was used to identify factors associated with hospitalizations and in hospital mortality. Postal codes were used to assign climatic and pollutant factors to each patient. Results We detected 162,338 hospital admissions for COPD exacerbation. When seasonal effects were evaluated we observed that hospital admissions and mortality were more frequent in autumn and winter. In addition, we found significant associations of temperature, humidity, ozone (O3), carbon monoxide (CO), particulate matter up to 10 μm in size (PM10) and nitrogen dioxide (NO2) with hospital admissions. Lower temperatures at admission with COPD exacerbation versus 1, 1.5, 2 and 3 weeks prior to hospital admission for COPD exacerbation, were associated with a higher probability of dying in the hospital. Other environmental factors that were related to in-hospital mortality were NO2, O3, PM10 and CO. Conclusions Epidemiology of hospital admissions by COPD exacerbation was negatively affected by colder climatological factors (seasonality and absolute temperature) and short-term exposure to major air pollution (NO2, O3, CO and PM10).
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Affiliation(s)
- Javier de Miguel-Díez
- Pneumology Department, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain
| | | | - Ana López-de-Andrés
- Preventive Medicine and Public Health Teaching and Research Unit, Department of Health Sciences, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
- * E-mail:
| | - Alejandro Álvaro-Meca
- Preventive Medicine and Public Health Teaching and Research Unit, Department of Health Sciences, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
| | - Valentín Hernández-Barrera
- Preventive Medicine and Public Health Teaching and Research Unit, Department of Health Sciences, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
| | - Rodrigo Jiménez-García
- Preventive Medicine and Public Health Teaching and Research Unit, Department of Health Sciences, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
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10
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[Role of non pharmacological Interventions for asthma]. Presse Med 2019; 48:282-292. [PMID: 30871852 DOI: 10.1016/j.lpm.2019.02.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Revised: 12/27/2018] [Accepted: 02/13/2019] [Indexed: 12/14/2022] Open
Abstract
Smoking cessation remains a major issue for asthmatic smokers. Respiratory rehabilitation and respiratory physiotherapy have shown a benefit in controlling symptoms, preventing exacerbations and improving the quality of life. The control of the environment is crucial and must be approached in a global way. Management of obesity and psychological disorders should be systematically proposed. Allergen immunotherapy may be discussed in allergic persistent asthma to house dust mites. Certain dietary interventions or alternative medicines have not proved their worth.
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Abstract
Brettanomyces bruxellensis has been described as the principal spoilage yeast in the winemaking industry. To avoid its growth, wine is supplemented with SO2, which has been questioned due to its potential harm to health. For this reason, studies are being focused on searching for, ideally, natural new antifungals. On the other hand, it is known that in wine production there are a variety of microorganisms, such as yeasts and bacteria, that are possible biological controls. Thus, it has been described that some microorganisms produce antimicrobial peptides, which might control yeast and bacteria populations. Our laboratory has described the Candida intermedia LAMAP1790 strain as a natural producer of antimicrobial compounds against food spoilage microorganisms, as is B. bruxellensis, without affecting the growth of S. cerevisiae. We have demonstrated the proteinaceous nature of the antimicrobial compound and its low molecular mass (under 10 kDa). This is the first step to the possible use of C. intermedia as a selective bio-controller of the contaminant yeast in the winemaking industry.
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12
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Novel antimicrobial peptides produced by Candida intermedia LAMAP1790 active against the wine-spoilage yeast Brettanomyces bruxellensis. Antonie van Leeuwenhoek 2018; 112:297-304. [PMID: 30187229 DOI: 10.1007/s10482-018-1159-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 08/29/2018] [Indexed: 10/28/2022]
Abstract
Brettanomyces bruxellensis negatively impacts on the sensorial quality of wine by producing phenolic compounds associated with unpleasant odors. Thus, the control of this spoilage yeast is a critical factor during the winemaking process. A recent approach used to biocontrol undesired microorganisms is the use of yeast released antimicrobial peptides (AMPs), but this strategy has been poorly applied to wine-related microorganisms. The aim of this study was to evaluate the antifungal capacity of Candida intermedia LAMAP1790 against wine-spoilage strains of B. bruxellensis and fermentative strains of Saccharomyces cerevisiae, and also to determine the chemical nature of the compound. The exposure of strains to the supernatant of C. intermedia saturated cultures showed antifungal activity against B. bruxellensis, without affecting the growth of S. cerevisiae. By fractionation and concentration of C. intermedia supernatants, it was determined that the antifungal activity was related to the presence of heat-labile peptides with molecular masses under 5 kDa. To our knowledge, this is the first report of AMPs secreted by C. intermedia that control B. bruxellensis. This could lead to the development of new biocontrol strategies against this wine-spoilage yeast.
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Dai H, Fan J, Wu S, Yu Y, Liu D, Hu Z. Experimental study on ignition mechanisms of wet granulation sulfur caused by friction. JOURNAL OF HAZARDOUS MATERIALS 2018; 344:480-489. [PMID: 29096259 DOI: 10.1016/j.jhazmat.2017.10.056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 09/30/2017] [Accepted: 10/27/2017] [Indexed: 06/07/2023]
Abstract
It is common to see fire accidents caused by friction during the storage and transportation of wet granulation sulfur. To study the sulfur ignition mechanism under friction conditions, a new rotating test apparatus is developed to reproduce friction scenes at lab scale. A series of experiments are performed under different normal loads. The SEM-EDS and the XRD were utilized to examine the morphologies and compositions of the tested specimens and the friction products. Experimental results show that these two methods are mostly in agreement with each other. The iron-sulfide compounds are produced and the proportion of iron-sulfide compounds is reduced with normal loads increasing, compared to the total number of the friction products. The facts implied by the integration analysis of friction products with the temperature changes of the near friction surface unveil an underlying mechanism that may explain sulfur ignition by friction in real scenarios. The sulfur ignition may be mainly caused by the spontaneous combustion of iron sulfide compounds produced by friction under low normal load with 200N. With the increase of normal loads, the resulting iron-sulfide compounds are decreasing and the high temperature from friction heat begins to play a major role in causing fire.
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Affiliation(s)
- Haoyuan Dai
- College of Mechanical and Transportation Engineering, China University of Petroleum-Beijing, Fuxue Road 18, 102249 Changping, Beijing, China
| | - Jianchun Fan
- College of Mechanical and Transportation Engineering, China University of Petroleum-Beijing, Fuxue Road 18, 102249 Changping, Beijing, China.
| | - Shengnan Wu
- College of Mechanical and Transportation Engineering, China University of Petroleum-Beijing, Fuxue Road 18, 102249 Changping, Beijing, China
| | - Yanqiu Yu
- College of Mechanical and Transportation Engineering, China University of Petroleum-Beijing, Fuxue Road 18, 102249 Changping, Beijing, China; Sinopec Dazhou Natural Gas Purification Plant, 635000 Tuzhu Town, Xuanhan Country, Dazhou City, Sichuan Province, China
| | - Di Liu
- College of Mechanical and Transportation Engineering, China University of Petroleum-Beijing, Fuxue Road 18, 102249 Changping, Beijing, China
| | - Zhibin Hu
- College of Mechanical and Transportation Engineering, China University of Petroleum-Beijing, Fuxue Road 18, 102249 Changping, Beijing, China
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Goodman JE, Kennedy EM, Seeley M. Do individuals with asthma experience airway hyper-responsiveness after exposure to nitrogen dioxide? Regul Toxicol Pharmacol 2017; 89:279-287. [PMID: 28751262 DOI: 10.1016/j.yrtph.2017.07.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 07/21/2017] [Accepted: 07/23/2017] [Indexed: 11/29/2022]
Abstract
The current 100 ppb short-term National Ambient Air Quality Standard for NO2, and EPA's determination of a causal association for respiratory effects, are based in part on controlled human exposure studies evaluating airway hyper-responsiveness (AHR). A meta-analysis by Goodman et al. (2009) found increased AHR at 100 ppb NO2 but no clear concentration-response relationship up to 600 ppb, and an overall lack of an AHR effect for studies involving exercise or exposure to allergens. Several factors have been suggested to explain why effects on AHR are observed while people are at rest, but not during exercise or after exposure to allergens. These include an exercise-induced refractory period; partial reversal of bronchospasm from use of forced expiration maneuvers; and greater airway responsiveness of participants exposed to NO2 at rest. We reviewed the scientific evidence to determine whether there is biological support for these factors and found that none sufficiently explained the lack of an effect during exercise or after exposure to allergens. In the absence of either a consistent concentration-response or a plausible explanation for the paradoxical AHR findings, the biological significance of these findings is uncertain and provides equivocal support for NO2 as a causal factor of AHR at these exposure levels.
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Affiliation(s)
| | | | - Mara Seeley
- Gradient, 20 University Rd., Cambridge, MA 02138, USA.
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Pohl HR, Citra M, Abadin HA, Szadkowska-Stańczyk I, Kozajda A, Ingerman L, Nguyen A, Murray HE. Modeling emissions from CAFO poultry farms in Poland and evaluating potential risk to surrounding populations. Regul Toxicol Pharmacol 2017; 84:18-25. [PMID: 27986593 PMCID: PMC5642914 DOI: 10.1016/j.yrtph.2016.11.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 10/28/2016] [Accepted: 11/01/2016] [Indexed: 11/18/2022]
Abstract
The world-wide use of concentrated animal feeding operations (CAFOs) for livestock production demands the need to evaluate the potential impact to public health. We estimated the exposure of various airborne pollutants for populations residing in close proximity to 10 poultry CAFOs located in Central Poland. Ammonia (NH3), carbon dioxide (CO2), carbon monoxide (CO), hydrogen sulfide (H2S), methane (CH4), nitrogen dioxide (NO2), nitrous oxide (N2O), sulfur dioxide (SO2), and organic dust were the pollutants of interest for this study. Because no monitoring data were available, we used the steady-state Gaussian dispersion model AERMOD to estimate pollutant concentrations for the exposed population in order to calculate the hazard index (HI) for a combined mixture of chemicals. Our results indicate that while the levels of certain pollutants are expected to exceed background levels commonly found in the environment they did not result in calculated hazard indexes which exceeded unity suggesting low potential for adverse health effects for the surrounding community for the mixture of chemicals. The study was conducted through a cooperation between the Agency for Toxic Substances and Disease Registry (ATSDR) in the USA and the Nofer Institute of Occupational Medicine (NIOM) in Poland.
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Affiliation(s)
- H R Pohl
- Agency for Toxic Substances and Disease Registry, US Department of Health and Human Services, Atlanta, GA, USA.
| | - M Citra
- SRC, Inc., North Syracuse, NY, USA
| | - H A Abadin
- Agency for Toxic Substances and Disease Registry, US Department of Health and Human Services, Atlanta, GA, USA
| | | | - A Kozajda
- Nofer Institute of Occupational Medicine, Łódź, Poland
| | | | - A Nguyen
- SRC, Inc., North Syracuse, NY, USA
| | - H E Murray
- Agency for Toxic Substances and Disease Registry, US Department of Health and Human Services, Atlanta, GA, USA
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Chen F, Deng Z, Deng Y, Qiao Z, Lan L, Meng Q, Luo B, Zhang W, Ji K, Qiao X, Fan Z, Zhang M, Cui Y, Zhao X, Li X. Attributable risk of ambient PM 10 on daily mortality and years of life lost in Chengdu, China. THE SCIENCE OF THE TOTAL ENVIRONMENT 2017; 581-582:426-433. [PMID: 28069303 DOI: 10.1016/j.scitotenv.2016.12.151] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 12/01/2016] [Accepted: 12/15/2016] [Indexed: 06/06/2023]
Abstract
Attributable risk is an important indicator for planning and evaluating public health interventions. However, most current measures of the attributable risk of air pollutants have not considered temporal relationships between exposure and risk. More importantly, limited information is available regarding the attributable risk due to ambient air pollutants in basin regions like the Sichuan Basin, China. To quantify the association between PM10 and deaths in the Basin region, we used a measure proposed recently within the framework of the distributed lag non-linear model to estimate the attributable risk in Chengdu, China. Meanwhile, we examined the association between PM10 and years of life lost (YLL). Our analysis showed that population-attributable fractions for non-accidental, respiratory, and cardiovascular mortality were 0.569% (95% CI: -3.474%, 4.374%), 0.695% (95% CI: -5.260%, 6.457%), and 0.631% (95% CI: -6.973%, 7.390%), respectively. On average, a 1μg/m3 increase in PM10 was associated with cumulative increases of 0.26893, 0.30437, and 0.21924 YLL for non-accidental, respiratory, and cardiovascular mortality, respectively, referring to 20μg/m3. In addition, we found an inverse U-shaped pattern for the cumulative risk with 350μg/m3 as the reverse point. With a 1μg/m3 increase in PM10, YLL changed more significantly than mortality. Moreover, PM10 demonstrated remarkable effects on YLL among men and the elderly.
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Affiliation(s)
- Fei Chen
- Department of Epidemiology and Health Statistics, West China School of Public Health, Sichuan University, Chengdu 610041, Sichuan, China
| | - Zibing Deng
- Department of Epidemiology and Health Statistics, West China School of Public Health, Sichuan University, Chengdu 610041, Sichuan, China
| | - Ying Deng
- Sichuan Centre for Disease Control and Prevention, Chengdu 610041, Sichuan, China
| | - Zhijiao Qiao
- Department of Epidemiology and Health Statistics, West China School of Public Health, Sichuan University, Chengdu 610041, Sichuan, China
| | - Lan Lan
- Department of Epidemiology and Health Statistics, West China School of Public Health, Sichuan University, Chengdu 610041, Sichuan, China
| | - Qiong Meng
- School of Public Health, Kunming Medical University, Kunming, 650500, Yunnan, China
| | - Bin Luo
- Sichuan Environmental Monitoring Centre, Chengdu 610041, Sichuan, China
| | - Wei Zhang
- Sichuan Environmental Monitoring Centre, Chengdu 610041, Sichuan, China
| | - Kui Ji
- Sichuan Centre for Disease Control and Prevention, Chengdu 610041, Sichuan, China
| | - Xue Qiao
- Institute of New Energy and Low-Carbon Technology, Sichuan University, Chengdu, Sichuan, China
| | - Zhiwei Fan
- Department of Epidemiology and Health Statistics, West China School of Public Health, Sichuan University, Chengdu 610041, Sichuan, China
| | - Meixia Zhang
- Department of Epidemiology and Health Statistics, West China School of Public Health, Sichuan University, Chengdu 610041, Sichuan, China
| | - Yan Cui
- Department of Epidemiology and Health Statistics, West China School of Public Health, Sichuan University, Chengdu 610041, Sichuan, China
| | - Xing Zhao
- Department of Epidemiology and Health Statistics, West China School of Public Health, Sichuan University, Chengdu 610041, Sichuan, China.
| | - Xiaosong Li
- Department of Epidemiology and Health Statistics, West China School of Public Health, Sichuan University, Chengdu 610041, Sichuan, China.
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DeVries R, Kriebel D, Sama S. Outdoor Air Pollution and COPD-Related Emergency Department Visits, Hospital Admissions, and Mortality: A Meta-Analysis. COPD 2016; 14:113-121. [PMID: 27564008 DOI: 10.1080/15412555.2016.1216956] [Citation(s) in RCA: 104] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
A systematic literature review was performed to identify all peer-reviewed literature quantifying the association between short-term exposures of particulate matter <2.5 microns (PM2.5), nitrogen dioxide (NO2), and sulfur dioxide (SO2) and COPD-related emergency department (ED) visits, hospital admissions (HA), and mortality. These results were then pooled for each pollutant through meta-analyses with a random effects model. Subgroup meta-analyses were explored to study the effects of selected lag/averaging times and health outcomes. A total of 37 studies satisfied our inclusion criteria, contributing to a total of approximately 1,115,000 COPD-related acute events (950,000 HAs, 80,000 EDs, and 130,000 deaths) to our meta-estimates. An increase in PM2.5 of 10 ug/m3 was associated with a 2.5% (95% CI: 1.6-3.4%) increased risk of COPD-related ED and HA, an increase of 10 ug/m3 in NO2 was associated with a 4.2% (2.5-6.0%) increase, and an increase of 10 ug/m3 in SO2 was associated with a 2.1% (0.7-3.5%) increase. The strength of these pooled effect estimates, however, varied depending on the selected lag/averaging time between exposure and outcome. Similar pooled effects were estimated for each pollutant and COPD-related mortality. These results suggest an ongoing threat to the health of COPD patients from both outdoor particulates and gaseous pollutants. Ambient outdoor concentrations of PM2.5, NO2, and SO2 were significantly and positively associated with both COPD-related morbidity and mortality.
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Affiliation(s)
| | - David Kriebel
- a Department of Work Environment , University of Massachusetts Lowell , Lowell , Massachusetts , USA
| | - Susan Sama
- a Department of Work Environment , University of Massachusetts Lowell , Lowell , Massachusetts , USA
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Barnig C, Veaudor M, Gautier C, Margelidon-Cozzolino V, Pigearias B, Devouassoux G, Raherison C, De Blay F, Chanez P. [How to consider triggers and comorbid conditions in severe asthma in adults]. Presse Med 2016; 45:1030-1042. [PMID: 27544706 DOI: 10.1016/j.lpm.2016.07.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 07/05/2016] [Accepted: 07/12/2016] [Indexed: 12/16/2022] Open
Abstract
Triggers and precipitating factors as well as comorbid conditions are associated with asthma and severe asthma. They interfere with the potential to control the disease and represent an additional burden for the patients. Allergen exposure is well known to induce loss of control and exacerbations. Comorbid conditions belong to various fields of medicines including cardiovascular diseases, osteoporosis, obesity and sleep apneas and GERD. They should be diagnosed and treated for themselves according to the best state of the art. Their precise role et their contribution to severe asthma pathophysiology is largely unknown and longitudinal cohort studies are needed to better understand and treat the patients with severe asthma.
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Affiliation(s)
- Cindy Barnig
- Hôpitaux universitaires de Strasbourg, département de pneumologie, 67000 Strasbourg, France
| | - Martin Veaudor
- Université Claude-Bernard Lyon 1, hôpital de la Croix-Rousse, service de pneumologie, HCL, CIRI Inserm U1111, 69001 Lyon, France
| | - Clarisse Gautier
- AP-HM, Aix-Marseille université, département des maladies respiratoires, UMR 7333 CNRS, Inserm U1067, 13015 Marseille, France
| | - Victor Margelidon-Cozzolino
- Université Claude-Bernard Lyon 1, hôpital de la Croix-Rousse, service de pneumologie, HCL, CIRI Inserm U1111, 69001 Lyon, France
| | | | - Gilles Devouassoux
- Université Claude-Bernard Lyon 1, hôpital de la Croix-Rousse, service de pneumologie, HCL, CIRI Inserm U1111, 69001 Lyon, France
| | - Chantal Raherison
- CHU de Bordeaux, université de Bordeaux, service des maladies respiratoires, ISPED, U897, 33000 Bordeaux, France
| | - Frederic De Blay
- Hôpitaux universitaires de Strasbourg, département de pneumologie, 67000 Strasbourg, France
| | - Pascal Chanez
- AP-HM, Aix-Marseille université, département des maladies respiratoires, UMR 7333 CNRS, Inserm U1067, 13015 Marseille, France.
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Gandhi VD, Vliagoftis H. Airway epithelium interactions with aeroallergens: role of secreted cytokines and chemokines in innate immunity. Front Immunol 2015; 6:147. [PMID: 25883597 PMCID: PMC4382984 DOI: 10.3389/fimmu.2015.00147] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Accepted: 03/18/2015] [Indexed: 11/13/2022] Open
Abstract
Airway epithelial cells are the first line of defense against the constituents of the inhaled air, which include allergens, pathogens, pollutants, and toxic compounds. The epithelium not only prevents the penetration of these foreign substances into the interstitium, but also senses their presence and informs the organism’s immune system of the impending assault. The epithelium accomplishes the latter through the release of inflammatory cytokines and chemokines that recruit and activate innate immune cells at the site of assault. These epithelial responses aim to eliminate the inhaled foreign substances and minimize their detrimental effects to the organism. Quite frequently, however, the innate immune responses of the epithelium to inhaled substances lead to chronic and high level release of pro-inflammatory mediators that may mediate the lung pathology seen in asthma. The interactions of airway epithelial cells with allergens will be discussed with particular focus on interactions-mediated epithelial release of cytokines and chemokines and their role in the immune response. As pollutants are other major constituents of inhaled air, we will also discuss how pollutants may alter the responses of airway epithelial cells to allergens.
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Affiliation(s)
- Vivek D Gandhi
- Pulmonary Research Group, Department of Medicine, University of Alberta , Edmonton, AB , Canada
| | - Harissios Vliagoftis
- Pulmonary Research Group, Department of Medicine, University of Alberta , Edmonton, AB , Canada
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Abstract
Traffic and power generation are the main sources of urban air pollution. The idea that outdoor air pollution can cause exacerbations of pre-existing asthma is supported by an evidence base that has been accumulating for several decades, with several studies suggesting a contribution to new-onset asthma as well. In this Series paper, we discuss the effects of particulate matter (PM), gaseous pollutants (ozone, nitrogen dioxide, and sulphur dioxide), and mixed traffic-related air pollution. We focus on clinical studies, both epidemiological and experimental, published in the previous 5 years. From a mechanistic perspective, air pollutants probably cause oxidative injury to the airways, leading to inflammation, remodelling, and increased risk of sensitisation. Although several pollutants have been linked to new-onset asthma, the strength of the evidence is variable. We also discuss clinical implications, policy issues, and research gaps relevant to air pollution and asthma.
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Affiliation(s)
- Michael Guarnieri
- Department of Medicine, University of California, San Francisco, CA, USA; Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, CA, USA
| | - John R Balmes
- Department of Medicine, University of California, San Francisco, CA, USA; Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, CA, USA.
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21
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Cong S, Araki A, Ukawa S, Ait Bamai Y, Tajima S, Kanazawa A, Yuasa M, Tamakoshi A, Kishi R. Association of mechanical ventilation and flue use in heaters with asthma symptoms in Japanese schoolchildren: a cross-sectional study in Sapporo, Japan. J Epidemiol 2014; 24:230-8. [PMID: 24747197 PMCID: PMC4000771 DOI: 10.2188/jea.je20130135] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background Use of fuel heaters is associated with childhood asthma. However, no studies have evaluated the associations of flue use and mechanical ventilation (ventilation) with asthma symptoms in schoolchildren. Methods This cross-sectional study investigated schoolchildren in grades 1 through 6 (age 6–12 years) in Sapporo, Japan. From November 2008 through January 2009, parents completed questionnaires regarding their home environment and their children’s asthma symptoms. Results In total, 4445 (69.5%) parents of 6393 children returned the questionnaire. After excluding incomplete responses, data on 3874 children (60.6%) were analyzed. The prevalence of current asthma symptoms and ever asthma symptoms were 12.8% and 30.9%, respectively. As compared with electric heaters, current asthma symptoms was associated with use of flued heaters without ventilation (OR = 1.62; 95% CI, 1.03–2.64) and unflued heaters with ventilation (OR = 1.77; 95% CI, 1.09–2.95) or without ventilation (OR = 2.23; 95% CI, 1.31–3.85). Regardless of dampness, unflued heaters were significantly associated with current asthma symptoms in the presence and absence of ventilation. Conclusions Use of unflued heaters was associated with current asthma symptoms, regardless of dampness. In particular, the prevalence of current asthma symptoms was higher in the absence of ventilation than in the presence of ventilation. Ever asthma symptoms was only associated with use of unflued heaters without ventilation. Consequently, use of fuel heaters, especially those that have no flue or ventilation, deserves attention, as their use might be associated with childhood asthma symptoms.
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Affiliation(s)
- Shi Cong
- Hokkaido University Graduate School of Medicine, Department of Public Health Sciences
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22
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Weller GB, Cooley D. A sum characterization of hidden regular variation with likelihood inference via expectation-maximization. Biometrika 2014. [DOI: 10.1093/biomet/ast046] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Barrett EG, Day KC, Gigliotti AP, Reed MD, McDonald JD, Mauderly JL, Seilkop SK. Effects of simulated downwind coal combustion emissions on pre-existing allergic airway responses in mice. Inhal Toxicol 2012; 23:792-804. [PMID: 22035121 DOI: 10.3109/08958378.2011.609917] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONTEXT Coal-fired power plant emissions can contribute a significant portion of the ambient air pollution in many parts of the world. OBJECTIVE We hypothesized that exposure to simulated downwind coal combustion emissions (SDCCE) may exacerbate pre-existing allergic airway responses. METHODS Mice were sensitized and challenged with ovalbumin (OVA). Parallel groups were sham-sensitized with saline. Mice were exposed 6 h/day for 3 days to air (control, C) or SDCCE containing particulate matter (PM) at low (L; 100 μg/m³), medium (M; 300 μg/m³), or high (H; 1000 μg/m³) concentrations, or to the H level with PM removed by filtration (high-filtered, HF). Immediately after SDCCE exposure, mice received another OVA challenge (pre-OVA protocol). In a second (post-OVA) protocol, mice were similarly sensitized but only challenged to OVA before air/SDCCE. Measurement of airway hyperresponsiveness (AHR), bronchoalveolar lavage (BAL), and blood collection were performed ~24 h after the last exposure. RESULTS SDCCE significantly increased BAL macrophages and eosinophils in OVA-sensitized mice from the post-OVA protocol. However, there was no effect of SDCCE on BAL macrophages or eosinophils in OVA-sensitized mice from the pre-OVA protocol. BAL neutrophils were elevated following SDCCE in both protocols in nonsensitized mice. These changes were not altered by filtering out the PM. In the post-OVA protocol, SDCCE decreased OVA-specific IgG₁ in OVA-sensitized mice but increased levels of total IgE, OVA-specific IgE and OVA-specific IgG₁ and IgG(2a) in non-sensitized animals. In the pre-OVA protocol, SDCCE increased OVA-specific IgE in both sensitized and non-sensitized animals. Additionally, BAL IL-4, IL-13, and IFN-γ levels were elevated in sensitized mice. CONCLUSION These results suggest that acute exposure to either the particulate or gaseous phase of SDCCE can exacerbate various features of allergic airway responses depending on the timing of exposure in relation to allergen challenge.
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Affiliation(s)
- Edward G Barrett
- Lovelace Respiratory Research Institute, Albuquerque, NM 87108, USA.
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Johns DO, Linn WS. A review of controlled human SO₂ exposure studies contributing to the US EPA integrated science assessment for sulfur oxides. Inhal Toxicol 2011; 23:33-43. [PMID: 21222560 DOI: 10.3109/08958378.2010.539290] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Laboratory studies involving intentional and highly controlled exposures to air pollutants among groups of human volunteers provide valuable information related to the potential health effects of pollutants regulated under the US Clean Air Act. These controlled human exposure studies often provide biological plausibility for the associations between air-pollutant concentration and a given health endpoint observed in epidemiologic investigations. In some cases, results from human laboratory studies provide evidence of a relevant health effect at ambient or near-ambient concentrations and thus directly support the selection of air quality standard levels. In the recently completed review of the US National Ambient Air Quality Standards (NAAQS) for sulfur dioxide (SO₂), the US Environmental Protection Agency (EPA) concluded that short-term exposures to SO₂ are causally associated with an increase in respiratory morbidity. This determination was based in large part on findings from laboratory studies of controlled exposures to SO₂ among small groups of asthmatic individuals. The purpose of this review is to concisely present an overview of the evidence from controlled human exposure studies of SO₂-induced respiratory health effects following short-term exposures. While the majority of these studies were conducted over 20 years ago, the findings and insights gained from this work continues to play an integral role in evaluating the respiratory effects of ambient exposures to SO₂.
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Affiliation(s)
- Douglas O Johns
- National Center for Environmental Assessment, Office of Research and Development, US Environmental Protection Agency, Research Triangle Park, NC 27711, USA.
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Hesterberg TW, Bunn WB, McClellan RO, Hamade AK, Long CM, Valberg PA. Critical review of the human data on short-term nitrogen dioxide (NO2) exposures: evidence for NO2 no-effect levels. Crit Rev Toxicol 2010; 39:743-81. [PMID: 19852560 DOI: 10.3109/10408440903294945] [Citation(s) in RCA: 100] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Nitrogen dioxide (NO2) is a ubiquitous atmospheric pollutant due to the widespread prevalence of both natural and anthropogenic sources, and it can be a respiratory irritant when inhaled at elevated concentrations. Evidence for health effects of ambient NO2 derives from three types of studies: observational epidemiology, human clinical exposures, and animal toxicology. Our review focuses on the human clinical studies of adverse health effects of short-term NO2 exposures, given the substantial uncertainties and limitations in interpretation of the other lines of evidence. We examined more than 50 experimental studies of humans inhaling NO2, finding notably that the reporting of statistically significant changes in lung function and bronchial sensitivity did not show a consistent trend with increasing NO2 concentrations. Functional changes were generally mild and transient, the reported effects were not uniformly adverse, and they were not usually accompanied by NO2-dependent increases in symptoms. The available human clinical results do not establish a mechanistic pathway leading to adverse health impacts for short-term NO2 exposures at levels typical of maximum 1-h concentrations in the present-day ambient environment (i.e., below 0.2 ppm). Our review of these data indicates that a health-protective, short-term NO2 guideline level for susceptible (and healthy) populations would reflect a policy choice between 0.2 and 0.6 ppm. EXTENDED ABSTRACT: Nitrogen dioxide (NO2) is a ubiquitous atmospheric pollutant due to the widespread prevalence of both natural and anthropogenic sources, and it can be a respiratory irritant when inhaled at elevated concentrations. Natural NO2 sources include volcanic action, forest fires, lightning, and the stratosphere; man-made NO2 emissions derive from fossil fuel combustion and incineration. The current National Ambient Air Quality Standard (NAAQS) for NO2, initially established in 1971, is 0.053 ppm (annual average). Ambient concentrations monitored in urban areas in the United States are approximately 0.015 ppm, as an annual mean, i.e., below the current NAAQS. Short-term (1-h peak) NO2 concentrations outdoors are not likely to exceed 0.2 ppm, and even 1-h periods exceeding 0.1 ppm are infrequent. Inside homes, 1-h NO2 peaks, typically arising from gas cooking, can range between 0.4 and 1.5 ppm. The health effects evidence of relevance to ambient NO2 derives from three lines of investigation: epidemiology studies, human clinical studies, and animal toxicology studies. The NO2 epidemiology remains inconsistent and uncertain due to the potential for exposure misclassification, residual confounding, and co-pollutant effects, whereas animal toxicology findings using high levels of NO2 exposure require extrapolation to humans exposed at low ambient NO2 levels. Given the limitations and uncertainties in the other lines of health effects evidence, our review thus focused on clinical studies where human volunteers (including asthmatics, children, and elderly) inhaled NO2 at levels from 0.1 to 3.5 ppm during short-term ((1/2)-6-h) exposures, often combined with exercise, and occasionally combined with co-pollutants. We examined the reported biological effects and classified them into (a) lung immune responses and inflammation, (b) lung function changes and airway hyperresponsiveness (AHR), and (c) health effects outside the lungs (extrapulmonary). We examined more than 50 experimental studies of humans inhaling NO2, finding that such clinical data on short-term exposure allowed discrimination of NO2 no-effect levels versus lowest-adverse-effects levels. Our conclusions are summarized by these six points: For lung immune responses and inflammation: (1) healthy subjects exposed to NO2 below 1 ppm do not show pulmonary inflammation; (2) at 2 ppm for 4 h, neutrophils and cytokines in lung-lavage fluid can increase, but these changes do not necessarily correlate with significant or sustained changes in lung function; (3) there is no consistent evidence that NO2 concentrations below 2 ppm increase susceptibility to viral infection; (4) for asthmatics and individuals having chronic obstructive pulmonary disease (COPD), NO2-induced lung inflammation is not expected below 0.6 ppm, although one research group reported enhancement of proinflammatory processes at 0.26 ppm. With regard to NO2-induced AHR: (5) studies of responses to specific or nonspecific airway challenges (e.g., ragweed, methacholine) suggest that asthmatic individuals were not affected by NO2 up to about 0.6 ppm, although some sensitive subsets may respond to levels as low as 0.2 ppm. And finally, for extra-pulmonary effects: (6) such effects (e.g., changes in blood chemistry) generally required NO2 concentrations above 1-2 ppm. Overall, our review of data from experiments with humans indicates that a health-protective, short-term-average NO2 guideline level for susceptible populations (and healthy populations) would reflect a policy choice between 0.2 and 0.6 ppm. The available human clinical results do not establish a mechanistic pathway leading to adverse health impacts for short-term NO2 exposures at levels typical of maximum 1-h concentrations in the present-day ambient environment (i.e., below 0.2 ppm).
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Munidasa DT, Koike E, Kobayashi T. An in vitro study of the effect of size and timing of administration of titanium dioxide particles on antigen presenting activity of alveolar macrophages and peripheral blood monocytes. Inhal Toxicol 2009; 21:849-56. [PMID: 19653805 DOI: 10.1080/08958370802524373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Previous studies have shown that inhaled particles exacerbate asthma and allergic rhinitis. Several factors related to the particle may play a role in immune-stimulating activity; however, the underlying mechanisms remain unclear. We carried out in vitro studies to investigate the effects of TiO(2) particle exposure on antigen presenting activity and expression of the associated cell-surface molecules (Ia, B7.1, B7.2) in rat derived monocytes and alveolar macrophages, in terms of two aspects of the particles: (1) size (59 nm (ST) and 350 nm (LT) particles), and (2) the timing of particle exposure (before antigen exposure or co-administered). Results indicated that particle exposure prior to antigen exposure led to decreased antigen presenting activity in both types of cell. This decrease was greater with ST particles. In monocytes, the expression of cell surface molecules decreased similarly with both particles. Conversely, alveolar macrophages showed greater expression of Ia with ST than with LT exposures. Ia expression was confirmed to be functionally active by a mixed lymphocyte reaction. It is possible that particle exposure might result in poor antigen processing, thereby leading to decreased antigen presenting activity. Co-exposure of particles and antigen induced an increase in antigen presenting activity with both types of particle; however, ST exposure induced greater antigen presenting activity. The expression of Ia also increased similarly with both particle sizes. This suggests that, in a co-exposure situation, antigen may be processed without intensive retardation by particles, and factors other than Ia may affect antigen presenting activity. In conclusion, both size and timing of exposure to TiO(2) particles affect antigen presenting activity of monocytes and alveolar macrophages.
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Singh V, Sharma BB, Yadav R, Meena P. Respiratory morbidity attributed to auto-exhaust pollution in traffic policemen of Jaipur, India. J Asthma 2009; 46:118-21. [PMID: 19253114 DOI: 10.1080/02770900802448436] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
AIMS This study was conducted to evaluate pulmonary effects of traffic pollution on traffic police. METHODS The traffic police working in Jaipur city were given a predetermined respiratory health questionnaire, and their clinical profile and lung functions were measured. RESULTS This study showed that there were prominent respiratory symptoms and reduced forced expiratory volume in 1 second (FEV(1)) in subjects exposed to traffic pollution. When smokers were excluded, it showed a significant difference in FEV(1) data of non-smoking subjects exposed to traffic generated pollution and those not exposed. The difference observed was 95.3 +/- 13.6 versus 87.8 +/- 0.95%, respectively, and 95%CI = 4.420-10.517, p = 0.001. CONCLUSIONS Respiratory morbidity with respect to lung function tests is observed more in groups working in heavy traffic than the control group.
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Affiliation(s)
- Virendra Singh
- Department of Medicine, SMS Medical College and Hospital, Jaipur, India.
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Pénard-Morand C, Annesi-Maesano I. [Allergic respiratory diseases and outdoor air pollution]. Rev Mal Respir 2009; 25:1013-26. [PMID: 18971807 DOI: 10.1016/s0761-8425(08)74417-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
INTRODUCTION After having increased for some time, the prevalence of allergic diseases may have reached a plateau. During this increase, considerable concomitant changes in air pollution have occurred. Photo-oxidant air pollution, related to traffic, has become preponderant. The implication of air pollution in the epidemic of allergies is still debated. BACKGROUND Experimental studies have suggested that the effect of air pollutants, including particulates and ozone, on the worsening and even the induction of allergies is biologically plausible. In addition, epidemiological studies have shown a short term impact of the peaks of air pollution on exacerbations of asthma. On the other hand, the results of epidemiological studies dealing with the long-term effects of chronic exposure to air pollution on the prevalence of allergies are less consistent. VIEWPOINTS The implementation of new-born cohorts, the use of dispersion models to improve exposure assessment and the study of gene-environment correlations, should increase our knowledge of the role of traffic-related air pollutants in the development of allergies and identify subjects more sensitive to their effects. CONCLUSIONS Some traffic-related air pollutants may have played a more important role in the increase in the prevalence of allergies than was assumed from the first epidemiological studies.
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Antibiotics. ASTHMA AND COPD 2009. [PMCID: PMC7150331 DOI: 10.1016/b978-0-12-374001-4.00053-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
This chapter describes the optimal approach to antibiotic treatment of exacerbations recognizing these limitations. Such an approach relies upon an accurate diagnosis of an exacerbation, including judicious application of diagnostic tests. Determining the severity of an exacerbation follows this. If antibiotics are indicated, then a risk stratification approach is described to choose an appropriate antibiotic. An increase in airway inflammation from the baseline level in a patient appears central to the pathogenesis of most acute exacerbations. Airway inflammation measured in induced or expectorated sputum, bronchoalveolar lavage or bronchial biopsy has revealed that increased inflammation accompanies exacerbations and resolves with treatment. Potential pathogens in chronic obstructive pulmonary disease (COPD) exacerbations include typical respiratory bacterial pathogens, respiratory viruses, and atypical bacteria. The current model of bacterial exacerbation pathogenesis involves both host and pathogen factors. Acquisition of strains of bacterial pathogens that are new to the host from the environment is the primary event that puts the patient with COPD at risk for an exacerbation. The traditional aims of treatment of an exacerbation are improvement in clinical status and the prevention of complications. The role of antibiotics in the treatment of COPD exacerbations has been a matter of controversy. Even more contentious has been the issue whether antibiotic choice is relevant to clinical outcome of exacerbations. Recommendations for antibiotic use among published guidelines are inconsistent.
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Mitra Azadniv Mark J. Utell Paul E.. EFFECTS OF NITROGEN DIOXIDE EXPOSURE ON HUMAN HOST DEFENSE. Inhal Toxicol 2008. [DOI: 10.1080/089583798197556] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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Latza U, Gerdes S, Baur X. Effects of nitrogen dioxide on human health: systematic review of experimental and epidemiological studies conducted between 2002 and 2006. Int J Hyg Environ Health 2008; 212:271-87. [PMID: 18771952 DOI: 10.1016/j.ijheh.2008.06.003] [Citation(s) in RCA: 141] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2008] [Revised: 06/19/2008] [Accepted: 06/24/2008] [Indexed: 11/29/2022]
Abstract
In order to assess health effects in humans caused by environmental nitrogen dioxide (NO(2)) a systematic review of studies in humans was conducted. MEDLINE database was searched for epidemiological studies and experiments on adverse effects of NO(2) published between 2002 and 2006. The evidence with regard to NO(2) exposure limits was assessed using the Scottish Intercollegiate Guidelines Network (SIGN) grading system and the modified three star system. Of the 214 articles retrieved 112 fulfilled the inclusion criteria. There was limited evidence that short-term exposure to a 1-h mean value below 200 microg NO(2)/m(3) is associated with adverse health effects provided by only one study on mortality in patients with severe asthma (*2+). The effect remained after adjusting for other air pollutants. There was moderate evidence that short-term exposure below a 24-h mean value of 50 microg NO(2)/m(3) at monitor stations increases hospital admissions and mortality (**2+). Evidence was also moderate when the search was restricted to susceptible populations (children, adolescents, elderly, and asthmatics). There was moderate evidence that long-term exposure to an annual mean below 40 microg NO(2)/m(3) was associated with adverse health effects (respiratory symptoms/diseases, hospital admissions, mortality, and otitis media) provided by generally consistent findings in five well-conducted cohort and case-control studies with some shortcomings in the study quality (**2+). Evidence was also moderate when the search was restricted to studies in susceptible populations (children and adolescents) and for the combination with other air pollutants. The most frequent reasons for decreased study quality were potential misclassification of exposure and selection bias. None of the high-quality observational studies evaluated was informative for the key questions due to the choice of the dose parameter (e.g., 1-week mean) and exposure levels above the limit values. Inclusion of study designs unlisted in the SIGN grading system did not bring additional evidence regarding exposures below the current air quality limit values for NO(2). As several recent studies reported adverse health effects below the current exposure limits for NO(2) particularly among susceptible populations regarding long-term exposure further research is needed. Apart from high-quality epidemiological studies on causality and the interaction of NO(2) with other air pollutants there is a need for double-blinded randomized cross-over studies among susceptible populations for further evaluation of the short-term exposure limits.
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Affiliation(s)
- Ute Latza
- Institute for Occupational Medicine and Maritime Medicine (ZfAM), University of Hamburg, Hamburg State Department for Social Affairs, Family, Health, and Consumer Protection, Hamburg, Germany.
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Siddiqi A, Sethi S. Optimizing antibiotic selection in treating COPD exacerbations. Int J Chron Obstruct Pulmon Dis 2008; 3:31-44. [PMID: 18488427 PMCID: PMC2528209 DOI: 10.2147/copd.s1089] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Our understanding of the etiology, pathogenesis and consequences of acute exacerbations of chronic obstructive pulmonary disease (COPD) has increased substantially in the last decade. Several new lines of evidence demonstrate that bacterial isolation from sputum during acute exacerbation in many instances reflects a cause-effect relationship. Placebo-controlled antibiotic trials in exacerbations of COPD demonstrate significant clinical benefits of antibiotic treatment in moderate and severe episodes. However, in the multitude of antibiotic comparison trials, the choice of antibiotics does not appear to affect the clinical outcome, which can be explained by several methodological limitations of these trials. Recently, comparison trials with nontraditional end-points have shown differences among antibiotics in the treatment of exacerbations of COPD. Observational studies that have examined clinical outcome of exacerbations have repeatedly demonstrated certain clinical characteristics to be associated with treatment failure or early relapse. Optimal antibiotic selection for exacerbations has therefore incorporated quantifying the risk for a poor outcome of the exacerbation and choosing antibiotics differently for low risk and high risk patients, reserving the broader spectrum drugs for the high risk patients. Though improved outcomes in exacerbations with antibiotic choice based on such risk stratification has not yet been demonstrated in prospective controlled trials, this approach takes into account concerns of disease heterogeneity, antibiotic resistance and judicious antibiotic use in exacerbations.
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Affiliation(s)
- Attiya Siddiqi
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine,Veterans Affairs Western New York Health Care System, Buffalo, NY 14125, USA
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VENABLES KM, ALLITT U, COLLIER CG, EMBERLIN J, GREIG JB, HARDAKER PJ, HIGHHAM JH, LATNG-MORTON T, MAYNARD RL, MURRAY V, STRACHAN D, TEE RD. Thunderstorm-related asthma - the epidemic of 24/25 June 1994. Clin Exp Allergy 2008. [DOI: 10.1046/j.1365-2222.1997.790893.x] [Citation(s) in RCA: 93] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Cai C, Xu J, Zhang M, Chen XD, Li L, Wu J, Lai HW, Zhong NS. Prior SO2 exposure promotes airway inflammation and subepithelial fibrosis following repeated ovalbumin challenge. Clin Exp Allergy 2008; 38:1680-7. [PMID: 18631350 DOI: 10.1111/j.1365-2222.2008.03053.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Exposure to allergens or air pollutants often leads to asthma exacerbations associated with aggravation of airway inflammation. Although, repeated allergen challenge often induces chronic allergic airway inflammation (CAAI) and airway remodelling, yet, the effects of brief exposure to air pollutants such as SO(2) on development of CAAI and airway remodelling remain to be clarified. OBJECTIVE The aim of the experiment was to investigate the effects of acute neutrophilic airway inflammation induced by brief exposure to SO(2) on development of CAAI and subepithelial fibrosis (SEF) in a murine model of asthma. METHODS Acute airway inflammation was induced by brief exposure to 50 p.p.m. SO(2) (1 h/d, 3 days). CAAI and SEF in BALB/c mice were induced by repeated challenge with ovalbumin (OVA) for 5 or 9 weeks with or without prior exposure to SO(2). Bronchoalveolar lavage fluid (BALF) eosinophilia as index of CAAI, BALF endothelin-1 (ET-1) and TGF-beta1 levels, morphometric evaluation of fibrotic area beneath subbasement membrane and lung hydroxyproline content (Hyp) as indexes of SEF were monitored. RESULTS Exposure to SO(2) led to acute neutrophilic inflammation and epithelial sloughing with profound elevation of BALF ET-1. Repeated OVA challenge resulted in CAAI and SEF along with elevation of Hyp, increase of fibrotic area beneath subbasement membrane and elevation of BALF TGF-beta1. Preceding SO(2) exposure exaggerated BALF eosinophilia, facilitated and enhanced SEF with more significant elevation of BALF ET-1 and TGF-beta1 levels compared with OVA-challenged mice without prior exposure to SO(2). The increase of Hyp was positively correlated with elevation of BALF TGF-beta1 during CAAI (r=0.842, P<0.01). CONCLUSION This data demonstrated that SEF developed in parallel with severity and time course of CAAI following repeated OVA challenge. SO(2)-induced acute epithelial injury and neutrophilic inflammation could enhance CAAI and promote SEF, probably through overexpression of ET-1 and TGF-beta1.
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Affiliation(s)
- C Cai
- Department of Pulmonology, No. 1 Hospital of Beijing University, Beijing, China
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Martinez FJ, Curtis JL, Albert R. Role of macrolide therapy in chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis 2008; 3:331-50. [PMID: 18990961 PMCID: PMC2629987 DOI: 10.2147/copd.s681] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a leading cause of death and disability worldwide. The Global Burden of Disease study has concluded that COPD will become the third leading cause of death worldwide by 2020, and will increase its ranking of disability-adjusted life years lost from 12th to 5th. Acute exacerbations of COPD (AECOPD) are associated with impaired quality of life and pulmonary function. More frequent or severe AECOPDs have been associated with especially markedly impaired quality of life and a greater longitudinal loss of pulmonary function. COPD and AECOPDs are characterized by an augmented inflammatory response. Macrolide antibiotics are macrocyclical lactones that provide adequate coverage for the most frequently identified pathogens in AECOPD and have been generally included in published guidelines for AECOPD management. In addition, they exert broad-ranging, immunomodulatory effects both in vitro and in vivo, as well as diverse actions that suppress microbial virulence factors. Macrolide antibiotics have been used to successfully treat a number of chronic, inflammatory lung disorders including diffuse panbronchiolitis, asthma, noncystic fibrosis associated bronchiectasis, and cystic fibrosis. Data in COPD patients have been limited and contradictory but the majority hint to a potential clinical and biological effect. Additional, prospective, controlled data are required to define any potential treatment effect, the nature of this effect, and the role of bronchiectasis, baseline colonization, and other cormorbidities.
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Affiliation(s)
- Fernando J Martinez
- Division of Pulmonary and Critical Care Medicine, University of Michigan Health System, Ann Arbor, MI 48109-0360, USA.
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Martinez FJ. Pathogen-directed therapy in acute exacerbations of chronic obstructive pulmonary disease. PROCEEDINGS OF THE AMERICAN THORACIC SOCIETY 2007; 4:647-58. [PMID: 18073397 PMCID: PMC2647652 DOI: 10.1513/pats.200707-097th] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2007] [Accepted: 08/22/2007] [Indexed: 12/15/2022]
Abstract
Acute exacerbations of chronic obstructive pulmonary disease (COPD) are important events in the natural history of this chronic lung disorder. These events can be caused by a large number of infectious and noninfectious agents and are associated with an increased local and systemic inflammatory response. Their frequency and severity have been linked to progressive deterioration in lung function and health status. Infectious pathogens ranging from viral to atypical and typical bacteria have been implicated in the majority of episodes. Most therapeutic regimens to date have emphasized broad, nonspecific approaches to bronchoconstriction and pulmonary inflammation. Increasingly, therapy that targets specific etiologic pathogens has been advocated. These include clinical and laboratory-based methods to identify bacterial infections. Further additional investigation has suggested specific pathogens within this broad class. As specific antiviral therapies become available, better diagnostic approaches to identify specific pathogens will be required. Furthermore, prophylactic therapy for at-risk individuals during high-risk times may become a standard therapeutic approach. As such, the future will likely include aggressive diagnostic algorithms based on the combination of clinical syndromes and rapid laboratory modalities to identify specific causative bacteria or viruses.
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Affiliation(s)
- Fernando J Martinez
- Division of Pulmonary and Critical Care Medicine, University of Michigan Health System, 1500 East Medical Center Drive, SPC 5360, Ann Arbor, MI 48109-5360, USA.
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Duramad P, Harley K, Lipsett M, Bradman A, Eskenazi B, Holland NT, Tager IB. Early environmental exposures and intracellular Th1/Th2 cytokine profiles in 24-month-old children living in an agricultural area. ENVIRONMENTAL HEALTH PERSPECTIVES 2006; 114:1916-22. [PMID: 17185285 PMCID: PMC1764130 DOI: 10.1289/ehp.9306] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
BACKGROUND Children who reside in agricultural settings are potentially exposed to higher levels of organophosphate (OP) pesticides, endotoxin, and allergens than their urban counterparts. Endotoxin and allergens stimulate maturation of the immune response in early childhood, but little is known about the effect of exposures to OPs or to the three combined. OBJECTIVES In this study, we investigated the relationships between these exposures and T-helper 1 (Th1) and T-helper 2 (Th2) cytokines, biomarkers of allergic asthma, in the subjects of CHAMACOS (Center for the Health Assessment of Mothers and Children of Salinas), a longitudinal birth cohort in Salinas Valley, California. Exposures were ascertained by interviewer-administered questionnaires and by home visits, and clinical diagnoses were abstracted from medical records. Blood samples were collected at 12 and 24 months of age and analyzed for Th1/Th2 status by flow cytometric detection of intracellular interferon-gamma/interleukin-4 cytokine expression. FINDINGS Mean Th2 levels were significantly higher in children with doctor-diagnosed asthma and children with wheezing at 2 years of age. In a multiple linear regression model, exclusive breast-feeding at 1 month and pet ownership were associated with 35.3% (p < 0.01) and 34.5% (p = 0.01) increases in Th1, respectively. Maternal agricultural work and presence of gas stove in the home were associated with a 25.9% increase (p = 0.04) and 46.5% increase (p < 0.01) in Th2, respectively. CONCLUSIONS Asthma and wheeze outcomes in children at 24 months of age are associated with elevated Th2 status in children at an early age. Our data further suggest that early exposures to an agricultural environment, breast-feeding, pets, and gas stoves affect the development of children's Th1/Th2 immune response.
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Affiliation(s)
- Paurene Duramad
- Center for Children’s Environmental Health, School of Public Health, University of California, Berkeley, California, USA
| | - Kim Harley
- Center for Children’s Environmental Health, School of Public Health, University of California, Berkeley, California, USA
| | - Michael Lipsett
- Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, California, USA
| | - Asa Bradman
- Center for Children’s Environmental Health, School of Public Health, University of California, Berkeley, California, USA
| | - Brenda Eskenazi
- Center for Children’s Environmental Health, School of Public Health, University of California, Berkeley, California, USA
| | - Nina T. Holland
- Center for Children’s Environmental Health, School of Public Health, University of California, Berkeley, California, USA
- Address correspondence to N.T. Holland, 759 University Hall, Berkeley, CA 94720-7460 USA. Telelphone: (510) 643-5427. Fax: (510) 643-5426. E-mail:
| | - Ira B. Tager
- Center for Children’s Environmental Health, School of Public Health, University of California, Berkeley, California, USA
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KNOX RB, SUPHIOGLU C, TAYLOR P, DESAI R, WATSON HC, PENG JL, BURSILL LA. Major grass pollen allergen Lol p 1 binds to diesel exhaust particles: implications for asthma and air pollution. Clin Exp Allergy 2006. [DOI: 10.1111/j.1365-2222.1997.tb00702.x] [Citation(s) in RCA: 189] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Witten A, Solomon C, Abbritti E, Arjomandi M, Zhai W, Kleinman M, Balmes J. Effects of nitrogen dioxide on allergic airway responses in subjects with asthma. J Occup Environ Med 2006; 47:1250-9. [PMID: 16340706 DOI: 10.1097/01.jom.0000177081.62204.8d] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE We sought to determine whether nitrogen dioxide (NO2) can enhance airway inflammation after allergen challenge in asthmatic subjects. METHODS Fifteen house-dust-mite (HDM)-sensitive asthmatic subjects were exposed for 3 hours to filtered air or 0.4 ppm NO2, followed by inhalational challenge with HDM allergen. Markers of inflammation were measured in sputum at 6 hours and 26 hours after allergen challenge. RESULTS After exposure to NO2, eosinophil concentration decreased significantly in the 6-hour postallergen sputum. No significant NO2-related difference was observed for other variables. CONCLUSIONS Our results suggest that, in most asthmatic individuals, multi-hour exposure to a high ambient concentration of NO2 does not enhance the inflammatory response to subsequent inhaled allergen as assessed by cell distribution in induced sputum. Because the decrease in airway eosinophils has been reported in previous animal studies, future research should be directed toward the mechanism of this effect.
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Affiliation(s)
- Allyson Witten
- Lung Biology Center and Division of Occupational and Environmental Medicine, University of California, San Francisco, California 94143-0843, USA
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Abstract
Exacerbations of COPD are thought to be caused by complex interactions between the host, bacteria, viruses, and environmental pollution. These factors increase the inflammatory burden in the lower airways, overwhelming the protective anti-inflammatory defences leading to tissue damage. Frequent exacerbations are associated with increased morbidity and mortality, a faster decline in lung function, and poorer health status, so prevention or optimal treatment of exacerbations is a global priority. In order to evolve new treatment strategies there has been great interest in the aetiology and pathophysiology of exacerbations, but progress has been hindered by the heterogeneous nature of these episodes, vague definitions of an exacerbation, and poor stratification of known confounding factors when interpreting results. We review how an exacerbation should be defined, its inflammatory basis, and the importance of exacerbations on disease progression. Important aetiologies, with their potential underlying mechanisms, are discussed and the significance of each aetiology is considered.
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Affiliation(s)
- E Sapey
- Lung Investigation Unit, Queen Elizabeth Hospital, Birmingham B15 2TH, UK
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Pénard-Morand C, Charpin D, Raherison C, Kopferschmitt C, Caillaud D, Lavaud F, Annesi-Maesano I. Long-term exposure to background air pollution related to respiratory and allergic health in schoolchildren. Clin Exp Allergy 2006; 35:1279-87. [PMID: 16238786 DOI: 10.1111/j.1365-2222.2005.02336.x] [Citation(s) in RCA: 144] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND The impact of air pollution on asthma and allergies still remains a debate. OBJECTIVE Our cross-sectional study was intended to analyse the associations between long-term exposure to background air pollution and atopic and respiratory outcomes in a large population-based sample of schoolchildren. METHODS Six thousand six hundred and seventy-two children aged 9-11 years recruited from 108 randomly schools in six French cities underwent a clinical examination including a skin prick test (SPT) to common allergens, exercise-induced bronchial reactivity (EIB) and skin examination for flexural dermatitis. The prevalence of asthma, allergic rhinitis (AR) and atopic dermatitis was assessed by a standardized health questionnaire completed by the parents. Three-year-averaged concentrations of air pollutants (NO2, SO2, PM10 and O3) were calculated at children' schools using measurements of background monitoring stations. RESULTS After adjusting for confounders, EIB, lifetime asthma and lifetime AR were found to be positively related to an increase in the exposure to SO2, PM10 and O3. The adjusted odds ratios (aOR) per increase of 5 microg/m3 of SO2 was 1.39 (95% confidence interval (CI)=1.15-1.66) for EIB and 1.19 (1.00-1.41) for lifetime asthma. The aOR for lifetime AR per increase of 10 microg/m3 of PM10 was 1.32 (CI=1.04-1.68). Moreover, SPT positivity was associated with O3 (aOR=1.34; CI=1.24-1.46). Associations with past year symptoms were consistent, even if not always statistically significant. Results persisted in long-term resident (current address for at least 8 years) children. However, no consistent positive association was found with NO2. CONCLUSIONS A moderate increase in long-term exposure to background ambient air pollution was associated with an increased prevalence of respiratory and atopic indicators in children.
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Affiliation(s)
- C Pénard-Morand
- INSERM U472, Epidemiology of Allergic and Respiratory Diseases, Villejuif, France.
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Park JW, Lim YH, Kyung SY, An CH, Lee SP, Jeong SH, Ju YS. Effects of ambient particulate matter on peak expiratory flow rates and respiratory symptoms of asthmatics during Asian dust periods in Korea. Respirology 2006; 10:470-6. [PMID: 16135170 DOI: 10.1111/j.1440-1843.2005.00728.x] [Citation(s) in RCA: 93] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Dust generating events frequently produce ambient dust particles that are less than 10 microm in diameter, and these have been linked to adverse effects in the general population. However, the evidence linking these particles to adverse effects on the airways of asthmatic individuals is limited. The objective of this study was to investigate the possible adverse effects of Asian dust events on the respiratory functions and symptoms of subjects with bronchial asthma. METHODOLOGY From March to June 2002, individuals were enrolled who had been diagnosed as having asthma by bronchial challenge or by their bronchodilator response. The patients were divided into three groups according to asthma severity: mild, moderate and severe. Patients with other major disease states were excluded. Patients completed twice-daily diaries monitoring PEF, respiratory symptoms, and daily activities. The daily and hourly mean levels of particulate matter <10 microm in diameter (PM(10)), as well as nitrogen dioxide (NO(2)), sulphur dioxide (SO(2)), ozone (O(3)) and carbon monoxide (CO) were measured at 10 monitoring sites in Incheon, Korea. RESULTS Dust events occurred 14 times during the study period. On dusty days there were increased levels of PM(10), decreased levels of NO(2) and SO(2), and no change in the CO levels, compared to the levels on control days. An increase in PM(10) concentration was associated with increases in PEF variability of >20% (P<0.05), more night-time symptoms (P<0.05), and a decrease in the mean PEF (P<0.05), calculated by longitudinal data analysis. In contrast, there was no association between the PM(10) levels and bronchodilator inhaler use or daytime respiratory symptoms. Using a general additive Poisson regression model, a borderline association was noted between PM(10) and respiratory symptoms, with a relative risk of 1.05 (95% confidence interval (CI), 0.99--1.17). There was no association between the PM(10) concentrations and PEF measurements, with PEF variability of >20% between the morning and evening values and a relative risk of 1.05 (95% CI, 0.89--1.24) in all subjects. CONCLUSIONS This study provides evidence that Asian dust events are impacting on the respiratory symptoms of subjects with bronchial asthma, and ambient air pollution, particularly elevated PM(10), might be one of the aggravating factors.
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Affiliation(s)
- Jeong Woong Park
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Gachon Medical School, Gil Medical Center, Incheon, Korea.
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Casset A, Purohit A, Marchand C, Le Calvé S, Donnay C, Uring-Lambert B, Bahram S, Pauli G, de Blay F. Le formaldéhyde inhalé et la réponse bronchique. Rev Mal Respir 2006. [DOI: 10.1016/s0761-8425(06)73414-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Kraft M, Eikmann T, Kappos A, Künzli N, Rapp R, Schneider K, Seitz H, Voss JU, Wichmann HE. The German view: effects of nitrogen dioxide on human health--derivation of health-related short-term and long-term values. Int J Hyg Environ Health 2005; 208:305-18. [PMID: 16078645 DOI: 10.1016/j.ijheh.2005.04.002] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The presented overview concerning health relevant effects caused by nitrogen dioxide (NO2) resumes the current state of results from animal experiments and human studies (epidemiology and short-term chambers studies). NO2 concentrations applied in animal experiments were mostly considerably higher than in ambient air. Therefore, short- and long-term limit values were derived from human data. Experimental studies conducted with humans demonstrate effects after short-term exposure to concentrations at or above 400 microg NO2/m3. Effects on patients with light asthma could not be observed after short-term exposure to concentrations below 200 microg/m3. On basis of epidemiological long-term studies a threshold below which no effect on human health is expected could not be specified. Two short-term limit values have been proposed to protect public health: a 1-h value of 100 microg/m3 and a 24-h mean value of 50 microg/m3. Due to the limitations of epidemiological studies to disentangle effects of single pollutants, a long-term limit value cannot be easily derived. However, applying the precautionary principle, it is desirable to adopt an annual mean of 20 microg NO2/m3 as a long-term mean standard to protect public health.
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Affiliation(s)
- Martin Kraft
- Ministry of the Environment and Conservation, Agriculture and Consumer Protection of the state of North Rhine-Westphalia, Düsseldorf, Germany.
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Sethi S, Murphy TF. Acute exacerbations of chronic bronchitis: new developments concerning microbiology and pathophysiology--impact on approaches to risk stratification and therapy. Infect Dis Clin North Am 2005; 18:861-82, ix. [PMID: 15555829 DOI: 10.1016/j.idc.2004.07.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Exacerbations are a characteristic feature of chronic obstructive pulmonary disease and contribute significantly to associated morbidity and mortality. Renewed interest in this common clinical problem and research using new investigative tools has enhanced substantially the understanding of the pathogenesis of exacerbations. Results of recent clinical trials and observational studies have allowed refinements in treatment of exacerbations that should im-prove patient outcomes. This article discusses a rational, stratified approach to the use of antibiotics for this condition based on these recent studies.
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Affiliation(s)
- Sanjay Sethi
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University at Buffalo SUNY, Buffalo, NY 14260, USA.
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Maeda Y, Shida T, Akiyama K. Childhood Onset Adult Asthma: A Comparison of Asthma Development with Exposure to High and Reduced Levels of Air Pollution. Allergol Int 2005. [DOI: 10.2332/allergolint.54.435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Phoa LL, Toelle BG, Ng K, Marks GB. Effects of gas and other fume emitting heaters on the development of asthma during childhood. Thorax 2004; 59:741-5. [PMID: 15333848 PMCID: PMC1747141 DOI: 10.1136/thx.2003.014241] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Several studies have shown adverse effects of gas cookers and heaters on respiratory health. The long term effects of early life exposure to these appliances are not known. This study investigated the effect of exposure to fume emitting heaters, currently and during the first year of life, on the risk of asthma outcomes. METHODS A cross sectional study of schoolchildren (n = 627) aged 8-11 years was conducted in Belmont, Australia. Information on symptoms and heating types was collected by parent completed questionnaire. Atopy was assessed by skin prick tests and airway hyperresponsiveness (AHR) was assessed by histamine challenge test. RESULTS There was no association between the current use of fume emitting heaters and any of the asthma outcomes. However, having been exposed to fume emitting heaters during the first year of life was associated with an increased risk of having AHR (relative risk (RR) 1.47, 95% confidence interval (CI) 1.06 to 2.03), recent wheeze (RR 1.44, 95% CI 1.11 to 1.86), and recent wheeze + AHR (RR 2.08, 95% CI 1.31 to 3.31). CONCLUSION If confirmed in other settings, this finding would require a review of the range of heating types that are appropriate for use in households in which young children live.
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Affiliation(s)
- L L Phoa
- Woolcock Institute of Medical Research, University of Sydney, Australia
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Rios JLM, Boechat JL, Sant'Anna CC, França AT. Atmospheric pollution and the prevalence of asthma: study among schoolchildren of 2 areas in Rio de Janeiro, Brazil. Ann Allergy Asthma Immunol 2004; 92:629-34. [PMID: 15237764 DOI: 10.1016/s1081-1206(10)61428-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Air pollutants have been associated with the exacerbation of respiratory diseases. They may intensify the inflammatory allergic response and airways reactivity to inhaled allergens. However, it is still not clear if air pollution contributes to the increased prevalence of asthma. OBJECTIVE To investigate if different levels of air pollution exposure can be related to differences in the prevalence of asthma. METHODS The International Study of Asthma and Allergies in Childhood (ISAAC) protocol was used to determine and compare the prevalence of asthma among schoolchildren in 2 cities of the metropolitan region of Rio de Janeiro, Brazil, Duque de Caxias (DC) and Seropédica (SR), which have different levels of atmospheric pollution. The research involved 4,064 students aged 13 to 14 years from 49 schools in DC and 1,129 from 17 schools in SR. Air pollution was evaluated by the concentration of inhalable particulate matter (PM10). RESULTS ISAAC's written questionnaire was answered by 4,040 students aged 13 to 14 years in DC and 1,080 in SR. Between 1998 and 2000, the PM10 annual arithmetic mean was 124 microg/m3 in DC and 35 microg/m3 in SR (acceptable level is up to 50 microg/m3). The prevalence of wheezing ever was 35.1% in DC and 29.9% in SR (P = .001), and the prevalence of wheezing in the last 12 months was 19.0% in DC and 15.0% in SR (P = .002). In DC, 14.5% of the adolescents presented 1 to 3 crises of wheezing in the last year, whereas in SR only 11.0% presented 1 to 3 crises (P = .003). CONCLUSIONS In this study, the prevalence of asthma in adolescents was directly related to atmospheric pollution.
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Affiliation(s)
- José Luiz Magalhães Rios
- Division of Immunology, Department of Internal Medicine, Hospital Universitário Clementino Fraga Filho, Faculdade de Medicina, Unversidade Federal do Rio de Janeiro.
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Behrens T, Taeger D, Maziak W, Duhme H, Rzehak P, Weiland SK, Keil U. Self-reported traffic density and atopic disease in children. Results of the ISAAC Phase III survey in Muenster, Germany. Pediatr Allergy Immunol 2004; 15:331-9. [PMID: 15305942 DOI: 10.1111/j.1399-3038.2004.00157.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Positive associations between traffic exposure and atopic respiratory disorders in children have been described in several studies. We analyzed data related to self-reported truck traffic density and several symptoms and diagnoses of asthma and hay fever (12-month wheezing and rhinitis symptoms, diagnoses of asthma and hay fever) from the ISAAC Phase III survey in Muenster, Germany, using core written and video questionnaires. Data were collected from representative school-based samples (n = 7345) of 6-7- and 13-14-yr-olds. In 13-14-yr-olds, according to exposure levels categorized into rare, frequent, and constant, with the 'never'-category used as reference, the sex-adjusted prevalence ratios were 1.29 (95% CI = 1.08-1.53), 1.58 (1.29-1.94), and 1.57 (1.18-2.10) for wheeze in the past 12 months, and 1.20 (1.06-1.34), 1.35 (1.17-1.55), and 1.69 (1.42-2.0) for rhinitis symptoms in the past 12 months. Prevalence ratios in 6-7-yr-olds and results for a diagnosis of asthma were less consistent while no positive association was detected between hay fever and truck traffic in both age groups. When analyses were based on a more general traffic indicator (self-reported traffic noise), no consistent associations were observed. Our data provide support for the hypothesis that residential exposure to truck traffic may adversely affect the health of children.
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Affiliation(s)
- Thomas Behrens
- Institute of Epidemiology and Social Medicine, University of Münster, Münster, Germany.
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