Desert dust exposure is associated with increased risk of asthma hospitalization in children

Health Effects of Desert Dust Storms in Children With Asthma: Knowledge, Perceptions and Practices of School Health Visitors in Cyprus

Introduction: Cyprus is located in the Eastern Mediterranean and is heavily exposed to desert dust storm (DDS) events, which diminish air quality and adversely impact paediatric asthma morbidity. School health visitors (SHVs) play a key role in asthma management in schoolchildren and are pivotal for the development of school-based intervention programs. Objectives: This study aimed to examine the knowledge, practices and perceptions of SHVs on paediatric asthma management. Additionally, we sought to determine the factors associated with SHVs' level of engagement in school-based intervention programs to mitigate DDS-associated health effects. Methods: An anonymous questionnaire on asthma management practices and perceptions was administered to all SHVs in Cyprus. We assessed the association between the perceived importance and real-life implementation of asthma management practices and, in addition, asthma management practices and preparedness of local authorities to respond to DDS events were compared across categories for different sociodemographic characteristics. A binary logistic regression analysis was carried out to determine predictors among SHVs for supporting a school-based intervention program for DDS. Results: Responses from 78/93 SHVs (84%) revealed mean estimates for perceived importance ranging between 8.20 (lowest) for performing regular check-ups and 9.6 (highest) for monitoring student health records and immunisation status. Significant differences were demonstrated between the perceived importance of most of the reported asthma management practices and the extent of their implementation. Moderate appreciation among SHVs on a 1-5 Likert scale was reported for the regulatory authorities' preparedness (M = 3.48, SD = 0,88) and current practices (M = 2.66, SD = 0.13) to respond to DDS. Conclusion: Asthma management practices in school settings in Cyprus, a country highly exposed to DDS events, are suboptimal and responses during DDS are fragmented. Despite the perceived low preparedness, from the authorities, SHVs recognise the health impact of DDS on children with asthma and support plans for desert dust-mitigation programs in schools.

Dust Storms and Emergency Department Visits in 3 Southwestern States Using NWS Storm Reports

Importance

Dust storms are projected to increase with climate change. The short-term health outcomes associated with dust storms in the US are not well characterized, especially for morbidity outcomes.

Objective

To estimate associations between dust storms and diagnosis-specific emergency department (ED) visits during 2005 to 2018.

Design, Setting, and Participants

In this cross-sectional study using a time-stratified case-crossover design, short-term associations between dust storms and ED visits were estimated at the zip code level using conditional Poisson analysis with adjustment for meteorology and within-month trends. Same-day dust storm events and storm events within a lag period of up to 7 days were considered. State-wide patient-level ED visit records acquired from 3 state health departments (Arizona, California, and Utah) were analyzed. Data were analyzed between April 21 and November 12, 2024.

Exposures

Dust storm events were reported by the US National Weather Service and assigned to each patient zip code that had at least a 5% areal overlap with the National Weather Service forecast zone.

Main Outcomes and Measures

Patient-level ED visits for asthma, chronic obstructive pulmonary disease, culture-negative pneumonia, congestive heart failure (CHF), cerebrovascular disease, ischemic heart disease, and visits due to motor vehicle accidents.

Results

The analysis included 33 500 ED visits among the outcomes of interest (5717 children aged 0-17 years [17.1%] and 11 150 adults aged >65 years [33.3%]; 17 394 male [51.9%] and 16 104 female [48.1%]; 2829 Black [8.4%] and 22 537 White [67.2%]; 9256 Hispanic [27.6%]) and 206 dust-impacted zip codes. The strongest associations between dust storms and ED visits were found for asthma (lag 0-2 relative risk [RR], 1.06; 95% CI, 1.01-1.11; P = .03), culture-negative pneumonia (lag 0-7 RR, 1.06; 95% CI, 1.02-1.10; P = .002), CHF (lag 0-7 RR, 1.06; 95% CI, 1.01-1.10; P = .01), and motor vehicle accidents (lag 0 RR, 1.13; 95% CI, 1.04-1.23; P = .003). Associations of dust storm exposure with ischemic heart disease were mostly protective (eg, lag 0-2 RR, 0.89; 95% CI, 0.84-0.95; P < .001). Associations of dust storm exposure with risk of ED visits for CHF and motor vehicle accidents were robust against adjustment for ambient ozone (eg, CHF: RR, 1.08; 95% CI, 1.03-1.13; P = .003) and nitrogen dioxide (eg, CHF: RR, 1.08; 95% CI, 1.03-1.13; P = .003) air pollution.

Conclusions and Relevance

In this study, dust storms were positively associated with ED visits for asthma, pneumonia, heart failure, and motor vehicle accidents. These findings contribute to our understanding of the association of dust storms with morbidity in the US and potential outcomes under a changing climate.

[Allergy and immunotoxicology in preventive and clinical medicine from theory to practice: Environmental factors in bronchial asthma]

BACKGROUND

According to the gene-environment interactions concept, the mechanism of health impairment can be explained by genetic factors, environmental factors, or their interaction. Physical and mental health effects resulting from environmental exposure may be classified either as toxicity, immune response, and allergic reaction. Moreover, despite the already established therapeutic approaches to bronchial asthma and decreasing mortality due to bronchial asthma, patients with difficult and severe asthma are increasing in number. This review outlines recent topics in the field of allergies, focusing on asthma.

RESULTS AND DISCUSSION

Living environment-derived pollutants and their involvement in the pathogenesis of asthma and its exacerbation, referred to here as an exposome concept, comprises the three domains of internal, specific external, and general external. Living environment-derived pollutants include exposure to pollutants in workplaces, climate change, air pollution, microplastics, tobacco smoke, biodiversity change and loss, changing dietary habits, and the microbiome. These are associated with the modernization, urbanization, and globalization of human society. Although many novel compounds are currently available, their harmful health effects, such as allergy, are not thoroughly understood. Hence, the means to mitigate these are unknown. Dietary changes from a traditional diet rich in fish to a Western-style diet are considered critical environmental factors and therefore, associated with an increased prevalence of allergies. Cytokines, including thymic stromal lymphopoietin, IL-25, and IL-33, released from the airway epithelium in response to various triggers (exposure to diverse environmental factors) are known as alarmins. Anti-alarmin antibodies are a promising therapeutic approach against severe and difficult allergic disorders. Collaboration between hospitals and clinics and occupational and clinical medicine is imperative for treating and managing severe asthma. In addition to avoiding environmental exposure, understanding the pathogenesis and exacerbation of asthma is essential for future research in the field of allergy and immunotoxicology.

The effect and burden of sand-dust storms on asthma hospitalization: Evidence from cities with arid climate in China

Evidence concerning the impact of sand-dust storms (SDS) on asthma is limited, and little is known about the associated public health burden, especially in regions with arid climate. Therefore, this study seeks to evaluate the effect of SDS on asthma hospitalization and quantify the associated hospital and economic burden in multiple cities with typical arid climate. We collected provincial asthma hospitalization, air pollutants and meteorological data of 14 cities in Gansu province. The space-time-stratified case-crossover design combined with a conditional quasi-Poisson regression was used to estimate the association between SDS and asthma hospitalization during 2018-2022. We further explored the interactive effect of SDS and low temperature, and explored potential effect modifications of gender, age, seasons and regions by stratified analyses. Finally, we calculated the hospital and economic burden of asthma attributed to SDS. A total of 54,134 hospitalization records for asthma and 791 SDS events were recorded during the study period. Northwestern area with arid climate displayed more frequent SDS events and asthma hospitalization compared with regions with subtropical or temperate monsoon climate. The relative risk (RR) of asthma hospitalization increased with SDS, with the greatest RR at lag1, which was 1.164 with a 95% confidence interval (CI) of 1.101-1.231. We further found that low temperature had an interactive effect with SDS to trigger asthma hospitalization. Stronger associations were observed in males, school-aged children, cold season and northwestern area. The total fraction of asthma hospitalization attributable to SDS was 1.64 % (95% CI: 1.06%-2.18%), and a conservative estimate of relative healthcare costs was 4.49 (95% CI: 2.92 to 5.99) million China Yuan. Our findings suggest the necessity of controlling SDS and implementing region-specific public health policies as well as personal protective measures against SDS.

Acceleration of acute lung inflammation by IL-1α released through cell death of alveolar macrophages upon phagocytosis of fine Asian sand dust particles

Asian sand dust (ASD), a significant desert sand dust, contains sub-2.5 µm fine particles and adversely affects human health, particularly exacerbating respiratory diseases. Despite this, the intricate physiological responses triggered by inhaled ASD particles remain incompletely understood. This study aimed to comprehensively examine the respiratory effects of ASD, focusing on the spatial distribution of inhaled ASD fine particles within the lungs and the immediate physiological responses they incite. Intratracheal administration of ASD fine particles in mice resulted in efficient phagocytosis by alveolar macrophages (AMs), leading to subsequent neutrophilic inflammation. A subset of ASD-phagocytosed AMs underwent necroptosis, releasing interleukin-1α (IL-1α), causing an increase in chemokines and neutrophils. These responses occurred rapidly within hours of exposure, with endotoxin in ASD particles contributing to the process. Despite variations in desert sand dust composition based on collection locale and timing, this study's findings provide a foundational basis for understanding the biological effects of desert sand dust. Insights gained into the biological responses to desert sand dust hold promise for developing preventive measures such as air purifiers, and therapeutic agents such as IL-1α neutralizing antibodies, antibacterial agents and cell death inhibitors for human diseases associated with such environmental exposures.

Exploring the Relationship between Wind Patterns and Hospital Admissions Due to Respiratory Symptoms in Children

Respiratory disorders significantly impact adolescents' health, often resulting in hospital admissions. Meteorological elements such as wind patterns have emerged as potential contributors to respiratory symptoms. However, it remains uncertain whether fluctuations in wind characteristics over extended periods have a tangible impact on respiratory health, particularly in regions characterized by distinct annual wind patterns. Crete is situated in the central-eastern Mediterranean Sea and frequently faces southerly winds carrying Sahara Desert sand from Africa and northerly winds from the Aegean Sea. This retrospective study analyzes long-term wind direction data and their relationship to respiratory symptoms observed in children up to 14 years old admitted at the University Hospital of Heraklion between 2002 and 2010. Symptoms such as headache, dyspnea, dry cough, dizziness, tachypnea, throat ache, and earache were predominantly reported during the presence of southern winds. Fever, productive cough, and chest pain were more frequently reported during northern winds. Cough was the most common symptom regardless of the wind pattern. Southern winds were significantly associated with higher probabilities of productive or non-productive cough, headache, dyspnea, tachypnea, dizziness, earache, and throat ache. Northern winds were related to a higher incidence of productive cough. Rhinitis, asthma, allergies, pharyngitis, and sinusitis were related to southern winds, while bronchiolitis and pneumonia were associated with northern winds. These findings underscore the critical role of local climatic factors, emphasizing their potential impact on exacerbating respiratory conditions in children. Moreover, they point out the need for further research to elucidate the underlying mechanisms and develop targeted interventions for at-risk populations.

Improved childhood asthma control after exposure reduction interventions for desert dust and anthropogenic air pollution: the MEDEA randomised controlled trial

INTRODUCTION

Elevated particulate matter (PM) concentrations of anthropogenic and/or desert dust origin are associated with increased morbidity among children with asthma.

OBJECTIVE

The Mitigating the Health Effects of Desert Dust Storms Using Exposure-Reduction Approaches randomised controlled trial assessed the impact of exposure reduction recommendations, including indoor air filtration, on childhood asthma control during high desert dust storms (DDS) season in Cyprus and Greece.

DESIGN, PARTICIPANTS, INTERVENTIONS AND SETTING

Primary school children with asthma were randomised into three parallel groups: (a) no intervention (controls); (b) outdoor intervention (early alerts notifications, recommendations to stay indoors and limit outdoor physical activity during DDS) and (c) combined intervention (same as (b) combined with indoor air purification with high efficiency particulate air filters in children's homes and school classrooms. Asthma symptom control was assessed using the childhood Asthma Control Test (c-ACT), spirometry (forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC)) and fractional exhaled nitric oxide (FeNO).

RESULTS

In total, 182 children with asthma (age; mean=9.5, SD=1.63) were evaluated during 2019 and 2021. After three follow-up months, the combined intervention group demonstrated a significant improvement in c-ACT in comparison to controls (β=2.63, 95% CI 0.72 to 4.54, p=0.007), which was more profound among atopic children (β=3.56, 95% CI 0.04 to 7.07, p=0.047). Similarly, FEV1% predicted (β=4.26, 95% CI 0.54 to 7.99, p=0.025), the need for any asthma medication and unscheduled clinician visits, but not FVC% and FeNO, were significantly improved in the combined intervention compared with controls.

CONCLUSION

Recommendations to reduce exposure and use of indoor air filtration in areas with high PM pollution may improve symptom control and lung function in children with asthma.

TRIAL REGISTRATION NUMBER

NCT03503812.

Short-Term Nitrogen Dioxide Exposure and Emergency Hospital Admissions for Asthma in Children: A Case-Crossover Analysis in England

Background

There is an increasing body of evidence associating short-term ambient nitrogen dioxide (NO2) exposure with asthma-related hospital admissions in children. However, most studies have relied on temporally resolved exposure information, potentially ignoring the spatial variability of NO2. We aimed to investigate how daily NO2 estimates from a highly resolved spatio-temporal model are associated with the risk of emergency hospital admission for asthma in children in England.

Methods

We conducted a time-stratified case-crossover study including 111,766 emergency hospital admissions for asthma in children (aged 0-14 years) between 1st January 2011 and 31st December 2015 in England. Daily NO2 levels were predicted at the patients' place of residence using spatio-temporal models by combining land use data and chemical transport model estimates. Conditional logistic regression models were used to obtain the odds ratios (OR) and confidence intervals (CI) after adjusting for temperature, relative humidity, bank holidays, and influenza rates. The effect modifications by age, sex, season, area-level income deprivation, and region were explored in stratified analyses.

Results

For each 10 µg/m³ increase in NO2 exposure, we observed an 8% increase in asthma-related emergency admissions using a five-day moving NO2 average (mean lag 0-4) (OR 1.08, 95% CI 1.06-1.10). In the stratified analysis, we found larger effect sizes for male (OR 1.10, 95% CI 1.07-1.12) and during the cold season (OR 1.10, 95% CI 1.08-1.12). The effect estimates varied slightly by age group, area-level income deprivation, and region.

Significance

Short-term exposure to NO2 was significantly associated with an increased risk of asthma emergency admissions among children in England. Future guidance and policies need to consider reflecting certain proven modifications, such as using season-specific countermeasures for air pollution control, to protect the at-risk population.

Impact of Global Climate Change on Pulmonary Health: Susceptible and Vulnerable Populations

As fossil fuel combustion continues to power the global economy, the rate of climate change is accelerating, causing severe respiratory health impacts and large disparities in the degree of human suffering. Hotter and drier climates lead to longer and more severe wildland fire seasons, impairing air quality around the globe. Hotter temperatures lead to higher amounts of ozone and particles, causing the exacerbation of chronic respiratory diseases and premature mortality. Longer pollen seasons and higher pollen concentrations provoke allergic airway diseases. In arid regions, accelerated land degradation and desertification are promoting dust pollution and impairing food production and nutritional content that are essential to respiratory health. Extreme weather events and flooding impede healthcare delivery and can lead to poor indoor air quality due to mold overgrowth. Climate and human activities that harm the environment and ecosystem may also affect the emergence and spread of viral infections, including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and associated morbidity and mortality exacerbated by air pollution. Children and elderly individuals are more susceptible to the adverse health effects of climate change. Geographical and socioeconomic circumstances, together with a decreased capacity to adapt, collectively increase vulnerability to the adverse effects of climate change. Successful mitigation of anthropogenic climate change is dependent on the commitment of energy-intensive nations to manage greenhouse gas emissions, as well as societal support and response to aggravating factors. In this review, we focus on the respiratory health impacts of global climate change, with an emphasis on susceptible and vulnerable populations and low- and middle-income countries.

Cold-induced adaptive thermogenesis is impaired by exposure of Asian sand dust in mice

Desertification and desert sandstorms caused by the worsening global warming pose increasing risks to human health. In particular, Asian sand dust (ASD) exposure has been related to an increase in mortality and hospital admissions for respiratory diseases. In this study, we investigated the effects of ASD on metabolic tissues in comparison to diesel particulate matter (DPM) that is known to cause adverse health effects. We found that larger lipid droplets were accumulated in the brown adipose tissues (BAT) of ASD-administered but not DPM-administered mice. Thermogenic gene expression was decreased in these mice as well. When ASD-administered mice were exposed to the cold, they failed to maintain their body temperature, suggesting that the ASD administration had led to impairments in cold-induced adaptive thermogenesis. However, impaired thermogenesis was not observed in DPM-administered mice. Furthermore, mice fed a high-fat diet that were chronically administered ASD demonstrated unexplained weight loss, indicating that chronic administration of ASD could be lethal in obese mice. We further identified that ASD-induced lung inflammation was not exacerbated in uncoupling protein 1 knockout mice, whose thermogenic capacity is impaired. Collectively, ASD exposure can impair cold-induced adaptive thermogenic responses in mice and increase the risk of mortality in obese mice.

Responses of schoolchildren with asthma to recommendations to reduce desert dust exposure: Results from the LIFE-MEDEA intervention project using wearable technology

Current public health recommendations for desert dust storms (DDS) events focus on vulnerable population groups, such as children with asthma, and include advice to stay indoors and limit outdoor physical activity. To date, no scientific evidence exists on the efficacy of these recommendations in reducing DDS exposure. We aimed to objectively assess the behavioral responses of children with asthma to recommendations for reduction of DDS exposure. In two heavily affected by DDS Mediterranean regions (Cyprus & Crete, Greece), schoolchildren with asthma (6-11 years) were recruited from primary schools and were randomized to control (business as usual scenario) and intervention groups. All children were equipped with pedometer and GPS sensors embedded in smartwatches for objective real-time data collection from inside and outside their classroom and household settings. Interventions included the timely communication of personal DDS alerts accompanied by exposure reduction recommendations to both the parents and school-teachers of children in the intervention group. A mixed effect model was used to assess changes in daily levels of time spent, and steps performed outside classrooms and households, between non-DDS and DDS days across the study groups. The change in the time spent outside classrooms and homes, between non-DDS and DDS days, was 37.2 min (p_value = 0.098) in the control group and -62.4 min (p_value < 0.001) in the intervention group. The difference in the effects between the two groups was statistically significant (interaction p_value < 0.001). The change in daily steps performed outside classrooms and homes, was -495.1 steps (p_value = 0.350) in the control group and -1039.5 (p_value = 0.003) in the intervention group (interaction p_value = 0.575). The effects on both the time and steps performed outside were more profound during after-school hours. To summarize, among children with asthma, we demonstrated that timely personal DDS alerts and detailed recommendations lead to significant behavioral changes in contrast to the usual public health recommendations.

Cannabis, an emerging aeroallergen in southeastern Spain (Region of Murcia)

The evolution of the behaviour of the Cannabis taxon in the Region of Murcia, Spain, has been analysed (in the cities of Cartagena, 1993-2020; Murcia, 2010-2020; and Lorca, 2010-2020). An attempt has been made to establish the origin of Cannabis pollen in this region to determine whether it is transported locally or from long distances based on air mass origins. Cannabis is an herbaceous, normally dioecious and anemophilous plant, which produces large quantities of pollen grains. It has been widely used for fibre (hemp), bird food (hempseed), essential oils and narcotics. The origin of Cannabis pollen grains has been established by calculating back trajectories at the altitudes of: 750, 1500 and 2500 m above mean sea level (m amsl); 350, 500 and 650 m amsl; and 10, 100 and 250 m amsl, using the HYSPLIT model. Considering this data, 29 days of Cannabis pollen potentially originating in Africa were identified in Cartagena, 19 days in Murcia and 15 days in Lorca. Of the remaining days, the air mass back trajectories showed local or regional pollen origins. These were 83 days in Cartagena, 61 days in Murcia and 57 days in Lorca. The presence of Cannabis in the bioaerosol of the Region of Murcia is irregular, and it is considered a minority pollen type. However, from 2017 to 2020, concentrations increased, with a positive and significant trend of 90% in the Annual Pollen Integral. The pollen season can be defined between June and August. This increase in the concentration of Cannabis pollen grains during this period coincides with an increase in local transport, suggesting the possibility of increased Cannabis cultivation in the study area.

Comparison of the Concentration of Suspended Particles and Their Chemical Composition near the Ground Surface and Dust Extinction Coefficient by LIDAR

In many epidemiological studies, the dust extinction coefficient measured by light detection and ranging (LIDAR) is used as an indicator of exposure to Asian dust. However, few reports on the relationship between the distribution of total suspended particles (TSPs) near the ground surface and the dust extinction coefficient exist. In this study, we examined the relationship between the concentrations of TSPs near the ground surface, substances indicative of mineral content, and air pollutants that may be transported with Asian dust and dust extinction coefficients in two regions: Imizu and Yurihama-Matsue, from March to May in 2011 and 2013. In both years, large dust extinction coefficients were observed in Imizu and Matsue on days when the concentrations of TSPs and mineral content indicators were high near the ground surface in Imizu and Yurihama, and Asian dust was expected to be highly suspended. In both regions, the concentrations of TSPs and mineral content indicators were significantly positively correlated with the dust extinction coefficient. The concentrations of all air pollutants analyzed were significantly positively correlated with the dust extinction coefficient in each region in 2013, but not in 2011. These results suggest that the dust extinction coefficient is a useful indicator of Asian dust near the ground surface; however, as harmful air pollutants occasionally move with Asian dust, it is necessary to monitor these pollutants near the ground surface when conducting an epidemiological study on the health effect of airborne particles.

Asian dust storms result in a higher risk of the silicosis hospital admissions

PURPOSE

Previous studies found that silicosis was majorly associated with occupation-related risks. However, little evidence was available to clarify the relation between Asian dust storm (ADS) and silicosis hospital admissions. This present paper aims to investigate the association between ADS events and hospital admissions for silicosis.

METHODS

We applied a Poisson time-series regression on the 2000-2012 National Health Insurance Research Database in Taiwan, linking air quality data and ambient temperature data to estimate the impact of ADS on silicosis hospital admissions in the age-specific groups.

RESULTS

A total of 2154 hospital admissions were recorded for silicosis in Taiwan, for a daily average number of 0.45. The number rises from 0.43 on a day without ADS to 0.70 on the outbreak day and continues increasing to 0.83 one day after outbreak. Among patients under 45, the effect of ADS appears on the event day as well as several post-event days (lag2-6) at the significant level of p < 0.1. There is also a significant lag effect on post-event day 2 (p < 0.05) for those aged above 74.

CONCLUSION

Asian dust storms do result in a rise of silicosis hospital admissions, particularly for those above 74, those under 45, and for females.

Tracheitis hospital admissions are associated with Asia dust storm

The risks of tracheitis have been widely studied, but no investigation has yet to assess the impact of air pollutants on tracheitis hospital admissions. This research explores the relationship between Asia dust storm (ADS) and tracheitis hospital admissions, by using a Poisson time-series model on the 2000-2012 National Health Insurance Research Database (NHIRB) from Taiwan and linking air pollutants and temperature data. From a total of 126,013 tracheitis hospital admissions, the average number of daily tracheitis hospital admissions is 26.53 and increases 10% notably one day after ADS. The empirical result shows that ADS does significantly affect tracheitis hospital admissions 3 and 5 days after an event for the overall sample and 2-4 days after it for females. For the age group <45, the number significantly increases 3-4 days after ADS, revealing that ADS has a prolonged effect on tracheitis hospital admissions.

Changes in Ambient Bacterial Community in Northern Taiwan during Long-Range Transport: Asian Dust Storm and Frontal Pollution

Long-range transport (LRT) can carry air pollutants to downwind areas. However, studies about the impacts of LRT on bacterial communities are few. This study investigated the influence of Asian dust storms (ADS) and frontal pollution (FP) on bacterial communities in ambient air using next-generation sequencing (NGS) and Terminal Restriction Fragment Length Polymorphism (T-RFLP). Air samples were collected at Cape Fugui (CF) and National Taiwan University (NTU) in northern Taiwan before (or background days), during, and after LRTs from November 2013 to March 2015. The richness, H index, and evenness increased during FPs and then decreased after FPs. During and after ADS and FP, the prevalence of the phylum Proteobacteria decreased, but that of Firmicutes increased. The dominant class of Proteobacteria changed from Alphaproteobacteria on background days to Betaproteobacteria during LRTs. At the genus level, the high abundance of Ralstonia and Bacillus during FP and Clostridium during ADS were detected at both locations. Additionally, Ralstonia was dominant at CF during ADS. In conclusion, FP and ADS both changed the bacterial community. The indicator genus was Clostridium and Ralstonia for ADS as well as Bacillus and Ralstonia for FP. Given the potential health threats posed by the bioaerosols transported, people should avoid outdoor activities during LRTs.

Saharan Dust and Childhood Respiratory Symptoms in Benin

Mineral dust is one of the largest natural constituents of coarse particulate matter (PM10). Most of these dust emissions originate from northern Africa, and several hundred tera-grams of dust are emitted annually from this region. Previous evidence has linked dust PM10 to adverse respiratory outcomes in children. However, most of these studies have been from high-income countries (HICs) or examined dust from other regions of the world, mainly Asia. Evidence from low-to-middle-income countries (LMICs) in Africa is scarce. Respiratory infections are one of the leading causes of under-five mortality across the globe. However, there is a poignant disparity in studies examining these outcomes in children in the region where most dust is emitted. This study linked remotely sensed satellite data to a nationally representative survey to examine acute exposure to dust in children living in Benin using a time-stratified case-crossover analysis. We identified acute effects of exposure to dust and increased risk of cough in children under five. The effect of increased risk is strongest within two weeks of exposure and dissipates by four weeks. Children living in rural areas and households with lower income had a greater risk of adverse respiratory outcomes when exposed to dust. We could elucidate the specific period and conditions of increased risk for respiratory problems in children living in Benin.

Uncontrolled asthma and household environmental exposures in Puerto Rico

OBJECTIVE

To describe asthma control and household environmental exposures among adults and children with asthma in Puerto Rico.

METHODS

A cross-sectional analysis was conducted using data from the 2014-2016 Behavioral Risk Factor Surveillance System Asthma Call-back Survey on 931 adults and 177 children with current asthma in Puerto Rico. These data were analyzed to assess the prevalence of uncontrolled asthma in Puerto Rico and potential associations with household environmental exposure to cockroaches, smoke, and mold. Asthma control was classified using daytime and nighttime symptoms, activity limitation, and short-acting beta agonist use. Prevalence and prevalence ratios were calculated, adjusting for sample weighting.

RESULTS

An estimated 53% of adults with asthma and 29% of children with asthma in Puerto Rico have uncontrolled asthma. Among adults with asthma, in the past 30 days, 29% had seen or smelled mold and 50% had seen cockroaches; in the past week, 12% reported having someone smoke in their home. Adults with uncontrolled asthma were 1.4 times more likely to have observed mold in their homes than were those with controlled asthma when adjusting for age, sex, education, and income (prevalence ratio [95% confidence interval]: 1.4 [1.1, 1.8]). Children with uncontrolled asthma were also more likely to have mold observed in their home than were children with controlled asthma (adjusted PR [95% CI]: 3.0 [1.3, 7.1]).

CONCLUSIONS

Uncontrolled asthma is common among adults and children with asthma in Puerto Rico. These results suggest potential differences in household mold exposure by asthma control status.

Role of Particulate Matter from Afghanistan and Iraq in Deployment-Related Lung Disease

Approximately 3 million United States military personnel and contractors were deployed to Southwest Asia and Afghanistan over the past two decades. After returning to the United States, many developed persistent respiratory symptoms, including those due to asthma, rhinosinusitis, bronchiolitis, and others, which we collectively refer to as deployment-related lung diseases (DRLD). The mechanisms of different DRLD have not been well defined. Limited studies from us and others suggest that multiple factors and biological signaling pathways contribute to the onset of DRLD. These include, but are not limited to, exposures to high levels of particulate matter (PM) from sandstorms, burn pit combustion products, improvised explosive devices, and diesel exhaust particles. Once inhaled, these hazardous substances can activate lung immune and structural cells to initiate numerous cell-signaling pathways such as oxidative stress, Toll-like receptors, and cytokine-driven cell injury (e.g., interleukin-33). These biological events may lead to a pro-inflammatory response and airway hyperresponsiveness. Additionally, exposures to PM and other environmental hazards may predispose military personnel and contractors to more severe disease due to the interactions of those hazardous materials with subsequent exposures to allergens and cigarette smoke. Understanding how airborne exposures during deployment contribute to DRLD may identify effective targets to alleviate respiratory diseases and improve quality of life in veterans and active duty military personnel.

Mechanisms underlying the health effects of desert sand dust

Desertification and climate change indicate a future expansion of the global area of dry land and an increase in the risk of drought. Humans may therefore be at an ever-increasing risk of frequent exposure to, and resultant adverse health effects of desert sand dust. This review appraises a total of 52 experimental studies that have sought to identify mechanisms and intermediate endpoints underlying epidemiological evidence of an impact of desert dust on cardiovascular and respiratory health. Toxicological studies, in main using doses that reflect or at least approach real world exposures during a dust event, have demonstrated that virgin sand dust particles and dust storm particles sampled at remote locations away from the source induce inflammatory lung injury and aggravate allergen-induced nasal and pulmonary eosinophilia. Effects are orchestrated by cytokines, chemokines and antigen-specific immunoglobulin potentially via toll-like receptor/myeloid differentiation factor signaling pathways. Findings suggest that in addition to involvement of adhered chemical and biological pollutants, mineralogical components may also be implicated in the pathogenesis of human respiratory disorders during a dust event. Whilst comparisons with urban particulate matter less than 2.5 μm in diameter (PM2.5) suggest that allergic inflammatory responses are greater for microbial element-rich dust- PM2.5, aerosols generated during dust events appear to have a lower oxidative potential compared to combustion-generated PM2.5 sampled during non-dust periods. In vitro findings suggest that the significant amounts of suspended desert dust during storm periods may provide a platform to intermix with chemicals on its surfaces, thereby increasing the bioreactivity of PM2.5 during dust storm episodes, and that mineral dust surface reactions are an unrecognized source of toxic organic chemicals in the atmosphere, enhancing toxicity of aerosols in urban environments. In summary, the experimental research on desert dust on respiratory endpoints go some way in clarifying the mechanistic effects of atmospheric desert dust on the upper and lower human respiratory system. In doing so, they provide support for biological plausibility of epidemiological associations between this particulate air pollutant and events including exacerbation of asthma, hospitalization for respiratory infections and seasonal allergic rhinitis.

Lung Inflammatory Response to Environmental Dust Exposure in Mice Suggests a Link to Regional Respiratory Disease Risk

PURPOSE

The Salton Sea, California's largest lake, is designated as an agricultural drainage reservoir. In recent years, the lake has experienced shrinkage due to reduced water sources, increasing levels of aerosolized dusts in surrounding regions. Communities surrounding the Salton Sea have increased asthma prevalence versus the rest of California; however, a connection between dust inhalation and lung health impacts has not been defined.

METHODS

We used an established intranasal dust exposure murine model to study the lung inflammatory response following single or repetitive (7-day) exposure to extracts of dusts collected in regions surrounding the Salton Sea (SSDE), complemented with in vitro investigations assessing SSDE impacts on the airway epithelium.

RESULTS

In these investigations, single or repetitive SSDE exposure induced significant lung inflammatory cytokine release concomitant with neutrophil influx. Repetitive SSDE exposure led to significant lung eosinophil recruitment and altered expression of genes associated with allergen-mediated immune response, including Clec4e. SSDE treatment of human bronchial epithelial cells (BEAS-2B) induced inflammatory cytokine production at 5- and 24-hours post-treatment. When BEAS-2B were exposed to protease activity-depleted SSDE (PDSSDE) or treated with SSDE in the context of protease-activated receptor-1 and -2 antagonism, inflammatory cytokine release was decreased. Furthermore, repetitive exposure to PDSSDE led to decreased neutrophil and eosinophilic influx and IL-6 release in mice compared to SSDE-challenged mice.

CONCLUSION

These investigations demonstrate potent lung inflammatory responses and tissue remodeling in response to SSDE, in part due to environmental proteases found within the dusts. These studies provide the first evidence supporting a link between environmental dust exposure, protease-mediated immune activation, and respiratory disease in the Salton Sea region.

Do Saharan Dust Days Carry a Risk of Hospitalization From Respiratory Diseases for Citizens of the Canary Islands (Spain)?

BACKGROUND

Saharan dust meets the Canary Islands at the beginning of its westward path across the North Atlantic, exceeding the European daily levels for PM10; for this reason, their two provincial capital cities, constitute optimal sites where to evaluate the health effects of this natural event.

OBJECTIVES

To assess the short-term association between Saharan Dust Days (SDDs) and respiratory morbidity in the two capital cities.

METHODS

We carried out a time-series analysis with daily emergency hospital admissions due to all respiratory system diseases, chronic obstructive pulmonary disease (COPD) and asthma between 2001 and 2005, assessing the independent effect of SDDs, defined according to the application of the methodology accepted by the European Environmental Office. We also examined accumulated effect, and some other specific SDDs' features.

RESULTS

We found a short-term association between SDDs and the increase in admission risk for the three outcomes during concurrent SDDs, compared to non-SDDs, that spread from 0 to 5th day: 22.6% (95% confidence interval [CI], 10.4, 36.0) for all respiratory diseases and 29.9% (95%CI: 6.6, 58.4) for COPD in Santa Cruz de Tenerife, and 33.4% (95%CI: -2.1,82.0) for asthma in Las Palmas de Gran Canaria. We obtained a robust association when Saharan dust transported at low altitude, when SDDs belonged to long episodes (≥5days), from the fifth SDD onwards and those SDDs with medium (50<PM<150) or high (≥150) PM10 levels.

CONCLUSIONS

We found evidence that SDDs carry a risk of emergency hospital admission from respiratory diseases in the Canary Islands.

Association with Ambient Air Pollutants and School Absence Due to Sickness in Schoolchildren: A Case-Crossover Study in a Provincial Town of Japan

The effect of ambient air pollutants and Asian dust (AD) on absence from school due to sickness has not been well researched. By conducting a case-crossover study, this study investigated the influence of ambient air pollutants and desert sand dust particles from East Asia on absence from school due to sickness. From November 2016 to July 2018, the daily cases of absence due to sickness were recorded in five elementary schools in Matsue, Japan. During the study period, a total of 16,915 absence cases were recorded, which included 4865 fever cases and 2458 cough cases. The relative risk of overall absence in a 10-μg/m³ increment of PM_2.5 and a 0.1-km^-1 of desert sand dust particles from East Asia were found with 1.28 (95%CI: 1.15-1.42) and 2.15 (1.04-4.45) at lag0, respectively. The significant influence of PM_2.5 persisted at lag5 and that of desert sand dust particles at lag2. NO₂ had statistically significant effects at lag2, lag3, and lag4. However, there was no evidence of a positive association of O_x and SO₂ with absence from school. These results suggested that PM_2.5, NO₂, and AD increased the risk of absence due to sickness in schoolchildren.

Investigating the effects of dust storms on morbidity and mortality due to cardiovascular and respiratory diseases: A systematic review

New epidemiological studies acknowledge the detrimental effects of dust storms on health. The aim of this study was to systematically review the effects of dust storms on the morbidity and mortality rates of cardiovascular and respiratory diseases. The results of this study were obtained based on articles published in English-language journals. For the purpose of this study, all articles published until the end of 2020 based on the search in the "Scopus," "Web of Science," and "PubMed" databases were selected. Articles were searched independently by two trained researchers. Dust storms are the cause of many diseases and health-related complications, of which cardiovascular and respiratory diseases are common. It is necessary to recognize and investigate the harmful effects of dust storms to prevent serious harms to human societies. In the reviewed articles, the impact of dust storms on several diseases, including cardiovascular and respiratory diseases, has been analyzed. Most of these articles acknowledge the effect of dust storms on increasing the incidence and mortality rate of these diseases, although in some articles this effect is not statistically significant. Many studies conducted around the world confirm the harmful effects of dust storms on cardiovascular and respiratory diseases, including increase in the number and duration of hospitalizations, as well as increase in mortality and exacerbation of these diseases. However, some studies do not consider the harmful effects of dust storms on the above diseases to be statistically significant.

Global Health Impacts of Dust Storms: A Systematic Review

BACKGROUND

Dust storms and their impacts on health are becoming a major public health issue. The current study examines the health impacts of dust storms around the world to provide an overview of this issue.

METHOD

In this systematic review, 140 relevant and authoritative English articles on the impacts of dust storms on health (up to September 2019) were identified and extracted from 28 968 articles using valid keywords from various databases (PubMed, WOS, EMBASE, and Scopus) and multiple screening steps. Selected papers were then qualitatively examined and evaluated. Evaluation results were summarized using an Extraction Table.

RESULTS

The results of the study are divided into two parts: short and long-term impacts of dust storms. Short-term impacts include mortality, visitation, emergency medical dispatch, hospitalization, increased symptoms, and decreased pulmonary function. Long-term impacts include pregnancy, cognitive difficulties, and birth problems. Additionally, this study shows that dust storms have devastating impacts on health, affecting cardiovascular and respiratory health in particular.

CONCLUSION

The findings of this study show that dust storms have significant public health impacts. More attention should be paid to these natural hazards to prepare for, respond to, and mitigate these hazardous events to reduce their negative health impacts.Registration: PROSPERO registration number CRD42018093325.

Positive Externalities of Climate Change Mitigation and Adaptation for Human Health: A Review and Conceptual Framework for Public Health Research

Anthropogenic climate change is adversely impacting people and contributing to suffering and increased costs from climate-related diseases and injuries. In responding to this urgent and growing public health crisis, mitigation strategies are in place to reduce future greenhouse gas emissions (GHGE) while adaptation strategies exist to reduce and/or alleviate the adverse effects of climate change by increasing systems' resilience to future impacts. While these strategies have numerous positive benefits on climate change itself, they also often have other positive externalities or health co-benefits. This knowledge can be harnessed to promote and improve global public health, particularly for the most vulnerable populations. Previous conceptual models in mitigation and adaptation studies such as the shared socioeconomic pathways (SSPs) considered health in the thinking, but health outcomes were not their primary intention. Additionally, existing guidance documents such as the World Health Organization (WHO) Guidance for Climate Resilient and Environmentally Sustainable Health Care Facilities is designed primarily for public health professionals or healthcare managers in hospital settings with a primary focus on resilience. However, a detailed cross sectoral and multidisciplinary conceptual framework, which links mitigation and adaptation strategies with health outcomes as a primary end point, has not yet been developed to guide research in this area. In this paper, we briefly summarize the burden of climate change on global public health, describe important mitigation and adaptation strategies, and present key health benefits by giving context specific examples from high, middle, and low-income settings. We then provide a conceptual framework to inform future global public health research and preparedness across sectors and disciplines and outline key stakeholders recommendations in promoting climate resilient systems and advancing health equity.

Effect of Asian dust on respiratory symptoms among children with and without asthma, and their sensitivity

There has been little study on the effect of Asian dust exposure on respiratory symptoms among children who are vulnerable to environmental factors. In this panel study, we investigated the effect of Asian dust on respiratory symptoms among children with and without asthma, and their sensitivity. Children attending two elementary schools (137 total), and 23 children with asthma from cooperating medical institutions in Fukuoka prefecture were recruited. Subjects measured peak expiratory flow rate (PEF), and recorded asthma-like symptoms, cough, nasal symptoms and use of medication in a diary from April 1, 2013 to June 30, 2013. To assess exposure to Asian dust, we used Light Detection and Ranging (LIDAR) data. For the analysis of the association between Asian dust and respiratory symptoms, the case-crossover design and generalized estimating equation (GEE) models were used. Taking individual sensitivity to respiratory aggravation into consideration, the subjects were classified into three groups: children without asthma, children with asthma who do not use long-term preventive medication (CA) and children with asthma who use long-term preventive medication (CA-LTM). For CA, Asian dust exposure was significantly associated with asthma-like symptoms, with a hazard ratio of 5.17 (95%CI: 1.02=26.12) at Lag0, and the change in %maxPEF, -1.65% (95%CI:-2.82, -0.48) at Lag0. For children without asthma, a statistically significant association was found between Asian dust exposure and the change in %maxPEF, -0.56% (95%CI: -1.31, -0.08) at Lag1. However, no adverse effects were observed in CA-LTM. Temperature had significant effects on %maxPEF for three groups. Asian dust, photochemical oxidant and pollen caused simultaneously additive adverse effects on nasal symptoms for children without asthma. This study suggests the possibility that long-term preventive medication to manage asthma may suppress aggravation of respiratory symptoms due to Asian dust and may be an effective prevention.

The MEDEA childhood asthma study design for mitigation of desert dust health effects: implementation of novel methods for assessment of air pollution exposure and lessons learned

BACKGROUND

Desert dust events in Mediterranean countries, originating mostly from the Sahara and Arabian deserts, have been linked to climate change and are associated with significant increase in mortality and hospital admissions from respiratory causes. The MEDEA clinical intervention study in children with asthma is funded by EU LIFE+ program to evaluate the efficacy of recommendations aiming to reduce exposure to desert dust and related health effects.

METHODS

This paper describes the design, methods, and challenges of the MEDEA childhood asthma study, which is performed in two highly exposed regions of the Eastern Mediterranean: Cyprus and Greece-Crete. Eligible children are recruited using screening surveys performed at primary schools and are randomized to three parallel intervention groups: a) no intervention for desert dust events, b) interventions for outdoor exposure reduction, and c) interventions for both outdoor and indoor exposure reduction. At baseline visits, participants are enrolled on MEDena® Health-Hub, which communicates, alerts and provides exposure reduction recommendations in anticipation of desert dust events. MEDEA employs novel environmental epidemiology and telemedicine methods including wearable GPS, actigraphy, health parameters sensors as well as indoor and outdoor air pollution samplers to assess study participants' compliance to recommendations, air pollutant exposures in homes and schools, and disease related clinical outcomes.

DISCUSSION

The MEDEA study evaluates, for the first time, interventions aiming to reduce desert dust exposure and implement novel telemedicine methods in assessing clinical outcomes and personal compliance to recommendations. In Cyprus and Crete, during the first study period (February-May 2019), a total of 91 children participated in the trial while for the second study period (February-May 2020), another 120 children completed data collection. Recruitment for the third study period (February-May 2021) is underway. In this paper, we also present the unique challenges faced during the implementation of novel methodologies to reduce air pollution exposure in children. Engagement of families of asthmatic children, schools and local communities, is critical. Successful study completion will provide the knowledge for informed decision-making both at national and international level for mitigating the health effects of desert dust events in South-Eastern Europe.

TRIAL REGISTRATION

ClinicalTrials.gov: NCT03503812 , April 20, 2018.

Health in dust belt cities and beyond-an essay by Nick Middleton

Desert dust is associated with morbidity and mortality, and distant spread means lessons for mitigating the harms can be found by looking beyond cities in arid regions, writes Nick Middleton

Prevalence of Asthma and Sleep-Related Breathing Disorder in School-Going Children

Objective:

The main objective of the study was to determine the prevalence of asthma and sleep-related breathing disorder (SRBD) in school-going children.

Methods:

This school-based, cross-sectional study was conducted among children of age groups of 6–7 and 13–14 years from 31 public and private schools in rural and urban areas of Jodhpur. A pretested and validated questionnaire in Hindi for childhood asthma, International Study of Asthma and Allergies in Childhood questionnaire and 22-item pediatric SRBD scale were used to collect data.

Results:

A total of 2245 children were screened for asthma and SRBD. The overall prevalence of asthma and SRBD in school children in Jodhpur was 8.0% (95% confidence interval [CI]: 6.9%–9.2%) and 9.5% (95% CI: 8.4–10.8), respectively. Asthma was found to be significantly associated with SRBD in school-going children in Jodhpur (odds ratio: 4.8; 95% CI: 3.3–6.8) on multiple logistic regression analysis.

Conclusion:

There is a significantly high prevalence of asthma and SRBD with a good association between them in school-going children.

Critical role of IL-33, but not IL-25 or TSLP, in silica crystal-mediated exacerbation of allergic airway eosinophilia

Silica crystals (silica), which are a major mineral component of volcanic ash and desert dust, contribute to the pathogenesis of pulmonary disorders such as asthma and fibrosis. Although administration of silica or sand dust to rodents exacerbates development of ovalbumin-induced or house dust mite-induced asthma-like airway inflammation, the detailed mechanisms remain unclear. Here, using murine models, we found that silica can induce IL-33 expression in pulmonary epithelial cells. IL-33, but not IL-25 or TSLP, and type 2 cytokines such as IL-5 and IL-13 were critically involved in silica's exacerbation of OVA-induced airway eosinophilia in mice. Innate lymphoid cells (ILCs), but not T, B or NKT cells, were also involved in the setting. Moreover, a scavenger receptor that recognized silica was important for silica's exacerbating effect. These observations suggest that IL-33 induced in epithelial cells by silica activates ILCs to produce IL-5 and/or IL-13, contributing to silica's exacerbation of OVA-induced airway eosinophilia in mice. Our findings provide new insight into the underlying mechanisms of exacerbation of pulmonary disorders such as asthma following inhalation of silica-containing materials such as volcanic ash and desert dust.

Investigating the culturable atmospheric fungal and bacterial microbiome in West Texas: implication of dust storms and origins of the air parcels

Individuals often experience ailments such as allergies, asthma and respiratory tract infections throughout the year. Weather reports often include estimations of common allergens that can affect these individuals. To describe the local 'atmospheric microbiome' in Lubbock, Texas, USA, we examined the culturable fungal and bacterial microbiome present in the air on calm and dust storm days using internal transcribed spacer (ITS)-1 and 16S rRNA amplicon sequencing, respectively. While some types of airborne fungi were frequently present throughout the year, distinct differences were also observed between calm and dust storm days. We also observed the influence of the origin of air parcels and wind elevation of the air trajectory. The most abundant genera of fungi identified during the study period were Cryptococcus, Aureobasidium, Alternaria, Cladosporium and Filobasidium. This observation was not surprising considering the agricultural intensive environment of West Texas. Interestingly, Cladosporium, a common allergenic mold, was increased during days with dust storm events. The predominant bacterial genera observed were Bacillus, Pseudomonas, Psychrobacter, Massilia and Exiguobacterium. The relative abundance of the psychrophiles, Psychrobacter and Exiguobacterium, was surprising, given the semi-aridity of West Texas. Coupling our observations with back trajectories of the wind (Hybrid Single-Particle Lagrangian Integrated Trajectory models) demonstrated that dust storms, regional anthropogenic activity and origin of air parcels are important influences on the diversity and temporal presence of the atmospheric microbiome.

Association between African Dust Transport and Acute Exacerbations of COPD in Miami

Background: Air pollution is increasingly recognized as a risk factor for acute exacerbation of chronic obstructive pulmonary disease (COPD). Changing climate and weather patterns can modify the levels and types of air pollutants. For example, dust outbreaks increase particulate air pollution. Objective: This paper examines the effect of Saharan dust storms on the concentration of coarse particulate matter in Miami, and its association with the risk of acute exacerbation of COPD (AECOPD). Methods: In this prospective cohort study, 296 COPD patients (with 313 events) were followed between 2013 and 2016. We used Light Detection and Ranging (LIDAR) and satellite-based Aerosol Optical Depth (AOD) to identify dust events and quantify particulate matter (PM) exposure, respectively. Exacerbation events were modeled with respect to location- and time-lagged dust and PM exposures, using multivariate logistic regressions. Measurements and main results: Dust duration and intensity increased yearly during the study period. During dust events, AOD increased by 51% and particulate matter ≤2.5 µm in aerodynamic diameter (PM_2.5) increased by 25%. Adjusting for confounders, ambient temperature and local PM_2.5 exposure, one-day lagged dust exposure was associated with 4.9 times higher odds of two or more (2+ hereto after) AECOPD events (odds ratio = 4.9; 95% CI = 1.8–13.4; p < 0.001). Ambient temperature exposure also showed a significant association with 2+ and 3+ AECOPD events. The risk of AECOPD lasted up to 15 days after dust exposure, declining from 10× higher on day 0 to 20% higher on day 15. Conclusions: Saharan dust outbreaks observed in Miami elevate the concentration of PM and increase the risk of AECOPD in COPD patients with recurring exacerbations.

Associations Between Dust Storms and Intensive Care Unit Admissions in the United States, 2000-2015

Anthropogenic climate change is influencing the incidence of dust storms and associated human exposure to coarse particulate matter (PM2.5-10) in the United States. Studies have found adverse health consequences related to dust exposure. These consequences include respiratory disease exacerbations and premature mortality, resulting in increased health care utilization. However, the impact of dust storms on critical care demand has not been studied in the United States. We seek to quantify the relationship between dust storms and surges in critical care demand by investigating the association between dust storms and intensive care unit (ICU) admissions at nearby hospitals from 2000 to 2015. ICU data were acquired from Premier, Inc. and encompass 15-20% of all ICU admissions in the United States. Dust storm, meteorology, and air pollutant data were downloaded from the U.S. National Weather Service, the U.S. National Climatic Data Center, and the U.S. Environmental Protection Agency websites, respectively. Associations between ICU admission and dust storms, controlling for temperature, dew point temperature, ambient PM2.5 and ozone, as well as seasonally varying confounders, were estimated using a distributed lag conditional Poisson model with overdispersion. We found a 4.8% (95% CI: 0.4, 9.4; p = 0.033) increase in total ICU admissions on the day of the dust storm (Lag 0) and a 9.2% (95% CI: 1.8, 17.0; p = 0.013) and 7.5% (95% CI: 0.3, 15.2; p = 0.040) increase in respiratory admissions at Lags 0 and 5. North American dust storms are associated with increases in same day and lagged demand for critical care services at nearby hospitals.

Characterizing environmental asthma triggers and healthcare use patterns in Puerto Rico

Objective: Asthma carries a high burden of disease for residents of Puerto Rico. We conducted this study to better understand asthma-related healthcare use and to examine potential asthma triggers.Methods: We characterized asthma-related healthcare use in 2013 by demographics, region, and date using outpatient, hospital, and emergency department (ED) insurance claims with a primary diagnostic ICD-9-CM code of 493.XX. We examined environmental asthma triggers, including outdoor allergens (i.e., mold and pollen), particulate pollution, and influenza-like illness. Analyses included descriptive statistics and Poisson time-series regression.Results: During 2013, there were 550,655 medical asthma claims reported to the Puerto Rico Healthcare Utilization database, representing 148 asthma claims/1,000 persons; 71% of asthma claims were outpatient visits, 19% were hospitalizations, and 10% were ED visits. Females (63%), children aged ≤9 years (77% among children), and adults aged ≥45 years (80% among adults) had the majority of asthma claims. Among health regions, Caguas had the highest asthma claim-rate at 142/1,000 persons (overall health region claim-rate = 108). Environmental exposures varied across the year and demonstrated seasonal patterns. Metro health region regression models showed positive associations between increases in mold and particulate matter <10 microns in diameter (PM10) and outpatient asthma claims.Conclusions: This study provides information about patterns of asthma-related healthcare use across Puerto Rico. Increases in mold and PM10 were associated with increases in asthma claims. Targeting educational interventions on exposure awareness and reduction techniques, especially to persons with higher asthma-related healthcare use, can support asthma control activities in public health and clinical settings.

Development of a system for the detection of the inflammatory response induced by airborne fine particulate matter in rat tracheal epithelial cells

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Atmospheric endotoxin level is related to inflammatory response induction

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Stable cell lines established to determine the expression of pro-inflammatory genes

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Our system serves monitoring of inflammatory response to airborne particulate matter

Exposure to airborne particulate matter (PM) is related to the increased risk of several diseases, including chronic and allergic rhinitis. We have previously shown that atmospheric endotoxin level was positively associated with the number of emergency department visits for asthma even after adjusting for meteorological factors, suggestive of the significant association between atmospheric endotoxin level and asthma exacerbation. Whether atmospheric endotoxin level is related to inflammatory response induction is, however, unclear. Here, we established stable cell lines to determine the promoter activity of the genes encoding pro-inflammatory cytokines such as tumor necrosis factor alpha, interleukin 6 (IL6), and IL33 by transfection of each reporter plasmid into rat tracheal epithelial EGV-4 T cells. These cells could measure the inflammatory response induced by endotoxin treatment more easily, rapidly, and sensitively than the conventional system using immunodetection assays. Furthermore, we revealed a relationship between atmospheric endotoxin level and inflammatory response induction. Thus, the system established herein may serve as a promising tool to monitor inflammatory response induced upon PM exposure.

Development of a system for the detection of the inflammatory response induced by airborne fine particulate matter in rat tracheal epithelial cells

Exposure to airborne particulate matter (PM) is related to the increased risk of several diseases, including chronic and allergic rhinitis. We have previously shown that atmospheric endotoxin level was positively associated with the number of emergency department visits for asthma even after adjusting for meteorological factors, suggestive of the significant association between atmospheric endotoxin level and asthma exacerbation. Whether atmospheric endotoxin level is related to inflammatory response induction is, however, unclear. Here, we established stable cell lines to determine the promoter activity of the genes encoding pro-inflammatory cytokines such as tumor necrosis factor alpha, interleukin 6 (IL6), and IL33 by transfection of each reporter plasmid into rat tracheal epithelial EGV-4 T cells. These cells could measure the inflammatory response induced by endotoxin treatment more easily, rapidly, and sensitively than the conventional system using immunodetection assays. Furthermore, we revealed a relationship between atmospheric endotoxin level and inflammatory response induction. Thus, the system established herein may serve as a promising tool to monitor inflammatory response induced upon PM exposure.

Occurrence and sources of chromophoric organic carbon in fine particulate matter over Xi'an, China

Understanding the characteristics and sources of atmospheric chromophores is essential to assess their impact on climate change and the quality of atmospheric environment. In this work, the fine particulate matter (PM_2.5) samples of Xi'an, China in 2017 were analyzed by excitation-emission matrices and parallel factor analysis (EEM-PARAFAC) method to obtain the species, content, sources and seasonal variation characteristics of atmospheric chromophores. The results showed that humic-like (HULIS) chromophores and polycyclic aromatic hydrocarbons-like (PAHs-like) chromophores were the most abundant chromophores in the samples, accounting for 42% and 33%, respectively. With the aggravation of air pollution, the relative content of low-polarity chromophores increased markedly, while the relative content of polar chromophores decreased. The concentrations of atmospheric chromophores exhibited obvious seasonal variation characteristics: high in winter and low in summer. Similarly, the relative contributions of atmospheric chromophores from each source varied with the season. In addition, special weather and human activities had a significant influence on the source of atmospheric chromophores. Dust source was an important source of atmospheric chromophores, which was susceptible to long-range incoming air masses from northwestern regions in spring. However, the chromophores from the dust source were easily removed by wet precipitation, which was the same as the chromophores from the combustion source. The chromophores from the combustion source were susceptible to human activities. The contribution of combustion source to atmospheric chromophores was reduced due to the implementation of air pollution control policies during the Chinese Spring Festival. In summer, the formation of photochemical secondary chromophores was more significant than in other seasons, and the photochemical secondary chromophores increased due to the formation of liquid phase reactions under high relative humidity conditions.

Japanese guidelines for childhood asthma 2020

The Japanese Guideline for Childhood Asthma (JGCA) 2020 is a translation of the Japanese Pediatric Guideline for the Treatment and Management of Asthma (JPGL) 2017 into English, which was published by the Japanese Society of Pediatric Allergy and Clinical Immunology. It makes recommendations for best practices in the management of childhood asthma, including management of acute exacerbations and non-pharmacological and pharmacological management. These guidelines will be of interest to non-specialist physicians involved in the care of children with asthma. In JPGL, JPGL2017 is the first evidence-based guidelines updated according to the GRADE system and Minds approach, and it addresses eight clinical questions about the treatment of childhood asthma. In children aged ≤5 years, infant and preschool asthma is diagnosed according to the response to short acting beta2 agonists or the effect of a therapeutic trial during 1 month with controller treatment and worsening after treatment cessation. Long-term management both promotes pharmacological therapy and measures against risk factors that induce exacerbation, better patient education and a partnership with trinity. In addition, long-term management should not be carried out without review but rather be based on a cycle of evaluation, adjustment and treatment. In JPGL2017, the transdermal patch and oral beta2 agonists are positioned as drugs within the concept of "short-term additional treatment" to be used until the symptoms are stabilized when the control state transiently deteriorates.

Health Effects of Asian Dust: A Systematic Review and Meta-Analysis

BACKGROUND

Potential adverse health effects of Asian dust exposure have been reported, but systematic reviews and quantitative syntheses are lacking.

OBJECTIVE

We reviewed epidemiologic studies that assessed the risk of mortality, hospital admissions, and symptoms/dysfunction associated with exposure to Asian dust.

METHODS

We performed a systematic search of PubMed and Web of Science to identify studies that reported the association between Asian dust exposure and human health outcomes. We conducted separate meta-analyses using a random-effects model for mortality and hospital admissions for a specific health outcome and assessed pooled estimates for each lag when at least three studies were available for a specific lag.

RESULTS

We identified 89 studies that met our inclusion criteria for the systematic review, and 21 studies were included in the meta-analysis. The pooled estimates (percentage changes) of mortality from circulatory and respiratory causes for Asian dust days vs. non-Asian dust days were 2.33% [95% confidence interval (CI): 0.76, 3.93] increase at lag 0 and 3.99% (95% CI: 0.08, 8.06) increase at lag 3, respectively. The increased risk for hospital admissions for respiratory disease, asthma, and pneumonia peaked at lag 3 by 8.85% (95% CI: 0.80, 17.55), 14.55% (95% CI: 6.74, 22.94), and 8.51% (95% CI: 2.89, 14.44), respectively. Seven of 12 studies reported reduced peak expiratory flow, and 16 of 21 studies reported increased respiratory symptoms associated with Asian dust exposure. There were substantial variations between the studies in definitions of Asian dust, study designs, model specifications, and confounder controls.

DISCUSSION

We found evidence of increased mortality and hospital admissions for circulatory and respiratory events. However, the number of studies included in the meta-analysis was not large and further evidences are merited to strengthen our conclusions. Standardized protocols for epidemiological studies would facilitate interstudy comparisons. https://doi.org/10.1289/EHP5312.

The impact of exposure to desert dust on infants' symptoms and countermeasures to reduce the effects

BACKGROUND

The association between particulate matter (PM), including desert dust, and allergic symptoms has not been well studied. We examined whether PM exacerbated nose/eye/respiratory symptoms in infants, with a focus on the desert dust element, and assessed possible countermeasures.

METHODS

We conducted a panel study of 1492 infants from October 2014 to July 2016 in 3 regions in Japan as an adjunct study of the Japan Environment and Children's Study. Infants' daily symptom scores and behaviors were acquired by web-based questionnaires sent to mothers, who answered within a day using mobile phones. Odds ratios (OR) for symptom development per increased fine PM or desert dust exposure were estimated. Regular use of medications and behaviors on the day of exposure were investigated as possible effect modifiers.

RESULTS

Infants developed nose/eye/respiratory symptoms significantly more often in accordance with fine particulate levels (adjusted OR per 10 µg/m³ increase: 1.04, 95% confidence interval [CI]: 1.01-1.07). A model including both fine particulates and desert dust showed reduced OR for fine particulates and robust OR for desert dust (adjusted OR per 0.1/km increase: 1.16, 95% CI: 1.09-1.23). An increased OR was observed both in infants who had previously wheezed and in those who had never wheezed. Receiving information on the particulate forecast, reducing time outdoors, closing windows, and regular use of leukotriene receptor antagonists were significant effect modifiers.

CONCLUSIONS

Transborder desert dust arrival increased the risk of nose/eye/respiratory symptoms development in infants. Regular use of leukotriene receptor antagonists and other countermeasures reduced the risk.

Quantitative CT-based structural alterations of segmental airways in cement dust-exposed subjects

Background

Dust exposure has been reported as a risk factor of pulmonary disease, leading to alterations of segmental airways and parenchymal lungs. This study aims to investigate alterations of quantitative computed tomography (QCT)-based airway structural and functional metrics due to cement-dust exposure.

Methods

To reduce confounding factors, subjects with normal spirometry without fibrosis, asthma and pneumonia histories were only selected, and a propensity score matching was applied to match age, sex, height, smoking status, and pack-years. Thus, from a larger data set (N = 609), only 41 cement dust-exposed subjects were compared with 164 non-cement dust-exposed subjects. QCT imaging metrics of airway hydraulic diameter (D_h), wall thickness (WT), and bifurcation angle (θ) were extracted at total lung capacity (TLC) and functional residual capacity (FRC), along with their deformation ratios between TLC and FRC.

Results

In TLC scan, dust-exposed subjects showed a decrease of D_h (airway narrowing) especially at lower-lobes (p < 0.05), an increase of WT (wall thickening) at all segmental airways (p < 0.05), and an alteration of θ at most of the central airways (p < 0.001) compared with non-dust-exposed subjects. Furthermore, dust-exposed subjects had smaller deformation ratios of WT at the segmental airways (p < 0.05) and θ at the right main bronchi and left main bronchi (p < 0.01), indicating airway stiffness.

Conclusions

Dust-exposed subjects with normal spirometry demonstrated airway narrowing at lower-lobes, wall thickening at all segmental airways, a different bifurcation angle at central airways, and a loss of airway wall elasticity at lower-lobes. The airway structural alterations may indicate different airway pathophysiology due to cement dusts.

Do Saharan Dust Days Carry a Risk of Hospitalization From Respiratory Diseases for Citizens of the Canary Islands (Spain)?

BACKGROUND

Saharan dust meets the Canary Islands at the beginning of its westward path across the North Atlantic, exceeding the European daily levels for PM10; for this reason, their two provincial capital cities, constitute optimal sites where to evaluate the health effects of this natural event.

OBJECTIVES

To assess the short-term association between Saharan Dust Days (SDDs) and respiratory morbidity in the two capital cities.

METHODS

We carried out a time-series analysis with daily emergency hospital admissions due to all respiratory system diseases, chronic obstructive pulmonary disease (COPD) and asthma between 2001 and 2005, assessing the independent effect of SDDs, defined according to the application of the methodology accepted by the European Environmental Office. We also examined accumulated effect, and some other specific SDDs' features.

RESULTS

We found a short-term association between SDDs and the increase in admission risk for the three outcomes during concurrent SDDs, compared to non-SDDs, that spread from 0 to 5th day: 22.6% (95% confidence interval [CI], 10.4, 36.0) for all respiratory diseases and 29.9% (95%CI: 6.6, 58.4) for COPD in Santa Cruz de Tenerife, and 33.4% (95%CI: -2.1,82.0) for asthma in Las Palmas de Gran Canaria. We obtained a robust association when Saharan dust transported at low altitude, when SDDs belonged to long episodes (≥5days), from the fifth SDD onwards and those SDDs with medium (50

CONCLUSIONS

We found evidence that SDDs carry a risk of emergency hospital admission from respiratory diseases in the Canary Islands.

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Key Words

• African air intrusions
• Calima sahariana
• Enfermedades respiratorias
• Generalized additive model
• Hospital admissions
• Ingresos hospitalarios
• Intrusiones de aire africano
• Modelos aditivos generalizados
• Particulate matter
• Partículas en suspensión
• Respiratory diseases
• Saharan dust
• Series temporales
• Time-series

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Affiliation(s)

Elena López-Villarrubia Dirección General de Salud Pública. Gobierno de Canarias, Alfonso XIII, 4, 35003 Las Palmas de Gran Canaria, Spain; Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, C/ Monforte de Lemos 3-5, 28029 Madrid, Spain.
Olga Costa Estirado Dirección General de Salud Pública. Gobierno de Canarias, Alfonso XIII, 4, 35003 Las Palmas de Gran Canaria, Spain; FISABIO-UJI-Universitat de València, Epidemiology and Environmental Health Joint Research Unit, Avenida de Catalunya 21, 46020 Valencia, Spain
Carmen Íñiguez Hernández Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, C/ Monforte de Lemos 3-5, 28029 Madrid, Spain; FISABIO-UJI-Universitat de València, Epidemiology and Environmental Health Joint Research Unit, Avenida de Catalunya 21, 46020 Valencia, Spain
Ferran Ballester Díez Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, C/ Monforte de Lemos 3-5, 28029 Madrid, Spain; FISABIO-UJI-Universitat de València, Epidemiology and Environmental Health Joint Research Unit, Avenida de Catalunya 21, 46020 Valencia, Spain; Department of Nursing, University of Valencia, C/ Jaume Roig, 46010 Valencia, Spain

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Air pollutants disrupt iron homeostasis to impact oxidant generation, biological effects, and tissue injury

Air pollutants cause changes in iron homeostasis through: 1) a capacity of the pollutant, or a metabolite(s), to complex/chelate iron from pivotal sites in the cell or 2) an ability of the pollutant to displace iron from pivotal sites in the cell. Through either pathway of disruption in iron homeostasis, metal previously employed in essential cell processes is sequestered after air pollutant exposure. An absolute or functional cell iron deficiency results. If enough iron is lost or is otherwise not available within the cell, cell death ensues. However, prior to death, exposed cells will attempt to reverse the loss of requisite metal. This response of the cell includes increased expression of metal importers (e.g. divalent metal transporter 1). Oxidant generation after exposure to air pollutants includes superoxide production which functions in ferrireduction necessary for cell iron import. Activation of kinases and phosphatases and transcription factors and increased release of pro-inflammatory mediators also result from a cell iron deficiency, absolute or functional, after exposure to air pollutants. Finally, air pollutant exposure culminates in the development of inflammation and fibrosis which is a tissue response to the iron deficiency challenging cell survival. Following the response of increased expression of importers and ferrireduction, activation of kinases and phosphatases and transcription factors, release of pro-inflammatory mediators, and inflammation and fibrosis, cell iron is altered, and a new metal homeostasis is established. This new metal homeostasis includes increased total iron concentrations in cells with metal now at levels sufficient to meet requirements for continued function.

[Health Effects of Asian Dust Events: A Literature Review Update of Epidemiological Evidence]

Asian dust is a phenomenon involving the long-range transport of atmospheric pollutants originating from the desert areas of China and Mongolia. In recent years, the health effects of Asian dust have raised public concerns. Numerous studies on the health effects of Asian dust have been published since the last review in 2010. Thus, a literature review was conducted to shed light on the latest epidemiologic findings. PubMed and Science Direct databases were used for the review of epidemiologic studies published between June 2009 and April 2018. We identified 53 epidemiologic studies. Mortality, ambulance transportation, hospitalization/medical examination, changes in symptomatic, functional, and examination findings, as well as birth outcomes have been reported as outcomes. When the outcomes were categorized by disease, the effects of Asian dust on respiratory, cardiovascular, and allergic diseases raised concerns. The common evidences of causation between Asian dust and these diseases were the consistency of findings and temporal sequence of association. As results of research on dose-response relationships have become available, and the possibility that the health effects of Asian dust may vary depending on its chemical composition has been pointed out, further research using the exposure level indicators of Asian dust or its chemical composition should be conducted. Furthermore, with focus on the crucial issue of reducing exposure, research related to prevention and raising awareness should be further promoted.

Dust Heterogeneous Reactions during Long-Range Transport of a Severe Dust Storm in May 2017 over East Asia

Dust aerosol has important climate and environmental effects, which could be changed by internally mixing with anthropogenic aerosol as a result of heterogeneous reactions; however, the importance of these reactions is not fully understood yet. In this study, synergetic observations and an air quality model were used to analyze the transport of a severe dust storm and its impacts on nitrate and sulfate levels over East Asia between 3 and 11 May 2017. The model successfully reproduced the occurrence and transport of the dust storm compared to dust RGB imageries of the Himawari-8 satellite and dust extinction coefficients observed by LIDAR. The model also reasonably simulated the variations of observed nitrate and sulfate concentrations, and the results indicated that the dust heterogeneous reactions were dominant pathways for nitrate formation, but they had limited contribution for sulfate in both fine and coarse mode in Fukuoka, Japan. Dust nitrate formed rapidly after leaving China, and the highest period-averaged concentration of dust nitrate (>5 μg m−3) was shown over the Yellow Sea. Based on model results; we found that the mass ratio of dust nitrate to dust aerosol could reach 10% over the Pacific Ocean. Our results confirmed the importance of heterogeneous reactions on compositions of dust particles.

Cardiovascular and respiratory emergency dispatch due to short-term exposure to ambient PM10 in Dezful, Iran

Introduction: This study was conducted to determine the relation between exposure to particulate matter less than 10 microns (PM₁₀) caused by dust storms and the risk of cardiovascular, respiratory and traffic accident missions carried out by Emergency Medical Services (EMS).

Methods: This was a time-series study conducted in Dezful city, Iran. Daily information on the number of missions by the EMS due to cardiovascular, respiratory and crash problems and data on PM₁₀ were inquired from March 2013 until March 2016. A generalized linear model (GLM) with distributed lag models (DLMs) was used to evaluate the relation between the number of EMS missions and the average daily PM₁₀. The latent effects of PM₁₀ were estimated in single and cumulative lags, up to 14 days.

Results: In the adjusted model, for each IQR increase in the average daily PM₁₀ concentration, the risk of EMS missions in the total population in single lags of 2 to 7 days, and the cumulative lags of 0-7 and 0-14 days after exposure had a 0.8, 0.8, 0.8, 0.8, 0.7, 0.6, 6.7 and 1.4% significant increase. Also, for each IQR increase in the daily mean concentration of PM₁₀ in single 1 to 7, and cumulative lags of 0-2, 0-7, and 0-14 days after exposure, respectively, a 2.4, 2.7, 2.8, 2.9, 2.9, 2.7, 2.5, 7.4, 23.5 and 33. 3 % increase was observed in the risk of EMS cardiovascular missions.

Conclusion: Increase in daily PM₁₀ concentrations in Dezful is associated with an increase in the risk of EMS missions in lags up to two weeks after exposure.

Effect of exposure to Asian sand dust-Particulate matter on liver Tenascin-C expression in human cancer cell and mouse hepatic tissue

Asian Sand Dust-Particulate Matter (ASD-PM) aerosol brings large amounts of wind-eroded soil particles containing high concentrations of metallic components caused by industrialization and vehicles. Proinflammatory and cytotoxic cytokines trigger local inflammatory responses and cause a systematically high incidence of cardiovascular and other diseases. Tenascin C (Tn-C) is known to be expressed in damaged tissue or in a developmental stage of tissue. In this study, we examined the expression of Tn-C and Fibronectin in human cancer-cell lines and in liver tissue of mice treated with ASD-PM to investigate the inflammatory and cell-damage effects of ASD-PM. In our in vivo study, mice were intratracheally instilled with saline suspensions of ASD-PM particles. Instillation of these particles was repeated twice a week for 12 weeks and the liver tissues were stained with hematoxylin, eosin, and Masson's trichrome, and we carried out an IF. Tn-C expression in liver tissues was detected by RT-PCR and western blot analysis. In the results, the expression of Tn-C increased in a dose-dependent manner in both RNA and Immunofluorescence assay (IF). In our in vitro study, A549 and Hep3B cell lines were incubated in culture media with Transforming Growth Factor-Beta1(TGF-β1) and ASD-PM. Immunofluorescence microscopy images showed a two times stronger expression of fluorescence in the ASD-treated group than in that treated with TGF-β1. They also showed a stronger expression of Tn-C in proportion to the concentration of ASD-PM. We confirmed that ASD-PM when inhaled formally migrated to other organs and induced Tn-C expression. ASD-PM containing metals causes expression of Tn-C in liver tissue in proportion to the concentration of ASD-PM.

Associations of chemical composition and sources of PM2.5 with lung function of severe asthmatic adults in a low air pollution environment of urban Nagasaki, Japan

Previous studies have linked ambient PM_2.5 to decreased pulmonary function, but the influence of specific chemical elements and emission sources on the severe asthmatic is not well understood. We examined the mass, chemical constituents, and sources of PM_2.5 for short-term associations with the pulmonary function of adults with severe asthma in a low air pollution environment in urban Nagasaki, Japan. We recruited 35 asthmatic adults and obtained the daily record of morning peak expiratory flow (PEF) in spring 2014-2016. PM_2.5 filters were extracted from an air quality monitoring station (178 days) and measured for 27 chemical elements. Source apportionment was performed using Positive Matrix Factorization (PMF). We fitted generalized linear model with generalized estimating equation (GEE) method to estimate changes in PEF (from personal monthly maximum) and odds of severe respiratory deterioration (first ≥ 15% PEF reduction within a 1-week interval) associated with mass, constituents, and sources of PM_2.5, with adjustment for temperature and relative humidity. Constituent sulfate (SO₄^2-) and PM_2.5 from oil combustion and traffic were associated with reduced PEF. An interquartile range (IQR) increase in SO₄^2- (3.7 μg/m³, average lags 0-1) was associated with a decrease of 0.38% (95% confidence interval = -0.75% to -0.001%). An IQR increase in oil combustion and traffic-sourced PM_2.5 (2.64 μg/m³, lag 1) was associated with a decrease of 0.33% (-0.62% to -0.002%). We found a larger PEF decrease associated with PM_2.5 from dust/soil on Asian Dust days. There was no evidence linking total mass and metals to reduced pulmonary function. The ventilatory capacity of adults with severe asthma is susceptible to specific constituents/sources of PM_2.5 such as sulfate and oil combustion and traffic despite active self-management of asthma and low air pollution levels in the study location.