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Berman JD, Abadi AM, Bell JE. Existing Challenges and Opportunities for Advancing Drought and Health Research. Curr Environ Health Rep 2024; 11:255-265. [PMID: 38568401 DOI: 10.1007/s40572-024-00440-z] [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] [Accepted: 03/08/2024] [Indexed: 05/12/2024]
Abstract
PURPOSE OF REVIEW Drought is one of the most far-reaching natural disasters, yet drought and health research is sparse. This may be attributed to the challenge of quantifying drought exposure, something complicated by multiple drought indices without any designed for health research. The purpose of this general review is to evaluate current drought and health literature and highlight challenges or scientific considerations when performing drought exposure and health assessments. RECENT FINDINGS The literature revealed a small, but growing, number of drought and health studies primarily emphasizing Australian, western European, and US populations. The selection of drought indices and definitions of drought are inconsistent. Rural and agricultural populations have been identified as vulnerable cohorts, particularly for mental health outcomes. Using relevant examples, we discuss the importance of characterizing drought and explore why health outcomes, populations of interest, and compound environmental hazards are crucial considerations for drought and health assessments. As climate and health research is prioritized, we propose guidance for investigators performing drought-focused analyses.
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Affiliation(s)
- Jesse D Berman
- Division of Environmental Health Sciences, School of Public Health, University of Minnesota, Mayo Mail Code #807, 420 Delaware Street SE, Minneapolis, MN, 55455, USA.
| | - Azar M Abadi
- Department of Environmental Health Sciences, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, 35233, USA
| | - Jesse E Bell
- Department of Environmental, Agricultural, and Occupational Health, Medical Center College of Public Health, University of Nebraska, Omaha, NE, USA
- School of Natural Resources, University of Nebraska-Lincoln, Lincoln, NE, USA
- Daugherty Water for Food Global Institute, University of Nebraska, Lincoln, NE, USA
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2
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Buford M, Lacher S, Slattery M, Levings DC, Postma B, Holian A, Migliaccio C. A mouse model of wildfire smoke-induced health effects: sex differences in acute and sustained effects of inhalation exposures. Inhal Toxicol 2024:1-11. [PMID: 38769076 DOI: 10.1080/08958378.2024.2354398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 05/07/2024] [Indexed: 05/22/2024]
Abstract
Due to climate change, wildfires have increased in intensity and duration. While wildfires threaten lives directly, the smoke has more far-reaching adverse health impacts. During an extreme 2017 wildfire event, residents of Seeley Lake, Montana were exposed to unusually high levels of wood smoke (WS) causing sustained effects on lung function (decreased FEV1/FVC). Objective: The present study utilized an animal model of WS exposure to research cellular and molecular mechanisms of the resulting health effects. Methods: Mice were exposed to inhaled WS utilizing locally harvested wood to recapitulate community exposures. WS was generated at a rate resulting in a 5 mg/m3 PM2.5 exposure for five days. Results: This exposure resulted in a similar 0.28 mg/m2 particle deposition (lung surface area) in mice that was calculated for human exposure. As with the community observations, there was a significant effect on lung function, increased resistance, and decreased compliance, that was more pronounced in males at an extended (2 months) timepoint and males were more affected than females: ex vivo assays illustrated changes to alveolar macrophage functions (increased TNFα secretion and decreased efferocytosis). Female mice had significantly elevated IL-33 levels in lungs, however, pretreatment of male mice with IL-33 resulted in an abrogation of the observed WS effects, suggesting a dose-dependent role of IL-33. Additionally, there were greater immunotoxic effects in male mice. Discussion: These findings replicated the outcomes in humans and suggest that IL-33 is involved in a mechanism of the adverse effects of WS exposures that inform on potential sex differences.
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Affiliation(s)
- Mary Buford
- University of MT, Center for Environmental Health Sciences, Missoula, MT, USA
| | - Sarah Lacher
- Department of Biomedical Sciences, University of MN Medical School, Duluth, MN, USA
| | - Matthew Slattery
- Department of Biomedical Sciences, University of MN Medical School, Duluth, MN, USA
| | - Daniel C Levings
- Department of Biomedical Sciences, University of MN Medical School, Duluth, MN, USA
| | - Britten Postma
- University of MT, Center for Environmental Health Sciences, Missoula, MT, USA
| | - Andrij Holian
- University of MT, Center for Environmental Health Sciences, Missoula, MT, USA
| | - Chris Migliaccio
- University of MT, Center for Environmental Health Sciences, Missoula, MT, USA
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3
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Crocker ME, Cogen JD, Karr CJ. Wildfire smoke knowledge gaps: A survey of pediatric pulmonary providers in Washington State. Pediatr Pulmonol 2024; 59:1099-1102. [PMID: 38153213 PMCID: PMC10978282 DOI: 10.1002/ppul.26835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 12/14/2023] [Indexed: 12/29/2023]
Affiliation(s)
- Mary E Crocker
- Department of Pediatrics, Division of Pulmonary & Sleep Medicine, University of Washington, Seattle, Washington, USA
- Seattle Children's Hospital, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Jonathan D Cogen
- Department of Pediatrics, Division of Pulmonary & Sleep Medicine, University of Washington, Seattle, Washington, USA
- Seattle Children's Hospital, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Catherine J Karr
- Department of Pediatrics, University of Washington, Seattle, Washington, USA
- Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, Washington, USA
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4
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Do V, Chen C, Benmarhnia T, Casey JA. Spatial Heterogeneity of the Respiratory Health Impacts of Wildfire Smoke PM 2.5 in California. GEOHEALTH 2024; 8:e2023GH000997. [PMID: 38560560 PMCID: PMC10978801 DOI: 10.1029/2023gh000997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Revised: 03/13/2024] [Accepted: 03/15/2024] [Indexed: 04/04/2024]
Abstract
Wildfire smoke fine particles (PM2.5) are a growing public health threat as wildfire events become more common and intense under climate change, especially in the Western United States. Studies assessing the association between wildfire PM2.5 exposure and health typically summarize the effects over the study area. However, health responses to wildfire PM2.5 may vary spatially. We evaluated spatially-varying respiratory acute care utilization risks associated with short-term exposure to wildfire PM2.5 and explored community characteristics possibly driving spatial heterogeneity. Using ensemble-modeled daily wildfire PM2.5, we defined a wildfire smoke day to have wildfire-specific PM2.5 concentration ≥15 μg/m3. We included daily respiratory emergency department visits and unplanned hospitalizations in 1,396 California ZIP Code Tabulation Areas (ZCTAs) and 15 census-derived community characteristics. Employing a case-crossover design and conditional logistic regression, we observed increased odds of respiratory acute care utilization on wildfire smoke days at the state level (odds ratio [OR] = 1.06, 95% confidence interval [CI]: 1.05, 1.07). Across air basins, ORs ranged from 0.88 to 1.57, with the highest effect estimate in San Diego. A within-community matching design and spatial Bayesian hierarchical model also revealed spatial heterogeneity in ZCTA-level rate differences. For example, communities with a higher percentage of Black or Pacific Islander residents had stronger wildfire PM2.5-outcome relationships, while more air conditioning and tree canopy attenuated associations. We found an important heterogeneity in wildfire smoke-related health impacts across air basins, counties, and ZCTAs, and we identified characteristics of vulnerable communities, providing evidence to guide policy development and resource allocation.
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Affiliation(s)
- V. Do
- Department of Environmental Health SciencesColumbia University Mailman School of Public HealthNew YorkNYUSA
| | - C. Chen
- Scripps Institution of Oceanography, UC San DiegoLa JollaCAUSA
| | - T. Benmarhnia
- Scripps Institution of Oceanography, UC San DiegoLa JollaCAUSA
- Irset Institut de Recherche en Santé, Environnement et Travail, UMR‐S 1085, Inserm, University of Rennes, EHESPRennesFrance
| | - J. A. Casey
- Department of Environmental Health SciencesColumbia University Mailman School of Public HealthNew YorkNYUSA
- Department of EpidemiologyUniversity of WashingtonSeattleWAUSA
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5
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Bowman WS, Schmidt RJ, Sanghar GK, Thompson Iii GR, Ji H, Zeki AA, Haczku A. "Air That Once Was Breath" Part 1: Wildfire-Smoke-Induced Mechanisms of Airway Inflammation - "Climate Change, Allergy and Immunology" Special IAAI Article Collection: Collegium Internationale Allergologicum Update 2023. Int Arch Allergy Immunol 2024:1-17. [PMID: 38452750 DOI: 10.1159/000536578] [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: 12/12/2023] [Accepted: 01/23/2024] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND Wildfires are a global concern due to their wide-ranging environmental, economic, and public health impacts. Climate change contributes to an increase in the frequency and intensity of wildfires making smoke exposure a more significant and recurring health concern for individuals with airway diseases. Some of the most prominent effects of wildfire smoke exposure are asthma exacerbations and allergic airway sensitization. Likely due to the delayed recognition of its health impacts in comparison with cigarette smoke and industrial or traffic-related air pollution, research on the composition, the mechanisms of toxicity, and the cellular/molecular pathways involved is poor or non-existent. SUMMARY This review discusses potential underlying pathological mechanisms of wildfire-smoke-related allergic airway disease and asthma. We focused on major gaps in understanding the role of wildfire smoke composition in the development of airway disease and the known and potential mechanisms involving cellular and molecular players of oxidative injury at the epithelial barrier in airway inflammation. We examine how PM2.5, VOCs, O3, endotoxin, microbes, and toxic gases may affect oxidative stress and inflammation in the respiratory mucosal barrier. We discuss the role of AhR in mediating smoke's effects in alarmin release and IL-17A production and how glucocorticoid responsiveness may be impaired by IL-17A-induced signaling and epigenetic changes leading to steroid-resistant severe airway inflammation. KEY MESSAGE Effective mitigation of wildfire-smoke-related respiratory health effects would require comprehensive research efforts aimed at a better understanding of the immune regulatory effects of wildfire smoke in respiratory health and disease.
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Affiliation(s)
- Willis S Bowman
- UC Davis Lung Center, University of California, Davis, California, USA
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, School of Medicine, Sacramento, California, USA
| | - Rebecca J Schmidt
- Department of Public Health Sciences, School of Medicine, Sacramento, California, USA
| | - Gursharan K Sanghar
- UC Davis Lung Center, University of California, Davis, California, USA
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, School of Medicine, Sacramento, California, USA
| | - George R Thompson Iii
- UC Davis Lung Center, University of California, Davis, California, USA
- Division of Infectious Diseases, Department of Medicine, School of Medicine, Sacramento, California, USA
| | - Hong Ji
- UC Davis Lung Center, University of California, Davis, California, USA
- Department of Anatomy, Physiology, and Cell Biology, School of Veterinary Medicine, Davis, California, USA
| | - Amir A Zeki
- UC Davis Lung Center, University of California, Davis, California, USA
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, School of Medicine, Sacramento, California, USA
| | - Angela Haczku
- UC Davis Lung Center, University of California, Davis, California, USA
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, School of Medicine, Sacramento, California, USA
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Barkoski J, Van Fleet E, Liu A, Ramsey S, Kwok RK, Miller AK. Data Linkages for Wildfire Exposures and Human Health Studies: A Scoping Review. GEOHEALTH 2024; 8:e2023GH000991. [PMID: 38487553 PMCID: PMC10937504 DOI: 10.1029/2023gh000991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 01/23/2024] [Accepted: 01/25/2024] [Indexed: 03/17/2024]
Abstract
Wildfires are increasing in frequency and intensity, with significant consequences that impact human health. A scoping review was conducted to: (a) understand wildfire-related health effects, (b) identify and describe environmental exposure and health outcome data sources used to research the impacts of wildfire exposures on health, and (c) identify gaps and opportunities to leverage exposure and health data to advance research. A literature search was conducted in PubMed and a sample of 83 articles met inclusion criteria. A majority of studies focused on respiratory and cardiovascular outcomes. Hospital administrative data was the most common health data source, followed by government data sources and health surveys. Wildfire smoke, specifically fine particulate matter (PM2.5), was the most common exposure measure and was predominantly estimated from monitoring networks and satellite data. Health data were not available in real-time, and they lacked spatial and temporal coverage to study health outcomes with longer latency periods. Exposure data were often available in real-time and provided better temporal and spatial coverage but did not capture the complex mixture of hazardous wildfire smoke pollutants nor exposures associated with non-air pathways such as soil, household dust, food, and water. This scoping review of the specific health and exposure data sources used to underpin these studies provides a framework for the research community to understand: (a) the use and value of various environmental and health data sources, and (b) the opportunities for improving data collection, integration, and accessibility to help inform our understanding of wildfires and other environmental exposures.
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Affiliation(s)
- J. Barkoski
- Social & Scientific Systems, Inc.a DLH Holdings CompanyDurhamNCUSA
| | - E. Van Fleet
- Social & Scientific Systems, Inc.a DLH Holdings CompanyDurhamNCUSA
| | - A. Liu
- Department of Health and Human ServicesNational Institute of Environmental Health SciencesNational Institutes of HealthDurhamNCUSA
- Kelly Government SolutionsRockvilleMDUSA
| | - S. Ramsey
- Social & Scientific Systems, Inc.a DLH Holdings CompanyDurhamNCUSA
| | - R. K. Kwok
- Department of Health and Human ServicesNational Institute on AgingNational Institutes of HealthBaltimoreMDUSA
| | - A. K. Miller
- Department of Health and Human ServicesNational Institute of Environmental Health SciencesNational Institutes of HealthDurhamNCUSA
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7
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Ahdoot S, Baum CR, Cataletto MB, Hogan P, Wu CB, Bernstein A. Climate Change and Children's Health: Building a Healthy Future for Every Child. Pediatrics 2024; 153:e2023065504. [PMID: 38374809 DOI: 10.1542/peds.2023-065504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/19/2023] [Indexed: 02/21/2024] Open
Abstract
The warming of our planet matters to every child. Driven by fossil fuel-generated greenhouse gas emissions, climate conditions stable since the founding of modern pediatrics in the mid-nineteenth century have shifted, and old certainties are falling away. Children's physical and mental health are threatened by climate change through its effects on temperature, precipitation, and extreme weather; ecological disruption; and community disruption. These impacts expose and amplify existing inequities and create unprecedented intergenerational injustice. Fossil fuel extraction and combustion cause harm today and reach centuries into the future, jeopardizing the health, safety, and prosperity of today's children and future generations. Appreciating the unique vulnerability of their patients, pediatricians have become leading health advocates for climate actions necessary to protect all living and future children. Policies that reduce reliance on fossil fuels and promote cleaner air, facilitate walking and bicycling, encourage more sustainable diets, increase access to nature, and develop more connected communities lead to immediate gains in child health and equity, and build a foundation for generations of children to thrive.
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Affiliation(s)
- Samantha Ahdoot
- University of Virginia School of Medicine, Charlottesville, Virginia
| | - Carl R Baum
- Section of Pediatric Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Mary Bono Cataletto
- Division of Pediatric Pulmonology and Sleep Medicine, Department of Pediatrics, New York University Long Island School of Medicine, Mineola, New York
| | - Patrick Hogan
- Pediatric Residency Program, Oregon Health & Science University, Portland, Oregon
| | - Christina B Wu
- O'Neill Center for Global and National Health Law, Georgetown University Law Center, Washington, District of Columbia
| | - Aaron Bernstein
- Division of General Pediatrics, Boston Children's Hospital, and Center for Climate, Health, and the Global Environment, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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8
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Ahdoot S, Baum CR, Cataletto MB, Hogan P, Wu CB, Bernstein A. Climate Change and Children's Health: Building a Healthy Future for Every Child. Pediatrics 2024; 153:e2023065505. [PMID: 38374808 DOI: 10.1542/peds.2023-065505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/19/2023] [Indexed: 02/21/2024] Open
Abstract
Observed changes in temperature, precipitation patterns, sea level, and extreme weather are destabilizing major determinants of human health. Children are at higher risk of climate-related health burdens than adults because of their unique behavior patterns; developing organ systems and physiology; greater exposure to air, food, and water contaminants per unit of body weight; and dependence on caregivers. Climate change harms children through numerous pathways, including air pollution, heat exposure, floods and hurricanes, food insecurity and nutrition, changing epidemiology of infections, and mental health harms. As the planet continues to warm, climate change's impacts will worsen, threatening to define the health and welfare of children at every stage of their lives. Children who already bear higher burden of disease because of living in low-wealth households and communities, lack of access to high quality education, and experiencing racism and other forms of unjust discrimination bear greater risk of suffering from climate change hazards. Climate change solutions, advanced through collaborative work of pediatricians, health systems, communities, corporations, and governments lead to immediate gains in child health and equity and build a foundation for generations of children to thrive. This technical report reviews the nature of climate change and its associated child health effects and supports the recommendations in the accompanying policy statement on climate change and children's health.
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Affiliation(s)
- Samantha Ahdoot
- University of Virginia School of Medicine, Charlottesville, Virginia
| | - Carl R Baum
- Section of Pediatric Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Mary Bono Cataletto
- Division of Pediatric Pulmonology and Sleep Medicine, Department of Pediatrics, New York University Long Island School of Medicine, Mineola, New York
| | - Patrick Hogan
- Pediatric Residency Program, Oregon Health & Science University, Portland, Oregon
| | - Christina B Wu
- O'Neill Center for Global and National Health Law, Georgetown University Law Center, Washington, District of Columbia
| | - Aaron Bernstein
- Division of General Pediatrics, Boston Children's Hospital, and Center for Climate, Health, and the Global Environment, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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9
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Casey JA, Kioumourtzoglou MA, Padula A, González DJX, Elser H, Aguilera R, Northrop AJ, Tartof SY, Mayeda ER, Braun D, Dominici F, Eisen EA, Morello-Frosch R, Benmarhnia T. Measuring long-term exposure to wildfire PM 2.5 in California: Time-varying inequities in environmental burden. Proc Natl Acad Sci U S A 2024; 121:e2306729121. [PMID: 38349877 PMCID: PMC10895344 DOI: 10.1073/pnas.2306729121] [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: 05/02/2023] [Accepted: 01/13/2024] [Indexed: 02/15/2024] Open
Abstract
Wildfires have become more frequent and intense due to climate change and outdoor wildfire fine particulate matter (PM2.5) concentrations differ from relatively smoothly varying total PM2.5. Thus, we introduced a conceptual model for computing long-term wildfire PM2.5 and assessed disproportionate exposures among marginalized communities. We used monitoring data and statistical techniques to characterize annual wildfire PM2.5 exposure based on intermittent and extreme daily wildfire PM2.5 concentrations in California census tracts (2006 to 2020). Metrics included: 1) weeks with wildfire PM2.5 < 5 μg/m3; 2) days with non-zero wildfire PM2.5; 3) mean wildfire PM2.5 during peak exposure week; 4) smoke waves (≥2 consecutive days with <15 μg/m3 wildfire PM2.5); and 5) mean annual wildfire PM2.5 concentration. We classified tracts by their racial/ethnic composition and CalEnviroScreen (CES) score, an environmental and social vulnerability composite measure. We examined associations of CES and racial/ethnic composition with the wildfire PM2.5 metrics using mixed-effects models. Averaged 2006 to 2020, we detected little difference in exposure by CES score or racial/ethnic composition, except for non-Hispanic American Indian and Alaska Native populations, where a 1-SD increase was associated with higher exposure for 4/5 metrics. CES or racial/ethnic × year interaction term models revealed exposure disparities in some years. Compared to their California-wide representation, the exposed populations of non-Hispanic American Indian and Alaska Native (1.68×, 95% CI: 1.01 to 2.81), white (1.13×, 95% CI: 0.99 to 1.32), and multiracial (1.06×, 95% CI: 0.97 to 1.23) people were over-represented from 2006 to 2020. In conclusion, during our study period in California, we detected disproportionate long-term wildfire PM2.5 exposure for several racial/ethnic groups.
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Affiliation(s)
- Joan A. Casey
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, NY10032
- Department of Environmental and Occupational Health, University of Washington School of Public Health, Seattle, WA98195
| | | | - Amy Padula
- Department of Obstetrics, Gynecology and Reproductive Sciences, Program on Reproductive Health and the Environment, University of California San Francisco, San Francisco, CA94143
| | - David J. X. González
- Department of Environmental Policy, Science, and Management, University of California, Berkeley, CA94720
- Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, CA94704
| | - Holly Elser
- Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia, PA19104
| | - Rosana Aguilera
- Scripps Institution of Oceanography, University of California San Diego, La Jolla, CA92037
| | | | - Sara Y. Tartof
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA91101
| | - Elizabeth Rose Mayeda
- Department of Epidemiology, University of California Los Angeles Fielding School of Public Health, Los Angeles, CA90095
| | - Danielle Braun
- Department of Biostatistics, Harvard TH Chan School of Public Health, Boston, MA02115
- Department of Data Science, Dana-Farber Cancer Institute, Boston, MA02215
| | - Francesca Dominici
- Department of Biostatistics, Harvard TH Chan School of Public Health, Boston, MA02115
| | - Ellen A. Eisen
- Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, CA94704
| | - Rachel Morello-Frosch
- Department of Environmental Policy, Science, and Management, University of California, Berkeley, CA94720
- Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, CA94704
| | - Tarik Benmarhnia
- Scripps Institution of Oceanography, University of California San Diego, La Jolla, CA92037
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10
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Wilgus ML, Merchant M. Clearing the Air: Understanding the Impact of Wildfire Smoke on Asthma and COPD. Healthcare (Basel) 2024; 12:307. [PMID: 38338192 PMCID: PMC10855577 DOI: 10.3390/healthcare12030307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 01/19/2024] [Accepted: 01/20/2024] [Indexed: 02/12/2024] Open
Abstract
Wildfires are a global natural phenomenon. In North America, wildfires have not only become more frequent, but also more severe and longer in duration, a trend ascribed to climate change combined with large fuel stores left from modern fire suppression. The intensification of wildfire activity has significant implications for planetary health and public health, as exposure to fine particulate matter (PM2.5) in wildfire smoke is linked to adverse health effects. This review focuses on respiratory morbidity from wildfire smoke exposure. Inhalation of wildfire PM2.5 causes lung injury via oxidative stress, local and systemic inflammation, airway epithelium compromise, and increased vulnerability to infection. Wildfire PM2.5 exposure results in exacerbations of pre-existing asthma and chronic obstructive pulmonary disease, with an escalation in healthcare utilization, including emergency department visits and hospitalizations. Wildfire smoke exposure may be associated with asthma onset, long-term impairment of lung function, and increased all-cause mortality. Children, older adults, occupationally-exposed groups, and possibly women are the most at risk from wildfire smoke. Future research is needed to clarify best practices for risk mitigation and wildfire management.
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Affiliation(s)
- May-Lin Wilgus
- Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 90095-1405, USA;
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11
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Wen J, Heft-Neal S, Baylis P, Boomhower J, Burke M. Quantifying fire-specific smoke exposure and health impacts. Proc Natl Acad Sci U S A 2023; 120:e2309325120. [PMID: 38085772 PMCID: PMC10743475 DOI: 10.1073/pnas.2309325120] [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: 06/12/2023] [Accepted: 09/21/2023] [Indexed: 12/18/2023] Open
Abstract
Rapidly changing wildfire regimes across the Western United States have driven more frequent and severe wildfires, resulting in wide-ranging societal threats from wildfires and wildfire-generated smoke. However, common measures of fire severity focus on what is burned, disregarding the societal impacts of smoke generated from each fire. We combine satellite-derived fire scars, air parcel trajectories from individual fires, and predicted smoke PM2.5 to link source fires to resulting smoke PM2.5 and health impacts experienced by populations in the contiguous United States from April 2006 to 2020. We quantify fire-specific accumulated smoke exposure based on the cumulative population exposed to smoke PM2.5 over the duration of a fire and estimate excess asthma-related emergency department (ED) visits as a result of this exposure. We find that excess asthma visits attributable to each fire are only moderately correlated with common measures of wildfire severity, including burned area, structures destroyed, and suppression cost. Additionally, while recent California fires contributed nearly half of the country's smoke-related excess asthma ED visits during our study period, the most severe individual fire was the 2007 Bugaboo fire in the Southeast. We estimate that a majority of smoke PM2.5 comes from sources outside the local jurisdictions where the smoke is experienced, with 87% coming from fires in other counties and 60% from fires in other states. Our approach could enable broad-scale assessment of whether specific fire characteristics affect smoke toxicity or impact, inform cost-effectiveness assessments for allocation of suppression resources, and help clarify the growing transboundary nature of local air quality.
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Affiliation(s)
- Jeff Wen
- Department of Earth System Science, Stanford University, Stanford, CA94305
| | - Sam Heft-Neal
- Center on Food Security and the Environment, Stanford University, Stanford, CA94305
| | - Patrick Baylis
- Department of Economics, University of British Columbia, Vancouver, BCV6T 1Z4, Canada
| | - Judson Boomhower
- Department of Economics, University of California, San Diego, CA92093
- National Bureau of Economic Research, Cambridge, MA02138
| | - Marshall Burke
- Center on Food Security and the Environment, Stanford University, Stanford, CA94305
- National Bureau of Economic Research, Cambridge, MA02138
- Doerr School of Sustainability, Stanford University, Stanford, CA94305
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12
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Wedmore F, Nolan T, Watts N. Sustainable practice: what can I do? BMJ 2023; 383:2461. [PMID: 37931936 DOI: 10.1136/bmj.p2461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2023]
Affiliation(s)
| | | | - Nick Watts
- Centre for Sustainable Medicine, National University of Singapore, Singapore
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13
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Balmes JR, Holm SM. Increasing wildfire smoke from the climate crisis: Impacts on asthma and allergies. J Allergy Clin Immunol 2023; 152:1081-1083. [PMID: 37739070 DOI: 10.1016/j.jaci.2023.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 09/15/2023] [Accepted: 09/15/2023] [Indexed: 09/24/2023]
Affiliation(s)
- John R Balmes
- Department of Medicine, University of California San Francisco, Calif; School of Public Health, University of California Berkeley, Berkeley, Calif.
| | - Stephanie M Holm
- Department of Medicine, University of California San Francisco, Calif; Western States Pediatric Environmental Health Specialty Unit, San Francisco, Calif
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14
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Balakrishnan B, Callahan SJ, Cherian SV, Subramanian A, Sarkar S, Bhatt N, Scholand MB. Climate Change for the Pulmonologist: A Focused Review. Chest 2023; 164:963-974. [PMID: 37054776 DOI: 10.1016/j.chest.2023.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 04/03/2023] [Accepted: 04/04/2023] [Indexed: 04/15/2023] Open
Abstract
Climate change adversely impacts global health. Increasingly, temperature variability, inclement weather, declining air quality, and growing food and clean water supply insecurities threaten human health. Earth's temperature is projected to increase up to 6.4 °C by the end of the 21st century, exacerbating the threat. Public and health care professionals, including pulmonologists, perceive the detrimental effects of climate change and air pollution and support efforts to mitigate its effects. In fact, evidence is strong that premature cardiopulmonary death is associated with air pollution exposure via inhalation through the respiratory system, which functions as a portal of entry. However, little guidance is available for pulmonologists in recognizing the effects of climate change and air pollution on the diverse range of pulmonary disorders. To educate and mitigate risk for patients competently, pulmonologists must be armed with evidence-based findings of the impact of climate change and air pollution on specific pulmonary diseases. Our goal is to provide pulmonologists with the background and tools to improve patients' health and to prevent adverse outcomes despite climate change-imposed threats. In this review, we detail current evidence of climate change and air pollution impact on a diverse range of pulmonary disorders. Knowledge enables a proactive and individualized approach toward prevention strategies for patients, rather than merely treating ailments reactively.
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Affiliation(s)
- Bathmapriya Balakrishnan
- Section of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, West Virginia University, Morgantown, WV; Occupational and Environmental Health Section, Diffuse Lung Disease and Lung Transplant Network, CHEST, Glenview, IL.
| | - Sean J Callahan
- Division of Pulmonary Medicine, University of Utah Health, Salt Lake City, UT; Division of Pulmonary Medicine, George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT; Occupational and Environmental Health Section, Diffuse Lung Disease and Lung Transplant Network, CHEST, Glenview, IL
| | - Sujith V Cherian
- Division of Critical Care, Pulmonary and Sleep Medicine, University of Texas Health-McGovern Medical School, Houston; Occupational and Environmental Health Section, Diffuse Lung Disease and Lung Transplant Network, CHEST, Glenview, IL
| | - Abirami Subramanian
- Department of Pulmonary and Critical Care Medicine, Baylor Scott and White Health, Dallas, TX; Occupational and Environmental Health Section, Diffuse Lung Disease and Lung Transplant Network, CHEST, Glenview, IL
| | - Sauradeep Sarkar
- Section of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, West Virginia University, Morgantown, WV
| | - Nitin Bhatt
- Division of Pulmonary, Critical Care and Sleep Medicine, Ohio State University, Columbus, OH; Occupational and Environmental Health Section, Diffuse Lung Disease and Lung Transplant Network, CHEST, Glenview, IL
| | - Mary-Beth Scholand
- Division of Pulmonary Medicine, University of Utah Health, Salt Lake City, UT; Occupational and Environmental Health Section, Diffuse Lung Disease and Lung Transplant Network, CHEST, Glenview, IL
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15
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Xu H, Song J, He X, Guan X, Wang T, Zhu Y, Xu X, Li M, Liu L, Zhang B, Fang J, Zhao Q, Song X, Xu B, Huang W. Ambient Anthropogenic Carbons and Pediatric Respiratory Infections: A Case-Crossover Analysis in the Megacity Beijing. GEOHEALTH 2023; 7:e2023GH000820. [PMID: 37534336 PMCID: PMC10392781 DOI: 10.1029/2023gh000820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 07/02/2023] [Accepted: 07/05/2023] [Indexed: 08/04/2023]
Abstract
Carbon loading in airway cells has shown to worsen function of antimicrobial peptides, permitting increased survival of pathogens in the respiratory tract; however, data on the impacts of carbon particles on childhood acute respiratory infection (ARI) is limited. We assembled daily health data on outpatient visits for ARI (bronchitis, pneumonia, and total upper respiratory infection [TURI]) in children aged 0-14 years between 2015 and 2019 in Beijing, China. Anthropogenic carbons, including black carbon (BC) and its emission sources, and wood smoke particles (delta carbon, ultra-violet absorbing particulate matter, and brown carbon) were continuously monitored. Using a time-stratified case-crossover approach, conditional logistic regression was performed to derive risk estimates for each outcome. A total of 856,899 children were included, and a wide range of daily carbon particle concentrations was observed, with large variations for BC (0.36-20.44) and delta carbon (0.48-57.66 μg/m3). Exposure to these particles were independently associated with ARI, with nearly linear exposure-response relationships. Interquartile range increases in concentrations of BC and delta carbon over prior 0-8 days, we observed elevation of the odd ratio of bronchitis by 1.201 (95% confidence interval, 1.180, 1.221) and 1.048 (95% CI, 1.039, 1.057), respectively. Stronger association was observed for BC from traffic sources, which increased the odd ratio of bronchitis by 1.298 (95% CI, 1.273, 1.324). Carbon particles were also associated with elevated risks of pneumonia and TURI, and subgroup analyses indicated greater risks among children older than 6 years. Our findings suggested that anthropogenic carbons in metropolitan areas may pose a significant threat to clinical manifestations of respiratory infections in vulnerable populations.
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Affiliation(s)
- Hongbing Xu
- Department of Occupational and Environmental Health SciencesPeking University School of Public HealthPeking University Institute of Environmental MedicineBeijingChina
- State Key Laboratory of Vascular Homeostasis and RemodelingPeking UniversityBeijingChina
| | - Jing Song
- The First Affiliated Hospital of Xiamen UniversityXiamenChina
| | - Xinghou He
- Department of Occupational and Environmental Health SciencesPeking University School of Public HealthPeking University Institute of Environmental MedicineBeijingChina
- State Key Laboratory of Vascular Homeostasis and RemodelingPeking UniversityBeijingChina
| | - Xinpeng Guan
- Department of Occupational and Environmental Health SciencesPeking University School of Public HealthPeking University Institute of Environmental MedicineBeijingChina
- State Key Laboratory of Vascular Homeostasis and RemodelingPeking UniversityBeijingChina
| | - Tong Wang
- Key Lab of Medical Protection for Electromagnetic RadiationMinistry of Education of ChinaInstitute of ToxicologyCollege of Preventive MedicineArmy Medical University (Third Military Medical University)ChongqingChina
| | - Yutong Zhu
- Department of Occupational and Environmental Health SciencesPeking University School of Public HealthPeking University Institute of Environmental MedicineBeijingChina
- State Key Laboratory of Vascular Homeostasis and RemodelingPeking UniversityBeijingChina
| | - Xin Xu
- China National Clinical Research Center of Respiratory DiseasesRespiratory Department of Beijing Children's HospitalCapital Medical UniversityNational Center for Children's HealthBeijingChina
| | - Mengyao Li
- Department of Occupational and Environmental Health SciencesPeking University School of Public HealthPeking University Institute of Environmental MedicineBeijingChina
- State Key Laboratory of Vascular Homeostasis and RemodelingPeking UniversityBeijingChina
| | - Lingyan Liu
- Department of Occupational and Environmental Health SciencesPeking University School of Public HealthPeking University Institute of Environmental MedicineBeijingChina
- State Key Laboratory of Vascular Homeostasis and RemodelingPeking UniversityBeijingChina
| | - Bin Zhang
- Department of Occupational and Environmental Health SciencesPeking University School of Public HealthPeking University Institute of Environmental MedicineBeijingChina
- State Key Laboratory of Vascular Homeostasis and RemodelingPeking UniversityBeijingChina
| | - Jiakun Fang
- Department of Occupational and Environmental Health SciencesPeking University School of Public HealthPeking University Institute of Environmental MedicineBeijingChina
- State Key Laboratory of Vascular Homeostasis and RemodelingPeking UniversityBeijingChina
| | - Qian Zhao
- Department of Occupational and Environmental Health SciencesPeking University School of Public HealthPeking University Institute of Environmental MedicineBeijingChina
- State Key Laboratory of Vascular Homeostasis and RemodelingPeking UniversityBeijingChina
| | - Xiaoming Song
- Department of Occupational and Environmental Health SciencesPeking University School of Public HealthPeking University Institute of Environmental MedicineBeijingChina
- State Key Laboratory of Vascular Homeostasis and RemodelingPeking UniversityBeijingChina
| | - Baoping Xu
- China National Clinical Research Center of Respiratory DiseasesRespiratory Department of Beijing Children's HospitalCapital Medical UniversityNational Center for Children's HealthBeijingChina
| | - Wei Huang
- Department of Occupational and Environmental Health SciencesPeking University School of Public HealthPeking University Institute of Environmental MedicineBeijingChina
- State Key Laboratory of Vascular Homeostasis and RemodelingPeking UniversityBeijingChina
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16
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Noah TL, Worden CP, Rebuli ME, Jaspers I. The Effects of Wildfire Smoke on Asthma and Allergy. Curr Allergy Asthma Rep 2023; 23:375-387. [PMID: 37171670 PMCID: PMC10176314 DOI: 10.1007/s11882-023-01090-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2023] [Indexed: 05/13/2023]
Abstract
PURPOSE OF REVIEW To review the recent literature on the effects of wildfire smoke (WFS) exposure on asthma and allergic disease, and on potential mechanisms of disease. RECENT FINDINGS Spatiotemporal modeling and increased ground-level monitoring data are allowing a more detailed picture of the health effects of WFS exposure to emerge, especially with regard to asthma. There is also epidemiologic and some experimental evidence to suggest that WFS exposure increases allergic predisposition and upper airway or sinonasal disease, though much of the literature in this area is focused more generally on PM2.5 and is not specific for WFS. Experimental evidence for mechanisms includes disruption of epithelial integrity with downstream effects on inflammatory or immune pathways, but experimental models to date have not consistently reflected human disease in this area. Exposure to WFS has an acute detrimental effect on asthma. Potential mechanisms are suggested by in vitro and animal studies.
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Affiliation(s)
- Terry L Noah
- Department of Pediatrics, University of North Carolina at Chapel Hill, 260 Macnider Building, 333 S. Columbia St., Chapel Hill, NC, 27599, USA.
- Center for Environmental Medicine, Asthma and Lung Biology, University of North Carolina at Chapel Hill, Chapel Hill, USA.
| | - Cameron P Worden
- Department of Otolaryngology/Head & Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, USA
- Center for Environmental Medicine, Asthma and Lung Biology, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Meghan E Rebuli
- Department of Pediatrics, University of North Carolina at Chapel Hill, 260 Macnider Building, 333 S. Columbia St., Chapel Hill, NC, 27599, USA
- Center for Environmental Medicine, Asthma and Lung Biology, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Ilona Jaspers
- Department of Pediatrics, University of North Carolina at Chapel Hill, 260 Macnider Building, 333 S. Columbia St., Chapel Hill, NC, 27599, USA
- Center for Environmental Medicine, Asthma and Lung Biology, University of North Carolina at Chapel Hill, Chapel Hill, USA
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17
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Dhingra R, Keeler C, Staley BS, Jardel HV, Ward-Caviness C, Rebuli ME, Xi Y, Rappazzo K, Hernandez M, Chelminski AN, Jaspers I, Rappold AG. Wildfire smoke exposure and early childhood respiratory health: a study of prescription claims data. Environ Health 2023; 22:48. [PMID: 37370168 PMCID: PMC10294519 DOI: 10.1186/s12940-023-00998-5] [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: 01/17/2023] [Accepted: 06/08/2023] [Indexed: 06/29/2023]
Abstract
Wildfire smoke is associated with short-term respiratory outcomes including asthma exacerbation in children. As investigations into developmental wildfire smoke exposure on children's longer-term respiratory health are sparse, we investigated associations between developmental wildfire smoke exposure and first use of respiratory medications. Prescription claims from IBM MarketScan Commercial Claims and Encounters database were linked with wildfire smoke plume data from NASA satellites based on Metropolitan Statistical Area (MSA). A retrospective cohort of live infants (2010-2016) born into MSAs in six western states (U.S.A.), having prescription insurance, and whose birthdate was estimable from claims data was constructed (N = 184,703); of these, gestational age was estimated for 113,154 infants. The residential MSA, gestational age, and birthdate were used to estimate average weekly smoke exposure days (smoke-day) for each developmental period: three trimesters, and two sequential 12-week periods post-birth. Medications treating respiratory tract inflammation were classified using active ingredient and mode of administration into three categories:: 'upper respiratory', 'lower respiratory', 'systemic anti-inflammatory'. To evaluate associations between wildfire smoke exposure and medication usage, Cox models associating smoke-days with first observed prescription of each medication category were adjusted for infant sex, birth-season, and birthyear with a random intercept for MSA. Smoke exposure during postnatal periods was associated with earlier first use of upper respiratory medications (1-12 weeks: hazard ratio (HR) = 1.094 per 1-day increase in average weekly smoke-day, 95%CI: (1.005,1.191); 13-24 weeks: HR = 1.108, 95%CI: (1.016,1.209)). Protective associations were observed during gestational windows for both lower respiratory and systemic anti-inflammatory medications; it is possible that these associations may be a consequence of live-birth bias. These findings suggest wildfire smoke exposure during early postnatal developmental periods impact subsequent early life respiratory health.
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Affiliation(s)
- Radhika Dhingra
- Department of Environmental Science and Engineering, Gillings School of Global Public Health, University of North Carolina, 135 Dauer Drive, C.B 7431, Chapel Hill, NC, 27599, USA.
- Brody School of Medicine, East Carolina University, Greenville, NC, USA.
| | - Corinna Keeler
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Brooke S Staley
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Hanna V Jardel
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Center for Public Health and Environmental Assessment, United States Environmental Protection Agency, Durham, NC, USA
| | - Cavin Ward-Caviness
- Center for Public Health and Environmental Assessment, United States Environmental Protection Agency, Durham, NC, USA
| | - Meghan E Rebuli
- Department of Pediatrics, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Center for Environmental Medicine, Asthma, and Lung Biology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Yuzhi Xi
- Department of Environmental Science and Engineering, Gillings School of Global Public Health, University of North Carolina, 135 Dauer Drive, C.B 7431, Chapel Hill, NC, 27599, USA
| | - Kristen Rappazzo
- Center for Public Health and Environmental Assessment, United States Environmental Protection Agency, Durham, NC, USA
| | - Michelle Hernandez
- Department of Pediatrics, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Ann N Chelminski
- Center for Public Health and Environmental Assessment, United States Environmental Protection Agency, Durham, NC, USA
| | - Ilona Jaspers
- Department of Pediatrics, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Center for Environmental Medicine, Asthma, and Lung Biology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Ana G Rappold
- Center for Public Health and Environmental Assessment, United States Environmental Protection Agency, Durham, NC, USA
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18
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Reid CE, Considine EM, Watson GL, Telesca D, Pfister GG, Jerrett M. Effect modification of the association between fine particulate air pollution during a wildfire event and respiratory health by area-level measures of socio-economic status, race/ethnicity, and smoking prevalence. ENVIRONMENTAL RESEARCH, HEALTH : ERH 2023; 1:025005. [PMID: 38332844 PMCID: PMC10852067 DOI: 10.1088/2752-5309/acc4e1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
Fine particulate air pollution (PM2.5) is decreasing in most areas of the United States, except for areas most affected by wildfires, where increasing trends in PM2.5 can be attributed to wildfire smoke. The frequency and duration of large wildfires and the length of the wildfire season have all increased in recent decades, partially due to climate change, and wildfire risk is projected to increase further in many regions including the western United States. Increasingly, empirical evidence suggests differential health effects from air pollution by class and race; however, few studies have investigated such differential health impacts from air pollution during a wildfire event. We investigated differential risk of respiratory health impacts during the 2008 northern California wildfires by a comprehensive list of socio-economic status (SES), race/ethnicity, and smoking prevalence variables. Regardless of SES level across nine measures of SES, we found significant associations between PM2.5 and asthma hospitalizations and emergency department (ED) visits during these wildfires. Differential respiratory health risk was found by SES for ED visits for chronic obstructive pulmonary disease where the highest risks were in ZIP codes with the lowest SES levels. Findings for differential effects by race/ethnicity were less consistent across health outcomes. We found that ZIP codes with higher prevalence of smokers had greater risk of ED visits for asthma and pneumonia. Our study suggests that public health efforts to decrease exposures to high levels of air pollution during wildfires should focus on lower SES communities.
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Affiliation(s)
- C E Reid
- Department of Geography, University of Colorado Boulder, Boulder, CO, United States of America
| | - E M Considine
- Department of Applied Math, University of Colorado Boulder, Boulder, CO, United States of America
- Current address: Department of Biostatistics, Harvard T.H. Chan School of Public Health, Harvard University., Boston, MA, United States of America
| | - G L Watson
- Department of Biostatistics, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, United States of America
| | - D Telesca
- Department of Biostatistics, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, United States of America
| | - G G Pfister
- National Center for Atmospheric Research, Boulder, CO, United States of America
| | - M Jerrett
- Department of Environmental Health Sciences, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, United States of America
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19
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Saberi P, Ming K, Arnold EA, Leddy AM, Weiser SD. Extreme weather events and HIV: development of a conceptual framework through qualitative interviews with people with HIV impacted by the California wildfires and their clinicians. BMC Public Health 2023; 23:950. [PMID: 37231393 DOI: 10.1186/s12889-023-15957-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 05/22/2023] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND People with HIV (PWH) are disproportionately vulnerable to the impacts of wildfires, given the need for frequent access to healthcare systems, higher burden of comorbidities, higher food insecurity, mental and behavioral health challenges, and challenges of living with HIV in a rural area. In this study, we aim to better understand the pathways through which wildfires impact health outcomes among PWH. METHODS From October 2021 through February 2022, we conducted individual semi-structured qualitative interviews with PWH impacted by the Northern California wildfires and clinicians of PWH who were impacted by wildfires. The study aims were to explore the influence of wildfires on the health of PWH and to discuss measures at the individual, clinic, and system levels that helped to mitigate these impacts. RESULTS We interviewed 15 PWH and 7 clinicians. While some PWH felt that surviving the HIV epidemic added to their resilience against wildfires, many felt that the wildfires compounded the HIV-related traumas that they have experienced. Participants outlined five main routes by which wildfires negatively impacted their health: (1) access to healthcare (medications, clinics, clinic staff), (2) mental health (trauma; anxiety, depression, or stress; sleep disturbances; coping strategies), (3) physical health (cardiopulmonary, other co-morbidities), (4) social/economic impacts (housing, finances, community), and (5) nutrition and exercise. The recommendations for future wildfire preparedness were at the (1) individual-level (what to have during evacuation), (2) pharmacy-level (procedural, staffing), and (3) clinic- or county-level (funds and vouchers; case management; mental health services; emergency response planning; other services such as telehealth, home visits, home laboratory testing). CONCLUSIONS Based on our data and prior research, we devised a conceptual framework that acknowledges the impact of wildfires at the community-, household-, and individual-level with implications for physical and mental health outcomes among PWH. These findings and framework can help in developing future interventions, programs, and policies to mitigate the cumulative impacts of extreme weather events on the health of PWH, particularly among individuals living in rural areas. Further studies are needed to examine health system strengthening strategies, innovative methods to improve access to healthcare, and community resilience through disaster preparedness. TRIAL REGISTRATION N/A.
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Affiliation(s)
- Parya Saberi
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.
| | - Kristin Ming
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Emily A Arnold
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Anna M Leddy
- Division of pulmonary and critical care medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Sheri D Weiser
- Division of HIV, Infectious Diseases and Global Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
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20
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Mulliken JS, Hampshire KN, Rappold AG, Fung M, Babik JM, Doernberg SB. Risk of systemic fungal infections after exposure to wildfires: a population-based, retrospective study in California. Lancet Planet Health 2023; 7:e381-e386. [PMID: 37164514 DOI: 10.1016/s2542-5196(23)00046-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 02/10/2023] [Accepted: 02/15/2023] [Indexed: 05/12/2023]
Abstract
BACKGROUND Large-scale wildfires in California, USA, are increasing in both size and frequency, with substantial health consequences. The capacity for wildfire smoke to displace microbes and cause clinically significant fungal infections is poorly understood. We aimed to determine whether exposure to wildfire smoke was associated with an increased risk of hospital admissions for systemic fungal infections. METHODS In this population-based, retrospective study, we used hospital administrative data from 22 hospitals in California, USA, to analyse the association between wildfire smoke exposure and monthly hospital admissions for aspergillosis and coccidioidomycosis. We included hospitals that were members of the Vizient Clinical Data Base or Resource Manager during the study and excluded those that did not have complete reporting into Vizient during the study period. Smoke exposure was estimated using satellite-imaged smoke plumes in the hospital county. Incident rate ratios were calculated for all infection types 1 month and 3 months after smoke exposure. FINDINGS Between Oct 1, 2014, and May 31, 2018, there were a median of 1638 annual admissions per hospital in the study sample. Individual patient demographics were not collected. We did not observe an association between smoke exposure and rate of hospital admission for aspergillosis. However, hospital admission for coccidioidomycosis increased by 20% (95% CI 5-38) in the month following any smoke exposure. Hospital admission increased by 2% (0-4) for every day that there had been smoke exposure in the previous month, after adjustment for temperature and temporal trend. Similar results were obtained with smoke exposure data from the 3 months before admission. INTERPRETATION In the months following wildfire smoke exposure, California hospitals saw increased coccidioidomycosis infections. Given the projected increase in California wildfires and their expansion in endemic territories of soil-dwelling fungi, the ability for wildfire smoke to carry microbes and cause human disease warrants further research. FUNDING None.
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Affiliation(s)
| | | | - Ana G Rappold
- United States Environmental Protection Agency, Durham, NC, USA
| | - Monica Fung
- University of California San Francisco, San Francisco, CA, USA
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21
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Thilakaratne R, Hoshiko S, Rosenberg A, Hayashi T, Buckman JR, Rappold AG. Wildfires and the Changing Landscape of Air Pollution-related Health Burden in California. Am J Respir Crit Care Med 2023; 207:887-898. [PMID: 36520960 DOI: 10.1164/rccm.202207-1324oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 12/14/2022] [Indexed: 12/23/2022] Open
Abstract
Rationale: Wildfires are a growing source of pollution including particulate matter ⩽2.5 μm in aerodynamic diameter (PM2.5), but associated trends in health burden are not well characterized. Objectives: We investigated trends and disparities in PM2.5-related cardiorespiratory health burden (asthma, chronic obstructive pulmonary disease, and all-cause respiratory and cardiovascular emergency department [ED] visits and hospital admissions) for all days and wildfire smoke-affected days across California from 2008 to 2016. Methods: Using residential Zone Improvement Plan code and daily PM2.5 exposures, we estimated overall and subgroup-specific (age, gender, race and ethnicity) associations with cardiorespiratory outcomes. Health burden trends and disparities were evaluated on the basis of relative risk, attributable number, and attributable fraction by demographic and geographic factors and over time. Measurements and Main Results: PM2.5-attributed burden steadily decreased, whereas the fraction attributed to wildfire smoke varied by fire season intensity, constituting up to 15% of the annual PM2.5-burden. The highest relative risk and PM2.5-attributed burden (92 per 100,000 people) was observed for respiratory ED visits, accounting for 2.2% of the respiratory annual burden. Disparities in overall morbidity in the oldest age, Black, and "other" race groups were also reflected in PM2.5-attributed burden, whereas Asian populations had the highest risk rate in respiratory outcomes and thus the largest fraction of the total burden attributed to the exposure. In contrast, high wildfire PM2.5-attributed burden rates in rural, central, and northern California populations occurred because of differential exposure. Conclusions: In California, wildfires' impact on air quality offset the public health gains achieved through reductions in nonsmoke PM2.5. Disproportionate effects could be attributed to differences in subpopulation susceptibility, relative risk, and differential exposure.
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Affiliation(s)
- Ruwan Thilakaratne
- Environmental Health Investigations Branch, California Department of Public Health, Richmond, California
- California Department of Public Health/Cal EIS Program, Richmond, California
| | - Sumi Hoshiko
- Environmental Health Investigations Branch, California Department of Public Health, Richmond, California
| | - Andrew Rosenberg
- Environmental Health Investigations Branch, California Department of Public Health, Richmond, California
| | | | - Joseph Ryan Buckman
- Environmental Health Investigations Branch, California Department of Public Health, Richmond, California
- California Department of Public Health/Cal EIS Program, Richmond, California
| | - Ana G Rappold
- Center for Public Health and Environmental Assessment, U.S. Environmental Protection Agency, Durham, North Carolina
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22
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Dilger AE, Bergmark RW. Environmental sustainability in otolaryngologic surgery. Curr Opin Otolaryngol Head Neck Surg 2023. [DOI: 10.1097/moo.0000000000000888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
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23
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Considine EM, Hao J, deSouza P, Braun D, Reid CE, Nethery RC. Evaluation of Model-Based PM 2.5 Estimates for Exposure Assessment during Wildfire Smoke Episodes in the Western U.S. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2023; 57:2031-2041. [PMID: 36693177 PMCID: PMC10288567 DOI: 10.1021/acs.est.2c06288] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Investigating the health impacts of wildfire smoke requires data on people's exposure to fine particulate matter (PM2.5) across space and time. In recent years, it has become common to use machine learning models to fill gaps in monitoring data. However, it remains unclear how well these models are able to capture spikes in PM2.5 during and across wildfire events. Here, we evaluate the accuracy of two sets of high-coverage and high-resolution machine learning-derived PM2.5 data sets created by Di et al. and Reid et al. In general, the Reid estimates are more accurate than the Di estimates when compared to independent validation data from mobile smoke monitors deployed by the US Forest Service. However, both models tend to severely under-predict PM2.5 on high-pollution days. Our findings complement other recent studies calling for increased air pollution monitoring in the western US and support the inclusion of wildfire-specific monitoring observations and predictor variables in model-based estimates of PM2.5. Lastly, we call for more rigorous error quantification of machine-learning derived exposure data sets, with special attention to extreme events.
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Affiliation(s)
- Ellen M. Considine
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, 02115, USA
| | - Jiayuan Hao
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, 02115, USA
| | - Priyanka deSouza
- Department of Urban and Regional Planning, University of Colorado Denver, University of Colorado Denver, Denver, Colorado, 80202, USA
- CU Population Center, University of Colorado Boulder, Boulder, Colorado, 80309, USA
| | - Danielle Braun
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, 02115, USA
- Department of Data Science, Dana-Farber Cancer Institute, Boston, Massachusetts, 02215, USA
| | - Colleen E. Reid
- CU Population Center, University of Colorado Boulder, Boulder, Colorado, 80309, USA
- Department of Geography, University of Colorado Boulder, Boulder, Colorado, 80302, USA
- Earth Lab, University of Colorado Boulder, Boulder, Colorado, 80303, USA
| | - Rachel C. Nethery
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, 02115, USA
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Elser H, Rowland ST, Marek MS, Kiang MV, Shea B, Do V, Benmarhnia T, Schneider ALC, Casey JA. Wildfire smoke exposure and emergency department visits for headache: A case-crossover analysis in California, 2006-2020. Headache 2023; 63:94-103. [PMID: 36651537 PMCID: PMC10066880 DOI: 10.1111/head.14442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 10/26/2022] [Accepted: 11/02/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To evaluate the association of short-term exposure to overall fine particulate matter of <2.5 μm (PM2.5 ) and wildfire-specific PM2.5 with emergency department (ED) visits for headache. BACKGROUND Studies have reported associations between PM2.5 exposure and headache risk. As climate change drives longer and more intense wildfire seasons, wildfire PM2.5 may contribute to more frequent headaches. METHODS Our study included adult Californian members (aged ≥18 years) of a large de-identified commercial and Medicare Advantage claims database from 2006 to 2020. We identified ED visits for primary headache disorders (subtypes: tension-type headache, migraine headache, cluster headache, and "other" primary headache). Claims included member age, sex, and residential zip code. We linked daily overall and wildfire-specific PM2.5 to residential zip code and conducted a time-stratified case-crossover analysis considering 7-day average PM2.5 concentrations, first for primary headache disorders combined, and then by headache subtype. RESULTS Among 9898 unique individuals we identified 13,623 ED encounters for primary headache disorders. Migraine was the most frequently diagnosed headache (N = 5534/13,623 [47.6%]) followed by "other" primary headache (N = 6489/13,623 [40.6%]). For all primary headache ED diagnoses, we observed an association of 7-day average wildfire PM2.5 (odds ratio [OR] 1.17, 95% confidence interval [CI] 0.95-1.44 per 10 μg/m3 increase) and by subtype we observed increased odds of ED visits associated with 7-day average wildfire PM2.5 for tension-type headache (OR 1.42, 95% CI 0.91-2.22), "other" primary headache (OR 1.40, 95% CI 0.96-2.05), and cluster headache (OR 1.29, 95% CI 0.71-2.35), although these findings were not statistically significant under traditional null hypothesis testing. Overall PM2.5 was associated with tension-type headache (OR 1.29, 95% CI 1.03-1.62), but not migraine, cluster, or "other" primary headaches. CONCLUSIONS Although imprecise, these results suggest short-term wildfire PM2.5 exposure may be associated with ED visits for headache. Patients, healthcare providers, and systems may need to respond to increased headache-related healthcare needs in the wake of wildfires and on poor air quality days.
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Affiliation(s)
- Holly Elser
- Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Center for Population Health Sciences, Stanford University, Stanford, California, USA
| | - Sebastian T Rowland
- Environmental Health Sciences, Columbia Mailman School of Public Health, New York, New York, USA.,PSE Healthy Energy, Oakland, New York, USA
| | - Maksym S Marek
- Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Mathew V Kiang
- Epidemiology and Population Health, Stanford University School of Medicine, Stanford, California, USA
| | - Brittany Shea
- Environmental Health Sciences, Columbia Mailman School of Public Health, New York, New York, USA
| | - Vivian Do
- Environmental Health Sciences, Columbia Mailman School of Public Health, New York, New York, USA
| | - Tarik Benmarhnia
- Scripps Institution of Oceanography, University of California, San Diego, La Jolla, California, USA
| | - Andrea L C Schneider
- Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Joan A Casey
- Environmental Health Sciences, Columbia Mailman School of Public Health, New York, New York, USA
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Mechanisms of Lung Damage and Development of COPD Due to Household Biomass-Smoke Exposure: Inflammation, Oxidative Stress, MicroRNAs, and Gene Polymorphisms. Cells 2022; 12:cells12010067. [PMID: 36611860 PMCID: PMC9818405 DOI: 10.3390/cells12010067] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 12/12/2022] [Accepted: 12/13/2022] [Indexed: 12/28/2022] Open
Abstract
Chronic exposure to indoor biomass smoke from the combustion of solid organic fuels is a major cause of disease burden worldwide. Almost 3 billion people use solid fuels such as wood, charcoal, and crop residues for indoor cooking and heating, accounting for approximately 50% of all households and 90% of rural households globally. Biomass smoke contains many hazardous pollutants, resulting in household air pollution (HAP) exposure that often exceeds international standards. Long-term biomass-smoke exposure is associated with Chronic Obstructive Pulmonary Disease (COPD) in adults, a leading cause of morbidity and mortality worldwide, chronic bronchitis, and other lung conditions. Biomass smoke-associated COPD differs from the best-known cigarette smoke-induced COPD in several aspects, such as a slower decline in lung function, greater airway involvement, and less emphysema, which suggests a different phenotype and pathophysiology. Despite the high burden of biomass-associated COPD, the molecular, genetic, and epigenetic mechanisms underlying its pathogenesis are poorly understood. This review describes the pathogenic mechanisms potentially involved in lung damage, the development of COPD associated with wood-derived smoke exposure, and the influence of genetic and epigenetic factors on the development of this disease.
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Atmospheric Episodes Linked to Climate Change and Their Impact on Respiratory Health. Arch Bronconeumol 2022; 59:201-202. [PMID: 36509607 DOI: 10.1016/j.arbres.2022.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 11/22/2022] [Indexed: 12/02/2022]
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Kyu HH, Vongpradith A, Sirota SB, Novotney A, Troeger CE, Doxey MC, Bender RG, Ledesma JR, Biehl MH, Albertson SB, Frostad JJ, Burkart K, Bennitt FB, Zhao JT, Gardner WM, Hagins H, Bryazka D, Dominguez RMV, Abate SM, Abdelmasseh M, Abdoli A, Abdoli G, Abedi A, Abedi V, Abegaz TM, Abidi H, Aboagye RG, Abolhassani H, Abtew YD, Abubaker Ali H, Abu-Gharbieh E, Abu-Zaid A, Adamu K, Addo IY, Adegboye OA, Adnan M, Adnani QES, Afzal MS, Afzal S, Ahinkorah BO, Ahmad A, Ahmad AR, Ahmad S, Ahmadi A, Ahmadi S, Ahmed H, Ahmed JQ, Ahmed Rashid T, Akbarzadeh-Khiavi M, Al Hamad H, Albano L, Aldeyab MA, Alemu BM, Alene KA, Algammal AM, Alhalaiqa FAN, Alhassan RK, Ali BA, Ali L, Ali MM, Ali SS, Alimohamadi Y, Alipour V, Al-Jumaily A, Aljunid SM, Almustanyir S, Al-Raddadi RM, Al-Rifai RHH, AlRyalat SAS, Alvis-Guzman N, Alvis-Zakzuk NJ, Ameyaw EK, Aminian Dehkordi JJ, Amuasi JH, Amugsi DA, Anbesu EW, Ansar A, Anyasodor AE, Arabloo J, Areda D, Argaw AM, Argaw ZG, Arulappan J, Aruleba RT, Asemahagn MA, Athari SS, Atlaw D, Attia EF, Attia S, Aujayeb A, Awoke T, Ayana TM, Ayanore MA, Azadnajafabad S, Azangou-Khyavy M, Azari S, Azari Jafari A, Badar M, Badiye AD, Baghcheghi N, Bagherieh S, Baig AA, Banach M, Banerjee I, Bardhan M, Barone-Adesi F, Barqawi HJ, Barrow A, Bashiri A, Bassat Q, Batiha AMM, Belachew AB, Belete MA, Belgaumi UI, Bhagavathula AS, Bhardwaj N, Bhardwaj P, Bhatt P, Bhojaraja VS, Bhutta ZA, Bhuyan SS, Bijani A, Bitaraf S, Bodicha BBA, Briko NI, Buonsenso D, Butt MH, Cai J, Camargos P, Cámera LA, Chakraborty PA, Chanie MG, Charan J, Chattu VK, Ching PR, Choi S, Chong YY, Choudhari SG, Chowdhury EK, Christopher DJ, Chu DT, Cobb NL, Cohen AJ, Cruz-Martins N, Dadras O, Dagnaw FT, Dai X, Dandona L, Dandona R, Dao ATM, Debela SA, Demisse B, Demisse FW, Demissie S, Dereje D, Desai HD, Desta AA, Desye B, Dhingra S, Diao N, Diaz D, Digesa LE, Doan LP, Dodangeh M, Dongarwar D, Dorostkar F, dos Santos WM, Dsouza HL, Dubljanin E, Durojaiye OC, Edinur HA, Ehsani-Chimeh E, Eini E, Ekholuenetale M, Ekundayo TC, El Desouky ED, El Sayed I, El Sayed Zaki M, Elhadi M, Elkhapery AMR, Emami A, Engelbert Bain L, Erkhembayar R, Etaee F, Ezati Asar M, Fagbamigbe AF, Falahi S, Fallahzadeh A, Faraj A, Faraon EJA, Fatehizadeh A, Ferrara P, Ferrari AA, Fetensa G, Fischer F, Flavel J, Foroutan M, Gaal PA, Gaidhane AM, Gaihre S, Galehdar N, Garcia-Basteiro AL, Garg T, Gebrehiwot MD, Gebremichael MA, Gela YY, Gemeda BNB, Gessner BD, Getachew M, Getie A, Ghamari SH, Ghasemi Nour M, Ghashghaee A, Gholamrezanezhad A, Gholizadeh A, Ghosh R, Ghozy S, Goleij P, Golitaleb M, Gorini G, Goulart AC, Goyomsa GG, Guadie HA, Gudisa Z, Guled RA, Gupta S, Gupta VB, Gupta VK, Guta A, Habibzadeh P, Haj-Mirzaian A, Halwani R, Hamidi S, Hannan MA, Harorani M, Hasaballah AI, Hasani H, Hassan AM, Hassani S, Hassanian-Moghaddam H, Hassankhani H, Hayat K, Heibati B, Heidari M, Heyi DZ, Hezam K, Holla R, Hong SH, Horita N, Hosseini MS, Hosseinzadeh M, Hostiuc M, Househ M, Hoveidamanesh S, Huang J, Hussein NR, Iavicoli I, Ibitoye SE, Ikuta KS, Ilesanmi OS, Ilic IM, Ilic MD, Immurana M, Ismail NE, Iwagami M, Jaafari J, Jamshidi E, Jang SI, Javadi Mamaghani A, Javaheri T, Javanmardi F, Javidnia J, Jayapal SK, Jayarajah U, Jayaram S, Jema AT, Jeong W, Jonas JB, Joseph N, Joukar F, Jozwiak JJ, K V, Kabir Z, Kacimi SEO, Kadashetti V, Kalankesh LR, Kalhor R, Kamath A, Kamble BD, Kandel H, Kanko TK, Karaye IM, Karch A, Karkhah S, Kassa BG, Katoto PDMC, Kaur H, Kaur RJ, Keikavoosi-Arani L, Keykhaei M, Khader YS, Khajuria H, Khan EA, Khan G, Khan IA, Khan M, Khan MN, Khan MAB, Khan YH, Khatatbeh MM, Khosravifar M, Khubchandani J, Kim MS, Kimokoti RW, Kisa A, Kisa S, Kissoon N, Knibbs LD, Kochhar S, Kompani F, Koohestani HR, Korshunov VA, Kosen S, Koul PA, Koyanagi A, Krishan K, Kuate Defo B, Kumar GA, Kurmi OP, Kuttikkattu A, Lal DK, Lám J, Landires I, Ledda C, Lee SW, Levi M, Lewycka S, Liu G, Liu W, Lodha R, Lorenzovici L, Lotfi M, Loureiro JA, Madadizadeh F, Mahmoodpoor A, Mahmoudi R, Mahmoudimanesh M, Majidpoor J, Makki A, Malakan Rad E, Malik AA, Mallhi TH, Manla Y, Matei CN, Mathioudakis AG, Maude RJ, Mehrabi Nasab E, Melese A, Memish ZA, Mendoza-Cano O, Mentis AFA, Meretoja TJ, Merid MW, Mestrovic T, Micheletti Gomide Nogueira de Sá AC, Mijena GFW, Minh LHN, Mir SA, Mirfakhraie R, Mirmoeeni S, Mirza AZ, Mirza M, Mirza-Aghazadeh-Attari M, Misganaw AS, Misganaw AT, Mohammadi E, Mohammadi M, Mohammed A, Mohammed S, Mohan S, Mohseni M, Moka N, Mokdad AH, Momtazmanesh S, Monasta L, Moniruzzaman M, Montazeri F, Moore CE, Moradi A, Morawska L, Mosser JF, Mostafavi E, Motaghinejad M, Mousavi Isfahani H, Mousavi-Aghdas SA, Mubarik S, Murillo-Zamora E, Mustafa G, Nair S, Nair TS, Najafi H, Naqvi AA, Narasimha Swamy S, Natto ZS, Nayak BP, Nejadghaderi SA, Nguyen HVN, Niazi RK, Nogueira de Sá AT, Nouraei H, Nowroozi A, Nuñez-Samudio V, Nzoputam CI, Nzoputam OJ, Oancea B, Ochir C, Odukoya OO, Okati-Aliabad H, Okekunle AP, Okonji OC, Olagunju AT, Olufadewa II, Omar Bali A, Omer E, Oren E, Ota E, Otstavnov N, Oulhaj A, P A M, Padubidri JR, Pakshir K, Pakzad R, Palicz T, Pandey A, Pant S, Pardhan S, Park EC, Park EK, Pashazadeh Kan F, Paudel R, Pawar S, Peng M, Pereira G, Perna S, Perumalsamy N, Petcu IR, Pigott DM, Piracha ZZ, Podder V, Polibin RV, Postma MJ, Pourasghari H, Pourtaheri N, Qadir MMF, Raad M, Rabiee M, Rabiee N, Raeghi S, Rafiei A, Rahim F, Rahimi M, Rahimi-Movaghar V, Rahman A, Rahman MO, Rahman M, Rahman MA, Rahmani AM, Rahmanian V, Ram P, Ramezanzadeh K, Rana J, Ranasinghe P, Rani U, Rao SJ, Rashedi S, Rashidi MM, Rasul A, Ratan ZA, Rawaf DL, Rawaf S, Rawassizadeh R, Razeghinia MS, Redwan EMM, Reitsma MB, Renzaho AMN, Rezaeian M, Riad A, Rikhtegar R, Rodriguez JAB, Rogowski ELB, Ronfani L, Rudd KE, Saddik B, Sadeghi E, Saeed U, Safary A, Safi SZ, Sahebazzamani M, Sahebkar A, Sakhamuri S, Salehi S, Salman M, Samadi Kafil H, Samy AM, Santric-Milicevic MM, Sao Jose BP, Sarkhosh M, Sathian B, Sawhney M, Saya GK, Seidu AA, Seylani A, Shaheen AA, Shaikh MA, Shaker E, Shamshad H, Sharew MM, Sharhani A, Sharifi A, Sharma P, Sheidaei A, Shenoy SM, Shetty JK, Shiferaw DS, Shigematsu M, Shin JI, Shirzad-Aski H, Shivakumar KM, Shivalli S, Shobeiri P, Simegn W, Simpson CR, Singh H, Singh JA, Singh P, Siwal SS, Skryabin VY, Skryabina AA, Soltani-Zangbar MS, Song S, Song Y, Sood P, Sreeramareddy CT, Steiropoulos P, Suleman M, Tabatabaeizadeh SA, Tahamtan A, Taheri M, Taheri Soodejani M, Taki E, Talaat IM, Tampa M, Tandukar S, Tat NY, Tat VY, Tefera YM, Temesgen G, Temsah MH, Tesfaye A, Tesfaye DG, Tessema B, Thapar R, Ticoalu JHV, Tiyuri A, Tleyjeh II, Togtmol M, Tovani-Palone MR, Tufa DG, Ullah I, Upadhyay E, Valadan Tahbaz S, Valdez PR, Valizadeh R, Vardavas C, Vasankari TJ, Vo B, Vu LG, Wagaye B, Waheed Y, Wang Y, Waris A, West TE, Wickramasinghe ND, Xu X, Yaghoubi S, Yahya GAT, Yahyazadeh Jabbari SH, Yon DK, Yonemoto N, Zaman BA, Zandifar A, Zangiabadian M, Zar HJ, Zare I, Zareshahrabadi Z, Zarrintan A, Zastrozhin MS, Zeng W, Zhang M, Zhang ZJ, Zhong C, Zoladl M, Zumla A, Lim SS, Vos T, Naghavi M, Brauer M, Hay SI, Murray CJL. Age-sex differences in the global burden of lower respiratory infections and risk factors, 1990-2019: results from the Global Burden of Disease Study 2019. THE LANCET. INFECTIOUS DISEASES 2022; 22:1626-1647. [PMID: 35964613 PMCID: PMC9605880 DOI: 10.1016/s1473-3099(22)00510-2] [Citation(s) in RCA: 45] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 05/18/2022] [Accepted: 07/18/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND The global burden of lower respiratory infections (LRIs) and corresponding risk factors in children older than 5 years and adults has not been studied as comprehensively as it has been in children younger than 5 years. We assessed the burden and trends of LRIs and risk factors across all age groups by sex, for 204 countries and territories. METHODS In this analysis of data for the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, we used clinician-diagnosed pneumonia or bronchiolitis as our case definition for LRIs. We included International Classification of Diseases 9th edition codes 079.6, 466-469, 470.0, 480-482.8, 483.0-483.9, 484.1-484.2, 484.6-484.7, and 487-489 and International Classification of Diseases 10th edition codes A48.1, A70, B97.4-B97.6, J09-J15.8, J16-J16.9, J20-J21.9, J91.0, P23.0-P23.4, and U04-U04.9. We used the Cause of Death Ensemble modelling strategy to analyse 23 109 site-years of vital registration data, 825 site-years of sample vital registration data, 1766 site-years of verbal autopsy data, and 681 site-years of mortality surveillance data. We used DisMod-MR 2.1, a Bayesian meta-regression tool, to analyse age-sex-specific incidence and prevalence data identified via systematic reviews of the literature, population-based survey data, and claims and inpatient data. Additionally, we estimated age-sex-specific LRI mortality that is attributable to the independent effects of 14 risk factors. FINDINGS Globally, in 2019, we estimated that there were 257 million (95% uncertainty interval [UI] 240-275) LRI incident episodes in males and 232 million (217-248) in females. In the same year, LRIs accounted for 1·30 million (95% UI 1·18-1·42) male deaths and 1·20 million (1·07-1·33) female deaths. Age-standardised incidence and mortality rates were 1·17 times (95% UI 1·16-1·18) and 1·31 times (95% UI 1·23-1·41) greater in males than in females in 2019. Between 1990 and 2019, LRI incidence and mortality rates declined at different rates across age groups and an increase in LRI episodes and deaths was estimated among all adult age groups, with males aged 70 years and older having the highest increase in LRI episodes (126·0% [95% UI 121·4-131·1]) and deaths (100·0% [83·4-115·9]). During the same period, LRI episodes and deaths in children younger than 15 years were estimated to have decreased, and the greatest decline was observed for LRI deaths in males younger than 5 years (-70·7% [-77·2 to -61·8]). The leading risk factors for LRI mortality varied across age groups and sex. More than half of global LRI deaths in children younger than 5 years were attributable to child wasting (population attributable fraction [PAF] 53·0% [95% UI 37·7-61·8] in males and 56·4% [40·7-65·1] in females), and more than a quarter of LRI deaths among those aged 5-14 years were attributable to household air pollution (PAF 26·0% [95% UI 16·6-35·5] for males and PAF 25·8% [16·3-35·4] for females). PAFs of male LRI deaths attributed to smoking were 20·4% (95% UI 15·4-25·2) in those aged 15-49 years, 30·5% (24·1-36·9) in those aged 50-69 years, and 21·9% (16·8-27·3) in those aged 70 years and older. PAFs of female LRI deaths attributed to household air pollution were 21·1% (95% UI 14·5-27·9) in those aged 15-49 years and 18·2% (12·5-24·5) in those aged 50-69 years. For females aged 70 years and older, the leading risk factor, ambient particulate matter, was responsible for 11·7% (95% UI 8·2-15·8) of LRI deaths. INTERPRETATION The patterns and progress in reducing the burden of LRIs and key risk factors for mortality varied across age groups and sexes. The progress seen in children younger than 5 years was clearly a result of targeted interventions, such as vaccination and reduction of exposure to risk factors. Similar interventions for other age groups could contribute to the achievement of multiple Sustainable Development Goals targets, including promoting wellbeing at all ages and reducing health inequalities. Interventions, including addressing risk factors such as child wasting, smoking, ambient particulate matter pollution, and household air pollution, would prevent deaths and reduce health disparities. FUNDING Bill & Melinda Gates Foundation.
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Liu Y, Francis RA, Wooster MJ, Grosvenor MJ, Yan S, Roberts G. Systematic Mapping and Review of Landscape Fire Smoke (LFS) Exposure Impacts on Insects. ENVIRONMENTAL ENTOMOLOGY 2022; 51:871-884. [PMID: 36130330 PMCID: PMC9585373 DOI: 10.1093/ee/nvac069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Indexed: 06/15/2023]
Abstract
Landscape fire activity is changing in many regions because of climate change. Smoke emissions from landscape fires contain many harmful air pollutants, and beyond the potential hazard posed to human health, these also have ecological impacts. Insects play essential roles in most ecosystems worldwide, and some work suggests they may also be sensitive to smoke exposure. There is therefore a need for a comprehensive review of smoke impacts on insects. We systematically reviewed the scientific literature from 1930 to 2022 to synthesize the current state of knowledge of the impacts of smoke exposure from landscape fires on the development, behavior, and mortality of insects. We found: (1) 42 relevant studies that met our criteria, with 29% focused on the United States of America and 19% on Canada; (2) of these, 40 insect species were discussed, all of which were sensitive to smoke pollution; (3) most of the existing research focuses on how insect behavior responds to landscape fire smoke (LFS); (4) species react differently to smoke exposure, with for example some species being attracted to the smoke (e.g., some beetles) while others are repelled (e.g., some bees). This review consolidates the current state of knowledge on how smoke impacts insects and highlights areas that may need further investigation. This is particularly relevant since smoke impacts on insect communities will likely worsen in some areas due to increasing levels of biomass burning resulting from the joint pressures of climate change, land use change, and more intense land management involving fire.
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Affiliation(s)
- Yanan Liu
- Department of Geography, King’s College London, Bush House, 40 Aldwych, London, WC2B 4BG, UK
- Leverhulme Centre for Wildfires, Environment and Society, King’s College London, London WC2R 2LS, UK
| | - Robert A Francis
- Department of Geography, King’s College London, Bush House, 40 Aldwych, London, WC2B 4BG, UK
| | - Martin J Wooster
- Department of Geography, King’s College London, Bush House, 40 Aldwych, London, WC2B 4BG, UK
- Leverhulme Centre for Wildfires, Environment and Society, King’s College London, London WC2R 2LS, UK
- NERC National Centre for Earth Observation, King’s College London, London WC2R 2LS, UK
| | - Mark J Grosvenor
- Department of Geography, King’s College London, Bush House, 40 Aldwych, London, WC2B 4BG, UK
- Leverhulme Centre for Wildfires, Environment and Society, King’s College London, London WC2R 2LS, UK
- NERC National Centre for Earth Observation, King’s College London, London WC2R 2LS, UK
| | - Su Yan
- Department of Electrical and Electronic Engineering, Imperial CollegeLondon, London SW7 2BX, UK
| | - Gareth Roberts
- Geography and Environmental Science, University of Southampton, Southampton, UK
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Caumo S, Lázaro WL, Sobreira Oliveira E, Beringui K, Gioda A, Massone CG, Carreira R, de Freitas DS, Ignacio ARA, Hacon S. Human risk assessment of ash soil after 2020 wildfires in Pantanal biome (Brazil). AIR QUALITY, ATMOSPHERE & HEALTH 2022; 15:2239-2254. [PMID: 36187166 PMCID: PMC9516519 DOI: 10.1007/s11869-022-01248-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 09/07/2022] [Indexed: 11/27/2022]
Abstract
Wildfires have increased in the last years and, when caused by intentional illegal burnings, are frequently run out of control. Wildfire has been pointed out as an important source of polycyclic aromatic hydrocarbons (PAHs) and trace elements (TEs) — such as, As, Ni, and Pb — to environmental compartments, and thus may pose a risk to human health and to the ecosystem. In 2020, the Brazilian biome, Pantanal, faced the largest losses by wildfires in the last 22 years. Ashes from the topsoil layer in Pantanal were collected after these wildfires at 20 sites divided into the sediment, forest, PF, PS, and degraded sites. Toxicity and associated risks for human health were also evaluated. The areas highly impacted by wildfires and by artisanal gold mining activities showed higher concentrations for TEs and PAHs than the protected areas. Pb varied from 8 ± 4 to 224 ± 81 mg kg−1, and total PAH concentration ranged between 880 ± 314 and 1350 ± 70 ng g−1, at sites impacted by anthropogenic activities. Moreover, health risk assessments for TE and PAH indicated a potentially great risk for children and adults, via ingestion, inhalation, and dermal pathway. The carcinogenic risks exceeded reference values, for both TE and PAH, suggesting harmful conditions, especially for vulnerable groups, such as children and the elderly.
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Affiliation(s)
- Sofia Caumo
- National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, RJ Brazil
- Brazilian Research Network on Global Climate Change – Rede Clima, Rio de Janeiro, Brazil
| | - Wilkinson L. Lázaro
- Research Centre, Limnology, Biodiversity and Ethnobiology of the Pantanal, University of the State of Mato Grosso, Cáceres, MT Brazil
| | - Ernandes Sobreira Oliveira
- Research Centre, Limnology, Biodiversity and Ethnobiology of the Pantanal, University of the State of Mato Grosso, Cáceres, MT Brazil
| | - Karmel Beringui
- Department of Chemistry, Pontifical Catholic University of Rio de Janeiro (PUC-Rio), Rio de Janeiro, RJ Brazil
| | - Adriana Gioda
- Department of Chemistry, Pontifical Catholic University of Rio de Janeiro (PUC-Rio), Rio de Janeiro, RJ Brazil
| | - Carlos German Massone
- Department of Chemistry, Pontifical Catholic University of Rio de Janeiro (PUC-Rio), Rio de Janeiro, RJ Brazil
| | - Renato Carreira
- Department of Chemistry, Pontifical Catholic University of Rio de Janeiro (PUC-Rio), Rio de Janeiro, RJ Brazil
| | - Djair Sergio de Freitas
- Research Centre, Limnology, Biodiversity and Ethnobiology of the Pantanal, University of the State of Mato Grosso, Cáceres, MT Brazil
| | - Aurea R. A. Ignacio
- Research Centre, Limnology, Biodiversity and Ethnobiology of the Pantanal, University of the State of Mato Grosso, Cáceres, MT Brazil
| | - Sandra Hacon
- National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, RJ Brazil
- Brazilian Research Network on Global Climate Change – Rede Clima, Rio de Janeiro, Brazil
- Research Centre, Limnology, Biodiversity and Ethnobiology of the Pantanal, University of the State of Mato Grosso, Cáceres, MT Brazil
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Koman PD, Billmire M, Baker KR, Carter JM, Thelen BJ, French NHF, Bell SA. Using wildland fire smoke modeling data in gerontological health research (California, 2007-2018). THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 838:156403. [PMID: 35660427 DOI: 10.1016/j.scitotenv.2022.156403] [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: 01/27/2022] [Revised: 05/06/2022] [Accepted: 05/28/2022] [Indexed: 06/15/2023]
Abstract
Widespread population exposure to wildland fire smoke underscores the urgent need for new techniques to characterize fire-derived pollution for epidemiologic studies and to build climate-resilient communities especially for aging populations. Using atmospheric chemical transport modeling, we examined air quality with and without wildland fire smoke PM2.5. In 12-km gridded output, the 24-hour average concentration of all-source PM2.5 in California (2007-2018) was 5.16 μg/m3 (S.D. 4.66 μg/m3). The average concentration of fire-PM2.5 in California by year was 1.61 μg/m3 (~30% of total PM2.5). The contribution of fire-source PM2.5 ranged from 6.8% to 49%. We define a "smokewave" as two or more consecutive days with modeled levels above 35 μg/m3. Based on model-derived fire-PM2.5, 99.5% of California's population lived in a county that experienced at least one smokewave from 2007 to 2018, yet understanding of the impact of smoke on the health of aging populations is limited. Approximately 2.7 million (56%) of California residents aged 65+ years lived in counties representing the top 3 quartiles of fire-PM2.5 concentrations (2007-2018). For each year (2007-2018), grid cells containing skilled nursing facilities had significantly higher mean concentrations of all-source PM2.5 than cells without those facilities, but they also had generally lower mean concentrations of wildland fire-specific PM2.5. Compared to rural monitors in California, model predictions of wildland fire impacts on daily average PM2.5 carbon (organic and elemental) performed well most years but tended to overestimate wildland fire impacts for high-fire years. The modeling system isolated wildland fire PM2.5 from other sources at monitored and unmonitored locations, which is important for understanding exposures for aging population in health studies.
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Affiliation(s)
- Patricia D Koman
- University of Michigan, School of Public Health, Environmental Health Sciences, 1415 Washington Heights, Ann Arbor, MI 48109, USA.
| | - Michael Billmire
- Michigan Technological University, Michigan Tech Research Institute, 3600 Green Court, Suite 100, Ann Arbor, MI 48105, USA.
| | - Kirk R Baker
- U.S. Environmental Protection Agency, Office of Air and Radiation, Office of Air Quality Planning & Standards, Research Triangle Park, NC 27709, USA.
| | - Julie M Carter
- University of Michigan, School of Public Health, Environmental Health Sciences, 1415 Washington Heights, Ann Arbor, MI 48109, USA; Michigan Technological University, Michigan Tech Research Institute, 3600 Green Court, Suite 100, Ann Arbor, MI 48105, USA.
| | - Brian J Thelen
- Michigan Technological University, Michigan Tech Research Institute, 3600 Green Court, Suite 100, Ann Arbor, MI 48105, USA.
| | - Nancy H F French
- Michigan Technological University, Michigan Tech Research Institute, 3600 Green Court, Suite 100, Ann Arbor, MI 48105, USA.
| | - Sue Anne Bell
- University of Michigan, School of Nursing, Ann Arbor, MI 48109, USA.
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Cadet MJ. Integrating Climate Change Concepts into Advanced Practice Registered Nurses Curricula with the Application of the National Organization of Nurse Practitioner Faculties Competencies. J Prof Nurs 2022; 41:157-165. [DOI: 10.1016/j.profnurs.2022.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Revised: 05/05/2022] [Accepted: 05/15/2022] [Indexed: 11/27/2022]
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New seasonal pattern of pollution emerges from changing North American wildfires. Nat Commun 2022; 13:2043. [PMID: 35440561 PMCID: PMC9018720 DOI: 10.1038/s41467-022-29623-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 03/22/2022] [Indexed: 11/08/2022] Open
Abstract
Rising emissions from wildfires over recent decades in the Pacific Northwest are known to counteract the reductions in human-produced aerosol pollution over North America. Since amplified Pacific Northwest wildfires are predicted under accelerating climate change, it is essential to understand both local and transported contributions to air pollution in North America. Here, we find corresponding increases for carbon monoxide emitted from the Pacific Northwest wildfires and observe significant impacts on both local and down-wind air pollution. Between 2002 and 2018, the Pacific Northwest atmospheric carbon monoxide abundance increased in August, while other months showed decreasing carbon monoxide, so modifying the seasonal pattern. These seasonal pattern changes extend over large regions of North America, to the Central USA and Northeast North America regions, indicating that transported wildfire pollution could potentially impact the health of millions of people. Growing emissions from Pacific Northwest wildfires have increased atmospheric carbon monoxide in August, raising questions about potential health impacts as the seasonal pattern of air quality changes for large regions of North America.
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Brocke SA, Billings GT, Taft-Benz S, Alexis NE, Heise MT, Jaspers I. Woodsmoke particle exposure prior to SARS-CoV-2 infection alters antiviral response gene expression in human nasal epithelial cells in a sex-dependent manner. Am J Physiol Lung Cell Mol Physiol 2022; 322:L479-L494. [PMID: 35107034 PMCID: PMC8917918 DOI: 10.1152/ajplung.00362.2021] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 12/13/2021] [Accepted: 01/27/2022] [Indexed: 12/25/2022] Open
Abstract
Inhalational exposure to particulate matter (PM) derived from natural or anthropogenic sources alters gene expression in the airways and increases susceptibility to respiratory viral infection. Woodsmoke-derived ambient PM from wildfire events during 2020 was associated with higher COVID-19 case rates in the western United States. We hypothesized that exposure to suspensions of woodsmoke particles (WSPs) or diesel exhaust particles (DEPs) prior to SARS-CoV-2 infection would alter host immune gene expression at the transcript level. Primary human nasal epithelial cells (hNECs) from both sexes were exposed to WSPs or DEPs (22 μg/cm2) for 2 h, followed by infection with SARS-CoV-2 at a multiplicity of infection of 0.5. Forty-six genes related to SARS-CoV-2 entry and host response were assessed. Particle exposure alone minimally affected gene expression, whereas SARS-CoV-2 infection alone induced a robust transcriptional response in hNECs, upregulating type I and III interferons, interferon-stimulated genes, and chemokines by 72 h postinfection (p.i.). This upregulation was higher overall in cells from male donors. However, exposure to WSPs prior to infection dampened expression of antiviral, interferon, and chemokine mRNAs. Sex stratification of these results revealed that WSP exposure downregulated gene expression in cells from females more so than males. We next hypothesized that hNECs exposed to particles would have increased apical viral loads compared with unexposed cells. Although apical viral load was correlated to expression of host response genes, viral titer did not differ between groups. These data indicate that WSPs alter epithelial immune responses in a sex-dependent manner, potentially suppressing host defense to SARS-CoV-2 infection.
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Affiliation(s)
- Stephanie A Brocke
- Curriculum in Toxicology and Environmental Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Grant T Billings
- Crop and Soil Sciences Department, North Carolina State University, Raleigh, North Carolina
| | - Sharon Taft-Benz
- Department of Genetics, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Neil E Alexis
- Center for Environmental Medicine, Asthma, and Lung Biology, University of North Carolina, Chapel Hill, North Carolina
| | - Mark T Heise
- Department of Genetics, University of North Carolina School of Medicine, Chapel Hill, North Carolina
- Department of Microbiology and Immunology, University of North Carolina, Chapel Hill, North Carolina
| | - Ilona Jaspers
- Curriculum in Toxicology and Environmental Medicine, University of North Carolina, Chapel Hill, North Carolina
- Center for Environmental Medicine, Asthma, and Lung Biology, University of North Carolina, Chapel Hill, North Carolina
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Humphreys A, Walker EG, Bratman GN, Errett NA. What can we do when the smoke rolls in? An exploratory qualitative analysis of the impacts of rural wildfire smoke on mental health and wellbeing, and opportunities for adaptation. BMC Public Health 2022; 22:41. [PMID: 34991532 PMCID: PMC8740038 DOI: 10.1186/s12889-021-12411-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 12/02/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Extreme, prolonged wildfire smoke (WFS) events are becoming increasingly frequent phenomena across the Western United States. Rural communities, dependent on contributions of nature to people's quality of life, are particularly hard hit. While prior research has explored the physical health impacts of WFS exposure, little work has been done to assess WFS impacts on mental health and wellbeing, or potential adaptation solutions. METHODS Using qualitative methods, we explore the mental health and wellbeing impacts experienced by community members in a rural Washington State community that has been particularly hard hit by WFS in recent years, as well as individual, family, and community adaptation solutions. We conducted focus groups with residents and key informant interviews with local health and social service providers. RESULTS Participants identified a variety of negative mental health and wellbeing impacts of WFS events, including heightened anxiety, depression, isolation, and a lack of motivation, as well as physical health impacts (e.g., respiratory issues and lack of exercise). Both positive and negative economic and social impacts, as well as temporary or permanent relocation impacts, were also described. The impacts were not equitably distributed; differential experiences based on income level, outdoor occupations, age (child or elderly), preexisting health conditions, housing status, and social isolation were described as making some residents more vulnerable to WFS-induced physical and mental health and wellbeing challenges than others. Proposed solutions included stress reduction (e.g., meditation and relaxation lessons), increased distribution of air filters, development of community clean air spaces, enhancing community response capacity, hosting social gatherings, increasing education, expanding and coordination risk communications, and identifying opportunities for volunteering. Findings were incorporated into a pamphlet for community distribution. We present a template version herein for adaptation and use in other communities. CONCLUSIONS Wildfire smoke events present significant mental health and wellbeing impacts for rural communities. Community-led solutions that promote stress reduction, physical protection, and community cohesion have the opportunity to bolster resilience amid this growing public health crisis.
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Affiliation(s)
- Anna Humphreys
- Department of Health Systems and Population Health, University of Washington, Box 351621, 3980 15th Ave NE, Fourth Floor, Seattle, WA, 98195, USA
| | - Elizabeth G Walker
- Department of Environmental and Occupational Health Sciences, University of Washington, 4225 Roosevelt Way NE, Suite 100, Seattle, WA, 98105, USA
- Clean Air Methow, Methow Valley Citizens Council, PO Box 774, Twisp, WA, 98856, USA
| | - Gregory N Bratman
- Department of Environmental and Occupational Health Sciences, University of Washington, 4225 Roosevelt Way NE, Suite 100, Seattle, WA, 98105, USA
- School of Environmental and Forest Sciences, University of Washington, Anderson Hall, Box 352100, Seattle, WA, 98195, USA
| | - Nicole A Errett
- Department of Health Systems and Population Health, University of Washington, Box 351621, 3980 15th Ave NE, Fourth Floor, Seattle, WA, 98195, USA.
- Department of Environmental and Occupational Health Sciences, University of Washington, 4225 Roosevelt Way NE, Suite 100, Seattle, WA, 98105, USA.
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Keegan SA, Rahman KM. Health protection messaging for populations susceptible to air pollution during landscape fire smoke events: an integrative review. REVIEWS ON ENVIRONMENTAL HEALTH 2021; 36:599-609. [PMID: 33721920 DOI: 10.1515/reveh-2020-0134] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 02/21/2021] [Indexed: 06/12/2023]
Abstract
Public health communication strategies to protect against the health impacts of air pollution due to landscape fire are becoming increasingly urgent in Australia. How well the public, particularly susceptible populations, are receiving, understanding and acting upon health protection messages related to smoke events is poorly understood. This integrative review sought literature relevant to health protection messaging for smoke events, including appropriate message content and suitable message delivery, with a focus on vulnerable and sensitive populations. Using an exhaustive search strategy of databases and grey literature, 26 relevant articles were identified and thematically analysed to produce a synthesis of findings on key themes. Findings indicated that a variety of traditional and modern communication channels are needed to ensure health messages are received by those most at-risk and should consider locally relevant information. A key theme to emerge in this review was the need for health messaging to susceptible populations to commence in advance of bushfire seasons to facilitate health protective actions being taken. During the acute-phase of smoke events, messages that were short with non-technical advice, were recalled and complied with more often. The need to improve the consistency of message content was a recurrent theme in the literature and suggested a need for greater interagency collaboration and communication. Preliminary evidence from smartphone app studies show promising results for targeted communication, however, more robust research is needed on the efficacy of these communication channels. Further research is also needed on the health impacts of smoke events, related compounding issues and strategies to reduce health risks, to better inform health protection messaging to susceptible populations.
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Affiliation(s)
| | - Kazi Mizanur Rahman
- North Coast Public Health Unit, New South Wales Health, Lismore, NSW, Australia
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Xu R, Gao CX, Dimitriadis C, Smith CL, Carroll MTC, Ikin JF, Johnston FH, Sim MR, Abramson MJ, Guo Y. Long-term impacts of coal mine fire-emitted PM2.5 on hospitalisation: a longitudinal analysis of the Hazelwood Health Study. Int J Epidemiol 2021; 51:179-190. [PMID: 34871381 DOI: 10.1093/ije/dyab249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 11/16/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Little is known about the long-term health impacts of exposures to landscape fire smoke. We aimed to evaluate the association between exposure to coal mine fire-related particulate matter 2.5 μm or less in diameter (PM2.5) and hospitalisation in the 5 years following the 6-week Hazelwood coal mine fire in Australia in 2014. METHODS We surveyed 2725 residents (mean age: 58.3 years; 54.3% female) from an exposed and a comparison town. Individual PM2.5 exposures during the event were estimated using modelled PM2.5 concentrations related to the coal mine fire and self-reported location data. The individual exposure and survey data were linked with hospitalisation records between January 2009 and February 2019. Recurrent event survival analysis was used to evaluate relationships between PM2.5 exposure and hospitalisation following mine fire, adjusting for important covariates. RESULTS Each 10-µg/m3 increase in mine fire-related PM2.5 was associated with a 9% increased hazard [hazard ratio (HR) = 1.09; 95% confidence interval (CI): 1.01, 1.17] of respiratory hospitalisation over the next 5 years, with stronger associations observed for females (HR = 1.16; 95% CI: 1.06, 1.27) than males (HR = 0.99; 95% CI: 0.89, 1.11). In particular, increased hazards were observed for hospitalisations for asthma (HR = 1.43; 95% CI: 1.19, 1.73) and chronic obstructive pulmonary disease (HR = 1.14; 95% CI: 1.02, 1.28). No such association was found for hospitalisations for cardiovascular diseases, mental illness, injuries, type 2 diabetes, renal diseases or neoplasms. CONCLUSIONS A 6-week exposure to coal mine fire-related PM2.5 was associated with increased hazard of respiratory hospitalisations over the following 5 years, particularly for females.
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Affiliation(s)
- Rongbin Xu
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Caroline X Gao
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.,Centre for Youth Mental Health, University of Melbourne, Parkview, VIC, Australia
| | - Christina Dimitriadis
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Catherine L Smith
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | | | - Jillian F Ikin
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Fay H Johnston
- Menzies Institute of Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Malcolm R Sim
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Michael J Abramson
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Yuming Guo
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
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O’Hara KC, Ranches J, Roche LM, Schohr TK, Busch RC, Maier GU. Impacts from Wildfires on Livestock Health and Production: Producer Perspectives. Animals (Basel) 2021; 11:ani11113230. [PMID: 34827962 PMCID: PMC8614491 DOI: 10.3390/ani11113230] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 11/09/2021] [Accepted: 11/10/2021] [Indexed: 11/16/2022] Open
Abstract
Simple Summary Wildfires are increasing in frequency and severity across the Western United States. Efforts to understand the health impacts on humans are widespread and expanding; however, very little is known about the impact of wildfires and smoke exposure on livestock. This work presents the results of a survey of cattle, sheep, and goat producers in California, Oregon, and Nevada, on their experiences during the 2020 wildfire season. While few direct impacts of fires were reported among the 70 responses, 26% of respondents reported they had to evacuate livestock and 19% reported pasture losses. Indirect losses from smoke exposure, including pneumonia and reproductive losses were reported more broadly. This preliminary work highlights the need to better understand impacts of wildfires on livestock and how policy changes can help support the livestock production industry through these crises. Abstract Wildfires are increasing in frequency and severity across the Western United States. However, there is limited information available on the impacts these fires are having on the livelihood of livestock producers and their animals. This work presents the results of a survey evaluating the direct and indirect impacts of the 2020 wildfire season on beef cattle, dairy cattle, sheep, and goat, producers in California, Oregon, and Nevada. Seventy completed surveys were collected between May and July 2021. While dairy producers reported no direct impacts from the fires, beef, sheep, and goat producers were impacted by evacuations and pasture lost to fires. Only beef producers reported losses due to burns and burn-associated deaths or euthanasia. Dairy, beef, sheep, and goat producers observed reduced conception, poor weight gain, and drops in milk production. All but dairy producers also observed pneumonia. Lower birthweights, increased abortion rates, and unexplained deaths were reported in beef cattle, sheep, and goats. This work documents the wide-ranging impacts of wildfires on livestock producers and highlights the need for additional work defining the health impacts of fire and smoke exposure in livestock, as well as the policy changes needed to support producers experiencing direct and indirect losses.
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Affiliation(s)
- Kathleen C. O’Hara
- Center for Animal Disease Modeling and Surveillance (CADMS), School of Veterinary Medicine, University of California, Davis, CA 95616, USA;
| | - Juliana Ranches
- Eastern Oregon Agricultural Research Center (EOARC), Oregon State University, Burns, OR 97720, USA;
| | - Leslie M. Roche
- Department of Plant Sciences, University of California Davis, Davis, CA 95616, USA;
| | - Tracy Kay Schohr
- University of California Cooperative Extension, Plumas-Sierra-Butte Counties, Quincy, CA 96130, USA;
| | - Roselle C. Busch
- Department of Population Health & Reproduction, School of Veterinary Medicine, University of California Davis, Davis, CA 95616, USA;
| | - Gabriele U. Maier
- Department of Population Health & Reproduction, School of Veterinary Medicine, University of California Davis, Davis, CA 95616, USA;
- Correspondence:
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Malig BJ, Fairley D, Pearson D, Wu X, Ebisu K, Basu R. Examining fine particulate matter and cause-specific morbidity during the 2017 North San Francisco Bay wildfires. THE SCIENCE OF THE TOTAL ENVIRONMENT 2021; 787:147507. [PMID: 35142610 DOI: 10.1016/j.scitotenv.2021.147507] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 02/18/2021] [Accepted: 04/29/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Recent increases in wildfire frequency and severity necessitate better understanding of health effects of wildfire smoke to protect affected populations. OBJECTIVES We examined relationships between fine particulate matter (PM2.5) and morbidity during wildfires in California, and whether those relationships differed during the fire compared to a similar non-fire period. METHODS For nine San Francisco Bay Area counties, daily county-level diagnosis-specific counts of emergency department visits (EDVs) and hospitalizations were linked with county-level estimates of daily mean PM2.5 during the October 2017 Northern California wildfires and similar October days in 2015, 2016, and 2017. Associations were estimated using Poisson regression. RESULTS The median difference between county PM2.5 during the fire versus the non-fire period was 23.4 μg/m3, with days exceeding 80 μg/m3 in some counties. Over the entire study period, PM2.5 was most consistently linked to EDVs for respiratory disease (RREDV(lag0) per 23.4 μg/m3 increase: 1.25, 95% CI: 1.21, 1.30), asthma, chronic lower respiratory disease (CLRD; RREDV(lag0): 1.18, 95% CI: 1.10, 1.27), and acute myocardial infarction (RREDV(lag0): 1.14, 95% CI: 1.03, 1.25). Increases in acute upper respiratory infections and decreases in mental/behavioral EDVs were observed but were sensitive to model specification, specifically the inclusion of time-related covariates. Comparing fire and non-fire period EDV associations, we observed indications that PM2.5 during the fire was more strongly associated with asthma (RRlag0: 1.46, 95% CI: 1.38, 1.55) compared to non-fire period PM2.5 (RRlag0: 0.77, 95% CI: 0.55, 1.08), and the opposite observed for dysrhythmia, with the asthma difference being particularly robust to model choice. For hospitalizations, the most robust PM2.5 relationships were positive associations with respiratory, CLRD, and diabetes, and inverse associations with pneumonia. Respiratory and CLRD effect estimates were generally similar or smaller than for EDVs. CONCLUSIONS Elevated short-term PM2.5 levels from wildfire smoke appears to impact respiratory and other health domains.
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Affiliation(s)
- Brian J Malig
- Air and Climate Epidemiology Section, Office of Environmental Health Hazard Assessment, California Environmental Protection Agency, Oakland, CA, USA.
| | - David Fairley
- Bay Area Air Quality Management District, San Francisco, CA, USA
| | - Dharshani Pearson
- Air and Climate Epidemiology Section, Office of Environmental Health Hazard Assessment, California Environmental Protection Agency, Oakland, CA, USA
| | - Xiangmei Wu
- Air and Climate Epidemiology Section, Office of Environmental Health Hazard Assessment, California Environmental Protection Agency, Oakland, CA, USA
| | - Keita Ebisu
- Air and Climate Epidemiology Section, Office of Environmental Health Hazard Assessment, California Environmental Protection Agency, Oakland, CA, USA
| | - Rupa Basu
- Air and Climate Epidemiology Section, Office of Environmental Health Hazard Assessment, California Environmental Protection Agency, Oakland, CA, USA
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Ting MJ, Tsai YH, Chuang SP, Wang PH, Cheng SL. Is PM 2.5 associated with emergency department visits for mechanical ventilation in acute exacerbation of chronic obstructive pulmonary disease? Am J Emerg Med 2021; 50:566-573. [PMID: 34583244 DOI: 10.1016/j.ajem.2021.09.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 09/03/2021] [Accepted: 09/13/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Patients with chronic obstructive pulmonary disease (COPD) can have recurrent exacerbations and acute respiratory failure (ARF) triggered by particulate matter with a diameter of ≤2.5 μm (PM2.5). To prevent ventilator shortages, this study investigated the short-term association between PM2.5 concentration and emergency department visits (EDVs) among patients with acute exacerbation of COPD (AECOPD) requiring mechanical ventilation (MV). METHODS We conducted a time-series study to predict the PM2.5 concentration and number of ventilators needed. Daily counts of EDVs among AECOPD patients requiring ventilation from 2015 to 2019 were obtained from a hospital. Generalized linear models extending Poisson regression were used to explore the association of AECOPD with PM2.5 after controlling for the time trend, seasonal variations, and meteorological variables. RESULTS Eight hundred seventy-five AECOPD patients receiving MV were recorded, of whom 734 received noninvasive ventilation and 141 received invasive ventilatory support. EDVs for AECOPD patients with ARF significantly increased by 3.5% (95% confidence interval [CI]: 2.51%-4.42%) per 10 μg m-3 increase in PM2.5 concentration. Among seasons, PM2.5 concentration had the strongest effect on AECOPD patients with ARF in spring (<24.5 °C), with a 1.64% (95% CI: -0.56% to 3.83%) increase in admissions per 10 μg m-3 increase in same-day PM2.5 concentration. The interquartile range increase of 20 μg m-3 between winter and spring was associated with an average EDV increase of 48.66%. CONCLUSION This is the first study to predict the number of ventilators required by calculating quantitative estimates of the short-term effects of PM2.5 on EDVs for AECOPD patients with ARF. Adverse effects of PM2.5 on AECOPD patients requiring MV are evident, especially in the spring. Establishing protective standards and reducing the PM2.5 concentration to below various thresholds are urgently needed.
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Affiliation(s)
- Man-Ju Ting
- Division of Chest Medicine, Far Eastern Memorial Hospital, Banciao, New Taipei City, Taiwan.
| | - Ya-Hui Tsai
- Division of Pediatric Surgery, Far Eastern Memorial Hospital, Banciao, New Taipei City, Taiwan
| | - Shih-Ping Chuang
- Division of Chest Medicine, Far Eastern Memorial Hospital, Banciao, New Taipei City, Taiwan
| | - Ping-Huai Wang
- Division of Chest Medicine, Far Eastern Memorial Hospital, Banciao, New Taipei City, Taiwan
| | - Shih-Lung Cheng
- Division of Chest Medicine, Far Eastern Memorial Hospital, Banciao, New Taipei City, Taiwan
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Brocke SA, Billings GT, Taft-Benz S, Alexis NE, Heise MT, Jaspers I. Woodsmoke particulates alter expression of antiviral host response genes in human nasal epithelial cells infected with SARS-CoV-2 in a sex-dependent manner. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2021. [PMID: 34462747 DOI: 10.1101/2021.08.23.457411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
We have previously shown that exposure to particulate air pollution, both from natural and anthropogenic sources, alters gene expression in the airways and increases susceptibility to respiratory viral infection. Additionally, we have shown that woodsmoke particulates (WSP) affect responses to influenza in a sex-dependent manner. In the present study, we used human nasal epithelial cells (hNECs) from both sexes to investigate how particulate exposure could modulate gene expression in the context of SARS-CoV-2 infection. We used diesel exhaust particulate (DEP) as well as WSP derived from eucalyptus or red oak wood. HNECs were exposed to particulates at a concentration of 22 μg/cm 2 for 2 h then immediately infected with SARS-CoV-2 at a MOI (multiplicity of infection) of 0.5. Exposure to particulates had no significant effects on viral load recovered from infected cells. Without particulate exposure, hNECs from both sexes displayed a robust upregulation of antiviral host response genes, though the response was greater in males. However, WSP exposure before infection dampened expression of genes related to the antiviral host response by 72 h post infection. Specifically, red oak WSP downregulated IFIT1, IFITM3, IFNB1, MX1, CCL3, CCL5, CXCL11, CXCL10 , and DDX58 , among others. After sex stratification of these results, we found that exposure to WSP prior to SARS-CoV-2 infection downregulated anti-viral gene expression in hNECs from females more so than males. These data indicate that WSP, specifically from red oak, alter virus-induced gene expression in a sex-dependent manner and potentially suppress antiviral host defense responses following SARS-CoV-2 infection.
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Respiratory Health Effects of Wildfire Smoke during Summer of 2018 in the Jämtland Härjedalen Region, Sweden. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18136987. [PMID: 34210080 PMCID: PMC8297091 DOI: 10.3390/ijerph18136987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 06/21/2021] [Accepted: 06/26/2021] [Indexed: 11/23/2022]
Abstract
During the summer of 2018 Sweden experienced a high occurrence of wildfires, most intense in the low-densely populated Jämtland Härjedalen region. The aim of this study was to investigate any short-term respiratory health effects due to deteriorated air quality generated by the smoke from wildfires. For each municipality in the region Jämtland Härjedalen, daily population-weighted concentrations of fine particulate matter (PM2.5) were calculated through the application of the MATCH chemistry transport model. Modelled levels of PM2.5 were obtained for two summer periods (2017, 2018). Potential health effects of wildfire related levels of PM2.5 were examined by studying daily health care contacts concerning respiratory problems in each municipality in a quasi-Poisson regression model, adjusting for long-term trends, weekday patterns and weather conditions. In the municipality most exposed to wildfire smoke, having 9 days with daily maximum 1-h mean of PM2.5 > 20 μg/m3, smoke days resulted in a significant increase in daily asthma visits the same and two following days (relative risk (RR) = 2.64, 95% confidence interval (CI): 1.28–5.47). Meta-estimates for all eight municipalities revealed statistically significant increase in asthma visits (RR = 1.68, 95% CI: 1.09–2.57) and also when grouping all disorders of the lower airways (RR = 1.40, 95% CI: 1.01–1.92).
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Haikerwal A, Doyle LW, Wark JD, Irving L, Cheong JL. Wildfire smoke exposure and respiratory health outcomes in young adults born extremely preterm or extremely low birthweight. ENVIRONMENTAL RESEARCH 2021; 197:111159. [PMID: 33894239 DOI: 10.1016/j.envres.2021.111159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 03/15/2021] [Accepted: 04/07/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Adults born either extremely preterm (EP, <28 weeks gestation) or extremely low birthweight (ELBW, <1000 g birthweight) have more obstructive airflow than controls of normal birthweight (>2499 g). We compared self-reported adverse respiratory health outcomes in young adults born EP/ELBW with controls following smoke exposure from the 2019/2020 wildfires in the Australian state of Victoria, and explored if any effects were mediated by airway obstruction, reflected in the forced expiratory volume in 1 second (FEV1). METHODS EP/ELBW participants were derived from all survivors born in the state of Victoria in 1991-92. Contemporaneous controls of normal birthweight (>2499 g) were recruited in the newborn period and matched for sociodemographic variables. Both groups had been assessed at intervals through childhood and into adulthood. Those who participated in the most recent follow-up assessment at 25 years of age, when FEV1 had been measured, were sent a survey when they were approximately 28 years of age asking about respiratory health related outcomes (respiratory symptoms, health services usage, medication uptake) following wildfire smoke exposure over the southern hemisphere summer of 2019-20. RESULTS A total of 296 participants (166 EP/ELBW; 130 controls) were sent the survey; 44% of the EP/ELBW group and 47% of the control group responded. Compared with controls, EP/ELBW respondents reported more overall respiratory problems (30%vs 20%) and specific respiratory symptoms (breathlessness, wheezing, cough and chest tightness) following wildfire smoke exposure, as well as higher health services usage (e.g. local health clinic, hospital emergency department) and medication uptake for respiratory-related problems. Higher FEV1 values were associated with lower odds of most self-reported respiratory symptoms; adjusting for FEV1 attenuated the differences between EP/ELW and control groups. CONCLUSION Survivors born EP/ELBW may be at an increased risk of adverse respiratory health outcomes following wildfire smoke exposure in early adulthood, in part related to worse expiratory airflows.
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Affiliation(s)
- Anjali Haikerwal
- Newborn Services, The Royal Women's Hospital, Melbourne, Australia; Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia.
| | - Lex W Doyle
- Newborn Services, The Royal Women's Hospital, Melbourne, Australia; Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia; Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, Australia; Department of Paediatrics, The University of Melbourne, Melbourne, Australia
| | - John D Wark
- Department of Medicine, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, Australia; Bone and Mineral Medicine, The Royal Melbourne Hospital, Melbourne, Australia
| | - Louis Irving
- Respiratory and Sleep Medicine, The Royal Melbourne Hospital, Melbourne, Australia
| | - Jeanie Ly Cheong
- Newborn Services, The Royal Women's Hospital, Melbourne, Australia; Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia; Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, Australia
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Climate change, air pollution, and allergic respiratory diseases: a call to action for health professionals. Chin Med J (Engl) 2021; 133:1552-1560. [PMID: 32590458 PMCID: PMC7386356 DOI: 10.1097/cm9.0000000000000861] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Rising emissions of greenhouse gases in the atmosphere have warmed the planet substantially and are also accompanied by poor air quality. The increased prevalence of allergic airway disease worldwide can be partially attributed to those global environmental changes. Climate change and air pollution pose adverse impacts on respiratory allergies, and that the mechanisms are complex and interactive. Adverse weather conditions, such as extreme temperatures, can act directly on the respiratory tract to induce allergic respiratory illnesses. Thunderstorms and floods can alter the production and distribution of aeroallergens while wildfires and dust storms increase air pollution, and therefore indirectly enhance health risks. Concentrations of particulate matter and ozone in the air have been projected to increase with climate warming and air stagnation, and the rising temperatures and CO2 increase pollen, molds, and spores, which escalate the risk of allergic respiratory diseases. The synergistic effects of extreme heat and aeroallergens intensify the toxic effect of air pollutants, which in turn augment the allergenicity of aeroallergens. With the Earth's climate change, migration of humans and plants shift the living environments and allergens of susceptible people. Urban residents are exposed to multiple factors while children are sensitive to environmental exposure. Since climate change may pose many unexpected and persistent effects on allergic respiratory diseases, health professionals should advocate for effective mitigation and adaptation strategies to minimize its respiratory health effects.
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Hahn MB, Kuiper G, O'Dell K, Fischer EV, Magzamen S. Wildfire Smoke Is Associated With an Increased Risk of Cardiorespiratory Emergency Department Visits in Alaska. GEOHEALTH 2021; 5:e2020GH000349. [PMID: 34036208 PMCID: PMC8137270 DOI: 10.1029/2020gh000349] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 03/03/2021] [Accepted: 04/17/2021] [Indexed: 05/26/2023]
Abstract
Alaskan wildfires have major ecological, social, and economic consequences, but associated health impacts remain unexplored. We estimated cardiorespiratory morbidity associated with wildfire smoke (WFS) fine particulate matter with a diameter less than 2.5 μm (PM2.5) in three major population centers (Anchorage, Fairbanks, and the Matanuska-Susitna Valley) during the 2015-2019 wildfire seasons. To estimate WFS PM2.5, we utilized data from ground-based monitors and satellite-based smoke plume estimates. We implemented time-stratified case-crossover analyses with single and distributed lag models to estimate the effect of WFS PM2.5 on cardiorespiratory emergency department (ED) visits. On the day of exposure to WFS PM2.5, there was an increased odds of asthma-related ED visits among 15-65 year olds (OR = 1.12, 95% CI = 1.08, 1.16), people >65 years (OR = 1.15, 95% CI = 1.01, 1.31), among Alaska Native people (OR = 1.16, 95% CI = 1.09, 1.23), and in Anchorage (OR = 1.10, 95% CI = 1.05, 1.15) and Fairbanks (OR = 1.12, 95% CI = 1.07, 1.17). There was an increased risk of heart failure related ED visits for Alaska Native people (Lag Day 5 OR = 1.13, 95% CI = 1.02, 1.25). We found evidence that rural populations may delay seeking care. As the frequency and magnitude of Alaskan wildfires continue to increase due to climate change, understanding the health impacts will be imperative. A nuanced understanding of the effects of WFS on specific demographic and geographic groups facilitates data-driven public health interventions and fire management protocols that address these adverse health effects.
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Affiliation(s)
- M. B. Hahn
- Institute for Circumpolar Health StudiesUniversity of Alaska‐AnchorageAnchorageAKUSA
| | - G. Kuiper
- Institute for Circumpolar Health StudiesUniversity of Alaska‐AnchorageAnchorageAKUSA
| | - K. O'Dell
- Department of Atmospheric ScienceColorado State UniversityFort CollinsCOUSA
| | - E. V. Fischer
- Department of Atmospheric ScienceColorado State UniversityFort CollinsCOUSA
| | - S. Magzamen
- Department of Environmental and Radiological Health SciencesColorado State UniversityFort CollinsCOUSA
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Aguilera R, Corringham T, Gershunov A, Leibel S, Benmarhnia T. Fine Particles in Wildfire Smoke and Pediatric Respiratory Health in California. Pediatrics 2021; 147:peds.2020-027128. [PMID: 33757996 DOI: 10.1542/peds.2020-027128] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/06/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Exposure to airborne fine particles with diameters ≤2.5 μm (PM2.5) pollution is a well-established cause of respiratory diseases in children; whether wildfire-specific PM2.5 causes more damage, however, remains uncertain. We examine the associations between wildfire-specific PM2.5 and pediatric respiratory health during the period 2011-2017 in San Diego County, California, and compare these results with other sources of PM2.5. METHODS Visits to emergency and urgent care facilities of Rady's Children Hospital network in San Diego County, California, by individuals (aged ≤19 years) with ≥1 of the following respiratory conditions: difficulty breathing, respiratory distress, wheezing, asthma, or cough were regressed on daily, community-level exposure to wildfire-specific PM2.5 and PM2.5 from ambient sources (eg, traffic emissions). RESULTS A 10-unit increase in PM2.5 (from nonsmoke sources) was estimated to increase the number of admissions by 3.7% (95% confidence interval: 1.2% to 6.1%). In contrast, the effect of PM2.5 attributable to wildfire was estimated to be a 30.0% (95% confidence interval: 26.6% to 33.4%) increase in visits. CONCLUSIONS Wildfire-specific PM2.5 was found to be ∼10 times more harmful on children's respiratory health than PM2.5 from other sources, particularly for children aged 0 to 5 years. Even relatively modest wildfires and associated PM2.5 resolved on our record produced major health impacts, particularly for younger children, in comparison with ambient PM2.5.
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Affiliation(s)
| | | | | | - Sydney Leibel
- Departments of Allergy and Immunology and.,Pediatric Allergy and Immunology, and
| | - Tarik Benmarhnia
- Scripps Institution of Oceanography and.,Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, California
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Navarro KM, Clark KA, Hardt DJ, Reid CE, Lahm PW, Domitrovich JW, Butler CR, Balmes JR. Wildland firefighter exposure to smoke and COVID-19: A new risk on the fire line. THE SCIENCE OF THE TOTAL ENVIRONMENT 2021; 760:144296. [PMID: 33341613 PMCID: PMC7962897 DOI: 10.1016/j.scitotenv.2020.144296] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 11/12/2020] [Accepted: 11/30/2020] [Indexed: 05/19/2023]
Abstract
Throughout the United States, wildland firefighters respond to wildfires, performing arduous work in remote locations. Wildfire incidents can be an ideal environment for the transmission of infectious diseases, particularly for wildland firefighters who congregate in work and living settings. In this review, we examine how exposure to wildfire smoke can contribute to an increased likelihood of SARS-CoV-2 infection and severity of coronavirus disease (COVID-19). Human exposure to particulate matter (PM), a component of wildfire smoke, has been associated with oxidative stress and inflammatory responses; increasing the likelihood for adverse respiratory symptomology and pathology. In multiple epidemiological studies, wildfire smoke exposure has been associated with acute lower respiratory infections, such as bronchitis and pneumonia. Co-occurrence of SARS-CoV-2 infection and wildfire smoke inhalation may present an increased risk for COVID-19 illness in wildland firefighters due to PM based transport of SARS CoV-2 virus and up-regulation of angiotensin-converting enzyme II (ACE-2) (i.e. ACE-2 functions as a trans-membrane receptor, allowing the SARS-CoV-2 virus to gain entry into the epithelial cell). Wildfire smoke exposure may also increase risk for more severe COVID-19 illness such as cytokine release syndrome, hypotension, and acute respiratory distress syndrome (ARDS). Current infection control measures, including social distancing, wearing cloth masks, frequent cleaning and disinfecting of surfaces, frequent hand washing, and daily screening for COVID-19 symptoms are very important measures to reduce infections and severe health outcomes. Exposure to wildfire smoke may introduce additive or even multiplicative risk for SARS-CoV-2 infection and severity of disease in wildland firefighters. Thus, additional mitigative measures may be needed to prevent the co-occurrence of wildfire smoke exposure and SARS-CoV-2 infection.
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Affiliation(s)
- Kathleen M Navarro
- Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Division of Field Studies and Engineering, Cincinnati, OH, United States of America.
| | - Kathleen A Clark
- Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Respiratory Health Division, Morgantown, WV, United States of America
| | - Daniel J Hardt
- Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Western States Division, Spokane, WA, United States of America
| | - Colleen E Reid
- Geography Department, University of Colorado, Boulder, CO, United States of America
| | - Peter W Lahm
- USDA Forest Service, Fire and Aviation Management, Washington, DC, United States of America
| | - Joseph W Domitrovich
- USDA Forest Service, National Technology and Development Program, Missoula, MT, United States of America
| | - Corey R Butler
- Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Western States Division, Denver, CO, United States of America
| | - John R Balmes
- Department of Medicine, University of California, San Francisco, CA, United States of America; School of Public Health, University of California, Berkeley, CA, United States of America
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Enweasor C, Flayer CH, Haczku A. Ozone-Induced Oxidative Stress, Neutrophilic Airway Inflammation, and Glucocorticoid Resistance in Asthma. Front Immunol 2021; 12:631092. [PMID: 33717165 PMCID: PMC7952990 DOI: 10.3389/fimmu.2021.631092] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 01/18/2021] [Indexed: 12/15/2022] Open
Abstract
Despite recent advances in using biologicals that target Th2 pathways, glucocorticoids form the mainstay of asthma treatment. Asthma morbidity and mortality remain high due to the wide variability of treatment responsiveness and complex clinical phenotypes driven by distinct underlying mechanisms. Emerging evidence suggests that inhalation of the toxic air pollutant, ozone, worsens asthma by impairing glucocorticoid responsiveness. This review discusses the role of oxidative stress in glucocorticoid resistance in asthma. The underlying mechanisms point to a central role of oxidative stress pathways. The primary data source for this review consisted of peer-reviewed publications on the impact of ozone on airway inflammation and glucocorticoid responsiveness indexed in PubMed. Our main search strategy focused on cross-referencing "asthma and glucocorticoid resistance" against "ozone, oxidative stress, alarmins, innate lymphoid, NK and γδ T cells, dendritic cells and alveolar type II epithelial cells, glucocorticoid receptor and transcription factors". Recent work was placed in the context from articles in the last 10 years and older seminal research papers and comprehensive reviews. We excluded papers that did not focus on respiratory injury in the setting of oxidative stress. The pathways discussed here have however wide clinical implications to pathologies associated with inflammation and oxidative stress and in which glucocorticoid treatment is essential.
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Affiliation(s)
- Chioma Enweasor
- UC Davis Lung Center, University of California, Davis, CA, United States
| | - Cameron H. Flayer
- Center for Immunology and Inflammatory Diseases, Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Angela Haczku
- UC Davis Lung Center, University of California, Davis, CA, United States
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Gayle AV, Quint JK, Fuertes EI. Understanding the relationships between environmental factors and exacerbations of COPD. Expert Rev Respir Med 2021; 15:39-50. [PMID: 32713218 DOI: 10.1080/17476348.2020.1801426] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 07/22/2020] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Exacerbations of chronic obstructive pulmonary disease (COPD) are associated with a significant health burden both for patients and healthcare systems. Exposure to various environmental factors increases the risk of exacerbations. AREAS COVERED We searched PubMed and assessed literature published within the last 10 years to include epidemiological evidence on the relationships between air pollution, temperature and COPD exacerbation risk as well as the implications of extreme weather events on exacerbations. EXPERT OPINION Ongoing climate change is expected to increase air pollution levels, global temperature and the frequency and severity of extreme weather events, all of which are associated with COPD exacerbations. Further research is needed using patient-focused methodological approaches to better understand and quantify these relationships, so that effective mitigation strategies that decrease the risk of exacerbations can be developed.
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Affiliation(s)
- Alicia V Gayle
- Respiratory Epidemiology, Occupational Medicine and Public Health, National Heart and Lung Institute, Imperial College London , London, UK
- Global Real World Evidence, AstraZeneca Plc , Cambridge, UK
| | - Jennifer K Quint
- Respiratory Epidemiology, Occupational Medicine and Public Health, National Heart and Lung Institute, Imperial College London , London, UK
| | - Elaine I Fuertes
- Respiratory Epidemiology, Occupational Medicine and Public Health, National Heart and Lung Institute, Imperial College London , London, UK
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Wildfire particulate matter in Shasta County, California and respiratory and circulatory disease-related emergency department visits and mortality, 2013-2018. Environ Epidemiol 2020; 5:e124. [PMID: 33778357 PMCID: PMC7939433 DOI: 10.1097/ee9.0000000000000124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 11/10/2020] [Indexed: 01/09/2023] Open
Abstract
Supplemental Digital Content is available in the text. Wildfire smoke harms health. We add to this literature by evaluating the health effects of California’s 2018 Carr Fire and preceding wildfire seasons in Shasta County.
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Xu R, Yu P, Abramson MJ, Johnston FH, Samet JM, Bell ML, Haines A, Ebi KL, Li S, Guo Y. Wildfires, Global Climate Change, and Human Health. N Engl J Med 2020; 383:2173-2181. [PMID: 33034960 DOI: 10.1056/nejmsr2028985] [Citation(s) in RCA: 165] [Impact Index Per Article: 41.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Rongbin Xu
- From the School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC (R.X., P.Y., M.J.A., S.L., Y.G.), and Menzies Institute for Medical Research, University of Tasmania, Hobart (F.H.J.) - both in Australia; the Colorado School of Public Health, University of Colorado, Aurora (J.M.S.); the School of the Environment, Yale University, New Haven, CT (M.L.B.); the Department of Public Health, Environments, and Society and Department of Population Health, Centre on Climate Change and Planetary Health, London School of Hygiene and Tropical Medicine, London (A.H.); and the Center for Health and the Global Environment, University of Washington, Seattle (K.L.E.)
| | - Pei Yu
- From the School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC (R.X., P.Y., M.J.A., S.L., Y.G.), and Menzies Institute for Medical Research, University of Tasmania, Hobart (F.H.J.) - both in Australia; the Colorado School of Public Health, University of Colorado, Aurora (J.M.S.); the School of the Environment, Yale University, New Haven, CT (M.L.B.); the Department of Public Health, Environments, and Society and Department of Population Health, Centre on Climate Change and Planetary Health, London School of Hygiene and Tropical Medicine, London (A.H.); and the Center for Health and the Global Environment, University of Washington, Seattle (K.L.E.)
| | - Michael J Abramson
- From the School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC (R.X., P.Y., M.J.A., S.L., Y.G.), and Menzies Institute for Medical Research, University of Tasmania, Hobart (F.H.J.) - both in Australia; the Colorado School of Public Health, University of Colorado, Aurora (J.M.S.); the School of the Environment, Yale University, New Haven, CT (M.L.B.); the Department of Public Health, Environments, and Society and Department of Population Health, Centre on Climate Change and Planetary Health, London School of Hygiene and Tropical Medicine, London (A.H.); and the Center for Health and the Global Environment, University of Washington, Seattle (K.L.E.)
| | - Fay H Johnston
- From the School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC (R.X., P.Y., M.J.A., S.L., Y.G.), and Menzies Institute for Medical Research, University of Tasmania, Hobart (F.H.J.) - both in Australia; the Colorado School of Public Health, University of Colorado, Aurora (J.M.S.); the School of the Environment, Yale University, New Haven, CT (M.L.B.); the Department of Public Health, Environments, and Society and Department of Population Health, Centre on Climate Change and Planetary Health, London School of Hygiene and Tropical Medicine, London (A.H.); and the Center for Health and the Global Environment, University of Washington, Seattle (K.L.E.)
| | - Jonathan M Samet
- From the School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC (R.X., P.Y., M.J.A., S.L., Y.G.), and Menzies Institute for Medical Research, University of Tasmania, Hobart (F.H.J.) - both in Australia; the Colorado School of Public Health, University of Colorado, Aurora (J.M.S.); the School of the Environment, Yale University, New Haven, CT (M.L.B.); the Department of Public Health, Environments, and Society and Department of Population Health, Centre on Climate Change and Planetary Health, London School of Hygiene and Tropical Medicine, London (A.H.); and the Center for Health and the Global Environment, University of Washington, Seattle (K.L.E.)
| | - Michelle L Bell
- From the School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC (R.X., P.Y., M.J.A., S.L., Y.G.), and Menzies Institute for Medical Research, University of Tasmania, Hobart (F.H.J.) - both in Australia; the Colorado School of Public Health, University of Colorado, Aurora (J.M.S.); the School of the Environment, Yale University, New Haven, CT (M.L.B.); the Department of Public Health, Environments, and Society and Department of Population Health, Centre on Climate Change and Planetary Health, London School of Hygiene and Tropical Medicine, London (A.H.); and the Center for Health and the Global Environment, University of Washington, Seattle (K.L.E.)
| | - Andy Haines
- From the School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC (R.X., P.Y., M.J.A., S.L., Y.G.), and Menzies Institute for Medical Research, University of Tasmania, Hobart (F.H.J.) - both in Australia; the Colorado School of Public Health, University of Colorado, Aurora (J.M.S.); the School of the Environment, Yale University, New Haven, CT (M.L.B.); the Department of Public Health, Environments, and Society and Department of Population Health, Centre on Climate Change and Planetary Health, London School of Hygiene and Tropical Medicine, London (A.H.); and the Center for Health and the Global Environment, University of Washington, Seattle (K.L.E.)
| | - Kristie L Ebi
- From the School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC (R.X., P.Y., M.J.A., S.L., Y.G.), and Menzies Institute for Medical Research, University of Tasmania, Hobart (F.H.J.) - both in Australia; the Colorado School of Public Health, University of Colorado, Aurora (J.M.S.); the School of the Environment, Yale University, New Haven, CT (M.L.B.); the Department of Public Health, Environments, and Society and Department of Population Health, Centre on Climate Change and Planetary Health, London School of Hygiene and Tropical Medicine, London (A.H.); and the Center for Health and the Global Environment, University of Washington, Seattle (K.L.E.)
| | - Shanshan Li
- From the School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC (R.X., P.Y., M.J.A., S.L., Y.G.), and Menzies Institute for Medical Research, University of Tasmania, Hobart (F.H.J.) - both in Australia; the Colorado School of Public Health, University of Colorado, Aurora (J.M.S.); the School of the Environment, Yale University, New Haven, CT (M.L.B.); the Department of Public Health, Environments, and Society and Department of Population Health, Centre on Climate Change and Planetary Health, London School of Hygiene and Tropical Medicine, London (A.H.); and the Center for Health and the Global Environment, University of Washington, Seattle (K.L.E.)
| | - Yuming Guo
- From the School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC (R.X., P.Y., M.J.A., S.L., Y.G.), and Menzies Institute for Medical Research, University of Tasmania, Hobart (F.H.J.) - both in Australia; the Colorado School of Public Health, University of Colorado, Aurora (J.M.S.); the School of the Environment, Yale University, New Haven, CT (M.L.B.); the Department of Public Health, Environments, and Society and Department of Population Health, Centre on Climate Change and Planetary Health, London School of Hygiene and Tropical Medicine, London (A.H.); and the Center for Health and the Global Environment, University of Washington, Seattle (K.L.E.)
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