Nitrogen dioxide in indoor ice skating facilities: an international survey

Evaluation of the Indoor Air Quality in Governmental Oversight Supermarkets (Co-Ops) in Kuwait

Examining the indoor air environment of public venues, especially populated supermarkets such as Co-Ops in Kuwait, is crucial to ensure that these venues are safe from indoor environmental deficits such as sick building syndrome (SBS). The aim of this study was to characterize the quality of the indoor air environment of the Co-Ops supermarkets in Kuwait based on investigation of CO2, CO, NO2, H2S, TVOCs, and NMHC. On-site measurements were conducted to evaluate these parameters in three locations at the selected Co-Ops, and the perceived air quality (PAQ) was determined to quantify the air’s pollutants as perceived by humans. Moreover, the indoor air quality index (AQI) was constructed for the selected locations, and the ANOVA test was used to analyze the association between the observed concentrations among these environmental parameters. At least in one spot at each Co-Op, the tested environmental parameters exceeded the threshold limit set by the environmental agencies. The PAQ for Co-Op1, 2, and 3 are 1.25, 1.00, and 0.75 respectively. CO2 was significantly found in an association with CO, H2S, and TVOCs, and its indoor-outdoor concentrations were significantly correlated with R2 values ranges from 0.40 to 0.86 depending on the tested location.

Characterization of CO and NO2 exposures of ice skating rink maintenance workers

Air quality is a common concern among indoor ice rink facilities due to the use of gasoline/propane ice resurfacing equipment. Although previous studies have investigated spectator, guest, and skater exposures, a review of the literature revealed little published research regarding ice maintenance employees' exposures. Ice maintenance includes edging and resurfacing. The resurfacer is commonly referred to as a Zamboni®. Edging is almost always followed by resurfacing, but resurfacing frequently happens independently of edging. The purpose of this study was to characterize ice rink maintenance employees' exposures to CO and NO₂. Employees from four ice rinks in Salt Lake County, Utah were sampled using direct reading instruments during routine ice maintenance activities. Maintenance was divided into four activities: 1) Edging only, 2) Resurfacing after edging (not including edging), 3) Edging and resurfacing (Activities 1 and 2 combined), and 4) Resurfacing only (independent of edging). Activities 1, 2 and 3 were sampled twenty-four (n = 24) times. Activity 4 was sampled eight times. Sampling results were graphed and summarized using descriptive statistics. The highest measured CO concentration was 202 ppm, which occurred during edging. Average CO concentrations for all activities ranged from 0 ppm to 60.4 ppm. Minimal CO exposure was observed when resurfacing occurred without edging, which implies that elevated CO exposure measured while using the resurfacer may be residual CO from prior edging activities. NO₂ concentrations were negligible for all rinks and all activities. Results confirmed that gasoline edgers significantly contribute to indoor CO levels, with peak levels exceeding some recommended exposure levels. Indoor ice rink facilities should monitor employees' CO exposures and implement procedures to limit exposures. This may be achieved by limiting the number of laps taken with the edger or replacing gasoline powered edgers with electric edgers.

Air quality in indoor go-kart facilities in Germany

Indoor go-kart driving and viewing is enjoyed by people of all ages. However, it may pose health hazards, especially for children, pregnant women, cardiovascular patients, and elderly individuals. Depending on the race length, for example, high concentrations of various contaminants may result in severe health problems. Therefore, this project investigated the Indoor Air Quality of eight indoor go-kart facilities. In general, karts that used regular fuel produced the highest concentrations of CO, benzene, TVOC, and BaP, with maximum levels up to 150 mg/m³ , 170 μg/m³ , 2690 μg/m³ , and 8.7 ng/m³ , respectively. As expected, the maximum CO concentrations at go-kart facilities that used liquid gas and electric karts (20 and <6 mg/m³ , respectively) were significantly lower than those at other facilities. The highest 95th percentile values for NO (2680 μg/m³ ) and NO₂ (280 μg/m³ ) were measured for karts with liquid gas. The alkane, alkene, and cycloalkane groups, as well as benzene and the alkyl benzenes, were the predominant components of the measured TVOCs. Overall, owners of indoor go-kart tracks should ensure that the ventilation with regard to combustion products is optimally adapted in any case to reduce the levels of critical air pollutants.

Exposure assessment of non-electric ice resurfacer operators in indoor ice rinks: a pilot study

Exposure of ice resurfacer operators to indoor air contaminants was measured in six indoor ice arenas. A standardized questionnaire on technical and operational features was employed and indoor airborne concentrations of carbon monoxide (CO), carbon dioxide (CO₂), nitric oxide (NO), nitrogen dioxide (NO₂), sulfur dioxide (SO₂), and total volatile organic compounds (VOCs) were measured. Air samples were collected using a range of direct reading instruments attached to the driver's seat of the resurfacer. The range of mean exposure concentrations via positional sampling (i.e. as close as able to the operator's breathing zone) were 5.7-7.4 ppm, 694-2171 ppm, <0.5 to 0.5 ppm, and < 0.1 to 0.2 ppm, for CO, CO₂, NO, and NO₂, respectively. Exposure levels for SO₂ and VOC were below detection. Overall, each of the measured indoor air contaminants was found to be below its respective occupational exposure limits (OEL), suggesting that the risk of hazardous exposure is low. The use of natural gas as a fuel source is believed to contribute to low contaminant concentrations.

Exercise and asthma: an overview

The terms 'exercise-induced asthma' (EIA) and 'exercise-induced bronchoconstriction' (EIB) are often used interchangeably to describe symptoms of asthma such as cough, wheeze, or dyspnoea provoked by vigorous physical activity. In this review, we refer to EIB as the bronchoconstrictive response and to EIA when bronchoconstriction is associated with asthma symptoms. EIB is a common occurrence for most of the asthmatic patients, but it also affects more than 10% of otherwise healthy individuals as shown by epidemiological studies. EIA and EIB have a high prevalence also in elite athletes, especially within endurance type of sports, and an athlete's asthma phenotype has been described. However, the occurrence in elite athletes shows that EIA/EIB, if correctly managed, may not impair physical activity and top sports performance. The pathogenic mechanisms of EIA/EIB classically involve both osmolar and vascular changes in the airways in addition to cooling of the airways with parasympathetic stimulation. Airways inflammation plays a fundamental role in EIA/EIB. Diagnosis and pharmacological management must be carefully performed, with particular consideration of current anti-doping regulations, when caring for athletes. Based on the demonstration that the inhaled asthma drugs do not improve performance in healthy athletes, the doping regulations are presently much less strict than previously. Some sports are at a higher asthma risk than others, probably due to a high environmental exposure while performing the sport, with swimming and chlorine exposure during swimming as one example. It is considered very important for the asthmatic child and adolescent to master EIA/EIB to be able to participate in physical activity on an equal level with their peers, and a precise early diagnosis with optimal treatment follow-up is vital in this aspect. In addition, surprising recent preliminary evidences offer new perspectives for moderate exercise as a potential therapeutic tool for asthmatics.

Exercise and asthma: an overview

The terms 'exercise-induced asthma' (EIA) and 'exercise-induced bronchoconstriction' (EIB) are often used interchangeably to describe symptoms of asthma such as cough, wheeze, or dyspnoea provoked by vigorous physical activity. In this review, we refer to EIB as the bronchoconstrictive response and to EIA when bronchoconstriction is associated with asthma symptoms. EIB is a common occurrence for most of the asthmatic patients, but it also affects more than 10% of otherwise healthy individuals as shown by epidemiological studies. EIA and EIB have a high prevalence also in elite athletes, especially within endurance type of sports, and an athlete's asthma phenotype has been described. However, the occurrence in elite athletes shows that EIA/EIB, if correctly managed, may not impair physical activity and top sports performance. The pathogenic mechanisms of EIA/EIB classically involve both osmolar and vascular changes in the airways in addition to cooling of the airways with parasympathetic stimulation. Airways inflammation plays a fundamental role in EIA/EIB. Diagnosis and pharmacological management must be carefully performed, with particular consideration of current anti-doping regulations, when caring for athletes. Based on the demonstration that the inhaled asthma drugs do not improve performance in healthy athletes, the doping regulations are presently much less strict than previously. Some sports are at a higher asthma risk than others, probably due to a high environmental exposure while performing the sport, with swimming and chlorine exposure during swimming as one example. It is considered very important for the asthmatic child and adolescent to master EIA/EIB to be able to participate in physical activity on an equal level with their peers, and a precise early diagnosis with optimal treatment follow-up is vital in this aspect. In addition, surprising recent preliminary evidences offer new perspectives for moderate exercise as a potential therapeutic tool for asthmatics.

Exercise-Induced Lung Disease: Too Much of a Good Thing?

Exercise in children has important health benefits. However, in elite endurance athletes, there is an increased prevalence of exercise-induced bronchoconstriction and airway inflammation. Particularly at risk are those who practice in cold weather, ice rinks, swimming pools, and air pollution. The inflammation is caused by repetitive episodes of hyperventilation of cold, dry air, allergens, or toxins such as chlorine or air pollution. Children may be particularly at risk for lung injury under these conditions because of the immaturity and ongoing development of their lung. However, studies in pediatric athletes and exercising young children are sparse. Epithelial injury associated with hyperventilation of cold, dry air has not been described in children. However, exercise in the presence of air pollution and chlorine is associated with airway injury and the development of asthma in children; the effect appears to be modulated by both atopy and genetic polymorphisms. While management of exercise-induced bronchoconstriction and asthma is well established, there is little data to guide treatment or prevention of remodeling in athletes or inhalational lung injury in children. Studies underscore the need to maintain high levels of air quality. More investigations should be undertaken to better define the natural history, pathophysiology, and treatment of exercise-induced pulmonary inflammation in both elite athletes and exercising children.

Effects of nitrogen dioxide on human health: systematic review of experimental and epidemiological studies conducted between 2002 and 2006

In order to assess health effects in humans caused by environmental nitrogen dioxide (NO(2)) a systematic review of studies in humans was conducted. MEDLINE database was searched for epidemiological studies and experiments on adverse effects of NO(2) published between 2002 and 2006. The evidence with regard to NO(2) exposure limits was assessed using the Scottish Intercollegiate Guidelines Network (SIGN) grading system and the modified three star system. Of the 214 articles retrieved 112 fulfilled the inclusion criteria. There was limited evidence that short-term exposure to a 1-h mean value below 200 microg NO(2)/m(3) is associated with adverse health effects provided by only one study on mortality in patients with severe asthma (*2+). The effect remained after adjusting for other air pollutants. There was moderate evidence that short-term exposure below a 24-h mean value of 50 microg NO(2)/m(3) at monitor stations increases hospital admissions and mortality (**2+). Evidence was also moderate when the search was restricted to susceptible populations (children, adolescents, elderly, and asthmatics). There was moderate evidence that long-term exposure to an annual mean below 40 microg NO(2)/m(3) was associated with adverse health effects (respiratory symptoms/diseases, hospital admissions, mortality, and otitis media) provided by generally consistent findings in five well-conducted cohort and case-control studies with some shortcomings in the study quality (**2+). Evidence was also moderate when the search was restricted to studies in susceptible populations (children and adolescents) and for the combination with other air pollutants. The most frequent reasons for decreased study quality were potential misclassification of exposure and selection bias. None of the high-quality observational studies evaluated was informative for the key questions due to the choice of the dose parameter (e.g., 1-week mean) and exposure levels above the limit values. Inclusion of study designs unlisted in the SIGN grading system did not bring additional evidence regarding exposures below the current air quality limit values for NO(2). As several recent studies reported adverse health effects below the current exposure limits for NO(2) particularly among susceptible populations regarding long-term exposure further research is needed. Apart from high-quality epidemiological studies on causality and the interaction of NO(2) with other air pollutants there is a need for double-blinded randomized cross-over studies among susceptible populations for further evaluation of the short-term exposure limits.

Health risk assessment of indoor air pollution in Finnish ice arenas

Poor indoor air quality and epidemic carbon monoxide (CO) and nitrogen dioxide (NO(2)) poisonings due to exhaust emissions from ice resurfacers have been continuously reported from enclosed ice arenas for over 30 years. The health risks in users of Finnish ice arenas were analysed in three ways: (1) evaluation of four cases of epidemic CO poisonings, (2) modelling the association between NO(2) exposure and respiratory symptoms among junior ice hockey players, and (3) estimation of the number of arena users at risk of breathing poor quality air due to non-compliance of ice arenas with recommended abatement measures. The common causes for the CO poisonings involving over 300 subjects were large emissions from propane-fuelled ice resurfacer, small arena volume, negligible ventilation, and very recent opening of the arena. Rhinitis (prevalence 18.3%) and cough (13.7%) during or after training or game were significantly associated with the estimated personal NO(2) exposure of young hockey players (n=793) to average concentrations ranging from 21 to 1176 microg/m(3) in their home arena. During a 6-year follow-up of an intensive information campaign the portion of electric resurfacers increased from 9% to 27%, and that of emission control technology on propane-fuelled resurfacers increased from 13% to 84%. The portion of inadequately ventilated arenas decreased from 34% to 25%. However, 48% of the investigated Finnish ice arenas (n=125) did not fully comply with the non-regulatory recommendations. Consequently, 20000 daily users of ice arenas were estimated to remain in 2001 at risk of breathing poor quality air. Modern small and inadequately ventilated ice arenas pose their users (mostly children and young adults) at risk of breathing poor quality air and suffering from acute adverse health effects. Governmental regulations are needed worldwide to ensure safe sports in enclosed ice arenas.

A 5-year follow-up of airway symptoms after nitrogen dioxide exposure in an indoor ice arena

The authors investigated whether exposure to high levels of nitrogen dioxide (NO2) in an indoor ice hockey arena might be associated with airway symptoms 5 yr later. A follow-up questionnaire was answered by 71 subjects who had experienced such an exposure, accompanied by acute respiratory illness, in Stockholm in 1994. The same questionnaire was answered by 40 reference subjects. The overall response rate for both groups was 71%. Information was obtained regarding various background factors, such as smoking and respiratory symptoms since 1994. For those who had stopped playing ice hockey during the follow-up period, the exposure to high NO2 levels appeared to be associated with an increase in upper airways symptoms (i.e., nasal blockage or rhinitis) (odds ratio = 3.1, 95% confidence interval = 1.1, 8.8), after adjustment for age, smoking, and family history of allergy. These data suggest that exposure to high NO2 levels in an indoor ice arena may be associated with increased airway symptoms several years later.

Bronchoconstriction provoked by exercise in a high-particulate-matter environment is attenuated by montelukast

Airborne ultrafine and fine particulate matter (PM1 from fossil-fueled internal combustion engines may cause abnormal airway narrowing. Because of high PM1 exposure from ice resurfacing machines, the ice-rink athlete is especially vulnerable to PM1 toxicity. The purpose of this study was to evaluate protection by a single dose of montelukast in college ice hockey players following PM1 exposure exercise. Nine male ice hockey players (age 19.3+/-1.22 yr) performed 4 randomized, double-blinded, high-intensity, 6-min cycle ergometer trials in low [PM1] (2260+/-500 particles/cm3) and high [PM1] (348,600+/-121,600 particles/cm3) after placebo or montelukast. Pre- and postspirometry showed similar peak FEV1 (forced expiratory volume in 1 s) falls between placebo and montelukast after low [PM1] trials (14.5+/-18.06 vs. 9.5+/-11.75% of baseline, respectively). Peak FEV1 falls after high [PM1] trials were greater for placebo than for montelukast (17.3+/-9.79% vs. 1.7+/-5.77% of baseline; p<.0001). High [PM1] FEV1 fall after exercise following montelukast ingestion was less than after exercise following placebo ingestion under high and low [PM1] conditions and after exercise following montelukast ingestion under low [PM1] conditions at 5, 10, and 15 min postchallenge (p<.004, .0006, .009, respectively). Montelukast provided greater protection against bronchoconstriction after exercise during high [PM1] than low [PM1] exposure (approximately 90% vs. approximately 35%), suggesting that bronchoconstriction from PM1 exposure is predominately leukotriene mediated. The precise mechanism of airborne PM1-induced leukotriene-mediated airway narrowing remains unclear.

Baseline lung function, exercise-induced bronchoconstriction, and asthma-like symptoms in elite women ice hockey players

PURPOSE

Exercise-induced bronchoconstriction (EIB) is high among ice rink athletes and may be related to exercise ventilation of rink air pollutants. Impaired postchallenge expiratory flows are common for this population; however, baseline lung function and symptoms have not been fully evaluated.

METHODS

We examined resting lung function and asthma-like symptoms in relation to airway hyperresponsiveness in National Team female ice hockey players (N = 43). Subjects were grouped according to observed symptoms and medical history as symptomatic ('S') or asymptomatic ('A'). Baseline and postexercise lung function was determined.

RESULTS

Seventeen (39.5%) presented symptoms and 9 (21%) had EIB. Baseline FEV1, FEV1/FVC, and FEF25-75 were different between 'S' and 'A' (102 +/- 14% vs 116 +/- 12%, 77.7 +/- 7.5 vs 88.2 +/- 4.5, and 74 +/- 22% vs 118 +/- 24%, respectively; P < 0.05); FVC and PEF were not different. Ten 'S' athletes had <80% FEV1/FVC; 9 had <70% predicted FEF25-75. Six of 9 EIB+ subjects had symptoms; cough occurred in all six and was related to EIB (chi 2 = 4.23, OR = 6.5, CI = 1.1-44.1; P = 0.039).

CONCLUSION

Baseline lung function is related to symptoms and precludes EIB in some rink athletes, suggesting that EIB and its development is a heterogeneous and may involve fibrotic as well as inflammatory processes. Small airway dysfunction in ice arena athletes is likely related to internal combustion pollutants emitted from ice resurfacing machines.

Indoor air quality in ice skating rinks in Hong Kong

Indoor air quality in ice skating rinks has become a public concern due to the use of propane- or gasoline-powered ice resurfacers and edgers. In this study, the indoor air quality in three ice rinks with different volumes and resurfacer power sources (propane and gasoline) was monitored during usual operating hours. The measurements included continuous recording of carbon monoxide (CO), carbon dioxide (CO(2)), total volatile organic compounds (TVOC), particulate matter with a diameter less than 2.5 microm (PM(2.5)), particulate matter with diameter less than 10 microm (PM(10)), nitric oxide (NO), nitrogen dioxide (NO(2)), nitrogen oxide (NO(x)), and sulfur dioxide (SO(2)). The average CO, CO(2), and TVOC concentrations ranged from 3190 to 6749 microg/m(3), 851 to 1329 ppm, and 550 to 765 microg/m(3), respectively. The average NO and NO(2) concentrations ranged from 69 to 1006 microg/m(3) and 58 to 242 microg/m(3), respectively. The highest CO and TVOC levels were observed in the ice rink which a gasoline-fueled resurfacer was used. The highest NO and NO(2) levels were recorded in the ice rink with propane-fueled ice resurfacers. The air quality parameters of PM(2.5), PM(10), and SO(2) were fully acceptable in these ice rinks according to HKIAQO standards. Overall, ice resurfacers with combustion engines cause indoor air pollution in ice rinks in Hong Kong. This conclusion is similar to those of previous studies in Europe and North America.

Exercise-induced bronchospasm in the elite athlete

The term exercise-induced bronchospasm (EIB) describes the acute transient airway narrowing that occurs during and most often after exercise in 10 to 50% of elite athletes, depending upon the sport examined. Although multiple factors are unquestionably involved in the EIB response, airway drying caused by a high exercise-ventilation rate is primary in most cases. The severity of this reaction reflects the allergic predisposition of the athlete, the water content of the inspired air, the type and concentration of air pollutants inspired, and the intensity (or ventilation rate) of the exercise. The highest prevalence of EIB is seen in winter-sport populations, where athletes are chronically exposed to cold dry air and/or environmental pollutants found in indoor ice arenas. When airway surface liquid lost during the natural warming and humidification process of respiration is not replenished at a rate equal to the loss, the ensuing osmolarity change stimulates the release of inflammatory mediators and results in bronchospasm; this cascade of events is exacerbated by airway inflammation and airway remodelling. The acute EIB response is characterised by airway smooth muscle contraction, membrane swelling, and/or mucus plug formation. Evidence suggests that histamine, leukotrienes and prostanoids are likely mediators for this response. Although the presence of symptoms and a basic physical examination are marginally effective, objective measures of lung function should be used for accurate and reliable diagnosis of EIB. Diagnosis should include baseline spirometry, followed by an appropriate bronchial provocation test. To date, the best test to confirm EIB may simply be standard pulmonary function testing before and after high-intensity dry air exercise. A 10% post-challenge fall in forced expiratory volume in 1 second is used as diagnostic criteria. The goal of medical intervention is to limit EIB exacerbation and allow the athlete to train and compete symptom free. This is attempted through daily controller medications such as inhaled corticosteroids or by the prophylactic use of medications before exercise. In many cases, EIB is difficult to control. These and other data suggest that EIB in the elite athlete is in contrast with classic asthma.

Exposure to carbon monoxide and nitrogen dioxide in enclosed ice arenas

This article summarises the latest information on the adverse cardiorespiratory effects of exposure to carbon monoxide (CO) and nitrogen dioxide (NO(2)) in enclosed ice rinks. Sources of CO and NO(2) emissions are identified, current standards for these agents, as well as methods of controlling the emissions, dispersion, and evacuation of these toxic gases are presented. A detailed literature search involving 72 references in English and French from research conducted in North America and Europe was used. Material was from peer reviewed journals and other appropriate sources. Air pollutants such as carbon monoxide (CO), and nitrogen dioxide (NO(2)) which are present in enclosed skating facilities, may exacerbate a pre-existing pathogenic condition in those people who spend considerable time in these environments. Considering the popularity of ice hockey, short track speed skating, and figure skating, and the hundreds of hours that a sensitive person may spend each year in these environments, it would seem appropriate to seek more definitive answers to this important health problem. From the findings and conclusions of the research reviewed in this paper, 10 recommendations are listed.

Improvement of Air Quality in a Small Indoor Ice Arena by Effective Emission Control in Ice Resurfacers

The effectiveness of a new emission control system in the ice resurfacer was tested in an exhaust gas emission laboratory, and the improvement of the air quality in a small, enclosed ice arena was demonstrated in a 4.5-month follow-up study. The emission control system consisted of a lambda sensor-controlled fuel supply and a three-way metallic catalyst that were applied to a propane-fueled resurfacer. In the laboratory tests, the engine emissions of carbon monoxide (CO), hydrocarbons (HC), and nitrogen oxides (NO ) reduced simultaneously by 91, 90, and 96%, respectively. During the air quality follow-up the median 1-hour average nitrogen dioxide (N0₂) concentration inside the ice arena decreased from 430 ug/m³ (230ppb) to 58 ug/m³ (31 ppb), and that of CO decreased from 4.4 mg/m³ (3.8 ppm) to 1.5 mg/m³ (1.3 ppm). The new emission control system proved to be a feasible, reliable, and effective means to improve the indoor air quality in the ice arena. However, continuous mechanical ventilation was necessary during all business hours in order to achieve and maintain a fully acceptable air quality with this technology.

Characterization of Air Quality Problems in Five Finnish Indoor Ice Arenas

The air quality in five Finnish ice arenas with different volumes, ventilation systems, and resurfacer power sources (propane, gasoline, electric) was monitored during a usual training evening and a standardized, simulated ice hockey game. The measurements included continuous recording of carbon monoxide (CO), nitric oxide (NO), and nitrogen dioxide (NO₂) concentrations, and sampling and analysis of volatile organic compounds (VOCs). Emissions from the ice resurfacers with combustion engines caused indoor air quality problems in all ice arenas. The highest 1-hour average CO and NO₂ concentrations ranged from 20 to 33 mg/m³ (17 to 29 ppm) and 270 to 7440 µg/m³ (0.14 to 3.96 ppm), respectively. The 3-hour total VOC concentrations ranged from 150 to 1200 µg/m³. The highest CO and VOC levels were measured in the arena in which a gasoline-fueled resurfacer was used. The highest NO₂ levels were measured in small ice arenas with propane-fueled ice resurfacers and insufficient ventilation. In these arenas, the indoor NO₂ levels were about 100 times the levels measured in ambient outdoor air, and the highest 1-hour concentrations were about 20 times the national and World Health Organization (WHO) health-based air quality guidelines. The air quality was fully acceptable only in the arena with an electric resurfacer. The present study showed that the air quality problems of indoor ice arenas may vary with the fuel type of resurfacer and the volume and ventilation of arena building. It also confirmed that there are severe air quality problems in Finnish ice arenas similar to those previously described in North America.