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Percival E, Collison AM, da Silva Sena CR, De Queiroz Andrade E, De Gouveia Belinelo P, Gomes GMC, Oldmeadow C, Murphy VE, Gibson PG, Karmaus W, Mattes J. The association of exhaled nitric oxide with air pollutants in young infants of asthmatic mothers. Environ Health 2023; 22:84. [PMID: 38049853 PMCID: PMC10696885 DOI: 10.1186/s12940-023-01030-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 11/08/2023] [Indexed: 12/06/2023]
Abstract
BACKGROUND Exhaled nitric oxide is a marker of airway inflammation. Air pollution induces airway inflammation and oxidative stress. Little is known about the impact of air pollution on exhaled nitric oxide in young infants. METHODS The Breathing for Life Trial recruited pregnant women with asthma into a randomised controlled trial comparing usual clinical care versus inflammometry-guided asthma management in pregnancy. Four hundred fifty-seven infants from the Breathing for Life Trial birth cohort were assessed at six weeks of age. Exhaled nitric oxide was measured in unsedated, sleeping infants. Its association with local mean 24-h and mean seven-day concentrations of ozone, nitric oxide, nitrogen dioxide, carbon monoxide, sulfur dioxide, ammonia, particulate matter less than 10 μm (PM10) and less than 2.5 μm (PM2.5) in diameter was investigated. The air pollutant data were sourced from local monitoring sites of the New South Wales Air Quality Monitoring Network. The association was assessed using a 'least absolute shrinkage and selection operator' (LASSO) approach, multivariable regression and Spearman's rank correlation. RESULTS A seasonal variation was evident with higher median exhaled nitric oxide levels (13.6 ppb) in warmer months and lower median exhaled nitric oxide levels (11.0 ppb) in cooler months, P = 0.008. LASSO identified positive associations for exhaled nitric oxide with 24-h mean ammonia, seven-day mean ammonia, seven-day mean PM10, seven-day mean PM2.5, and seven-day mean ozone; and negative associations for eNO with seven-day mean carbon monoxide, 24-h mean nitric oxide and 24-h mean sulfur dioxide, with an R-square of 0.25 for the penalized coefficients. These coefficients selected by LASSO (and confounders) were entered in multivariable regression. The achieved R-square was 0.27. CONCLUSION In this cohort of young infants of asthmatic mothers, exhaled nitric oxide showed seasonal variation and an association with local air pollution concentrations.
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Affiliation(s)
- Elizabeth Percival
- Asthma & Breathing Research Centre, Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW, Australia
| | - Adam M Collison
- Asthma & Breathing Research Centre, Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW, Australia
| | - Carla Rebeca da Silva Sena
- Asthma & Breathing Research Centre, Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW, Australia
| | - Ediane De Queiroz Andrade
- Asthma & Breathing Research Centre, Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW, Australia
| | - Patricia De Gouveia Belinelo
- Asthma & Breathing Research Centre, Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW, Australia
| | - Gabriela Martins Costa Gomes
- Asthma & Breathing Research Centre, Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW, Australia
| | | | - Vanessa E Murphy
- Asthma & Breathing Research Centre, Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW, Australia
| | - Peter G Gibson
- Asthma & Breathing Research Centre, Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW, Australia
- Department of Respiratory and Sleep Medicine, John Hunter Hospital, Newcastle, NSW, Australia
| | - Wilfried Karmaus
- Division of Epidemiology, School of Public Health, and Environmental Health Science, University of Memphis, BiostatisticsMemphis, TN, 38152, USA
| | - Joerg Mattes
- Asthma & Breathing Research Centre, Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW, Australia.
- Department of Paediatric Respiratory & Sleep Medicine, John Hunter Children's Hospital, Newcastle, NSW, Australia.
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Bouma F, Nyberg F, Olin AC, Carlsen HK. Genetic susceptibility to airway inflammation and exposure to short-term outdoor air pollution. Environ Health 2023; 22:50. [PMID: 37386634 DOI: 10.1186/s12940-023-00996-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 06/02/2023] [Indexed: 07/01/2023]
Abstract
BACKGROUND Air pollution is a large environmental health hazard whose exposure and health effects are unequally distributed among individuals. This is, at least in part, due to gene-environment interactions, but few studies exist. Thus, the current study aimed to explore genetic susceptibility to airway inflammation from short-term air pollution exposure through mechanisms of gene-environment interaction involving the SFTPA, GST and NOS genes. METHODS Five thousand seven hundred two adults were included. The outcome measure was fraction of exhaled nitric oxide (FeNO), at 50 and 270 ml/s. Exposures were ozone (O3), particulate matter < 10 µm (PM10), and nitrogen dioxide (NO2) 3, 24, or 120-h prior to FeNO measurement. In the SFTPA, GST and NOS genes, 24 single nucleotide polymorphisms (SNPs) were analyzed for interaction effects. The data were analyzed using quantile regression in both single-and multipollutant models. RESULTS Significant interactions between SNPs and air pollution were found for six SNPs (p < 0.05): rs4253527 (SFTPA1) with O3 and NOx, rs2266637 (GSTT1) with NO2, rs4795051 (NOS2) with PM10, NO2 and NOx, rs4796017 (NOS2) with PM10, rs2248814 (NOS2) with PM10 and rs7830 (NOS3) with NO2. The marginal effects on FeNO for three of these SNPs were significant (per increase of 10 µg/m3):rs4253527 (SFTPA1) with O3 (β: 0.155, 95%CI: 0.013-0.297), rs4795051 (NOS2) with PM10 (β: 0.073, 95%CI: 0.00-0.147 (single pollutant), β: 0.081, 95%CI: 0.004-0.159 (multipollutant)) and NO2 (β: -0.084, 95%CI: -0.147; -0.020 (3 h), β: -0.188, 95%CI: -0.359; -0.018 (120 h)) and rs4796017 (NOS2) with PM10 (β: 0.396, 95%CI: 0.003-0.790). CONCLUSIONS Increased inflammatory response from air pollution exposure was observed among subjects with polymorphisms in SFTPA1, GSTT1, and NOS genes, where O3 interacted with SFTPA1 and PM10 and NO2/NOx with the GSTT1 and NOS genes. This provides a basis for the further exploration of biological mechanisms as well as the identification of individuals susceptible to the effects of outdoor air pollution.
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Affiliation(s)
- Femke Bouma
- Department of Occupational and Environmental Health, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Medicinaregatan 16A, BOX 414, 40530, Gothenburg, Sweden
| | - Fredrik Nyberg
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg University, Gothenburg, Sweden
| | - Anna-Carin Olin
- Department of Occupational and Environmental Health, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Medicinaregatan 16A, BOX 414, 40530, Gothenburg, Sweden
| | - Hanne Krage Carlsen
- Department of Occupational and Environmental Health, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Medicinaregatan 16A, BOX 414, 40530, Gothenburg, Sweden.
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3
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Nauwelaerts SJD, Van Goethem N, De Cremer K, Sierra NB, Vercauteren J, Stroobants C, Bernard A, Nawrot T, Roosens NHC, De Keersmaecker SCJ. Noninvasive integrative approach applied to children in the context of recent air pollution exposure demonstrates association between fractional exhaled nitric oxide (FeNO) and urinary CC16. ENVIRONMENTAL RESEARCH 2023; 216:114441. [PMID: 36191620 DOI: 10.1016/j.envres.2022.114441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 09/19/2022] [Accepted: 09/23/2022] [Indexed: 06/16/2023]
Abstract
Exposure to the air pollutant particulate matter (PM) is associated with increased risks of respiratory diseases and enhancement of airway inflammation in children. In the context of large scale air pollution studies, it can be challenging to measure fractional exhaled nitric oxide (FeNO) as indicator of lung inflammation. Urinary CC16 (U-CC16) is a potential biomarker of increased lung permeability and toxicity, increasing following short-term PM2.5 exposure. The single nucleotide polymorphism (SNP) CC16 G38A (rs3741240) affects CC16 levels and respiratory health. Our study aimed at assessing the use of U-CC16 (incl. CC16 G38A from saliva) as potential alternative for FeNO by investigating their mutual correlation in children exposed to PM. Samples from a small-scale study conducted in 42 children from urban (n = 19) and rural (n = 23) schools examined at two time points, were analysed. When considering recent (lag1) low level exposure to PM2.5 as air pollution measurement, we found that U-CC16 was positively associated with FeNO (β = 0.23; 95% CI [-0.01; 0.47]; p = 0.06) in an adjusted analysis using a linear mixed effects model. Further, we observed a positive association between PM2.5 and FeNO (β = 0.56; 95% CI [0.02; 1.09]; p = 0.04) and higher FeNO in urban school children as compared to rural school children (β = 0.72; 95% CI [0.12; 1.31]; p = 0.02). Although more investigations are needed, our results suggest that inflammatory responses evidenced by increased FeNO are accompanied by potential increased lung epithelium permeability and injury, evidenced by increased U-CC16. In future large scale studies, where FeNO measurement is less feasible, the integrated analysis of U-CC16 and CC16 G38A, using noninvasive samples, might be a suitable alternative to assess the impact of air pollution exposure on the respiratory health of children, which is critical for policy development at population level.
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Affiliation(s)
- Sarah J D Nauwelaerts
- Transversal Activities in Applied Genomics, Sciensano, Brussels, Belgium; Centre for Toxicology and Applied Pharmacology, University Catholique de Louvain, Brussels, Belgium
| | - Nina Van Goethem
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
| | - Koen De Cremer
- Platform Chromatography and Mass Spectrometry, Sciensano, Brussels, Belgium
| | | | | | - Christophe Stroobants
- Centre for Environmental Sciences, Hasselt University, Agoralaan Building D, 3590, Diepenbeek, Belgium
| | - Alfred Bernard
- Centre for Toxicology and Applied Pharmacology, University Catholique de Louvain, Brussels, Belgium
| | - Tim Nawrot
- Centre for Environmental Sciences, Hasselt University, Agoralaan Building D, 3590, Diepenbeek, Belgium; Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Nancy H C Roosens
- Transversal Activities in Applied Genomics, Sciensano, Brussels, Belgium
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Gao P, Wu Y, He L, Wang L, Fu Y, Zhang F, Krafft T, Martens P. Acute effects of ambient nitrogen oxides and interactions with temperature on cardiovascular mortality in Shenzhen, China. CHEMOSPHERE 2022; 287:132255. [PMID: 34826935 DOI: 10.1016/j.chemosphere.2021.132255] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 09/07/2021] [Accepted: 09/13/2021] [Indexed: 05/22/2023]
Abstract
BACKGROUND Though inconsistent, acute effects of ambient nitrogen oxides on cardiovascular mortality have been reported. Whereas, interactive roles of temperature on their relationships and joint effects of different indicators of nitrogen oxides were less studied. This study aimed to extrapolate the independent roles of ambient nitrogen oxides and temperature interactions on cardiovascular mortality. METHODS Data on mortality, air pollutants, and meteorological factors in Shenzhen from 2013 to 2019 were collected. Three indicators including nitric oxide (NO), nitrogen dioxide (NO2), and nitrogen oxides (NOX) were studied. Adjusted generalized additive models (GAMs) were applied to analyse their associations with cardiovascular mortality in different groups. RESULTS The average daily concentrations of NO, NO2, and NOX were 11.7 μg/m3, 30.7 μg/m3, and 53.2 μg/m3, respectively. Significant associations were shown with each indicator. Cumulative effects of nitrogen oxides were more obvious than distributed lag effects. Males, population under 65 years old, and population with stroke-related condition were more susceptible to nitrogen oxides. Adverse effects of nitrogen oxides were more significant at low temperature. Impacts of NO2 on cardiovascular mortality, and NO on stroke mortality were the most robust in the multi-pollutant models, whereas variations were shown in the other relationships. CONCLUSIONS Low levels of nitrogen oxides showed acute and adverse impacts and the interactive roles of temperature on cardiovascular mortality. Cumulative effects were most significant and joint effects of nitrogen oxides required more attention. Population under 65 years old and population with stroke-related health condition were susceptible, especially days at lower temperature.
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Affiliation(s)
- Panjun Gao
- Department of Health, Ethics & Society, CAPHRI Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Yongsheng Wu
- Shenzhen Center for Disease Control and Prevention, Shenzhen, China
| | - Lihuan He
- China National Environmental Monitoring Centre, Beijing, China
| | - Li Wang
- Key Laboratory of Land Surface Pattern and Simulation, Institute of Geographical Sciences and Natural Resources Research, Chinese Academy of Sciences, Beijing, China
| | - Yingbin Fu
- Shenzhen Center for Disease Control and Prevention, Shenzhen, China
| | - Fengying Zhang
- China National Environmental Monitoring Centre, Beijing, China.
| | - Thomas Krafft
- Department of Health, Ethics & Society, CAPHRI Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Pim Martens
- Maastricht Sustainability Institute (MSI), Maastricht University, Maastricht, the Netherlands
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5
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Assessing the Respiratory Effects of Air Pollution from Biomass Cookstoves on Pregnant Women in Rural India. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 18:ijerph18010183. [PMID: 33383756 PMCID: PMC7795669 DOI: 10.3390/ijerph18010183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 12/24/2020] [Accepted: 12/24/2020] [Indexed: 11/19/2022]
Abstract
Background: In India, biomass fuel is burned in many homes under inefficient conditions, leading to a complex milieu of particulate matter and environmental toxins known as household air pollution (HAP). Pregnant women are particularly vulnerable as they and their fetus may suffer from adverse consequences of HAP. Fractional exhaled nitric oxide (FeNO) is a noninvasive, underutilized tool that can serve as a surrogate for airway inflammation. We evaluated the prevalence of respiratory illness, using pulmonary questionnaires and FeNO measurements, among pregnant women in rural India who utilize biomass fuel as a source of energy within their home. Methods: We prospectively studied 60 pregnant women in their 1st and 2nd trimester residing in villages near Nagpur, Central India. We measured FeNO levels in parts per billion (ppb), St. George’s Respiratory Questionnaire (SGRQ-C) scores, and the Modified Medical Research Council (mMRC) Dyspnea Scale. We evaluated the difference in the outcome distributions between women using biomass fuels and those using liquefied petroleum gas (LPG) using two-tailed t-tests. Results: Sixty-five subjects (32 in Biomass households; 28 in LPG households; 5 unable to complete) were enrolled in the study. Age, education level, and second-hand smoke exposure were comparable between both groups. FeNO levels were higher in the Biomass vs. LPG group (25.4 ppb vs. 8.6 ppb; p-value = 0.001). There was a difference in mean composite SGRQ-C score (27.1 Biomass vs. 10.8 LPG; p-value < 0.001) including three subtotal scores for Symptoms (47.0 Biomass vs. 20.2 LPG; p-value< 0.001), Activity (36.4 Biomass vs. 16.5 LPG; p-value < 0.001) and Impact (15.9 Biomass vs. 5.2 LPG; p-value < 0.001). The mMRC Dyspnea Scale was higher in the Biomass vs. LPG group as well (2.9 vs. 0.5; p < 0.001). Conclusion: Increased FeNO levels and higher dyspnea scores in biomass-fuel-exposed subjects confirm the adverse respiratory effects of this exposure during pregnancy. More so, FeNO may be a useful, noninvasive biomarker of inflammation that can help better understand the physiologic effects of biomass smoke on pregnant women. In the future, larger studies are needed to characterize the utility of FeNO in a population exposed to HAP.
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Qiu F, Chen L, Wang H, Huang M, Sun X, Kan J, Du J, Li Y. Protective effect of supplementation with Ginseng,
Lilii Bulbus
and Poria against
PM
2
.5
in air pollution‐induced cardiopulmonary damage among adults. Phytother Res 2020; 35:877-887. [DOI: 10.1002/ptr.6835] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 07/06/2020] [Accepted: 07/18/2020] [Indexed: 12/20/2022]
Affiliation(s)
- Feng Qiu
- Key Laboratory of Environment and Health, Ministry of Education and Ministry of Environmental Protection, and State Key Laboratory of Environmental Health, School of Public Health, Tongji Medical College Huazhong University of Science and Technology Wuhan People's Republic of China
| | - Liang Chen
- Nutrilite Health Institute, Amway (Lin et al.) R&D Center Shanghai China
| | - Hanjin Wang
- Key Laboratory of Environment and Health, Ministry of Education and Ministry of Environmental Protection, and State Key Laboratory of Environmental Health, School of Public Health, Tongji Medical College Huazhong University of Science and Technology Wuhan People's Republic of China
| | - Min Huang
- Key Laboratory of Environment and Health, Ministry of Education and Ministry of Environmental Protection, and State Key Laboratory of Environmental Health, School of Public Health, Tongji Medical College Huazhong University of Science and Technology Wuhan People's Republic of China
| | - Xiaojie Sun
- Key Laboratory of Environment and Health, Ministry of Education and Ministry of Environmental Protection, and State Key Laboratory of Environmental Health, School of Public Health, Tongji Medical College Huazhong University of Science and Technology Wuhan People's Republic of China
| | - Juntao Kan
- Nutrilite Health Institute, Amway (Lin et al.) R&D Center Shanghai China
| | - Jun Du
- Nutrilite Health Institute, Amway (Lin et al.) R&D Center Shanghai China
| | - Yuanyuan Li
- Key Laboratory of Environment and Health, Ministry of Education and Ministry of Environmental Protection, and State Key Laboratory of Environmental Health, School of Public Health, Tongji Medical College Huazhong University of Science and Technology Wuhan People's Republic of China
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7
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Gong J, Zhu T, Hu M, Wu Z, Zhang JJ. Different metrics (number, surface area, and volume concentration) of urban particles with varying sizes in relation to fractional exhaled nitric oxide (FeNO). J Thorac Dis 2019; 11:1714-1726. [PMID: 31179118 DOI: 10.21037/jtd.2019.03.90] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background There have been increasing concerns on potential health effects of ultrafine particles (UFP); but little is known as to what are the most biologically relevant metrics for these particles that make up very little mass concentration. We examined a range of particle metrics (number, surface area, active surface area, and volume concentration) in relation to fractional exhaled nitric oxide (FeNO), a well-established biomarker of pulmonary inflammation. Methods We conducted a panel study in 17 non-asthmatic children who attended schools and resided near a monitoring site at which particles in the size range of 3-800 nm were measured using a TDMPS and particles in the size range of 0.5 to 10 µm were measured using an APS. Particles were classified by size into the nucleation, Aitken, accumulation, or coarse mode, respectively, for calculating mode-specific number, surface area, active surface area, and volume concentrations. Each participating child was measured for FeNO daily for 30 days. We used linear mixed-effects models to assess the associations between various particle metrics and FeNO. Results In terms of number concentration, ambient particles in the Aitken mode and in the accumulation mode were significantly and positively associated with FeNO; but particles in the nucleation mode were significantly and negatively associated with FeNO. Moreover, UFP as a lump sum of both nucleation-mode and Aikten-mode particles did not show a significant association with FeNO. In terms of surface area concentration, ambient particles only in the accumulation mode were significantly and positively associated with FeNO. In terms of volume concentration, ambient particles in both the accumulation mode and the coarse mode were significantly and positively associated with FeNO. Analyses of the relationships between FeNO and metrics for particles deposited in the respiratory tract generated consistent findings, showing a negative association for the number concentration of deposited particles (driven by nucleation-mode particles), a positive association for the surface area concentration of deposited particles (driven by accumulation-mode particles), and a positive association for the volume concentration of deposited particles (driven by accumulation-mode and coarse-mode particles). Conclusions Particles contributing largely to the surface area concentration and/or the volume concentration of ambient particles or particles deposited in the respiratory tract had a significant positive association with pulmonary inflammation. Nucleation-mode particles, that have large number concentrations but contribute little to the surface area or volume concentration of ambient or deposited particles, had a significant negative association with FeNO. This may indicate a different biological process or may simply be due to the negative and strong correlation between nucleation-mode and accumulation-mode particles. Given that particles in different modes may have different biological actions, measuring UFP as a whole may not necessarily be useful from a biological effect standpoint.
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Affiliation(s)
- Jicheng Gong
- Beijing Innovation Center for Engineering Science and Advanced Technology, College of Environmental Sciences and Engineering and Center for Environment and Health, Peking University, Beijing 100871, China.,State Key Joint Laboratory of Environmental Simulation and Pollution Control, College of Environmental Sciences and Engineering and Center for Environment and Health, Peking University, Beijing 100871, China
| | - Tong Zhu
- Beijing Innovation Center for Engineering Science and Advanced Technology, College of Environmental Sciences and Engineering and Center for Environment and Health, Peking University, Beijing 100871, China.,State Key Joint Laboratory of Environmental Simulation and Pollution Control, College of Environmental Sciences and Engineering and Center for Environment and Health, Peking University, Beijing 100871, China
| | - Min Hu
- Beijing Innovation Center for Engineering Science and Advanced Technology, College of Environmental Sciences and Engineering and Center for Environment and Health, Peking University, Beijing 100871, China.,State Key Joint Laboratory of Environmental Simulation and Pollution Control, College of Environmental Sciences and Engineering and Center for Environment and Health, Peking University, Beijing 100871, China
| | - Zhijun Wu
- State Key Joint Laboratory of Environmental Simulation and Pollution Control, College of Environmental Sciences and Engineering and Center for Environment and Health, Peking University, Beijing 100871, China
| | - Junfeng Jim Zhang
- State Key Joint Laboratory of Environmental Simulation and Pollution Control, College of Environmental Sciences and Engineering and Center for Environment and Health, Peking University, Beijing 100871, China.,Nicholas School of the Environment and Global Health Institute, Duke University, Durham, NC, USA.,Duke Kunshan University, Kunshan 215316, China
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8
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Guo H, Yang W, Jiang L, Lyu Y, Cheng T, Gao B, Li X. Association of short-term exposure to ambient air pollutants with exhaled nitric oxide in hospitalized patients with respiratory-system diseases. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2019; 168:394-400. [PMID: 30396136 DOI: 10.1016/j.ecoenv.2018.10.094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 10/21/2018] [Accepted: 10/24/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Previous studies have suggested that exposure to ambient air pollutants may adversely affect human health. However, few studies have examined the health effects of exposure to ambient air pollutants in hospitalized patients. OBJECTIVES To evaluate the association between short-term exposure to ambient air pollutants and exhaled nitric oxide fraction (FeNO) in a large cohort of hospitalized patients. METHODS FeNO was detected for 2986 hospitalized patients (ages 18-88 years). Daily average concentrations of SO2, NO2, O3, CO, PM2.5 and PM10 in 2014 and 2015 were obtained from nine fixed-site monitoring stations. Multiple linear regression models were chosen to assess the associations of exposure to ambient air pollutants with FeNO while adjusting for confounding variables. Lagged variable models were selected to determine the association between FeNO and ambient air pollutants concentrations with lags of up to 7 days prior to FeNO testing. RESULTS Interquartile-range (IQR) increases in the daily average SO2 (8.00 μg/m3) and PM2.5 (37.0 μg/m3) were strongly associated with increases in FeNO, with increases of 3.41% [95% confidence interval (CI), 0.94-5.93%] and 2.72% (95%CI, -0.09% to 5.61%), respectively. However, FeNO levels were not statistically associated with PM10, NO2, O3 or CO. In the two-pollutant models, the maximum correlation was for ambient SO2. We also found that FeNO was associated with IQR increases in daily average ambient concentrations of SO2 up to 3 and 4 days after the exposure events. CONCLUSIONS Short-term exposure to SO2 and PM2.5 were positively correlated with FeNO levels in hospitalized patients in Shanghai.
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Affiliation(s)
- Huibin Guo
- Department of Environmental Science & Engineering, Fudan University, Shanghai 200438, PR China
| | - Wenlan Yang
- Department of Respiratory Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| | - Li Jiang
- Department of Environmental Science & Engineering, Fudan University, Shanghai 200438, PR China
| | - Yan Lyu
- Department of Environmental Science & Engineering, Fudan University, Shanghai 200438, PR China
| | - Tiantao Cheng
- Department of Environmental Science & Engineering, Fudan University, Shanghai 200438, PR China
| | - Beilan Gao
- Department of Respiratory Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| | - Xiang Li
- Department of Environmental Science & Engineering, Fudan University, Shanghai 200438, PR China; Shanghai Institute of Pollution Control and Ecological Security, Shanghai 200092, PR China.
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9
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Exposure to Household Air Pollution from Biomass Cookstoves and Levels of Fractional Exhaled Nitric Oxide (FeNO) among Honduran Women. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15112544. [PMID: 30428575 PMCID: PMC6267103 DOI: 10.3390/ijerph15112544] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 10/26/2018] [Accepted: 11/07/2018] [Indexed: 12/14/2022]
Abstract
Household air pollution is estimated to be responsible for nearly three million premature deaths annually. Measuring fractional exhaled nitric oxide (FeNO) may improve the limited understanding of the association of household air pollution and airway inflammation. We evaluated the cross-sectional association of FeNO with exposure to household air pollution (24-h average kitchen and personal fine particulate matter and black carbon; stove type) among 139 women in rural Honduras using traditional stoves or cleaner-burning Justa stoves. We additionally evaluated interaction by age. Results were generally consistent with a null association; we did not observe a consistent pattern for interaction by age. Evidence from ambient and household air pollution regarding FeNO is inconsistent, and may be attributable to differing study populations, exposures, and FeNO measurement procedures (e.g., the flow rate used to measure FeNO).
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10
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Vlaanderen J, Pronk A, Rothman N, Hildesheim A, Silverman D, Hosgood HD, Spaan S, Kuijpers E, Godderis L, Hoet P, Lan Q, Vermeulen R. A cross-sectional study of changes in markers of immunological effects and lung health due to exposure to multi-walled carbon nanotubes. Nanotoxicology 2017; 11:395-404. [DOI: 10.1080/17435390.2017.1308031] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Jelle Vlaanderen
- Division of Environmental Epidemiology, Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - Anjoeka Pronk
- Risk Analysis for Products in Development (RAPID), TNO, Zeist, The Netherlands
| | - Nathaniel Rothman
- Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Allan Hildesheim
- Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Debra Silverman
- Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - H. Dean Hosgood
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Suzanne Spaan
- Risk Analysis for Products in Development (RAPID), TNO, Zeist, The Netherlands
| | - Eelco Kuijpers
- Risk Analysis for Products in Development (RAPID), TNO, Zeist, The Netherlands
| | - Lode Godderis
- Centre for Environment and Health, Katholieke Universiteit Leuven, Leuven, Belgium
- External Service for Prevention and Protection at Work, IDEWE, Heverlee, Belgium
| | - Peter Hoet
- Centre for Environment and Health, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Qing Lan
- Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Roel Vermeulen
- Division of Environmental Epidemiology, Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
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Comparison of the Fractional Exhaled Nitric Oxide Levels in Adolescents at Three Schools Located Three Different Distances from a Large Steel Mill. Can Respir J 2017; 2017:6231309. [PMID: 28265181 PMCID: PMC5317111 DOI: 10.1155/2017/6231309] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2016] [Revised: 12/04/2016] [Accepted: 12/27/2016] [Indexed: 11/17/2022] Open
Abstract
Objectives. Exposure to ambient metals and air pollutants in urban environments has been associated with impaired lung health and inflammation in the lungs. Fractional exhaled nitric oxide (FeNO) is a reliable marker of airway inflammation. In this study, we aimed to compare the FeNO levels of three schools that have different distances from iron and steel industry zone for assessing the effects of heavy metals and air pollution on their respiratory health. Methods. Pulmonary function test and FeNO measurements were evaluated in 387 adolescents in three schools which have different distance from plant. Results. FeNO levels were significantly higher in School I (n = 142; 18.89 ± 12.3 ppb) and School II (n = 131; 17.68 ± 7.7 ppb) than School III (n = 114; 4.28 ± 3.9 ppb). Increased FeNO concentration was related to the distance of iron and steel industry zone in young adults. Conclusion. The FeNO concentrations in school children were inversely proportional to the distance from the steel mill. There are needed some studies that can evaluate the safe distance and legislation must consider these findings.
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Shi J, Chen R, Yang C, Lin Z, Cai J, Xia Y, Wang C, Li H, Johnson N, Xu X, Zhao Z, Kan H. Association between fine particulate matter chemical constituents and airway inflammation: A panel study among healthy adults in China. ENVIRONMENTAL RESEARCH 2016; 150:264-268. [PMID: 27340812 DOI: 10.1016/j.envres.2016.06.022] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Revised: 05/26/2016] [Accepted: 06/14/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Ambient fine particulate matter (PM2.5) air pollution has been associated with increased airway inflammation, but the roles of various PM2.5 constituents remain to be determined. OBJECTIVES To investigate the acute effects of PM2.5 constituents on fractional exhaled nitric oxide (FeNO), a well-established biomarker of respiratory inflammation. METHODS A longitudinal panel study was performed among 32 healthy young adults in Shanghai, China from January 12th to February 6th, 2015. FeNO was repeatedly measured, 6-8 times per subject. Real-time mass concentration of ambient PM2.5 and chemical constituents were obtained from a nearby monitoring station. Linear mixed-effect models were applied to evaluate the association between FeNO and PM2.5 constituents, with the adjustment of age, gender, body mass index, temperature, relative humidity and day of week. The robustness of constituents' effects was also evaluated. RESULTS A total of 234 effective measurements of FeNO were obtained with a geometric mean of 13.1 ppb. The PM2.5-FeNO associations were strongest at lags of 0-6h and diminished at lags longer than 12h. An interquartile range increase in PM2.5 constituents (NH4(+), NO3(-), K(+), SO4(2-) and elemental carbon) at lags of 0-6h were significantly associated with increments in FeNO by 12.3%, 11.3%, 11.1%, 9.6% and 10.7%, respectively. After controlling for PM2.5 total mass and the colinearity, only elemental carbon remained significant. CONCLUSION Several chemical constituents of PM2.5 may impact FeNO following acute exposure. Elemental carbon in particular may be the primary component responsible for increased airway inflammation.
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Affiliation(s)
- Jingjin Shi
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education and Key Lab of Health Technology Assessment of the Ministry of Health, Fudan University, Shanghai 200032, China
| | - Renjie Chen
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education and Key Lab of Health Technology Assessment of the Ministry of Health, Fudan University, Shanghai 200032, China; Shanghai Key Laboratory of Atmospheric Particle Pollution and Prevention (LAP3), Fudan University, Shanghai 200032, China
| | - Changyuan Yang
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education and Key Lab of Health Technology Assessment of the Ministry of Health, Fudan University, Shanghai 200032, China
| | - Zhijing Lin
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education and Key Lab of Health Technology Assessment of the Ministry of Health, Fudan University, Shanghai 200032, China
| | - Jing Cai
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education and Key Lab of Health Technology Assessment of the Ministry of Health, Fudan University, Shanghai 200032, China
| | - Yongjie Xia
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education and Key Lab of Health Technology Assessment of the Ministry of Health, Fudan University, Shanghai 200032, China
| | - Cuicui Wang
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education and Key Lab of Health Technology Assessment of the Ministry of Health, Fudan University, Shanghai 200032, China
| | - Huichu Li
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education and Key Lab of Health Technology Assessment of the Ministry of Health, Fudan University, Shanghai 200032, China
| | - Natalie Johnson
- Department of Environment & Occupational Health, Texas A&M School of Public Health, College Station, TX 77843, United States
| | - Xiaohui Xu
- Department of Epidemiology & Biostatistics, Texas A&M School of Public Health, College Station, TX 77843, United States
| | - Zhuohui Zhao
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education and Key Lab of Health Technology Assessment of the Ministry of Health, Fudan University, Shanghai 200032, China.
| | - Haidong Kan
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education and Key Lab of Health Technology Assessment of the Ministry of Health, Fudan University, Shanghai 200032, China; Shanghai Key Laboratory of Atmospheric Particle Pollution and Prevention (LAP3), Fudan University, Shanghai 200032, China.
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Peng C, Luttmann-Gibson H, Zanobetti A, Cohen A, De Souza C, Coull BA, Horton ES, Schwartz J, Koutrakis P, Gold DR. AIR POLLUTION INFLUENCES ON EXHALED NITRIC OXIDE AMONG PEOPLE WITH TYPE II DIABETES. AIR QUALITY, ATMOSPHERE, & HEALTH 2016; 9:265-273. [PMID: 27213020 PMCID: PMC4871616 DOI: 10.1007/s11869-015-0336-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
OBJECTIVE In a population with type 2 diabetes mellitus (T2DM), we examined associations of short-term air pollutant exposures with pulmonary inflammation, measured as fraction of exhaled pulmonary nitric oxide (FeNO). METHODS Sixty-nine Boston Metropolitan residents with T2DM completed up to 5 bi-weekly visits with 321 offline FeNO measurements. We measured ambient concentrations of particle mass, number and components at our stationary central site. Ambient concentrations of gaseous air pollutants were obtained from state monitors. We used linear models with fixed effects for participants, adjusting for 24-hour mean temperature, 24-hour mean water vapor pressure, season, and scrubbed room NO the day of the visit, to estimate associations between FeNO and interquartile range increases in exposure. RESULTS Interquartile increases in the 6-hour averages of black carbon (BC) (0.5 μg/m3) and particle number (PN) (1,000 particles/cm3) were associated with increases in FeNO of 3.84% (95% CI 0.60% to 7.18%) and 9.86 % (95% CI 3.59% to 16.52%), respectively. We also found significant associations of increases in FeNO with increases in 24-hour moving averages of BC, PN and nitrogen oxides (NOx). CONCLUSION Recent studies have focused on FeNO as a marker for eosinophilic pulmonary inflammation in asthmatic populations. This study adds support to the relevance of FeNO as a marker for pulmonary inflammation in diabetic populations, whose underlying chronic inflammatory status is likely to be related to innate immunity and proinflammatory adipokines.
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Affiliation(s)
- Cheng Peng
- Department of Environmental Health, Harvard University School of Public Health, Boston, MA
| | - Heike Luttmann-Gibson
- Department of Environmental Health, Harvard University School of Public Health, Boston, MA
| | - Antonella Zanobetti
- Department of Environmental Health, Harvard University School of Public Health, Boston, MA
| | | | - Celine De Souza
- Department of Environmental Health, Harvard University School of Public Health, Boston, MA
| | - Brent A. Coull
- Department of Biostatistics, Harvard School of Public Health, Boston, MA
| | | | - Joel Schwartz
- Department of Environmental Health, Harvard University School of Public Health, Boston, MA
- Channing Laboratory, Harvard Medical School, Boston, MA
| | - Petros Koutrakis
- Department of Environmental Health, Harvard University School of Public Health, Boston, MA
| | - Diane R. Gold
- Department of Environmental Health, Harvard University School of Public Health, Boston, MA
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
- Channing Laboratory, Harvard Medical School, Boston, MA
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Mirowsky JE, Peltier RE, Lippmann M, Thurston G, Chen LC, Neas L, Diaz-Sanchez D, Laumbach R, Carter JD, Gordon T. Repeated measures of inflammation, blood pressure, and heart rate variability associated with traffic exposures in healthy adults. Environ Health 2015; 14:66. [PMID: 26276052 PMCID: PMC4537534 DOI: 10.1186/s12940-015-0049-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Accepted: 07/09/2015] [Indexed: 05/03/2023]
Abstract
BACKGROUND Previous human exposure studies of traffic-related air pollutants have demonstrated adverse health effects in human populations by comparing areas of high and low traffic, but few studies have utilized microenvironmental monitoring of pollutants at multiple traffic locations while looking at a vast array of health endpoints in the same population. We evaluated inflammatory markers, heart rate variability (HRV), blood pressure, exhaled nitric oxide, and lung function in healthy participants after exposures to varying mixtures of traffic pollutants. METHODS A repeated-measures, crossover study design was used in which 23 healthy, non-smoking adults had clinical cardiopulmonary and systemic inflammatory measurements taken prior to, immediately after, and 24 hours after intermittent walking for two hours in the summer months along three diverse roadways having unique emission characteristics. Measurements of PM2.5, PM10, black carbon (BC), elemental carbon (EC), and organic carbon (OC) were collected. Mixed effect models were used to assess changes in health effects associated with these specific pollutant classes. RESULTS Minimal associations were observed with lung function measurements and the pollutants measured. Small decreases in BP measurements and rMSSD, and increases in IL-1β and the low frequency to high frequency ratio measured in HRV, were observed with increasing concentrations of PM2.5 EC. CONCLUSIONS Small, acute changes in cardiovascular and inflammation-related effects of microenvironmental exposures to traffic-related air pollution were observed in a group of healthy young adults. The associations were most profound with the diesel-source EC.
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Affiliation(s)
- Jaime E Mirowsky
- Department of Environmental Medicine, New York University, Tuxedo, NY, USA.
| | - Richard E Peltier
- Division of Environmental Health Science, University of Massachusetts, Amherst, MA, USA.
| | - Morton Lippmann
- Department of Environmental Medicine, New York University, Tuxedo, NY, USA.
| | - George Thurston
- Department of Environmental Medicine, New York University, Tuxedo, NY, USA.
| | - Lung-Chi Chen
- Department of Environmental Medicine, New York University, Tuxedo, NY, USA.
| | - Lucas Neas
- U.S. EPA; Epidemiology Branch, Chapel Hill, NC, USA.
| | | | - Robert Laumbach
- Department of Environmental and Occupational Medicine, University of Medicine and Dentistry of New Jersey, Piscataway, NJ, USA.
| | | | - Terry Gordon
- Department of Environmental Medicine, New York University, Tuxedo, NY, USA.
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Mirowsky J, Gordon T. Noninvasive effects measurements for air pollution human studies: methods, analysis, and implications. JOURNAL OF EXPOSURE SCIENCE & ENVIRONMENTAL EPIDEMIOLOGY 2015; 25:354-80. [PMID: 25605444 PMCID: PMC6659729 DOI: 10.1038/jes.2014.93] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Revised: 09/26/2014] [Accepted: 11/05/2014] [Indexed: 05/09/2023]
Abstract
Human exposure studies, compared with cell and animal models, are heavily relied upon to study the associations between health effects in humans and air pollutant inhalation. Human studies vary in exposure methodology, with some work conducted in controlled settings, whereas other studies are conducted in ambient environments. Human studies can also vary in the health metrics explored, as there exists a myriad of health effect end points commonly measured. In this review, we compiled mini reviews of the most commonly used noninvasive health effect end points that are suitable for panel studies of air pollution, broken into cardiovascular end points, respiratory end points, and biomarkers of effect from biological specimens. Pertinent information regarding each health end point and the suggested methods for mobile collection in the field are assessed. In addition, the clinical implications for each health end point are summarized, along with the factors identified that can modify each measurement. Finally, the important research findings regarding each health end point and air pollutant exposures were reviewed. It appeared that most of the adverse health effects end points explored were found to positively correlate with pollutant levels, although differences in study design, pollutants measured, and study population were found to influence the magnitude of these effects. Thus, this review is intended to act as a guide for researchers interested in conducting human exposure studies of air pollutants while in the field, although there can be a wider application for using these end points in many epidemiological study designs.
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Affiliation(s)
- Jaime Mirowsky
- Department of Environmental Medicine, New York University School of Medicine, Nelson Institute of Environmental Medicine, Tuxedo, New York, USA
| | - Terry Gordon
- Department of Environmental Medicine, New York University School of Medicine, Nelson Institute of Environmental Medicine, Tuxedo, New York, USA
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Scarpa MC, Kulkarni N, Maestrelli P. The role of non-invasive biomarkers in detecting acute respiratory effects of traffic-related air pollution. Clin Exp Allergy 2015; 44:1100-18. [PMID: 25040251 DOI: 10.1111/cea.12373] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The role of non-invasive methods in the investigation of acute effects of traffic-related air pollution is not clearly established. We evaluated the usefulness of non-invasive biomarkers in detecting acute air pollution effects according to the age of participants, the disease status, their sensitivity compared with lung function tests and their specificity for a type of pollutant. Search terms lead to 535 titles, among them 128 had potentially relevant abstracts. Sixtynine full papers were reviewed, while 59 articles were excluded as they did not meet the selection criteria. Methods used to assess short-term effects of air pollution included analysis of nasal lavage (NAL) for the upper airways, and induced sputum (IS), exhaled breath condensate (EBC) and exhaled nitric oxide (FeNO) for central and lower airways. There is strong evidence that FeNO evaluation is useful independently from subject age, while IS analysis is suitable almost for adults. Biomarker changes are generally observed upon pollutant exposure irrespective of the disease status of the participants. None of the biomarkers identified are specific for a type of pollutant exposure. Based on experimental exposure studies, there is moderate evidence that IS analysis is more sensitive than lung function tests, whereas this is not the case for biomarkers obtained by NAL or EBC. Cells and some cytokines (IL-6, IL-8 and myeloperoxidase) have been measured both in the upper respiratory tract (NAL) and in the lower airways (IS). Overall, the response to traffic exposure seems different in the two compartments. In conclusion, this survey of current literature displays the complexity of this research field, highlights the significance of short-term studies on traffic pollution and gives important tips when planning studies to detect acute respiratory effects of air pollution in a non-invasive way.
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Affiliation(s)
- M C Scarpa
- Department of Cardiologic, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
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18
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Berhane K, Zhang Y, Salam MT, Eckel SP, Linn WS, Rappaport EB, Bastain TM, Lurmann F, Gilliland FD. Longitudinal effects of air pollution on exhaled nitric oxide: the Children's Health Study. Occup Environ Med 2014; 71:507-13. [PMID: 24696513 DOI: 10.1136/oemed-2013-101874] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVES To assess the effects of long-term variations in ambient air pollutants on longitudinal changes in exhaled nitric oxide (FeNO), a potentially useful biomarker of eosinophilic airway inflammation, based on data from the southern California Children's Health Study. METHODS Based on a cohort of 1211 schoolchildren from eight Southern California communities with FeNO measurements in 2006-2007 and 2007-2008, regression models adjusted for short-term effects of air pollution were fitted to assess the association between changes in annual long-term exposures and changes in FeNO. RESULTS Increases in annual average concentrations of 24-h average NO2 and PM2.5 (scaled to the IQR of 1.8 ppb and 2.4 μg/m(3), respectively) were associated with a 2.29 ppb (CI 0.36 to 4.21; p=0.02) and a 4.94 ppb (CI 1.44 to 8.47; p=0.005) increase in FeNO, respectively, after adjustments for short-term effects of the respective pollutants. In contrast, changes in annual averages of PM10 and O3 were not significantly associated with changes in FeNO. These findings did not differ significantly by asthma status. CONCLUSIONS Changes in annual average exposure to current levels of ambient air pollutants are significantly associated with changes in FeNO levels in children, independent of short-term exposures and asthma status. Use of this biomarker in population-based epidemiological research has great potential for assessing the impact of changing real world mixtures of ambient air pollutants on children's respiratory health.
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Affiliation(s)
- Kiros Berhane
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Yue Zhang
- University of Utah, Salt Lake City, Utah, USA
| | - Muhammad T Salam
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Sandrah P Eckel
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - William S Linn
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Edward B Rappaport
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Theresa M Bastain
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Fred Lurmann
- Sonoma Technology Inc., Petaluma, California, USA
| | - Frank D Gilliland
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
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BOS INGE, DE BOEVER PATRICK, VANPARIJS JEF, PATTYN NATHALIE, PANIS LUCINT, MEEUSEN ROMAIN. Subclinical Effects of Aerobic Training in Urban Environment. Med Sci Sports Exerc 2013; 45:439-47. [DOI: 10.1249/mss.0b013e31827767fc] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Association between total blood mercury and exhaled nitric oxide in US adults. Nitric Oxide 2013; 29:53-8. [DOI: 10.1016/j.niox.2012.12.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2012] [Revised: 10/18/2012] [Accepted: 12/27/2012] [Indexed: 01/10/2023]
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Environmental effects on fractional exhaled nitric oxide in allergic children. J Allergy (Cairo) 2011; 2012:916926. [PMID: 22162708 PMCID: PMC3228339 DOI: 10.1155/2012/916926] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2011] [Revised: 07/31/2011] [Accepted: 08/29/2011] [Indexed: 12/21/2022] Open
Abstract
Fractional exhaled nitric oxide (FeNO) is a non-invasive marker of airway inflammation in asthma and respiratory allergy. Environmental factors, especially indoor and outdoor air quality, may play an important role in triggering acute exacerbations of respiratory symptoms. The authors have reviewed the literature reporting effects of outdoor and indoor pollutants on FeNO in children. Although the findings are not consistent, urban and industrial pollution-mainly particles (PM(2.5) and PM(10)), nitrogen dioxide (NO(2)), and sulfur dioxide (SO(2))-as well as formaldehyde and electric baseboard heating have been shown to increase FeNO, whilst ozone (O(3)) tends to decrease it. Among children exposed to Environmental Tobacco Smoke (ETS) with a genetic polymorphisms in nitric oxide synthase genes (NOS), a higher nicotine exposure was associated with lower FeNO levels. Finally, although more studies are needed in order to better investigate the effect of gene and environment interactions which may affect the interpretation of FeNO values in the management of children with asthma, clinicians are recommended to consider environmental exposures when taking medical histories for asthma and respiratory allergy. Further research is also needed to assess the effects of remedial interventions aimed at reducing/abating environmental exposures in asthmatic/allergic patients.
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FENO Concentrations in World Trade Center Responders and Controls, 6 Years Post-9/11. Lung 2011; 189:295-303. [DOI: 10.1007/s00408-011-9307-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2010] [Accepted: 05/27/2011] [Indexed: 11/30/2022]
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Associations of primary and secondary organic aerosols with airway and systemic inflammation in an elderly panel cohort. Epidemiology 2011; 21:892-902. [PMID: 20811287 DOI: 10.1097/ede.0b013e3181f20e6c] [Citation(s) in RCA: 122] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Exposure-response information about particulate air-pollution constituents is needed to protect sensitive populations. Particulate matter <2.5 mm (PM2.5) components may induce oxidative stress through reactive-oxygen-species generation, including primary organics from combustion sources and secondary organics from photochemically oxidized volatile organic compounds. We evaluated differences in airway versus systemic inflammatory responses to primary versus secondary organic particle components, particle size fractions, and the potential of particles to induce cellular production of reactive oxygen species. METHODS A total of 60 elderly subjects contributed up to 12 weekly measurements of fractional exhaled nitric oxide (NO; airway inflammation biomarker), and plasma interleukin-6 (IL-6; systemic inflammation biomarker). PM2.5 mass fractions were PM0.25 (<0.25 μm) and PM0.25-2.5 (0.25-2.5 μm). Primary organic markers included PM2.5 primary organic carbon, and PM0.25 polycyclic aromatic hydrocarbons and hopanes. Secondary organic markers included PM2.5 secondary organic carbon, and PM0.25 water soluble organic carbon and n-alkanoic acids. Gaseous pollutants included carbon monoxide (CO) and nitrogen oxides (NOx; combustion emissions markers), and ozone (O3; photochemistry marker). To assess PM oxidative potential, we exposed rat alveolar macrophages in vitro to aqueous extracts of PM0.25 filters and measured reactive-oxygen-species production. Biomarker associations with exposures were evaluated with mixed-effects models. RESULTS Secondary organic markers, PM0.25-2.5, and O3 were positively associated with exhaled NO. Primary organic markers, PM0.25, CO, and NOx were positively associated with IL-6. Reactive oxygen species were associated with both outcomes. CONCLUSIONS Particle effects on airway versus systemic inflammation differ by composition, but overall particle potential to induce generation of cellular reactive oxygen species is related to both outcomes.
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Hulin M, Annesi-Maesano I, Moreau D, Caillaud D. Association entre pollution particulaire et inflammation des bronches : effet modulateur de l’asthme et de l’atopie. REVUE FRANCAISE D ALLERGOLOGIE 2010. [DOI: 10.1016/j.reval.2010.01.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Jacobs L, Nawrot TS, de Geus B, Meeusen R, Degraeuwe B, Bernard A, Sughis M, Nemery B, Panis LI. Subclinical responses in healthy cyclists briefly exposed to traffic-related air pollution: an intervention study. Environ Health 2010; 9:64. [PMID: 20973949 PMCID: PMC2984475 DOI: 10.1186/1476-069x-9-64] [Citation(s) in RCA: 92] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2010] [Accepted: 10/25/2010] [Indexed: 05/03/2023]
Abstract
BACKGROUND Numerous epidemiological studies have demonstrated adverse health effects of a sedentary life style, on the one hand, and of acute and chronic exposure to traffic-related air pollution, on the other. Because physical exercise augments the amount of inhaled pollutants, it is not clear whether cycling to work in a polluted urban environment should be encouraged or not. To address this conundrum we investigated if a bicycle journey along a busy commuting road would induce changes in biomarkers of pulmonary and systematic inflammation in a group of healthy subjects. METHODS 38 volunteers (mean age: 43 ± 8.6 years, 26% women) cycled for about 20 minutes in real traffic near a major bypass road (road test; mean UFP exposure: 28,867 particles per cm3) in Antwerp and in a laboratory with filtered air (clean room; mean UFP exposure: 496 particles per cm3). The exercise intensity (heart rate) and duration of cycling were similar for each volunteer in both experiments. Exhaled nitric oxide (NO), plasma interleukin-6 (IL-6), platelet function, Clara cell protein in serum and blood cell counts were measured before and 30 minutes after exercise. RESULTS Percentage of blood neutrophils increased significantly more (p = 0.004) after exercise in the road test (3.9%; 95% CI: 1.5 to 6.2%; p = 0.003) than after exercise in the clean room (0.2%; 95% CI: -1.8 to 2.2%, p = 0.83). The pre/post-cycling changes in exhaled NO, plasma IL-6, platelet function, serum levels of Clara cell protein and number of total blood leukocytes did not differ significantly between the two scenarios. CONCLUSIONS Traffic-related exposure to particles during exercise caused a small increase in the distribution of inflammatory blood cells in healthy subjects. The health significance of this isolated change is unclear.
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Affiliation(s)
- Lotte Jacobs
- Occupational and Environmental Medicine, Unit of Lung Toxicology, KULeuven, Herestraat 49 (O&N1 - box 706), 3000 Leuven, Belgium
| | - Tim S Nawrot
- Occupational and Environmental Medicine, Unit of Lung Toxicology, KULeuven, Herestraat 49 (O&N1 - box 706), 3000 Leuven, Belgium
- Centre for Environmental Sciences, Hasselt University, Agoralaan gebouw D, 3590 Diepenbeek, Belgium
| | - Bas de Geus
- Faculty of Physical Education and Physiotherapy, Dept. Human Physiology & Sports Medicine, Vrije Universitiet Brussel, Pleinlaan 2, 1050 Brussels, Belgium
| | - Romain Meeusen
- Faculty of Physical Education and Physiotherapy, Dept. Human Physiology & Sports Medicine, Vrije Universitiet Brussel, Pleinlaan 2, 1050 Brussels, Belgium
| | - Bart Degraeuwe
- Flemish Institute for Technological Research, Mol, Belgium
| | - Alfred Bernard
- Department of Public Health, Catholic University of Louvain, Belgium
| | - Muhammad Sughis
- Occupational and Environmental Medicine, Unit of Lung Toxicology, KULeuven, Herestraat 49 (O&N1 - box 706), 3000 Leuven, Belgium
| | - Benoit Nemery
- Occupational and Environmental Medicine, Unit of Lung Toxicology, KULeuven, Herestraat 49 (O&N1 - box 706), 3000 Leuven, Belgium
| | - Luc Int Panis
- Flemish Institute for Technological Research, Mol, Belgium
- Transportation Research Institute, Hasselt University, Diepenbeek, Belgium
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Flamant-Hulin M, Caillaud D, Sacco P, Penard-Morand C, Annesi-Maesano I. Air pollution and increased levels of fractional exhaled nitric oxide in children with no history of airway damage. JOURNAL OF TOXICOLOGY AND ENVIRONMENTAL HEALTH. PART A 2010; 73:272-83. [PMID: 20077297 DOI: 10.1080/15287390903249206] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Air pollution is associated with a wide range of adverse respiratory events. In order to study the mechanism associated with these effects, the relationships between fractional exhaled nitric oxide (FeNO), a potential marker of airway inflammation, and exposure to air pollution were examined in schoolchildren. FeNO was measured in 104 children (34 asthmatics and 70 non-asthmatics) drawn from the general population simultaneously with air pollution assessments (fine particles with an aerodiameter under 2.5 microm, nitrogen dioxide, acetaldehyde, and formaldehyde, with pumps and passive samplers) in schoolyards and classrooms. Asthmatics exhaled more FeNO than non-asthmatics. FeNO levels were significantly elevated in both asthmatic and non-asthmatic children exposed to high concentrations of formaldehyde, acetaldehyde, and PM(2.5). Differences between high versus low exposure in non-asthmatics resulted in an FeNO increase ranging from 45% for indoor acetaldehyde to 62% for indoor PM(2.5). Stronger associations were found in non-asthmatic children who were atopic, suggesting that atopic children may be more sensitive to air pollution than non-atopic children. Exposure to air pollution may lead to airway inflammation, as measured by FeNO, in schoolchildren. These associations occur even in children with no history of airway damage and seem to be enhanced in atopic subjects.
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Murata A, Kida K, Hasunuma H, Kanegae H, Ishimaru Y, Motegi T, Yamada K, Yoshioka H, Yamamoto K, Kudoh S. Environmental influence on the measurement of exhaled nitric oxide concentration in school children: special reference to methodology. J NIPPON MED SCH 2007; 74:30-6. [PMID: 17384475 DOI: 10.1272/jnms.74.30] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Measuring exhaled nitric oxide (eNO) is a noninvasive and useful method for evaluating the correlation between airway inflammation and air pollution. The method is being used in studies; however, the effects of polluted air on eNO values are poorly understood. If polluted air significantly affects eNO concentrations, then it would be hard to evaluate the concentration of eNO, particularly in epidemiological measurements to detect the effects of airway inflammation, such as that in bronchial asthma. Thus, we hypothesized that short-term exposure to air pollution affects eNO values. PURPOSE To study the effects of environmental nitrogen oxides on the measurement of eNO concentration. SUBJECTS AND METHODS A total of 19 school children who lived on a large street with heavy traffic with random allocation were studied. Subjects with bronchial asthma were identified with a questionnaire. Suspended particulate matter. including particulate matter with an aerodynamic diameter < or =2.5 microm (PM(2.5)), optical black carbon, nitric oxide (NO), nitric dioxide (NO(2)), and nitrogen oxides (NO(X)), were measured at a fixed place along the street every hour for 11 consecutive days. The concentrations of NO and NO(2) for each subject were measured by an individual 2-pyenyl-4,4,5,5-tetramethylimidazoline-3-oxide-1-oxyl sampler, and the concentration of eNO was measured with the off-line method. RESULTS Of 19 subjects, 3 were found to have bronchial asthma. The level of each pollutant for 11 days peaked during the mornings (6;9 a.m.) and evenings (6;9 p.m.) due to traffic jams; average eNO values in healthy subjects and those with asthma were 27.1 +/- 9.7 and 57.7 +/- 18.6 ppb (p=0.098), respectively. It was found that the eNO value remained high when the mean values of various pollutants remained high for 8 hours before the measurements. It was estimated that the mean eNO values increased by 1.08 ppb (95% CI: 0.72;1.45) when the mean NO(X) value for the previous 8 hours reached approximately 10 ppb. CONCLUSION We conclude that short-term exposure to polluted air of at least 8 hours before measurement affects eNO values. Therefore, caution should be exercised when measuring eNO value in epidemiological studies.
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Affiliation(s)
- Akira Murata
- Department of Internal Medicine, Division of Pulmonary Medicine, Nippon Medical School.
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Adar SD, Adamkiewicz G, Gold DR, Schwartz J, Coull BA, Suh H. Ambient and microenvironmental particles and exhaled nitric oxide before and after a group bus trip. ENVIRONMENTAL HEALTH PERSPECTIVES 2007; 115:507-12. [PMID: 17450216 PMCID: PMC1852653 DOI: 10.1289/ehp.9386] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2006] [Accepted: 12/04/2006] [Indexed: 05/03/2023]
Abstract
OBJECTIVES Airborne particles have been linked to pulmonary oxidative stress and inflammation. Because these effects may be particularly great for traffic-related particles, we examined associations between particle exposures and exhaled nitric oxide (FE(NO)) in a study of 44 senior citizens, which involved repeated trips aboard a diesel bus. METHODS Samples of FE(NO) collected before and after the trips were regressed against microenvironmental and ambient particle concentrations using mixed models controlling for subject, day, trip, vitamins, collection device, mold, pollen, room air nitric oxide, apparent temperature, and time to analysis. Although ambient concentrations were collected at a fixed location, continuous group-level personal samples characterized microenvironmental exposures throughout facility and trip periods. RESULTS In pre-trip samples, both microenvironmental and ambient exposures to fine particles were positively associated with FE(NO). For example, an interquartile increase of 4 microg/m(3) in the daily microenvironmental PM(2.5) concentration was associated with a 13% [95% confidence interval (CI), 2-24%) increase in FE(NO). After the trips, however, FE(NO) concentrations were associated pre-dominantly with microenvironmental exposures, with significant associations for concentrations measured throughout the whole day. Associations with exposures during the trip also were strong and statistically significant with a 24% (95% CI, 15-34%) increase in FE(NO) predicted per interquartile increase of 9 microg/m(3) in PM(2.5). Although pre-trip findings were generally robust, our post-trip findings were sensitive to several influential days. CONCLUSIONS Fine particle exposures resulted in increased levels of FE(NO) in elderly adults, suggestive of increased airway inflammation. These associations were best assessed by microenvironmental exposure measurements during periods of high personal particle exposures.
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Affiliation(s)
- Sara Dubowsky Adar
- Department of Environmental and Occupational Health Sciences, University of Washington, 4225 Roosevelt Way NE, Seattle, WA 98105, USA.
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Droma Y, Hanaoka M, Basnyat B, Arjyal A, Neupane P, Pandit A, Sharma D, Miwa N, Ito M, Katsuyama Y, Ota M, Kubo K. Genetic contribution of the endothelial nitric oxide synthase gene to high altitude adaptation in sherpas. High Alt Med Biol 2006; 7:209-20. [PMID: 16978133 DOI: 10.1089/ham.2006.7.209] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The Sherpas' adaptation to high altitude has been hypothesized as being due to a genetic basis since the beginning of the last century, but this has yet to be demonstrated. We randomly enrolled 105 Sherpas in Namche Bazaar (3440 m) and 111 non-Sherpa Nepalis in Kathmandu (1330 m) in Nepal. The genotypes of Glu298Asp and eNOS4b/a polymorphisms of the endothelial nitric oxide synthase (eNOS) gene were identified. The metabolites of nitric oxide (NO( x ): nitrite and nitrate) in serum were measured. The frequencies of the Glu and eNOS4b alleles were significantly higher in Sherpas (Glu: 87.5%; eNOS4b: 96.7%) than in non-Sherpas (Glu: 77.9%, p = 0.036; eNOS4b: 90.5%, p = 0.009). In addition, the combination of the wild types of Glu298Glu and eNOS4b/b was significantly greater in Sherpas (66.7%) than non-Sherpas (47.7%, p = 0.008). However, the serum NO( x ) was significantly lower in Sherpas (53.2 +/- 4.6 micromol/L) than in non-Sherpas (107.3 +/- 9.0 micromol/L, p < 0.0001). The wild alleles of the Glu298Asp and eNOS4b/a polymorphisms of the eNOS gene may be a benefit for the Sherpas' adaptation to high altitude. The nitric oxide metabolites (NO( x )) in serum vary individually, thus it is not a reliable indicator for endogenous nitric oxide production.
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Affiliation(s)
- Yunden Droma
- Department of Medicine, Shinshu University School of Medicine, Matsumoto, Japan
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Delfino RJ, Staimer N, Gillen D, Tjoa T, Sioutas C, Fung K, George SC, Kleinman MT. Personal and ambient air pollution is associated with increased exhaled nitric oxide in children with asthma. ENVIRONMENTAL HEALTH PERSPECTIVES 2006; 114:1736-43. [PMID: 17107861 PMCID: PMC1665398 DOI: 10.1289/ehp.9141] [Citation(s) in RCA: 160] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
BACKGROUND Research has shown associations between pediatric asthma outcomes and airborne particulate matter (PM). The importance of particle components remains to be determined. METHODS We followed a panel of 45 schoolchildren with persistent asthma living in Southern California. Subjects were monitored over 10 days with offline fractional exhaled nitric oxide (FeNO), a biomarker of airway inflammation. Personal active sampler exposures included continuous particulate matter < 2.5 microm in aerodynamic diameter (PM2.5), 24-hr PM2.5 elemental and organic carbon (EC, OC), and 24-hr nitrogen dioxide. Ambient exposures included PM2.5, PM2.5 EC and OC, and NO2. Data were analyzed with mixed models controlling for personal temperature, humidity and 10-day period. RESULTS The strongest positive associations were between FeNO and 2-day average pollutant concentrations. Per interquartile range pollutant increase, these were: for 24 microg/m3 personal PM2.5, 1.1 ppb FeNO [95% confidence interval (CI), 0.1-1.9]; for 0.6 microg/m3 personal EC, 0.7 ppb FeNO (95% CI, 0.3-1.1); for 17 ppb personal NO2, 1.6 ppb FeNO (95% CI, 0.4-2.8). Larger associations were found for ambient EC and smaller associations for ambient NO2. Ambient PM2.5 and personal and ambient OC were significant only in subjects taking inhaled corticosteroids (ICS) alone. Subjects taking both ICS and antileukotrienes showed no significant associations. Distributed lag models showed personal PM2.5 in the preceding 5 hr was associated with FeNO. In two-pollutant models, the most robust associations were for personal and ambient EC and NO2, and for personal but not ambient PM2.5. CONCLUSION PM associations with airway inflammation in asthmatics may be missed using ambient particle mass, which may not sufficiently represent causal pollutant components from fossil fuel combustion.
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Affiliation(s)
- Ralph J Delfino
- Epidemiology Division, Department of Medicine, School of Medicine, University of California, Irvine, Irvine, California 92617-7555, USA.
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Mar TF, Jansen K, Shepherd K, Lumley T, Larson TV, Koenig JQ. Exhaled nitric oxide in children with asthma and short-term PM2.5 exposure in Seattle. ENVIRONMENTAL HEALTH PERSPECTIVES 2005; 113:1791-4. [PMID: 16330366 PMCID: PMC1314923 DOI: 10.1289/ehp.7883] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
The objective of this study was to evaluate associations between short-term (hourly) exposures to particulate matter with aerodynamic diameters < 2.5 microm (PM2.5) and the fractional concentration of nitric oxide in exhaled breath (FE(NO) in children with asthma participating in an intensive panel study in Seattle, Washington. The exposure data were collected with tapered element oscillation microbalance (TEOM) PM2.5 monitors operated by the local air agency at three sites in the Seattle area. FE(NO) is a marker of airway inflammation and is elevated in individuals with asthma. Previously, we reported that offline measurements of FE(NO) are associated with 24-hr average PM2.5 in a panel of 19 children with asthma in Seattle. In the present study using the same children, we used a polynomial distributed lag model to assess the association between hourly lags in PM2.5 exposure and FE(NO) levels. Our model controlled for age, ambient NO levels, temperature, relative humidity, and modification by use of inhaled corticosteroids. We found that FE(NO) was associated with hourly averages of PM2.5 up to 10-12 hr after exposure. The sum of the coefficients for the lag times associated with PM2.5 in the distributed lag model was 7.0 ppm FE(NO). The single-lag-model FE(NO) effect was 6.9 [95% confidence interval (CI), 3.4 to 10.6 ppb] for a 1-hr lag, 6.3 (95% CI, 2.6 to 9.9 ppb ) for a 4-hr lag, and 0.5 (95% CI, -1.1 to 2.1 ppb) for an 8-hr lag. These data provide new information concerning the lag structure between PM2.5 exposure and a respiratory health outcome in children with asthma.
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Affiliation(s)
- Therese F Mar
- Department of Environmental Health and Occupational Sciences, University of Washington, Seattle, Washington 98195-7234, USA
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Jansen KL, Larson TV, Koenig JQ, Mar TF, Fields C, Stewart J, Lippmann M. Associations between health effects and particulate matter and black carbon in subjects with respiratory disease. ENVIRONMENTAL HEALTH PERSPECTIVES 2005; 113:1741-6. [PMID: 16330357 PMCID: PMC1314915 DOI: 10.1289/ehp.8153] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2005] [Indexed: 05/03/2023]
Abstract
We measured fractional exhaled nitric oxide (FE(NO)), spirometry, blood pressure, oxygen saturation of the blood (SaO2), and pulse rate in 16 older subjects with asthma or chronic obstructive pulmonary disease (COPD) in Seattle, Washington. Data were collected daily for 12 days. We simultaneously collected PM10 and PM2.5 (particulate matter < or = 10 microm or < or = 2.5 microm, respectively) filter samples at a central outdoor site, as well as outside and inside the subjects' homes. Personal PM10 filter samples were also collected. All filters were analyzed for mass and light absorbance. We analyzed within-subject associations between health outcomes and air pollution metrics using a linear mixed-effects model with random intercept, controlling for age, ambient relative humidity, and ambient temperature. For the 7 subjects with asthma, a 10 microg/m3 increase in 24-hr average outdoor PM10 and PM2.5 was associated with a 5.9 [95% confidence interval (CI), 2.9-8.9] and 4.2 ppb (95% CI, 1.3-7.1) increase in FE(NO), respectively. A 1 microg/m3 increase in outdoor, indoor, and personal black carbon (BC) was associated with increases in FE(NO) of 2.3 ppb (95% CI, 1.1-3.6), 4.0 ppb (95% CI, 2.0-5.9), and 1.2 ppb (95% CI, 0.2-2.2), respectively. No significant association was found between PM or BC measures and changes in spirometry, blood pressure, pulse rate, or SaO2 in these subjects. Results from this study indicate that FE(NO) may be a more sensitive marker of PM exposure than traditional health outcomes and that particle-associated BC is useful for examining associations between primary combustion constituents of PM and health outcomes.
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Affiliation(s)
- Karen L Jansen
- University of Washington, Seattle, Washington 98195, USA
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Abstract
Delayed offline measurement of exhaled nitric oxide (eNO), although useful in environmental and clinical research, is limited by the instability of stored breath samples. The authors characterized sources of instability with the goal of minimizing them. Breath and other air samples were stored under various conditions, and NO levels were measured repeatedly over 1-7 d. Concentration change rates varied positively with temperature and negatively with initial NO level, thus "stable" levels reflected a balance of NO-adding and NO-removing processes. Storage under refrigeration for a standardized period of time can optimize offline eNO measurement, although samples at room temperature are effectively stable for several hours.
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Affiliation(s)
- William S Linn
- Environmental Health Service, Los Amigos Research and Education Institute, Downey, California, USA.
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Koenig JQ, Mar TF, Allen RW, Jansen K, Lumley T, Sullivan JH, Trenga CA, Larson T, Liu LJS. Pulmonary effects of indoor- and outdoor-generated particles in children with asthma. ENVIRONMENTAL HEALTH PERSPECTIVES 2005; 113:499-503. [PMID: 15811822 PMCID: PMC1278493 DOI: 10.1289/ehp.7511] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2004] [Accepted: 01/10/2005] [Indexed: 05/03/2023]
Abstract
Most particulate matter (PM) health effects studies use outdoor (ambient) PM as a surrogate for personal exposure. However, people spend most of their time indoors exposed to a combination of indoor-generated particles and ambient particles that have infiltrated. Thus, it is important to investigate the differential health effects of indoor- and ambient-generated particles. We combined our recently adapted recursive model and a predictive model for estimating infiltration efficiency to separate personal exposure (E) to PM2.5 (PM with aerodynamic diameter < or = 2.5 microm) into its indoor-generated (Eig) and ambient-generated (Eag) components for 19 children with asthma. We then compared Eig and Eag to changes in exhaled nitric oxide (eNO), a marker of airway inflammation. Based on the recursive model with a sample size of eight children, Eag was marginally associated with increases in eNO [5.6 ppb per 10-microg/m3 increase in PM2.5; 95% confidence interval (CI), -0.6 to 11.9; p = 0.08]. Eig was not associated with eNO (-0.19 ppb change per 10 microg/m3). Our predictive model allowed us to estimate Eag and Eig for all 19 children. For those combined estimates, only Eag was significantly associated with an increase in eNO (Eag: 5.0 ppb per 10-microg/m3 increase in PM2.5; 95% CI, 0.3 to 9.7; p = 0.04; Eig: 3.3 ppb per 10-microg/m3 increase in PM2.5; 95% CI, -1.1 to 7.7; p = 0.15). Effects were seen only in children who were not using corticosteroid therapy. We conclude that the ambient-generated component of PM2.5 exposure is consistently associated with increases in eNO and the indoor-generated component is less strongly associated with eNO.
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Affiliation(s)
- Jane Q Koenig
- Department of Environmental Health and Occupational Sciences, University of Washington, Seattle, Washington 98195, USA.
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Adamkiewicz G, Ebelt S, Syring M, Slater J, Speizer FE, Schwartz J, Suh H, Gold DR. Association between air pollution exposure and exhaled nitric oxide in an elderly population. Thorax 2004; 59:204-9. [PMID: 14985553 PMCID: PMC1746963 DOI: 10.1136/thorax.2003.006445] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Animal models suggest that the cardiovascular effects of air pollution result in part from inflammation caused by proinflammatory mediators originating in the lung. In a human study of the cardiovascular effects of air pollution, we aimed to evaluate the potential association between air pollution levels and the fraction of exhaled nitric oxide (FE(NO)), a non-invasive measure of airway inflammation. METHODS Breath samples were collected weekly between September and December 2000 in a community based group of elderly subjects (median age 70.7 years) in Steubenville, Ohio. The samples were analysed for NO. Air pollution levels were measured concurrently at a central site monitor. RESULTS An increase in the 24 hour average PM(2.5) concentration of 17.7 micro g/m(3) was associated with an increase in FE(NO) of 1.45 ppb (95% CI 0.33 to 2.57) in models adjusted for subject, week of study, day of the week, hour of the day, ambient barometric pressure, temperature, and relative humidity. This represents a change of approximately 15% compared with the mean FE(NO) in the cohort (9.9 ppb). A significant association was also observed for a 24 hour moving average of ambient NO (0.83 ppb increase, 95% CI 0.26 to 1.40). In two-pollutant models, the magnitude and precision of the PM(2.5) effect was not reduced and the ambient NO effect was no longer significant. The associations between FE(NO) and PM(2.5) were significantly higher in subjects with a doctor's diagnosis of COPD (p value for interaction = 0.03). CONCLUSIONS Ambient pollution may lead to airway inflammation as measured by FE(NO). These subclinical inflammatory changes may be an important step in the pathogenesis of the cardiopulmonary effects induced by exposure to air pollution.
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Affiliation(s)
- G Adamkiewicz
- Channing Laboratory, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA.
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Koenig JQ, Jansen K, Mar TF, Lumley T, Kaufman J, Trenga CA, Sullivan J, Liu LJS, Shapiro GG, Larson TV. Measurement of offline exhaled nitric oxide in a study of community exposure to air pollution. ENVIRONMENTAL HEALTH PERSPECTIVES 2003; 111:1625-9. [PMID: 14527842 PMCID: PMC1241685 DOI: 10.1289/ehp.6160] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
As part of a large panel study in Seattle, Washington, we measured levels of exhaled nitric oxide (eNO) in children's homes and fixed-site particulate matter with aerodynamic diameters of 2.5 micro m or less (PM(2.5)) outside and inside the homes as well as personal PM(2.5) during winter and spring sessions of 2000-2001. Nineteen subjects 6-13 years of age participated; 9 of the 19 were on inhaled corticosteroid (ICS) therapy. Exhaled breath measurements were collected offline into a Mylar balloon for up to 10 consecutive days. Mean eNO values were 19.1 (SD +/- 11.4) ppb in winter sessions and 12.5 +/- 6.6 ppb in spring sessions. Fixed-site PM(2.5) mean concentrations were 10.1 +/- 5.7 microg/m(3) outside homes and 13.3 +/- 1.4 inside homes; the personal PM(2.5) mean was 13.4 +/- 3.2 microg/m(3). We used a linear mixed-effects model with random intercept and an interaction term for medications to test for within-subject-within-session associations between eNO and various PM(2.5) values. We found a 10 microg/m(3) increase in PM(2.5) from the outdoor, indoor, personal, and central-site measurements that was associated with increases in eNO in all subjects at lag day zero. The effect was 4.3 ppb [95% confidence interval (CI), 1.4-7.29] with the outdoor monitor, 4.2 ppb (95% CI, 1.02-7.4) for the indoor monitor, 4.5 ppb (95% CI, 1.02-7.9) with the personal monitor, and 3.8 ppb (95% CI, 1.2-6.4) for the central monitors. The interaction term for medication category (ICS users vs. nonusers) was significant in all analyses. These findings suggest that eNO can be used as an assessment tool in epidemiologic studies of health effects of air pollution.
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Affiliation(s)
- J Q Koenig
- Department of Environmental Health, University of Washington, Seattle, Washington 98195, USA.
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Kim JY, Hauser R, Wand MP, Herrick RF, Amarasiriwardena CJ, Christiani DC. The association of expired nitric oxide with occupational particulate metal exposure. ENVIRONMENTAL RESEARCH 2003; 93:158-66. [PMID: 12963400 DOI: 10.1016/s0013-9351(03)00017-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
Toxicologic studies have shown that soluble transition metals in residual oil fly ash (ROFA) can induce pulmonary injury. In this study, we investigated the association between the fractional concentration of expired nitric oxide (FENO) and exposure to metal constituents of particulate matter with an aerodynamic mass median diameter < or =2.5 microm (PM2.5) in boilermakers exposed to ROFA and metal fume. Metals investigated included vanadium, chromium, manganese, nickel, copper, and lead. Subjects were monitored for 5 consecutive days during boiler repair overhauls in 1999 (n=20) and 2000 (n=14). In 1999, we found a significant inverse association between log-transformed FENO and PM2.5 metal concentrations. LogFENO changed by -0.03 (95% CI: -0.04, -0.01), -0.56 (95% CI: -0.88, -0.24), -0.09 (95% CI: -0.16, -0.02), and -0.04 (95% CI: -0.07, -0.02) per microg/m3 of PM2.5 vanadium, chromium, manganese, and nickel, respectively. In 2000, no significant associations were observed, most likely due to exposure misclassification resulting from the use of respirators. The inverse association between PM2.5 metal exposure and FENO in subjects with limited respirator usage suggests that soluble transition metals might be partially responsible for the adverse pulmonary responses seen in workers exposed to ROFA.
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Affiliation(s)
- Jee Young Kim
- Occupational Health Program, Department of Environmental Health, Harvard School of Public Health, Boston, MA 02115, USA
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Abstract
Although work-related asthma is the most commonly recognized occupational lung disease, the condition remains underrecognized and underreported. New-onset occupational asthma and work aggravated asthma can have deleterious medical and socioeconomic consequences for the individual. Although interpretation and comparison between studies are hampered by the use of variable definitions of WRA and criteria for the diagnosis, as many as 20% of cases of new or aggravated adult asthma has important work-related factors. Thus, all asthmatic patients should be asked about their work, if their respiratory symptoms are worse when they work, or if a new job/exposure preceded the onset of symptoms. A series of longitudinal inception and apprentice cohort studies were undertaken to address significant weakness in the previous medical literature. These studies are just beginning to produce results, and provide strong evidence for asthma caused by exposure to specific occupational environments. They have begun to produce new understanding of the risk factors for developing OA, the natural history of OA and immune sensitization, and the existence of the healthy worker effect. New, non-invasive measures of airway inflammation have been developed with the potential for broad applications in the field of WRA. Although the measurement of exhaled NO and induced sputum analysis are primarily used as research tools, their place in clinical practice is likely to become clearer. These methods also have the potential to elucidate the various pathophysiologic mechanisms involved in WRA and may broaden our concept of occupational exposures that can initiate the onset of asthma.
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Affiliation(s)
- Nilo O Arnaiz
- Occupational and Environmental Medicine Program, Departments of Environmental Health and Medicine, School of Public Health and Community Medicine, School of Medicine, University of Washington, Box 357234, Seattle, WA, USA
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Abstract
Analysis of various biomarkers in exhaled breath allows completely non-invasive monitoring of inflammation and oxidative stress in the respiratory tract in inflammatory lung diseases, including asthma, chronic obstructive pulmonary disease (COPD), cystic fibrosis (CF), bronchiectasis and interstitial lung diseases. The technique is simple to perform, may be repeated frequently, and can be applied to children, including neonates, and patients with severe disease in whom more invasive procedures are not possible. Several volatile chemicals can be measured in the breath (nitric oxide, carbon monoxide, ammonia), and many non-volatile molecules (mediators, oxidation and nitration products, proteins) may be measured in exhaled breath condensate. Exhaled breath analysis may be used to quantify inflammation and oxidative stress in the respiratory tract, in differential diagnosis of airway disease and in the monitoring of therapy. Most progress has been made with exhaled nitric oxide (NO), which is increased in atopic asthma, is correlated with other inflammatory indices and is reduced by treatment with corticosteroids and antileukotrienes, but not (beta 2-agonists. In contrast, exhaled NO is normal in COPD, reduced in CF and diagnostically low in primary ciliary dyskinesia. Exhaled carbon monoxide (CO) is increased in asthma, COPD and CF. Increased concentrations of 8-isoprostane, hydrogen peroxide, nitrite and 3-nitrotyrosine are found in exhaled breath condensate in inflammatory lung diseases. Furthermore, increased levels of lipid mediators are found in these diseases, with a differential pattern depending on the nature of the disease process. In the future it is likely that smaller and more sensitive analyzers will extend the discriminatory value of exhaled breath analysis and that these techniques may be available to diagnose and monitor respiratory diseases in the general practice and home setting.
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Affiliation(s)
- Sergei A Kharitonov
- Department of Thoracic Medicine, National Heart and Lung Institute, Faculty of Medicine, Imperial College, Royal Brompton Hospital, London, UK.
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Affiliation(s)
- S A Kharitonov
- National Heart and Lung Institute, Imperial College, London, United Kingdom
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Silkoff PE, Martin D, Pak J, Westcott JY, Martin RJ. Exhaled nitric oxide correlated with induced sputum findings in COPD. Chest 2001; 119:1049-55. [PMID: 11296168 DOI: 10.1378/chest.119.4.1049] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
STUDY OBJECTIVES Neutrophilic airway inflammation may underlie the pathogenesis of COPD. We examined repeated measurements of the fractional concentration of exhaled nitric oxide (FENO) and the correlation with cells and mediators in induced sputum (IS) from patients with COPD. PARTICIPANTS Eleven COPD subjects (9 men and 2 women, aged 46 to 69 years) with predicted FEV(1) of 45 to 70%. SETTING A hospital research laboratory. DESIGN Single-cohort, prospective study with four visits at two weekly intervals. INTERVENTIONS FENO and spirometry were assessed at all visits, and IS for differential cell count, leukotriene-B(4) (LTB(4)) and interleukin (IL)-8, nitrite, and nitrate at visit 1, visit 3, and visit 4. RESULTS During the study, there were significant declines in mean percent predicted FEV(1), from 55.2 to 51.6% (p = 0.029), and mean FEV(1)/FVC ratio, from 50.4 to 45.4% (p = 0.001), accompanied by a significant increase in FENO geometric mean (95% confidence limits), from 15.2 (10.9 to 21.2) to 23.6 (17.1 to 32.4) parts per billion (p = 0.037), and sputum LTB(4), from 1.79 (1.03 to 3.11) to 3.57 (1.95 to 6.53) ng/mL (p = 0.033), but no significant change in other sputum parameters. From visits 1 to 4, the change in percent neutrophils correlated with the changes in FENO and IL-8 (r = 0.648, p = 0.028; r = 0.60, p = 0.05, respectively). Hypertonic saline solution induction of sputum caused a fall in FEV(1), from 1.83 +/- 0.44 to 1.46 +/- 0.44 L (p = 0.049). CONCLUSIONS The worsening spirometry results were accompanied by significant increases in FENO and sputum LTB(4). FENO may be related to neutrophilic inflammation driven by the chemoattractant IL-8. FENO and IS may be useful markers of airway inflammation in COPD patients. Sputum induction with hypertonic saline solution causes a significant fall in FEV(1) requiring appropriate caution.
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Affiliation(s)
- P E Silkoff
- Department of Medicine, National Jewish Medical and Research Center, Denver, CO 80206, USA.
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van Amsterdam JG, Nierkens S, Vos SG, Opperhuizen A, van Loveren H, Steerenberg PA. Exhaled nitric oxide: a novel biomarker of adverse respiratory health effects in epidemiological studies. ARCHIVES OF ENVIRONMENTAL HEALTH 2000; 55:418-23. [PMID: 11128880 DOI: 10.1080/00039890009604040] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The sampling of exhaled breath is a noninvasive procedure that can be performed easily in adults, children, and patients with respiratory disease. Several studies have demonstrated increased exhaled nitric oxide in patients with pulmonary disease, including asthma. In addition, exhaled nitric oxide may be an elegant tool for monitoring of environmental health effects of air pollution and the prevalence of atopy in epidemiological surveys. Recent literature about exhaled nitric oxide is presented in this article. Technical, physiological, and behavioral confounding factors of exhaled nitric oxide measurement are outlined.
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Affiliation(s)
- J G van Amsterdam
- Laboratory of Health Effects Research, National Institute of Public Health and the Environment, Bilthoven, The Netherlands
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Steerenberg PA, Nierkens S, van Loveren H, van Amsterdam JG. A simple method to sample exhaled NO not contaminated by ambient NO from children and adults in epidemiological studies. Nitric Oxide 2000; 4:168-74. [PMID: 10835297 DOI: 10.1006/niox.2000.0282] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
We previously showed that contamination of exhaled air by ambient NO could be avoided by 1 min of breathing and final inhalation of clean air (clean air procedure) prior to exhaled air sampling in balloons. This approach is, however, unsuitable for sampling large groups in epidemiological studies, because it is time consuming and laborious. We therefore discarded the initial part of exhaled air, which may contain ambient NO, in prebags of 250, 540, 775, 1000, and 2000 ml. The subsequent part of exhaled air was sampled in balloons and the NO content was measured. Inflation of a prebag of 500 ml to prevent ambient NO contamination proved to be effective only at low ambient NO levels (<20 ppb). Larger sizes of the prebag (1000 ml for adults and 775 ml for children) are, however, required so that contamination of the air sample at higher levels of ambient NO (up to 115 ppb) is excluded. Using different prebags of gradually increasing size, it was shown that the initial part of exhaled air (<500 ml) contained relatively high amounts of NO that gradually decreased, but attained a constant level in the subsequent air volumes. Using rather large prebags of 2000 and 1000 ml, respectively, in adults and children yielded exhaled NO levels even below those obtained the clean air procedure was applied in combination with a prebag of 540 ml. As this reduction also occurs at ambient NO levels of nearly zero, we suggest that this reduction was due to interference by the water vapor arising from the lowest part of the lungs. In conclusion, the use of a prebag to discard the initial volume of exhaled air ensures accurate measurement of exhaled endogenous NO in large-scale epidemiological studies not biased by ambient NO.
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Affiliation(s)
- P A Steerenberg
- Laboratory for Pathology and Immunobiology, National Institute of Public Health and The Environment, Bilthoven, 3720 BA, The Netherlands.
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van Amsterdam JG, Hollander A, Snelder JD, Fischer PH, van Loveren H, Vos JG, Opperhuizen A, Steerenberg PA. The effect of air pollution on exhaled nitric oxide of atopic and nonatopic subjects. Nitric Oxide 1999; 3:492-5. [PMID: 10637128 DOI: 10.1006/niox.1999.0258] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Levels of exhaled nitric oxide (NO) were determined in well-characterized atopic and nonatopic subjects on 4 days with a different level of outdoor air pollution. The two groups matched well regarding spirometric values, i.e., no difference with regard to FEV(1), FVC, and peak flow. On the 4 test days asymptomatic atopic subjects exhaled 1.5- to 2.4-fold higher levels of NO compared with nonatopic subjects. In both groups the increase in exhaled NO in response to air pollution was similar (2.5 times maximal increase, P < 0.01). In conclusion, atopic subjects exhale higher levels of NO compared with nonatopic subjects, but respond to a similar degree to increased levels of air pollution.
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Affiliation(s)
- J G van Amsterdam
- Laboratory of Health Effects Research, Laboratory for Pathology and Immunobiology, Bilthoven, 3720 BA, The Netherlands
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