Air pollution and daily admissions for chronic obstructive pulmonary disease in 6 European cities: results from the APHEA project

Short-Term Effects of Ambient Air Pollution on Chronic Obstructive Pulmonary Disease Admissions in Jiuquan, China

Recent findings indicate that air pollution contributes to the onset and advancement of chronic obstructive pulmonary disease (COPD). Nevertheless, there is insufficient research indicating that air pollution is linked to COPD in the region of inland northwest China. Daily hospital admission records for COPD, air pollutant levels, and meteorological factor information were collected in Jiuquan for this study between 1 January 2018 and 31 December 2019. We employed a distributed lag non-linear model (DLNM) integrated with the generalized additive model (GAM) to assess the association between air pollution and hospital admissions for COPD with single lag days from lag0 to lag7 and multiday moving average lag days from lag01 to lag07. For example, the pollutant concentration on the current day was lag0, and on the prior 7th day was lag7. The present and previous 7-day moving average pollutant concentration was lag07. Gender, age, and season-specific stratified analyses were also carried out. It is noteworthy that the delayed days exhibited a different pattern, and the magnitude of associations varied. For NO2 and CO, obvious associations with hospitalizations for COPD were found at lag1, lag01-lag07, and lag03-lag07, with the biggest associations at lag05 and lag06 [RR = 1.015 (95%CI: 1.008, 1.023) for NO2, RR = 2.049 (95%CI: 1.416, 2.966) for CO], while only SO2 at lag02 was appreciably linked to hospitalizations for COPD [1.167 (95%CI: 1.009, 1.348)]. In contrast, short-term encounters with PM2.5, PM10, and O3 were found to have no significant effects on COPD morbidity. The lag effects of NO2 and CO were stronger than those of PM2.5 and PM10. Males and those aged 65 years or older were more vulnerable to air pollution. When it came to the seasons, the impacts appeared to be more pronounced in the cold season. In conclusion, short-term encounters with NO2 and CO were significantly correlated with COPD hospitalization in males and the elderly (≥65).

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.

Persistence of emphysema following cessation of cigarette smoke exposure requires a susceptibility factor

Chronic obstructive pulmonary disease (COPD) is caused by cigarette smoke (CS) exposure but can often be progressive even in former smokers. Exposure of mice to CS for 22 wk causes emphysema, but whether emphysema persists after cessation of CS exposure is not clear. The purpose of this study was to determine whether emphysema persists in mice following a recovery period of 22 wk and whether a susceptibility factor, such as deficiency in the Bcl-2-interacting killer (Bik), is required for this persistence. Therefore, bik+/+ and bik-/- mice at 6-10 wk of age were exposed to 250 mg/m3 total particulate matter of CS or filtered air (FA) for 3 or 22 wk and were kept in FA for an additional 22 wk. Lungs were lavaged to quantify inflammatory cells, and sections were stained with hematoxylin and eosin to assess severity of emphysema. Exposure to CS for 3 wk increased the number of inflammatory cells in bik-/- mice compared with bik+/+ mice but not at 22 wk of exposure. At 22 wk of CS exposure, extent of emphysema was similar in bik+/+ and bik-/- mice. However, when mice were exposed to CS over the first 22 wk and were kept in FA for an additional 22 wk, emphysema remained similar in bik+/+ mice but was enhanced in bik-/- mice. These findings link increased inflammation with persistent emphysematous changes even after smoking cessation and demonstrate that a preexisting susceptibility condition is required to sustain enhanced emphysema that was initiated by long-term CS exposure.NEW & NOTEWORTHY Exposure of mice to cigarette smoke (CS) for 22 wk causes emphysema, but whether emphysema persists after an additional period of 6 mo after cessation of CS exposure has not been reported. In addition, the role of preexisting susceptibility in enhancing the persistence of CS-induced emphysema after exposure to CS has stopped has not been shown. The present study shows that a preexisting susceptibility must be present to enhance CS-induced emphysema after cessation of CS exposure.

Indoor particulate matter concentrations and air cleaner intervention association with biomarkers in former smokers with COPD

BACKGROUND

Indoor pollutants have been associated with worse clinical outcomes in chronic obstructive pulmonary disease (COPD). Elevated biomarkers are associated with ambient pollution exposure, however the association with indoor pollution remains unclear.

METHODS

Former smokers with spirometry-confirmed COPD were randomized to portable air cleaner or placebo. Indoor particulate matter (PM2.5, PM10, and ultrafine particles [UFP; PM<0.1]) and biomarkers were measured longitudinally at pre-specified intervals and course PM fraction (PM10-2.5) was calculated. Biomarkers were categorized based on associations with biologic mechanisms: inflammation (white blood cell count, interleukin [IL]-6, IL-8, IL-1β, tumor necrosis factor-α, interferon-γ, serum amyloid A), platelet activation (P-selectin, CD40 ligand [CD40L], 11-dehdydro-thromboxane-B2 [11dTxB2]), endothelial dysfunction (Vascular Cell Adhesion Molecule [VCAM]-1, Intercellular Adhesion Molecule [ICAM]-1), and oxidative stress (thiobarbituric acid reactive substances [TBARS], 8-hydroxydeoxyguanosine, 8-isoprostane). Associations between PM concentrations and each biomarker were analyzed using multivariable linear mixed models. An intention-to-treat analysis was performed to evaluate the air cleaner intervention on the biomarker levels longitudinally.

RESULTS

Fifty-eight participants were randomized to each group. Finer PM was more strongly associated with higher IL-8 (mean difference per doubling: UFP 13.9% [p = 0.02], PM2.5 6.8% [p = 0.002], PM10-2.5 5.0% [p = 0.02]) while interferon-γ was associated with UFP and IL-1β with PM10-2.5. UFP and PM2.5 were associated with elevated levels of the oxidative stress biomarkers TBARS and 8-isoprostane respectively. For platelet activation markers, UFP was associated with higher 11dTxB2 while PM2.5 was associated with higher P-selectin and CD40L. Pollutants were not associated with biomarkers of endothelial dysfunction. In intention-to-treat analysis there was no association of the air cleaner intervention with any of the biomarkers.

DISCUSSION

Among former smokers with COPD, elevated levels of indoor air pollutants, particularly ultrafine particles (PM<0.1), were associated with elevated biomarkers of inflammation, platelet activation, and oxidative stress. However, an air cleaner intervention that reduced PM did not significantly reduce biomarker levels.

The impact of the synergistic effect of SO2 and PM2.5/PM10 on obstructive lung disease in subtropical Taiwan

Background

Chronic Obstructive lung diseases (COPD) are complex conditions influenced by various environmental, lifestyle, and genetic factors. Ambient air pollution has been identified as a potential risk factor, causing 4.2 million deaths worldwide in 2016, accounting for 25% of all COPD-related deaths and 26% of all respiratory infection-related deaths. This study aims to evaluate the associations among chronic lung diseases, air pollution, and meteorological factors.

Methods

This cross-sectional study obtained data from the Taiwan Biobank and Taiwan Air Quality Monitoring Database. We defined obstructive lung disease as patients with FEV1/FVC < 70%. Descriptive analysis between spirometry groups was performed using one-way ANOVA and the chi-square or Fisher's exact test. A generalized additive model (GAM) was used to evaluate the relationship between SO2 and PM2.5/PM10 through equations and splines fitting.

Results

A total of 2,635 participants were enrolled. Regarding environmental factors, higher temperature, higher relative humidity, and lower rainfall were risk factors for obstructive lung disease. SO2 was positively correlated with PM10 and PM2.5, with correlation coefficients of 0.53 (p < 0.0001) and 0.52 (p < 0.0001), respectively. Additionally, SO2 modified the relative risk of obstructive impairment for both PM10 [β coefficient (β) = 0.01, p = 0.0052] and PM2.5 (β = 0.01, p = 0.0155). Further analysis per standard deviation (per SD) increase revealed that SO2 also modified the relationship for both PM10 (β = 0.11, p = 0.0052) and PM2.5 (β = 0.09, p = 0.0155). Our GAM analysis showed a quadratic pattern for SO2 (per SD) and PM10 (per SD) in model 1, and a quadratic pattern for SO2 (per SD) in model 2. Moreover, our findings confirmed synergistic effects among temperature, SO2 and PM2.5/PM10, as demonstrated by the significant associations of bivariate (SO2 vs. PM10, SO2 vs. PM2.5) thin-plate smoothing splines in models 1 and 2 with obstructive impairment (p < 0.0001).

Conclusion

Our study showed high temperature, humidity, and low rainfall increased the risk of obstructive lung disease. Synergistic effects were observed among temperature, SO2, and PM2.5/PM10. The impact of air pollutants on obstructive lung disease should consider these interactions.

Spatial distribution of unscheduled hospital admissions for chronic obstructive pulmonary disease in the central area of Asturias, Spain

BACKGROUND

Chronic obstructive pulmonary disease (COPD) is one of the major causes of mortality worldwide and also reports high morbidity rates and the global burden COPD has continued to rise over the last several decades. The best-known COPD risk factors are tobacco smoke and air pollution, but genetics, age, sex, and socioeconomic status are additional factors. This study aimed to assess the spatial distribution of unscheduled COPD hospital admissions of men and women in the central area of Asturias during 2016-2018 and identify trends, spatial patterns, or clusters in the area.

METHODS

Unscheduled COPD hospital admissions in the central area of Asturias were registered, geocoded, and grouped by census tracts (CTs), age, and sex. Standardized admission ratio, smoothed relative risk, posterior risk probability, and spatial clusters between relative risks throughout the study area were calculated and mapped.

RESULTS

The spatial distribution of COPD hospital admissions differed between men and women. For men, high-risk values were located primarily in the northwestern area of the study, whereas for women the cluster pattern was not as clear and high-risk CTs also reached central and southern areas. In both men and women, the north-northwest area included the majority of CTs with high-risk values.

CONCLUSIONS

The present study showed the existence of a spatial distribution pattern of unscheduled COPD hospital admissions in the central area of Asturias that was more pronounced for men than for women. This study could provide a starting point for generating knowledge about COPD epidemiology in Asturias.

Importance of Punctual Monitoring to Evaluate the Health Effects of Airborne Particulate Matter

Particulate matter (PM) pollution is one of the major public health problems worldwide, given the high mortality attributable to exposure to PM pollution and the high pathogenicity that is found above all in the respiratory, cardiovascular, and neurological systems. The main sources of PM pollution are the daily use of fuels (wood, coal, organic residues) in appliances without emissions abatement systems, industrial emissions, and vehicular traffic. This review aims to investigate the causes of PM pollution and classify the different types of dust based on their size. The health effects of exposure to PM will also be discussed. Particular attention is paid to the measurement method, which is unsuitable in the risk assessment process, as the evaluation of the average PM compared to the evaluation of PM with punctual monitoring significantly underestimates the health risk induced by the achievement of high PM values, even for limited periods of time.

Trends in prevalence, mortality, and disability-adjusted life-years relating to chronic obstructive pulmonary disease in Europe: an observational study of the global burden of disease database, 2001-2019

INTRODUCTION

Chronic Obstructive Pulmonary Disease (COPD) is associated with significant mortality and well-defined aetiological factors. Previous reports indicate that mortality from COPD is falling worldwide. This study aims to assess the burden of COPD using prevalence, mortality, and disability-adjusted life years (DALYs) between 2001 and 2019 in 28 European countries (the European Union and the United Kingdom).

METHODS

We extracted COPD data from the Global Burden of Disease database based on the International Classification of Diseases versions 10 (J41, 42, 43, 44 and 47). Age-standardised prevalence rates (ASPRs), age-standardised mortality rates (ASMRs), and DALYs were analysed for European countries by sex for each year (2001-2019) and reported per 100,000 population. We used Joinpoint regression analysis to quantify changing trends in the burden of COPD.

RESULTS

In 2019, the median ASPR across Europe was 3230/100,000 for males and 2202/100,000 for females. Between 2001 and 2019, the median percentage change in ASPR was - 9.7% for males and 4.3% for females. 23/28 countries demonstrated a decrease in ASPRs in males, and 11/28 demonstrated a decrease in females. The median percentage change in ASMR between 2001 and 2019 was - 27.5% for males and - 10.4% for females. 25/28 and 19/28 countries demonstrated a decrease in ASMR in males and females, respectively.

CONCLUSION

In the EU between 2001 and 2019 COPD prevalence has overall increased in females but continues to decrease in males and in some countries, female prevalence now exceeds that of males. COPD mortality in the EU has decreased overall between 2001 and 2019; however, this decrease is not universal, particularly in females, and therefore remains a substantial source of amenable mortality.

Influence of Selected Air Pollutants on Mortality and Pneumonia Burden in Three Polish Cities over the Years 2011-2018

Poland has one of the worst air qualities in the European Union, particularly regarding concentrations of particulate matter (PM). This study aimed to evaluate the short-term effects of air pollution and weather conditions on all-cause mortality and pneumonia-related hospitalizations in three Polish agglomerations. We investigated data from 2011 to 2018 on a number of health outcomes, concentrations of PM2.5, PM10, nitrogen dioxide (NO2), ozone (O3), and selected meteorological parameters. To examine the impact of air pollutants and weather conditions on mortality and pneumonia burden, we identified optimal general regression models for each agglomeration. The final models explained <24% of the variability in all-cause mortality. In the models with interactions, O3 concentration in Warsaw, NO2, O3, and PM2.5 concentrations in Cracow and PM10 and O3 concentrations in the Tricity explained >10% of the variability in the number of deaths. Up to 46% of daily variability in the number of pneumonia-related hospitalizations was explained by the combination of both factors, i.e., air quality and meteorological parameters. The impact of NO2 levels on pneumonia burden was pronounced in all agglomerations. We showed that the air pollution profile and its interactions with weather conditions exert a short-term effect on all-cause mortality and pneumonia-related hospitalizations. Our findings may be relevant for prioritizing strategies to improve air quality.

Impaired AT2 to AT1 cell transition in PM2.5-induced mouse model of chronic obstructive pulmonary disease

Background

Particular matter 2.5 (PM2.5) is one of the most important air pollutant, and it is positively associated with the development of chronic obstructive pulmonary disease (COPD). However, the precise underlying mechanisms through which PM2.5 promotes the development of COPD remains largely unknown.

Methods

Mouse alveolar destruction were determined by histological analysis of lung tissues and lung function test. Alveolar type II cells (AT2) to alveolar type I cells (AT1) transition in PM2.5-induced COPD mouse model was confirmed via immunofluorescence staining and qPCR analysis. The differentially expressed genes in PM2.5-induced COPD mouse model were identified by RNA-sequencing of alveolar epithelial organoids and generated by bioinformatics analysis.

Results

In this study, we found that 6 months exposure of PM2.5 induced a significantly decreased pulmonary compliance and resulted in pulmonary emphysema in mice. We showed that PM2.5 exposure significantly reduced the AT2 to AT1 cell transition in vitro and in vivo. In addition, we found a reduced expression of the intermediate AT2-AT1 cell process marker claudin 4 (CLDN4) at day 4 of differentiation in mouse alveolar organoids treated with PM2.5, suggesting that PM2.5 exposure inhibited AT2 cells from entering the transdifferentiation process. RNA-sequencing of mouse alveolar organoids showed that several key signaling pathways that involved in the AT2 to AT1 cell transition were significantly altered including the Wnt signaling, MAPK signaling and signaling pathways regulating pluripotency of stem cells following PM2.5 exposure.

Conclusions

In summary, these data demonstrate a critical role of AT2 to AT1 cell transition in PM2.5-induced COPD mouse model and reveal the signaling pathways that potentially regulate AT2 to AT1 cell transition during this process. Our findings therefore advance the current knowledge of PM2.5-induced COPD and may lead to a novel therapeutic strategy to treat this disease.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12931-022-01996-w.

Short-Term Air Pollution Exposure and Risk of Acute Exacerbation of Chronic Obstructive Pulmonary Disease in Korea: A National Time-Stratified Case-Crossover Study

We investigated the association between short-term exposure to air pollution and the risk of acute exacerbation of chronic obstructive pulmonary disease (AE-COPD) in seven metropolitan cities in Korea. We used national health insurance claims data to identify AE-COPD cases in 2015. We estimated short-term exposure to particulate matter (PM) with a diameter of ≤2.5 μm (PM_2.5), PM with diameters of ≤10 μm (PM₁₀), sulfur dioxide (SO₂), nitrogen dioxide (NO₂), carbon monoxide (CO), and ozone (O₃) obtained from the Ministry of Environment. We conducted a time-stratified, case-crossover study to evaluate the effect of short-term exposure to air pollution on hospital visits for AE-COPD, using a conditional logistic regression model. The risk of hospital visits for AE-COPD was significantly associated with interquartile range increases in PM₁₀ in a cumulative lag model (lag 0–2, 0.35%, 95% confidence interval (CI) 0.06–0.65%; lag 0–3, 0.39%, 95% CI 0.01–0.77%). The associations were higher among patients who were men, aged 40–64 years, with low household income, and with a history of asthma. However, other air pollutants were not significantly associated with the risk of hospital visits for AE-COPD. Short-term exposure to air pollution, especially PM₁₀, increases the risk of hospital visits for AE-COPD.

Impact of Exposure to Diesel Exhaust on Inflammation Markers and Proteases in Former Smokers with COPD: A Randomized, Double-Blinded, Crossover Study

Rationale: There is growing evidence that chronic obstructive pulmonary disease (COPD) can be caused and exacerbated by air pollution exposure. Objectives: Document the impact of short-term air pollution exposure on inflammation markers, proteases, and antiproteases in lower airways of older adults with and without COPD. Methods: Thirty participants (10 ex-smokers with mild-moderate COPD, 20 healthy (9 ex-smokers, 11 never-smokers), average age 60, completed this double-blinded controlled human crossover exposure study. Each participant was exposed to filtered air (control) and diesel exhaust (DE), in washout-separated two hour periods, in a randomly assigned order. Bronchoscopy was performed 24 hours post-exposure to collect lavage. Cell counts were performed on blood and airway samples. Enzyme-linked immunosorbent assays were performed to measure acute inflammatory proteins, matrix proteinases, and anti-proteases in the airway and blood samples. Measurements and Main Results: In former smokers with COPD, but not in the other participants, exposure to DE increased serum amyloid A (1.67 [1.21 to 2.30], p=0.04) and matrix metalloproteinase 10 (2.61 [1.38 to 4.91], p=0.04) in bronchoalveolar lavage. Circulating lymphocytes were increased following DE (0.14 [0.05 to 0.24] cells x 10⁹/L, p=0.03), irrespective of COPD status. Conclusions: A controlled human crossover study of diesel exhaust reveals that former smokers with COPD may be susceptible to an inflammatory response compared to ex-smokers without COPD or never-smoking healthy controls. Clinical trial registration available at www.clinicaltrials.gov, ID: NCT02236039.

Disparities in COPD Hospitalizations: A Spatial Analysis of Proximity to Toxics Release Inventory Facilities in Illinois

Disproportionate distribution of air pollution is a major burden on the health of people living in proximity to toxic facilities. There are over 1000 Toxics Release Inventory (TRI) facilities distributed across the state of Illinois. This study investigates and spatially analyzes the relationship between chronic obstructive pulmonary disease (COPD) hospitalizations and toxic emissions from TRI facilities. In addition, this study investigates the connection between COPD hospitalizations and socioeconomic variables. Accounting for dispersion of air pollution beyond the TRI facilities source was attained using the inverse distance weighting interpolation approach. Multiple statistical methods were used including principal components analysis, linear regression, and bivariate local indicators of spatial association (BiLISA). The results from the linear regression model and BiLISA clustering maps show there is a strong connection between COPD hospitalizations and socioeconomic status along with race. TRI emissions were not statistically significant, but there are three major clusters of high COPD hospitalizations with high TRI emissions. Rural areas also seem to carry a higher burden of pollution-emitting facilities and respiratory hospitalizations.

The Impact of Air Pollutants and Meteorological Factors on Chronic Obstructive Pulmonary Disease Exacerbations: A Nationwide Study

RATIONALE Chronic obstructive lung disease (COPD) is a chronic progressive disease. Although smoking is the most important risk factor, 30% of COPD patients are never smokers, and environmental agents are also influential. The effects of air pollutants and meteorological factors on COPD exacerbations have not been studied extensively. OBJECTIVE We aimed to investigate the air pollutants and meteorological factors that impact the incidence of COPD exacerbations. METHODS We obtained clinical data of COPD exacerbation cases from The National Health Insurance Service (NHIS) and merged it with 24-hour average values of air pollutants and meteorological factors from national databases. Patients who reside in eight metropolitan cities, where observatory stations are densely located, were selected for analysis. RESULTS In 1,404,505 COPD patients between 2013 and 2018, 15,282 COPD exacerbations leading to hospitalization or emergency room visits were identified. Among the various air pollutants and meteorological factors, particulate matter (PM)2.5, PM10, NO2, SO2, CO, O3, average temperature and diurnal temperature range (DTR) were associated with COPD exacerbations. GAM model analysis with cubic splines showed an inverted U-shaped relationship with PM2.5, PM10, CO, NO2, SO2, O3, DTR and humidity, while it displayed a U-shaped pattern with the average temperature. Distinct patterns were found from 2015-2016 to 2017-2018. CONCLUSIONS PM2.5, PM10, CO, NO2, O3, SO2, average temperature, humidity, and DTR affected the incidence of COPD exacerbations in various patterns, up to 10 lag days.

Personal exposure to air pollution and respiratory health of COPD patients in London

Previous studies have investigated the effects of air pollution on chronic obstructive pulmonary disease (COPD) patients using either fixed-site measurements or a limited number of personal measurements, usually for one pollutant and a short time period. These limitations may introduce bias and distort the epidemiological associations as they do not account for all the potential sources or the temporal variability of pollution.

We used detailed information on individuals’ exposure to various pollutants measured at fine spatiotemporal scale to obtain more reliable effect estimates. A panel of 115 patients was followed up for an average continuous period of 128 days carrying a personal monitor specifically designed for this project that measured temperature, nitrogen dioxide (NO₂), ozone (O₃), nitric oxide (NO), carbon monoxide (CO), and particulate matter with aerodynamic diameter <2.5 and <10 μm at 1-min time resolution. Each patient recorded daily information on respiratory symptoms and measured peak expiratory flow (PEF). A pulmonologist combined related data to define a binary variable denoting an “exacerbation”. The exposure–response associations were assessed with mixed effects models.

We found that gaseous pollutants were associated with a deterioration in patients’ health. We observed an increase of 16.4% (95% CI 8.6–24.6%), 9.4% (95% CI 5.4–13.6%) and 7.6% (95% CI 3.0–12.4%) in the odds of exacerbation for an interquartile range increase in NO₂, NO and CO, respectively. Similar results were obtained for cough and sputum. O₃ was found to have adverse associations with PEF and breathlessness. No association was observed between particulate matter and any outcome.

Our findings suggest that, when considering total personal exposure to air pollutants, mainly the gaseous pollutants affect COPD patients’ health.

Significant adverse associations were found between the respiratory health of COPD patients and their personal exposure to gaseous pollutants measured using portable sensors over 6 months. No significant associations were found for particulate pollutants.https://bit.ly/3aqMT6O

Impact of environmental factors on pulmonary tuberculosis in multi-levels industrial upgrading area of China

In the present paper, an association between the growth rate of PTB and the environmental impacting elements in the pearl river delta region and the closed industry related cities in China is studied. We summarized the characteristics of different industry characteristics in this region by three echelons of urban agglomerations conducted by K-means clustering model on the time series of their monthly AQI data. To determine the impact of environmental factors on the increase of PTB, the SMLR in GLM has been applied. We then measured the seasonal effect and suggest the spring to be the leading season which keep the highest possibility of the incidence of PTB. Besides giving the analysis by fixed meteorological factors, we presented a sensitive analysis with a variation of precipitation. The Genetic algorithms (GAs) is used to determine the "tolerant" interval and as the results, the width of "tolerant" almost keep a declining trend as the precipitation increasing except when the precipitation comes the interval [68,74]. In addition, with the precipitation increasing higher than 64 mm, the "tolerant" for the AQI values from the first and the second echelon both trend to decline, and a lenient environmental policy currently may easily cause a rapid development of PTB growth rate.

Associations between ambient air pollution and hospitalizations for acute exacerbation of chronic obstructive pulmonary disease in Jinhua, 2019

Most cities in China are experiencing severe air pollution due to rapid economic development and accelerated industrialization. Exposure to various air pollutants has been related to acute exacerbations of chronic obstructive pulmonary disease (AECOPD). However, less is known about the spatial association between air pollution and AECOPD hospitalizations in the Yangtze River delta (YRD) economic and industrial region. Jinhua city is located in the YRD region of East China, in the middle of Zhejiang province. For the first time, 1563 AECOPD hospitalization cases in Jinhua during 2019 were enrolled in our analysis. The spatial distribution of six pollutants (SO₂, CO, PM10, PM2.5, O₃, NO₂) and the population temporal-spatial specific air pollutant exposure levels were estimated using the ordinary Kriging model through geographic information system (GIS). Global Moran's I was used to explore the spatial association between ambient air pollutants and AECOPD hospitalizations. The Z-scores of residential SO₂, CO, PM10, PM2.5, O₃, and NO₂ levels were 31.88, 42.95, 45.90, 32.29, 52.18, and 34.59, respectively. The concentrations of six monitored pollutants and AECOPD hospitalizations showed statistically significant spatial clustering. A generalized linear model (GLM) using a Poisson distribution with the log-link function was used to construct a core model. After adjusting for potential confounders in the model, residential SO₂, NO₂ and O₃ concentrations were significantly associated with increased AECOPD hospitalizations.

Exacerbations of Lung Disease in Alpha-1 Antitrypsin Deficiency

Alpha-1 antitrypsin deficiency (AATD) is an important risk factor for development of chronic obstructive pulmonary disease (COPD). Patients with AATD classically develop a different pattern of lung disease from those with usual COPD, decline faster and exhibit a range of differences in pathogenesis, all of which may be relevant to phenotype and/or impact of exacerbations. There are a number of definitions of exacerbation, with the main features being worsening of symptoms over at least 2 days, which may be associated with a change in treatment. In this article we review the literature surrounding exacerbations in AATD, focusing, in particular, on ways in which they may differ from such events in usual COPD, and the potential impact on clinical management.

Clinical Features and C-Reactive Protein as Predictors of Bacterial Exacerbations of COPD

Introduction

Identifying predictors of bacterial and viral pathogens in sputum from patients with acute exacerbations of chronic obstructive pulmonary disease (COPD) may help direct management.

Methods

We used data from a trial evaluating a C-reactive protein (CRP) point of care guided approach to managing COPD exacerbations in primary care. We used regression analyses to identify baseline clinical features, including CRP value in those randomized to testing, associated with bacterial, viral or mixed infections, defined by the presence of bacterial and viral pathogens in sputum, detected by culture or polymerase chain reaction (PCR), respectively.

Results

Of 386 participants with baseline sputum samples, 79 (20.5%), 123 (31.9%), and 91 (23.6%) had bacterial, viral/atypical, and mixed bacterial/viral/atypical pathogens identified, respectively. Increasing sputum purulence assessed by color chart was associated with increased odds of finding bacterial and mixed (bacterial and viral/atypical) pathogens in sputum (area under the ROC curve (AUROC) for bacterial pathogens =0.739 (95% CI: 0.670, 0.808)). Elevated CRP was associated with increased odds of finding bacterial pathogens and mixed pathogens but did not significantly increase the AUROC for predicting bacterial pathogens over sputum color alone (AUROC for combination of sputum color and CRP = 0.776 (95% CI: 0.708, 0.843), p for comparison of models = 0.053). We found no association between the presence of sputum pathogens and other clinical or demographic features.

Conclusion

Sputum purulence was the best predictor of sputum bacterial pathogens and mixed bacterial viral/atypical pathogens in patients with COPD exacerbations in our study. Elevated CRP was associated with bacterial pathogens but did not add to the predictive value of sputum purulence.

Assessment of personal exposure to particulate air pollution in different microenvironments and traveling by several modes of transportation in Bogotá, Colombia: protocol for a mixed-methods study. (Preprint)

Background

Air pollution in most countries exceeds the levels recommended by the World Health Organization, causing up to one-third of deaths due to noncommunicable diseases. Fine particulate matter (PM_2.5) and black carbon (BC) from mobile sources are the main contaminants.

Objective

The aim of this study is to assess the relationship of exposure to air pollutants (PM_2.5 and BC) in microenvironments according to respiratory health and physical activity in users traveling by different types of transportation in Bogotá, Colombia.

Methods

A mixed methods study based on a convergent parallel design will be performed with workers and students. The sample will include 350 healthy transport users traveling by different urban transportation modes in three main routes in Bogotá. The study is broken down into two components: (1) a descriptive qualitative component focused on assessing the individual perception of air pollution using semistructured interviews; and (2) a cross-sectional study measuring the individual exposure to PM_2.5 and BC using portable instruments (DustTrak and microAeth, respectively), pulmonary function by spirometry, and physical activity with accelerometry. The analysis will include concurrent triangulation and logistic regression.

Results

The findings will be useful for the conception, design, and decision-making process in the sectors of health and mobility from public, academy, and private perspectives. This study includes personal measurements of PM_2.5 and BC during typical trips in the city to assess the exposure to these contaminants in the major roadways in real time. The study further compares the performance of two different lung tests to identify possible short-term respiratory effects. As a limitation, the protocol will include participants from different institutions in the city, which are not necessarily representative of all healthy populations in Bogotá. In this sense, it is not possible to draw causation conclusions. Moreover, a convergent parallel design could be especially problematic concerning integration because such a design often lacks a clear plan for making a connection between the two sets of results, which may not be well connected. Nevertheless, this study adopts a procedure for how to integrate qualitative and quantitative data in the interpretation of the results and a multilevel regression. The time that participants must live in the city will be considered; this will be controlled in the stratified analysis. Another limitation is the wide age range and working status of the participants. Regional pollution levels and episodes (PM_2.5) will be handled as confounding variables. The study is currently in the enrollment phase of the participants. Measurements have been made on 300 participants. Pandemic conditions affected the study schedule; however, the results are likely to be obtained by late 2022.

Conclusions

This study investigates the exposure to air pollutants in microenvironments in Bogotá, Colombia. To our knowledge, this is the first mixed methods study focusing on PM_2.5, BC, and respiratory health effects in a city over 2 meters above sea level. This study will provide an integration of air pollution exposure variables and respiratory health effects in different microenvironments.

International Registered Report Identifier (IRRID)

PRR1-10.2196/25690

The Management of Health Hazards Related to Municipal Solid Waste on Fire in Europe: An Environmental Justice Issue?

Landfilling should be the last option in an integrated Municipal Solid Waste (MSW) management approach. In the European Union (EU), the policy framework to protect the environment and the public health against the impact of health hazards related to urban solid waste management has been consistently implemented in recent decades. A growing interest in the negative impact of fires in waste landfills on the environment and people's health was reported in some European countries. In Italy, an increasing occurrence of arsons in MSW and landfills has been reported in recent years. During the summer of 2012, a multi-site arson occurred in the Palermo Municipal solid waste landfill of Bellolampo (western Sicily), giving rise to an environmental emergency of public health concern. Local health authorities reacted by creating an inter-institutional multidisciplinary task force with the aim to implement measures to prevent and control the risk of exposure by delimiting a protection area to be taken under strict monitoring. Environmental and epidemiological investigations were put in place by air, soil, and farm product sampling. A syndromic surveillance of the exposed population was conducted as well. The air monitoring stations system in place detected an increase in the concentrations of dioxins and dioxin-like substances with the PM10 highest emission pick documented within the first 24 h and estimated at about 60 μg/m3. Levels of heavy metals above the limits permitted by law were detected in the top- and sub-soil samples collected within the two landfill sampling sites and also in other nearby sites. Non-conforming concentration values of dioxins and dioxin-like substances were detected in samples taken from farms, milk, and water. The health syndromic surveillance did not document any daily increase in the notification of emergency admissions related to acute respiratory diseases or any other health effect potentially related to the waste arson, but these findings were limited by the non-systematic collection of data. The experience reported in the present case report, as declined within the European Union policy framework and in the view of environmental justice, documented the need to structure a permanent collaboration between the different institutional actors involved in environmental and public health protection activities in order to develop specific protocols to manage events related to the occurrence of waste-related environmental emergencies or disasters.

Air pollution and chronic obstructive pulmonary disease

There is considerable epidemiological evidence indicating that air pollution has adverse effects on human health and is closely related to respiratory diseases, including chronic obstructive pulmonary disease (COPD). These effects, which can be divided into short- and long-term effects, can manifest as an exacerbation of existing symptoms, impaired lung function, and increased hospitalization and mortality rates. Long-term exposure to air with a high concentration of pollutants may also increase the incidence of COPD. The combined effects of different pollutants may become more complex in the future; hence, there is a need for more intensive research on specific at-risk populations, and formulating corresponding protective strategies is crucial. We aimed to review the epidemiological evidence on the effect of air pollution on COPD, the possible pathophysiological mechanisms underlying this effect, as well as protective measures against the effects of air pollutants in patients with COPD.

The Effect of Emission Inventory on Modelling of Seasonal Exposure Metrics of Particulate Matter and Ozone with the WRF-Chem Model for Poland

In Poland, high concentrations of particulate matter (with a diameter smaller than 2.5 or 10 μm) exceeding the WHO threshold values are often measured in winter, while ozone (O3) concentrations are high in spring. In winter high PM2.5 and PM10 concentrations are linked to high residential combustion and road transport. The main objective of this study was to assess performance of the Weather Research and Forecasting model with Chemistry (WRF-Chem) model in reproducing observations for a period of 2017-2018 covering various meteorological conditions. We compare modelled and observed exposure metrics for PM2.5, PM10 and O3 for two sets of the WRF-Chem model runs: with coarse and fine resolution emission inventory (European Monitoring and Evaluation Programme (EMEP) and Chief Inspectorate of Environmental Protection (CIEP), respectively). CIEP run reduces the negative bias of PM2.5 and PM10 and improves the model performance for number of days with exceedance of WHO (World Health Organization) threshold for PM2.5 and PM10 24-h mean concentration. High resolution emission inventory for primary aerosols helps to better distinguish polluted urban areas from non-urban ones. There are no large differences for the model performance for O3 and secondary inorganic aerosols, and high-resolution emission inventory does not improve the results in terms of 8-h rolling mean concentrations of ozone.

Research on Energy Management of Hybrid Unmanned Aerial Vehicles to Improve Energy-Saving and Emission Reduction Performance

The rapid development of industry results in large energy consumption and a negative impact on the environment. Pollution of the environment caused by conventional energy sources such as petrol leads to increased demand for propulsion systems with higher efficiency and capable of energy-saving and emission reduction. The usage of hybrid technology is expected to improve energy conversion efficiency, reduce energy consumption and environmental pollution. In this paper, the simulation platform for the hybrid unmanned aerial vehicle (UAV) has been built by establishing the subsystem models of the UAV power system. Under the two chosen working conditions, the conventional cruise flight mission and the terrain tracking mission, the power tracking control and Q-Learning method have been used to design the energy management controller for the hybrid UAV. The fuel consumption and pollutant emissions under each working condition were calculated. The results show that the hybrid system can improve the efficiency of the UAV system, reduce the fuel consumption of the UAV, and so reduce the emissions of CO₂, NO_x, and other pollutants. This contributes to improving of environmental quality, energy-saving, and emission reduction, thereby contributing to the sustainable development of aviation.

Acute air pollution exposure alters neutrophils in never-smokers and at-risk humans

Outdoor air pollution exposure increases chronic obstructive pulmonary disease (COPD) hospitalisations, and may contribute to COPD development. The mechanisms of harm, and the extent to which at-risk populations are more susceptible are not fully understood. Neutrophils are recruited to the lung following diesel exhaust exposure, a model of traffic-related air pollution (TRAP), but their functional role in this response is unknown. The purpose of this controlled human-exposure crossover study was to assess the effects of acute diesel exhaust exposure on neutrophil function in never-smokers and at-risk populations, with support from additional in vitro studies.18 participants, including never-smokers (n=7), ex-smokers (n=4) and mild-moderate COPD patients (n=7), were exposed to diesel exhaust and filtered air for 2 h on separate occasions, and neutrophil function in blood (0 h and 24 h post-exposure) and bronchoalveolar lavage (24 h post-exposure) was assessed.Compared to filtered air, diesel exhaust exposure reduced the proportion of circulating band cells at 0 h, which was exaggerated in COPD patients. Diesel exhaust exposure increased the amount of neutrophil extracellular traps (NETs) in the lung across participants. COPD patients had increased peripheral neutrophil activation following diesel exhaust exposure. In vitro, suspended diesel exhaust particles increased the amount of NETs measured in isolated neutrophils. We propose NET formation as a possible mechanism through which TRAP exposure affects airway pathophysiology. In addition, COPD patients may be more prone to an activated inflammatory state following exposure.This is the first controlled human TRAP exposure study directly comparing at-risk phenotypes (COPD and ex-smokers) with lower-risk (never-smokers) participants, elucidating the human susceptibility spectrum.

Air Pollution and Health: The Need for a Medical Reading of Environmental Monitoring Data

Air pollution is a recent public health issue. In 2006, the World Health Organization (WHO) published updated air quality guidelines for a number of air pollutants (including PM10 and PM2.5), which recommended for particulate matter annual average concentration levels at half or less the limit values set by European legislation. In the European Union, around 80% of the European urban population is exposed to air pollution above the levels recommended by the WHO guidelines. Only in 2015 the WHO addressed for the first time the topic of the health impacts of air pollution in its general assembly, which adopted a resolution clearly defining air pollution as the world’s largest single environmental health risk factor. Nowadays, the WHO considers air pollution as a major public health threat, causing a 7% increase in overall mortality for each increase of 10 μg/m³ in annual average of PM2.5. This result has been achieved thanks to the outstanding efforts of the director of the WHO’s Environment and Public Health Department, Dr. Maria Neira, who has devoted her full commitment to highlighting the consequences that air pollution has on people’s health. More recently, at European level, the Air Quality Directive has been subject to a fitness check, published in 2019; the European Green Deal has since announced its aim to align EU air quality standards more closely with the WHO recommendations. Every year, the European Environment Agency (EEA) publishes its “Air Quality in Europe” Report to assess the figures on air pollution across Europe and related health impacts. However, environmental data provided by official regional or national agencies—used by decision makers to adopt preventive measures such as limitations on urban traffic or domestic heating—refer to legal thresholds established by the law (usually on the basis of values set at European level, at least for the EU). These legal thresholds, however, are not adequate to fully protect population against all impacts from air pollution as recommended by WHO and scientific evidence. Therefore, we point out the need for a medical reading of environmental monitoring data that should be performed both at national and regional or local level by health authorities, to foster population health protection against air pollution and guarantee the application of the precautionary principle. A stronger cooperation between environmental agencies and health authorities is needed to address the new challenges to human and planetary health arising from air pollution and climate change. Health authorities should integrate their medical staff with new professionals and researchers with adequate training in environmental sciences to foster population health protection against air pollution. For this purposes, multi-disciplinary research units or teams should be established by local health authorities on environmental health topics, working together with medical staff and environmental agencies for a mutual integration of competencies.

Au W, Zhao W, Xia ZL. A Systematic Review and Meta-Analysis of Short-Term Ambient Ozone Exposure and COPD Hospitalizations

Chronic obstructive pulmonary disease (COPD) is the third leading cause of death globally and ozone exposure is a main cause of its disease burden. However, studies on COPD hospitalizations from short-term ambient level ozone exposure have not generated consensus results. To address the knowledge gap, comprehensive and systematic searches in several databases were conducted using specific keywords for publications up to February 14, 2020. Random-effect models were used to derive overall excess risk estimates between short-term ambient-level ozone exposure and COPD hospitalizations. The influence analyses were used to test the robustness of the results. Both meta-regression and subgroup analyses were used to explore the sources of heterogeneity and potential modifying factors. Based on the results from 26 eligible studies, the random-effect model analyses show that a 10 µg/m³ increase in maximum 8-h ozone concentration was associated with 0.84% (95% CI: 0.09%, 1.59%) higher COPD hospitalizations. The estimates were higher for warm season and multiple-day lag but lower for old populations. Results from subgroup analyses also indicate a multiple-day lag trend and bigger significant health effects during longer day intervals. Although characteristics of individual studies added modest heterogeneity to the overall estimates, the results remained robust during further analyses and exhibited no evidence of publication bias. Our systematic review and meta-analysis indicate that short-term ambient level ozone exposure was associated with increased risk of COPD hospitalizations. The significant association with multiple-day lag trend indicates that a multiple-day exposure metric should be considered for establishing ambient ozone quality and exposure standards for improvement of population health. Future investigations and meta-analysis studies should include clinical studies as well as more careful lag selection protocol.

Procalcitonin and antibiotics in moderate-severe acute exacerbation of chronic obstructive pulmonary disease: to use or not to use

PURPOSE OF REVIEW

Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide. Acute exacerbations of COPD (AECOPD) are major driver for healthcare utilization with each exacerbation begetting the next exacerbation. It is, therefore, important to treat each episode effectively to prevent the next. However, this can be challenging as AECOPD result from complex interactions between host, environment and infective agents. The benefits of starting antibiotics in AECOPD, which are not life-threatening (e.g. not requiring mechanical ventilation) or not complicated by pneumonia remain controversial.

RECENT FINDINGS

The use of procalcitonin to guide antibiotic therapy in AECOPD has gained interest in recent years. The main advantage of this approach is a safe reduction in antibiotic use in a large group of patients, which may potentially translate to several other benefits. These include reduced antibiotic-related side-effects, reduced risk of developing antibiotic-resistant organisms and cost savings. This approach is associated with no increase in mortality or morbidity such as treatment failure, re-admission, admission to ICU.

SUMMARY

Procalcitonin-guided antibiotic therapy in AECOPD is a promising and safe approach, which may be ready for the prime time.

Effect of O3, PM10 and PM2.5 on cardiovascular and respiratory diseases in cities of France, Iran and Italy

At present, both tropospheric ozone (O₃) and particulate matters (PM) are among the most threatening air pollutants for human health in cities. The air pollution effects over public health include increased risk of hospital admissions and mortality for respiratory and cardiovascular diseases even when air pollutant concentrations are below European and international standards. The aim of this study was to (i) estimate the burden of mortality and morbidity for cardiovascular and respiratory diseases attributed to PM_2.5, PM₁₀ and O₃ in nine selected cities in France, Iran and Italy in 2015 and 2016 and to (ii) compare estimated burdens at current O₃ and PM levels with pre-industrial levels. The selected Mediterranean cities are among the most affected by the air pollution in Europe, in particular by rising O₃ while the selected Iranian cities rank as the most polluted by PM in the world. The software AirQ+ was used to estimate the short-term health effects, in terms of mortality and morbidity by using in situ air quality data, city-specific relative risk values and baseline incidence. Compared to pre-industrial levels, long-term exposures to ambient PM_2.5, PM₁₀ and O₃ have substantially contributed to mortality and hospital admissions in selected cities: about 8200 deaths for non-accidental causes, 2400 deaths for cardiovascular diseases, 540 deaths for respiratory diseases, 220 deaths for chronic obstructive pulmonary diseases as well as 18,800 hospital admissions for cardiovascular diseases and 3400 for respiratory diseases were reported in 2015. The study supports the need of city-specific epidemiological data and urgent strategies to mitigate the health burden of air pollution.

Comparison of air pollutant-related hospitalization burden from AECOPD in Shijiazhuang, China, between heating and non-heating season

Few researches have been investigated on the effects of ambient air pollutants from coal combustion on acute exacerbation of chronic obstructive pulmonary disease (AECOPD) hospitalizations. The whole time series was split into heating season and non-heating season. We used a quasi-Poisson generalized linear regression model combined with distributed lag non-linear models (DLNMs) to estimate the relative cumulative risk and calculate the air pollutant hospitalization burden of AECOPD for lag 0-7 days in heating season and non-heating season. There were higher PM_2.5, PM₁₀, NO₂, SO₂, and CO concentrations in heating seasons than non-heating season in Shijiazhuang; however, O₃ was higher in non-heating season than heating season. The AECOPD-associated relative cumulative risks for PM_2.5, PM₁₀, NO₂, and SO₂ for lag 0-7 days were significantly positively associated with hospitalization in heating and non-heating season; we found that the cumulative relative risk of NO₂ was the greatest in every 1 unit of air pollutants during the heating season and the cumulative relative risk of SO₂ was the greatest during the non-heating season. The results showed that 17.8%, 12.9%, 1.7%, 16.7%, and 10.5% of AECOPD hospitalizations could be attributable to PM_2.5, PM₁₀, SO₂, NO₂, and CO exposure in heating season, respectively. However, the results showed that 19.5%, 22.4%, 15%, 8.3%, and 10.4% of AECOPD hospitalizations could be attributable to PM_2.5, PM₁₀, SO₂, NO_2, and O₃ exposure in non-heating season, respectively. The attributable burden of AECOPD hospitalization in heating season and non-heating season are different. PM_2.5, PM₁₀, NO₂, and CO are the main factors of heating season, while PM₁₀, PM_2.5, SO₂, and O₃ are the main factors of non-heating season. In conclusions, the centralized heating can change the influence of attributable risk. When government departments formulate interventions to reduce the risk of acute hospitalization of chronic obstructive pulmonary disease (COPD), the influence of heating on disease burden should be considered.

Polycyclic aromatic compounds in urban air and associated inhalation cancer risks: A case study targeting distinct source sectors

Passive air sampling was conducted in Toronto and the Greater Toronto Area from 2016 to 2017 for 6 periods, in order to investigate ambient levels of polycyclic aromatic compounds (PACs) associated with different source types. The selected sampling sites (n = 8) cover geographical areas with varying source emissions including background, traffic, urban, industrial and residential sites. Passive air samples were analyzed for PACs which include PAHs, alkylated PAHs (alk-PAHs), dibenzothiophene and alkylated dibenzothiophenes (DBTs) and results for PAHs were used to calculate inhalation cancer risks using different approaches. The samples were also characterized for PAH derivatives including nitrated PAHs (NPAHs) and oxygenated PAHs (OPAHs). Concentrations of Σalk-PAHs and DBTs, which are known to be enriched in fossil fuels, as well as ΣNPAHs, were highest at a traffic site (MECP) located adjacent to the 18-lane Highway 401 that runs across Toronto. Except for an industrial site (HH/BU), PAC compositions were similar across the sampling sites with Σalk-PAHs being the most abundant class of PACs suggesting traffic emission was a major contributor to PACs in the atmosphere of Toronto. The industrial site exhibited a distinct chemical composition with ΣPAHs dominating over Σalk-PAHs and with elevated levels of fluoranthene, 9-nitroanthracene, and 9,10-anthraquinone, which likely reflects emissions from nearby industrial sources. MECP and HH/BU exhibited higher lifetime excess inhalation cancer risks indicating an association with traffic and industrial sources. The importance of the traffic sector as a source of PACs to ambient air is further supported by strong correlations of the ΣPAHs, Σalk-PAHs, DBTs, and ΣOPAHs with NO_x. This study highlights the importance of traffic as an emission source of PACs to urban air and the relevance of PAC classes other than just unsubstituted PAHs that are important but currently not included in air quality guidelines or for assessing inhalation cancer risks.

Air Pollution and Estimated Health Costs Related to Road Transportations of Goods in Italy: A First Healthcare Burden Assessment

Background: The Italian Society of Environmental Medicine has performed a preliminary assessment of the health impact attributable to road freight traffic in Italy. Methods: We estimated fine particulate matter (PM10, PM2.5) and nitrogen oxides (NOx) generated by road transportation of goods in Italy considering the number of trucks, the emission factors and the average annual distance covered in the year 2016. Simulations on data concerning Years of Life Lost (YLL) attributable to PM2.5 (593,700) and nitrogen oxides NO2 (200,700) provided by the European Environmental Agency (EEA) were used as a proxy of healthcare burden. We set three different healthcare burden scenarios, varying from 1/5 to 1/10 of the proportion of the overall particulate matter attributable to road freight traffic in Italy (about 7% on a total of 2262 tons/year). Results: Road freight traffic in Italy produced about 189 tons of PM10, 147 tons of PM2.5 and 4125 tons of NOx in year 2016, resulting in annual healthcare costs varying from 400 million up to 1.2 billion EUR per year. Conclusion: Road freight traffic has a relevant impact on air pollution and healthcare costs, especially if considered over a 10-year period. Any solution able to significantly reduce the road transportation of goods could decrease avoidable mortality due to air pollution and related costs.

Analysis of environmental risk factors for chronic obstructive pulmonary disease exacerbation: A case-crossover study (2004-2013)

Purpose

We aim to assess if air pollution levels and climatological factors are associated with hospital admissions for exacerbation of chronic obstructive pulmonary disease (COPD) in Spain from 2004 to 2013.

Methods

We conducted a retrospective study. Information on pollution level and climatological factors were obtained from the Spanish Meteorological Agency and hospitalizations from the Spanish hospital discharge database. A case-crossover design was used to identify factors associated with hospitalizations and in hospital mortality. Postal codes were used to assign climatic and pollutant factors to each patient.

Results

We detected 162,338 hospital admissions for COPD exacerbation. When seasonal effects were evaluated we observed that hospital admissions and mortality were more frequent in autumn and winter. In addition, we found significant associations of temperature, humidity, ozone (O₃), carbon monoxide (CO), particulate matter up to 10 μm in size (PM₁₀) and nitrogen dioxide (NO₂) with hospital admissions. Lower temperatures at admission with COPD exacerbation versus 1, 1.5, 2 and 3 weeks prior to hospital admission for COPD exacerbation, were associated with a higher probability of dying in the hospital. Other environmental factors that were related to in-hospital mortality were NO₂, O₃, PM₁₀ and CO.

Conclusions

Epidemiology of hospital admissions by COPD exacerbation was negatively affected by colder climatological factors (seasonality and absolute temperature) and short-term exposure to major air pollution (NO₂, O₃, CO and PM₁₀).

The short-term effects of air pollutants on hospitalizations for respiratory disease in Hefei, China

Previous studies have shown that ambient air pollution is associated with respiratory morbidity. However, the effects of air pollutants on health have rarely been studied in China. Our study aimed to estimate the short-term effects of particulate air pollutants on hospitalizations for three types of respiratory disease: pneumonia, chronic obstructive pulmonary disease (COPD), and asthma. We collected data on daily admissions for patients with each disease from the New Rural Cooperative Medical System (NRCMS) in Hefei, China. Daily records of air pollutants and meteorological data from January 2014 to March 2016 were also obtained. Distributed lag nonlinear models were employed in the analysis to evaluate the association between daily air pollutants and admissions. The highest effect of each pollutant on COPD hospital admission was observed with PM_2.5 at lag 12 (RR = 1.068, 95% CI 1.017 to 1.121) and PM₁₀ at lag 10 (RR = 1.031, 95% CI 1.002 to 1.060), for an increase of 10 μg/m³ in concentrations of the pollutants. The short-term effects of PM₁₀ on asthma hospital admissions peaked at lag 12 (RR = 1.057, 95% CI 1.010 to 1.107). According to our stratified analysis, we found that the effects on COPD admission were more pronounced in the warm season than in the cold season, and the elderly (≥ 65 years) and females were more vulnerable to air pollution.

Short-term effects of ambient air pollution on chronic obstructive pulmonary disease admissions in Beijing, China (2013-2017)

Purpose

Evidence between air pollution and COPD admissions is inconsistent and limited in China. In this study, we aimed to explore the effects of air pollutants on COPD admissions in Beijing, China.

Patients and methods

Daily COPD hospital admission visits derived from tertiary and secondary hospitals in Beijing were retrieved from January 2013 to February 2017. Air pollutant levels and meteorological data over the same periods were also achieved. Generalized additive model was applied to estimate the percentage changes with 95% CIs in daily admissions corresponding to 10 µg/m³ increases in pollutants levels [1 mg/m³ in carbon monoxide (CO)], stratified by age, gender, and season.

Results

Seventy-three thousand seventy-six COPD hospital admission visits were included with mean daily visits of 48 (21). Cumulative lag effect with per 10 µg/m³ increase in air pollutant levels was largest for nitrogen dioxide (NO₂) with 3.03% (95% CI: 1.82%-4.26%) at lag 06, for sulfur dioxide (SO₂) with 2.07% (95% CI: 1.00%-3.15%) at lag 01, for particulate matter ≤10 µm in aerodynamic diameter (PM₁₀) with 0.92% (95% CI: 0.55%-1.30%) at lag 07, and for particulate matter ≤2.5 µm in aerodynamic diameter (PM_2.5) with 0.82% (95% CI: 0.38%-1.26%) at lag 06, respectively. Percentage increase for each 1 mg/m³ increase in CO was 5.99% (95% CI: 2.74%-9.34%) at lag 06. Further, stronger effects on COPD admissions were found in warm seasons than in cold seasons.

Conclusion

Short-term exposures to PM_2.5, PM₁₀, NO₂, SO₂, and CO had adverse effects on COPD hospitalizations in Beijing with different magnitudes and lag days.

N-glycosylation patterns of plasma proteins and immunoglobulin G in chronic obstructive pulmonary disease

BACKGROUND

Chronic obstructive pulmonary disease (COPD) is a complex condition, whose diagnosis requires spirometric assessment. However, considering its heterogeneity, subjects with similar spirometric parameters do not necessarily have the same functional status. To overcome this limitation novel biomarkers for COPD have been investigated. Therefore, we aimed to explore the potential value of N-glycans as COPD biomarkers and to examine the individual variation of plasma protein and immunoglobulin G (IgG) glycosylation profiles in subjects with COPD and healthy controls.

METHODS

Both the total plasma protein and IgG N-glycome have been profiled in the total of 137 patients with COPD and 95 matching controls from Croatia. Replication cohort consisted of 61 subjects with COPD and 148 controls recruited at another Croatian medical centre.

RESULTS

Plasma protein N-glycome in COPD subjects exhibited significant decrease in low branched and conversely, an increase in more complex glycan structures (tetragalactosylated, trisialylated, tetrasialylated and antennary fucosylated glycoforms). We also observed a significant decline in plasma monogalactosylated species, and the same change replicated in IgG glycome. N-glycans also showed value in distinguishing subjects in different COPD GOLD stages, where the relative abundance of more complex glycan structures increased as the disease progressed. Glycans also showed statistically significant associations with the frequency of exacerbations and demonstrated to be affected by smoking, which is the major risk factor for COPD development.

CONCLUSIONS

This study showed that complexity of glycans associates with COPD, mirroring also the disease severity. Moreover, changes in N-glycome associate with exacerbation frequency and are affected by smoking. In general, this study provided new insights into plasma protein and IgG N-glycome changes occurring in COPD and pointed out potential novel markers of the disease progression and severity.

A time for everything and everything in its time - exploring the mechanisms underlying seasonality of COPD exacerbations

Across Europe, COPD affects 23 million people leading to annual health care costs of ~€25.1 billion. This burden is particularly severe during winter months in association with the peak incidence of exacerbation events. Seasonal variation in the health status of patients with COPD places additional and often critical pressure on already strained health care resources. COPD exacerbations are characterized by worsening day-to-day symptoms of an individual and often triggered by respiratory infections, but the process by which this occurs in a seasonal fashion is likely to be multifactorial. In this review, we discuss recent population studies that highlight the impact of seasonality in COPD and review the proposed biological mechanisms underlying this. An appraisal of the role of the host susceptibility and response, environmental triggers and the biology of respiratory pathogens is detailed. The impact of each aspect is considered, and an integrated model of the context for the whole individual and society in general is explored.

Ultrafine particle libraries for exploring mechanisms of PM2.5-induced toxicity in human cells

Air pollution worldwide, especially in China and India, has caused serious health issues. Because PM_2.5 particles consist of solid particles of diverse properties with payloads of inorganic, organic and biological pollutants, it is still not known what the major toxic components are and how these components induce toxicities. To explore this complex issue, we apply reductionism principle and an ultrafine particle library approach in this work. From investigation of 63 diversely functionalized ultrafine particles (FUPs) with adsorbed key pollutants, our findings indicate that 1) only certain pollutants in the payloads of PM_2.5 are responsible for causing cellular oxidative stress, cell apoptosis, and cytotoxicity while the particle carriers are much less toxic; 2) pollutant-induced cellular oxidative stress and oxidative stress-triggered apoptosis are identified as one of the dominant mechanisms for PM_2.5-induced cytotoxicity; 3) each specific toxic component on PM_2.5 (such as As, Pb, Cr or BaP) mainly affects its specific target organ(s) and, adding together, these pollutants may cause synergistic or just additive effects. Our findings demonstrate that reductionism concept and model PM_2.5 particle library approach are very effective in our endeavor to search for a better understanding of PM_2.5-induced health effects.

The respiratory virome in chronic obstructive pulmonary disease

Aim: To characterize the respiratory virome in moderate/severe chronic obstructive pulmonary disease (COPD) patients using metagenomics, with healthy subjects as the reference. Patients & Methods: Sputum COPD samples were collected during stability and exacerbations with negative usual-care microbiologic analysis. Results: Eukaryotic viruses from the Anelloviridae, Herpesviridae and Retroviridae families and phages from the Shiphoviridae family were commonly found in COPD, and the respiratory virome in stability and noninfectious exacerbations showed a substantial similarity. DNA viruses with the highest relative abundance in COPD are Anelloviridae. Conclusion: These results support a colonizing role for eukaryotic viruses in COPD and highlight the importance of analyzing both DNA and RNA viruses when focusing on the respiratory virome.

Exposure to nitrogen dioxide and chronic obstructive pulmonary disease (COPD) in adults: a systematic review and meta-analysis

Exposure to nitrogen dioxide (NO2) has long been linked to elevated mortality and morbidity from epidemiological evidences. However, questions remain unclear whether NO2 acts directly on human health or being an indicator of other ambient pollutants. In this study, random-effect meta-analyses were performed on examining exposure to nitrogen oxide (NOx) and its association with chronic obstructive pulmonary disease (COPD). The overall relative risk (RR) of COPD risk related to a 10 μg/m3 increase in NO2 exposure increased by 2.0%. The pooled effect on prevalence was 17% with an increase of 10 μg/m3 in NO2 concentration, and 1.3% on hospital admissions, and 2.6% on mortality. The RR of COPD cases related to NO2 long-term exposure was 2.5 and 1.4% in short-term exposure. The COPD effect related with a 10 μg/m3 increase in exposure to a general outdoor-sourced NO2 was 1.7 and 17.8% to exposure to an exclusively traffic-sourced NO2; importantly, we did observe the effect of NO2 on COPD mortality with a large majority in lag0. Long-term traffic exerted more severe impairments on COPD prevalence than long-term or short-term outdoor effect; long-term mortality effect on COPD was serious in single model from this meta-analysis. Overall, our study reported consistent evidence of the potential positive association between NO2 and COPD risk.

Susceptibility to short-term ozone exposure and cardiovascular and respiratory mortality by previous hospitalizations

BACKGROUND

Ozone (O₃) has been associated with cardiorespiratory mortality although few studies have explored susceptible populations based on prior disease. We aimed to investigate the role of previous hospitalization on the association between short-term exposure to O₃ and cardiovascular (CV) and respiratory mortality.

METHODS

We performed time series analyses using generalized additive models and case-crossover on 136,624 CV and 23,281 respiratory deaths in Stockholm County (1990-2010). Deaths were linked to hospital admissions data. We constructed 2-day and 7-day averages using daily 8-h maximum for O₃ and hourly values for PM_2.5, PM₁₀, NO₂, and NO_x from a fixed monitor.

RESULTS

We observed a 0.7% (95% CI: 0.1%, 1.3%) and 2.7% (95% CI: 0.8%, 4.6%) higher risk of CV and respiratory death per 10 μg/m³ higher 2-day and 7-day average O₃ respectively. Individuals previously hospitalized for myocardial infarction demonstrated 1.8% (95% CI: 0.4%, 3.4%) higher risk of CV death per 10 μg/m³ higher 2-day average O₃ and similar associations were observed in individuals with no previous hospitalization for any cause. Individuals with previous hospitalizations did not show susceptibility towards O₃-related risk of respiratory mortality. We observed no associations for other pollutants.

CONCLUSION

Short-term ozone exposure is associated with CV and respiratory mortality and our results may suggest higher susceptibility to CV mortality following O₃ exposure in individuals previously hospitalized for myocardial infarction. Higher risks were also observed in individuals with cardiovascular death as their first presentation of disease.

Post-Effect of Air Quality Improvement on Biomarkers for Systemic Inflammation and Microparticles in Asthma Patients After the 2008 Beijing Olympic Games: a Pilot Study

This study's aim was to investigate the post-effect of an air quality improvement on systemic inflammation and circulating microparticles in asthmatic patients during, and 2 months after, the Beijing Olympics 2008. We measured the levels of circulating inflammatory cytokines and microparticles in the peripheral blood from asthma patients and healthy controls during (phase 1), and 2 months after (phase 2) the Beijing 2008 Olympic Games. The concentrations of circulating cytokines (including TNFα, IL-6, IL-8, and IL-10) were still seen reduced in phase 2 when compared with those in phase 1. The number of circulating endothelial cell-derived microparticles was significantly lower during the phase 2 than that during phase 1 in asthma patients. The level of plasma lipopolysaccharide-binding protein (LBP) was significantly decreased in asthmatics in phase 2. The level of norepinephrine was significantly higher in phase 2 than that in phase 1 in plasma from both asthma patients and healthy subjects. There were no significant differences in the gene profile for the toll-like receptor (TLR) signaling from peripheral blood mononuclear cells. In vitro, microvesicles from patients with asthma impaired the relaxation to bradykinin and contraction to acetylcholine, whereas microparticles from healthy subjects did not. These data suggested that reduction in systemic pro-inflammatory responses and circulating LBP and increased level of norepinephrine in asthma patients persisted even after 2 months of the air pollution intervention. These changes were independent of the TLR signaling pathway. Circulating microparticles might be associated with airway smooth muscle dysfunction.

Association of ambient pollution with inhaler use among patients with COPD: a panel study

BACKGROUND

Studies have linked ambient air pollution to chronic obstructive pulmonary disease (COPD) healthcare encounters. However, the association between air quality and rescue medication use is unknown.

OBJECTIVES

We assessed the role of air pollution exposure for increased short-acting beta-2-agonist (SABA) use in patients with COPD through use of remote monitoring technology.

METHODS

Participants received a portable electronic inhaler sensor to record the date, time and location for SABA use over a 3-month period. Ambient air pollution data and meteorological data were collected from a centrally located federal monitoring station. Mixed-effects Poisson regression was used to examine the association of daily inhaler use with pollutant levels. Four criteria pollutants (PM_2.5, PM₁₀, O₃ and NO₂), two particulate matter species (elemental carbon (EC) and organic carbon), estimated coarse fraction of PM₁₀ (PM_10-2.5) and four multipollutant air quality measures were each examined separately, adjusting for covariates that passed a false discovery rate (FDR) screening.

RESULTS

We enrolled 35 patients with COPD (94.3% male and mean age: 66.5±8.5) with a mean forced expiratory volume in 1 s (FEV₁) % predicted of 44.9+17.2. Participants had a median of 92 observation days (range 52-109). Participants' average SABA inhaler use ranged from 0.4 to 13.1 puffs/day (median 2.8). Controlling for supplemental oxygen use, long-acting anticholinergic use, modified Medical Research Council Dyspnoea Scale and influenza season, an IQR increase in PM₁₀ concentration (8.0 µg/m³) was associated with a 6.6% increase in daily puffs (95% CI 3.5% to 9.9%; FDR <0.001). NO₂ and EC concentration were also significantly associated with inhaler use (3.9% and 2.9% per IQR increase, respectively).

CONCLUSIONS

Exposure to increased ambient air pollution were associated with a significant increase in SABA use for patients with COPD residing in a low-pollution area.

The effects of ozone on human health

Ozone is a highly reactive, oxidative gas associated with adverse health outcome, including mortality and morbidity. Data from monitoring sites worldwide show levels of ozone often exceeding EU legislation threshold and the more restrictive WHO guidelines for the protection of human health. Well-established evidence has been produced for short-term effects, especially on respiratory and cardiovascular systems, associated to ozone exposure. Less conclusive is the evidence for long-term effects, reporting suggestive associations with respiratory mortality, new-onset asthma in children and increased respiratory symptom effects in asthmatics. The growing epidemiological evidence and the increasing availability of routinely collected data on air pollutant concentrations and health statistics allow to produce robust estimates in health impact assessment routine. Most recent estimates indicate that in 2013 in EU-28, 16,000 premature deaths, equivalent to 192,000 years of life lost, are attributable to ozone exposure. Italy shows very high health impact estimates among EU countries, reporting 3380 premature deaths and 61 years of life lost (per 100,000 inhabitants) attributable to ozone exposure.

Epidemiological study of PM2.5 and risk of COPD-related hospital visits in association with particle constituents in Chuncheon, Korea

Background and objective

Aside from smoking, which is already recognized as a strong risk factor for COPD, interest in the impact of particulate matter (PM) on COPD is increasing. This study aimed to investigate the effect of PM, especially with an aerodynamic diameter ≤2.5 µm (PM2.5), and its chemical constituents on the exacerbation of COPD.

Methods

Data on hospital visits including admission and outpatient clinic visits for exacerbation of COPD in Chuncheon, Korea, between 2006 and 2012 were extracted from the National Health Insurance Service database. PM2.5 and its chemical constituents were measured on the roof of the four-story Kangwon National University Natural Sciences building once every 3 days. Meteorological data were provided by the Korean Meteorological Administration.

Results

During the study period, the mean level of PM2.5 was 35.0±25.2 µg/m3, and the number of daily hospital visits were 6.42±4.28 and 2.07±1.93 for males and females, respectively. The number of COPD-related hospital visits increased with increasing PM2.5 after adjusting for meteorological covariates and females tended to be more affected sooner than males. Among the PM2.5 constituents, Al, Si, and elemental carbon were associated with increased hospital visits and there was a difference according to sex. In males, some constituents of PM2.5 were related to an increased risk of a hospital visit, mainly on the first and second days of measurement (Lag1 and Lag2). In contrast, there was no significant increase in the risk of hospital visits due to any of the PM2.5 constituents in females.

Conclusion

Concentrations of PM2.5 mass and some of the PM2.5 constituents were associated with increased COPD-related hospital visits in Chuncheon.

Influence of Gaseous Pollutants on COPD Exacerbations in Patients with Cardiovascular Comorbidities

Exacerbations of chronic obstructive pulmonary disease (COPD) are a serious public health issue. Ambient pollution and meteorological factors are considered among precipitating factors. There are few data concerning the impact of ambient pollutants other than particulates on COPD exacerbations. Among gaseous pollutants four main groups of substances are primarily monitored: nitrogen oxides (NOx), sulphur dioxide (SO₂), carbon monoxide (CO), and ozone (O₃). In this study, 12,889 hospitalizations in the years 2006-2014 due to exacerbations of COPD in patients having a co-existing cardiovascular pathology were retrospectively analyzed. Cardiovascular disease was ruled out as the underlying reason of hospitalization. Data concerning the then accompanying gaseous pollutants and weather conditions were collected. The findings were that the impact of SO₂ content was significantly associated with the relative risk (RR) of COPD exacerbation when the exposure took place at least 30 days or longer before hospital admission (RR 1.04-1.05; p < 0.05). In contrast, risk of COPD exacerbation rose when a shortening of the time lag between exposure to NOx and hospital admission was considered (RR 1.02-1.04; p < 0.05). O₃ exposure was associated with a lower risk irrespective of the length of exposure/exacerbation lag (RR 0.77-0.90; p < 0.05). There were insignificant associations observed for CO. In conclusion, the study demonstrates a salient influence of a co-existing cardiovascular malady on the appearance of COPD-related respiratory exacerbations when the pollutant SO₂ and NOx contents rose. In contrast, higher O₃ content was associated with a lower risk of COPD exacerbation.

Burden of disease attributed to ambient air pollution in Thailand: A GIS-based approach

BACKGROUND

Growing urbanisation and population requiring enhanced electricity generation as well as the increasing numbers of fossil fuel in Thailand pose important challenges to air quality management which impacts on the health of the population. Mortality attributed to ambient air pollution is one of the sustainable development goals (SDGs). We estimated the spatial pattern of mortality burden attributable to selected ambient air pollution in 2009 based on the empirical evidence in Thailand.

METHODS

We estimated the burden of disease attributable to ambient air pollution based on the comparative risk assessment (CRA) framework developed by the World Health Organization (WHO) and the Global Burden of Disease study (GBD). We integrated geographical information systems (GIS)-based exposure assessments into spatial interpolation models to estimate ambient air pollutant concentrations, the population distribution of exposure and the concentration-response (CR) relationship to quantify ambient air pollution exposure and associated mortality. We obtained air quality data from the Pollution Control Department (PCD) of Thailand surface air pollution monitoring network sources and estimated the CR relationship between relative risk (RR) and concentration of air pollutants from the epidemiological literature.

RESULTS

We estimated 650-38,410 ambient air pollution-related fatalities and 160-5,982 fatalities that could have been avoided with a 20 reduction in ambient air pollutant concentrations. The summation of population-attributable fraction (PAF) of the disease burden for all-causes mortality in adults due to NO2 and PM2.5 were the highest among all air pollutants at 10% and 7.5%, respectively. The PAF summation of PM2.5 for lung cancer and cardiovascular disease were 16.8% and 14.6% respectively and the PAF summations of mortality attributable to PM10 was 3.4% for all-causes mortality, 1.7% for respiratory and 3.8% for cardiovascular mortality, while the PAF summation of mortality attributable to NO2 was 7.8% for respiratory mortality in Thailand.

CONCLUSION

Mortality due to ambient air pollution in Thailand varies across the country. Geographical distribution estimates can identify high exposure areas for planners and policy-makers. Our results suggest that the benefits of a 20% reduction in ambient air pollution concentration could prevent up to 25% of avoidable fatalities each year in all-causes, respiratory and cardiovascular categories. Furthermore, our findings can provide guidelines for future epidemiological investigations and policy decisions to achieve the SDGs.

Characteristics of ambient ozone (O3) pollution and health risks in Zhejiang Province

Troposphere ozone, which is from secondary formation processes, has been increasing dramatically during the last decades in China, inducing high health risks. In this study, temporal and spatial distribution of O₃ was studied among 13 sites of three cities during 2014-2016. The objectives were to clarify the characteristics of the ambient pollution of O₃ under the influence from other pollutants and meteorological parameters and the health outcomes from exposure to O₃. The concentrations of O₃ during summer were much higher than those during winter, and the concentrations in downtown areas were higher than in rural or mountain areas. PM_2.5, NO₂, SO₂, and wind speed (WS) were negatively correlated with O₃, and CO, temperature (T), and relative humidity (RH) were positively correlated with O₃. In multivariable analysis, two separate factors-solar radiation and atmospheric diffusion status, affected the O₃ levels. The concentrations of O₃ reached the highest level at 15:00 and the lowest value at about 6:00-8:00, with the similar trend to T and WS, and opposite to RH. According to the dose-response model, relative risks (RRs) and population attributable fractions (PAFs) with confidence intervals (CIs) for chronic obstructive pulmonary disease (COPD) from exposure to O₃ were 1.0612 (CI 1.0607-1.0616) and 5.32% (CI 5.29-5.36%), respectively, attributable to 2000 deaths in Zhejiang Province in 2014.