Ozone exposure decreases the effect of a deep inhalation on forced expiratory flow in normal subjects

Weekly Personal Ozone Exposure and Respiratory Health in a Panel of Greek Schoolchildren

BACKGROUND

The association of ozone exposure with respiratory outcomes has been investigated in epidemiologic studies mainly including asthmatic children. The findings reported had methodological gaps and inconsistencies.

OBJECTIVES

We aimed to investigate effects of personal ozone exposure on various respiratory outcomes in school-age children generally representative of the population during their normal activities.

METHODS

We conducted a panel study in a representative sample of school-age children in the two major cities of Greece, Athens and Thessaloniki. We followed 188, 10- to 11-y-old, elementary school students for 5 wk spread throughout the 2013–2014 academic year, during which ozone was measured using personal samplers. At the end of each study week, spirometry was performed by trained physicians, and the fractional concentration of nitric oxide in exhaled air (F_eNO) was measured. Students kept a daily time–activity–symptom diary and measured PEF (peak expiratory flow) using peak flow meters. Mixed models accounting for repeated measurements were applied.

RESULTS

An increase of 10 μg/m³ in weekly ozone concentration was associated with a decrease in FVC (forced vital capacity) and FEV₁ (forced expiratory volume in 1 s) of 0.03 L [95% confidence interval (CI): −0.05, −0.01] and 0.01 L (95% CI: −0.03, 0.003) respectively. The same increase in exposure was associated with a 11.10% (95% CI: 4.23, 18.43) increase in F_eNO and 19% (95% CI: −0.53, 42.75) increase in days with any symptom. The effect estimates were robust to PM₁₀ adjustment. No inverse association was found between ozone exposure and PEF.

CONCLUSIONS

The study provides evidence that airway inflammation and the frequency of respiratory symptoms increase, whereas lung function decreases with increased ozone exposure in schoolchildren. https://doi.org/10.1289/EHP635.

Association between Traffic Air Pollution and Reduced Forced Vital Capacity: A Study Using Personal Monitors for Outdoor Workers

Background

The effects of outdoor air pollution on lung function in adults are still controversial.

Objective

Evaluate the effects of exposure to different levels of traffic-generated PM_2.5 on workers’ lung functions in São Paulo, Brazil.

Methods

To cover a wide range of exposures, 101 non-smoking workers from three occupations (taxi drivers, traffic controllers, and forest rangers) were selected for the study. After clinical evaluation, the participants were scheduled to attend four consecutive weekly visits in which they received a 24-hour personal PM_2.5 sampler and had lung function tests measured on the following day. The association between the spirometric variables and the averaged PM_2.5 levels was assessed using robust regression models adjusted for age, waist circumference, time at the job, daily work hours, diabetes or hypertension and former smoking habits.

Results

Relative to workers in the lowest exposed group (all measures < 25 μg/m³), those with the highest level of exposure (all measures > 39.6 μg/m³) showed a reduction of predicted FVC (-12.2%; CI 95%: [-20.0% to -4.4%]), a marginal reduction of predicted FEV₁ (-9.1%; CI 95%: [-19.1% to 0.9%]) and an increase of predicted FEF_25-75%/FVC (14.9%; CI 95%: [2.9% to 26.8%]) without changes of FEV₁/FVC.

Conclusions

Exposure to vehicular traffic air pollution is associated with a small but significant reduction of FVC without a reduction of FEV₁/FVC.

TNF and IL-1β exposure increases airway narrowing but does not alter the bronchodilatory response to deep inspiration in airway segments

BACKGROUND AND OBJECTIVE

While chronic inflammation of the airway wall and the failure of deep inspiration (DI) to produce bronchodilation are both common to asthma, whether pro-inflammatory cytokines modulate the airway smooth muscle response to strain during DI is unknown. The primary aim of the study was to determine how an inflammatory environment (simulated by the use of pro-inflammatory cytokines) alters the bronchodilatory response to DI.

METHODS

We used whole porcine bronchial segments in vitro that were cultured in medium containing tumour necrosis factor and interleukin-1β for 2 days. A custom-built servo-controlled syringe pump and pressure transducer was used to measure airway narrowing and to simulate tidal breathing with intermittent DI manoeuvres.

RESULTS

Culture with tumour necrosis factor and interleukin-1β increased airway narrowing to acetylcholine but did not affect the bronchodilatory response to DI.

CONCLUSION

The failure of DI to produce bronchodilation in patients with asthma may not necessarily involve a direct effect of pro-inflammatory cytokines on airway tissue. A relationship between inflammation and airway hyper-responsiveness is supported, however, regulated by separate disease processes than those which attenuate or abolish the bronchodilatory response to DI in patients with asthma.

Expiratory flow limitation

Expiratory flow limitation occurs when flow ceases to increase with increasing expiratory effort. The equal pressure point concept has been largely successful in providing intuitive understanding of the phenomenon, wherein maximal flows are determined by lung recoil and resistance upstream of the site where bronchial transmural pressure is zero (the EPP). Subsequent work on the fluid dynamical foundations led to the wave-speed theory of flow limitation, where flow is limited at a site when the local gas velocity is equal to speed of propagation of pressure waves. Each is a local theory; full predictions require knowledge of both density-dependent Bernoulli pressure drops and viscosity-dependent pressure losses due to dissipation. The former is dominant at mid to high lung volumes, whereas the latter is more important at low lung volumes as the flow-limiting site moves peripherally. The observation of relative effort independence of the maximal flow versus volume curves is important clinically insofar as such maneuvers, when carefully performed, offer a unique window into the mechanics of the lung itself, with little confounding effects. In particular, the important contributions of lung recoil and airways resistance can often be assessed, with implications and applications to diagnosis and management of pulmonary disease.

Effects of wood smoke particles from wood-burning stoves on the respiratory health of atopic humans

Background

There is growing evidence that particulate air pollution derived from wood stoves causes acute inflammation in the respiratory system, increases the incidence of asthma and other allergic diseases, and increases respiratory morbidity and mortality. The objective of this study was to evaluate acute respiratory effects from short-term wood smoke exposure in humans. Twenty non-smoking atopic volunteers with normal lung function and without bronchial responsiveness were monitored during three different experimental exposure sessions, aiming at particle concentrations of about 200 μg/m³, 400 μg/m³, and clean air as control exposure. A balanced cross-over design was used and participants were randomly allocated to exposure orders. Particles were generated in a wood-burning facility and added to a full-scale climate chamber where the participants were exposed for 3 hours under controlled environmental conditions. Health effects were evaluated in relation to: peak expiratory flow (PEF), forced expiratory volume in the first second (FEV₁), and forced vital capacity (FVC). Furthermore, the effects were assessed in relation to changes in nasal patency and from markers of airway inflammation: fractional exhaled nitric oxide (FENO), exhaled breath condensate (EBC) and nasal lavage (NAL) samples were collected before, and at various intervals after exposure.

Results

No statistically significant effect of wood smoke exposure was found for lung function, for FENO, for NAL or for the nasal patency. Limited signs of airway inflammation were found in EBC.

Conclusion

In conclusion, short term exposure with wood smoke at a concentration normally found in a residential area with a high density of burning wood stoves causes only mild inflammatory response.

Effects on human eyes caused by experimental exposures to office dust with and without addition of aldehydes or glucan

Thirty-six volunteers (in three susceptibility groups: 11 subjects were non-allergic with nasal histamine hypersensitivity, 13 were non-allergic with normal sensitivity, and 12 were pollen allergic with or without nasal hypersensitivity) were exposed for three and a half hours in a climate chamber. Each subject was exposed to clean air (dust 45 +/- 38 microg/m(3) total suspended particle, TSP), house dust at 357 +/- 180 microg/m(3) TSP, house dust 382 +/- 175 microg/m(3) TSP with added glucan (50 ng/m(3)) and house dust 394 +/- 168 microg/m(3) TSP with added aldehydes corresponding to a gaseous phase of 300 microg/m(3) in the air. The study was explorative by nature. No significant effects of exposures as such were seen on break-up time, conjunctival epithelial damage score and Trolox Equivalent Antioxidant Capacity (TEAC) in tear film and subjective ratings. However, in TEAC a significant different time course was seen during exposures to aldehyde-containing dust indicating a subacute and late response to the exposures. Perceived eye irritation increased significantly during exposures to normal dust. The perception ratings were highly correlated, whereas no correlation was found between the subjective responses and the objective measurements.

PRACTICAL IMPLICATIONS

The findings indicate that measurement effects on the eyes are rather insensitive measures of short time effects of office dust exposures.

Interaction between ozone and airborne particulate matter in office air

This study investigated the hypotheses that humans are affected by air pollution caused by ozone and house dust, that the effect of simultaneous exposure to ozone and dust in the air is larger than the effect of these two pollutants individually, and that the effects can be measured as release of cytokines and changes of the respiratory function. Experimental exposures of eight atopic but otherwise healthy subjects were performed in a climate chamber under controlled conditions. The three controlled exposures were about 75 microg/m3 total suspended particulate matter, 0.3 p.p.m. ozone, and the combination of these. The exposure duration was 3 h. The outcome measures were interleukins and cells in nasal lavages (NAL), respiratory function, bronchial metacholine responsiveness, rhinometry symptoms and general well-being in a questionnaire and time course of general irritation on a visual analogue scale. Indications of interactions between exposure types were demonstrated for peak expiratory flow (PEF) (P<0.05) and for discomfort symptoms (P<0.03). Non-significant interactions were found for the concentration of interleukin-8 in NAL. The combined exposure was found to cause significantly more effects than either ozone exposures or dust exposures. This is interpreted as indications of a potentiation caused by the combined exposures to dust and ozone. The findings in this study are based on a limited number of subjects and thus should not be over-interpreted. However, they support the hypothesis that ozone at relatively high concentrations interacts with dust exposures to cause decrements in PEF and increase in discomfort measures.

PRACTICAL IMPLICATIONS

If confirmed at lower ozone and dust concentrations this finding could help to explain many problems with indoor air quality reported in offices throughout the world.