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Bao H, Dong J, Li D, Zhu L, Shu J. Short-Term Effects of Ambient Air Pollution on Chronic Obstructive Pulmonary Disease Admissions in Jiuquan, China. TOXICS 2024; 12:364. [PMID: 38787143 PMCID: PMC11125667 DOI: 10.3390/toxics12050364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 05/03/2024] [Accepted: 05/08/2024] [Indexed: 05/25/2024]
Abstract
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).
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Affiliation(s)
- Hairong Bao
- Department of Gerontal Respiratory Medicine, The First Hospital of Lanzhou University, Lanzhou 730000, China
| | - Jiyuan Dong
- School of Public Health, Lanzhou University, Lanzhou 730000, China
| | - Deshun Li
- Department of Gerontal Respiratory Medicine, The First Hospital of Lanzhou University, Lanzhou 730000, China
| | - Lisha Zhu
- Department of Gerontal Respiratory Medicine, The First Hospital of Lanzhou University, Lanzhou 730000, China
| | - Juan Shu
- Department of Gerontal Respiratory Medicine, The First Hospital of Lanzhou University, Lanzhou 730000, China
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Kashtan Y, Nicholson M, Finnegan CJ, Ouyang Z, Garg A, Lebel ED, Rowland ST, Michanowicz DR, Herrera J, Nadeau KC, Jackson RB. Nitrogen dioxide exposure, health outcomes, and associated demographic disparities due to gas and propane combustion by U.S. stoves. SCIENCE ADVANCES 2024; 10:eadm8680. [PMID: 38701214 PMCID: PMC11068006 DOI: 10.1126/sciadv.adm8680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 04/02/2024] [Indexed: 05/05/2024]
Abstract
Gas and propane stoves emit nitrogen dioxide (NO2) pollution indoors, but the exposures of different U.S. demographic groups are unknown. We estimate NO2 exposure and health consequences using emissions and concentration measurements from >100 homes, a room-specific indoor air quality model, epidemiological risk parameters, and statistical sampling of housing characteristics and occupant behavior. Gas and propane stoves increase long-term NO2 exposure 4.0 parts per billion volume on average across the United States, 75% of the World Health Organization's exposure guideline. This increased exposure likely causes ~50,000 cases of current pediatric asthma from long-term NO2 exposure alone. Short-term NO2 exposure from typical gas stove use frequently exceeds both World Health Organization and U.S. Environmental Protection Agency benchmarks. People living in residences <800 ft2 in size incur four times more long-term NO2 exposure than people in residences >3000 ft2 in size; American Indian/Alaska Native and Black and Hispanic/Latino households incur 60 and 20% more NO2 exposure, respectively, than the national average.
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Affiliation(s)
- Yannai Kashtan
- Earth System Science Department, Stanford University, 473 Via Ortega, Stanford, CA 94305, USA
| | - Metta Nicholson
- Earth System Science Department, Stanford University, 473 Via Ortega, Stanford, CA 94305, USA
| | - Colin J. Finnegan
- Earth System Science Department, Stanford University, 473 Via Ortega, Stanford, CA 94305, USA
| | - Zutao Ouyang
- Earth System Science Department, Stanford University, 473 Via Ortega, Stanford, CA 94305, USA
| | - Anchal Garg
- Earth System Science Department, Stanford University, 473 Via Ortega, Stanford, CA 94305, USA
| | - Eric D. Lebel
- PSE Healthy Energy, 1140 Broadway, Suite 750, Oakland, CA 94612, USA
| | | | | | - Janet Herrera
- Central California Asthma Collaborative, Suite J, 1400 Chester Ave., Bakersfield, CA 93301, USA
| | - Kari C. Nadeau
- T.H. Chan School of Public Health, Harvard University, 677 Huntington Ave., Boston, MA 02115, USA
| | - Robert B. Jackson
- Earth System Science Department, Stanford University, 473 Via Ortega, Stanford, CA 94305, USA
- Woods Institute for the Environment and Precourt Institute for Energy, Stanford, CA 94305, USA
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Wang W, Gulliver J, Beevers S, Freni Sterrantino A, Davies B, Atkinson RW, Fecht D. Short-Term Nitrogen Dioxide Exposure and Emergency Hospital Admissions for Asthma in Children: A Case-Crossover Analysis in England. J Asthma Allergy 2024; 17:349-359. [PMID: 38623450 PMCID: PMC11016460 DOI: 10.2147/jaa.s448600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 03/12/2024] [Indexed: 04/17/2024] Open
Abstract
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.
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Affiliation(s)
- Weiyi Wang
- UK Small Area Health Statistics Unit, MRC Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
- National Institute for Health and Care Research Health Protection Research Unit in Chemical and Radiation Threats and Hazards, School of Public Health, Imperial College London, London, UK
| | - John Gulliver
- Population Health Research Institute, St George’s, University of London, London, UK
| | - Sean Beevers
- MRC Centre for Environment and Health, Environmental Research Group, School of Public Health, Imperial College London, London, UK
- National Institute for Health and Care Research Health Protection Research Unit in Environmental Exposures and Health, School of Public Health, Imperial College London, London, UK
| | - Anna Freni Sterrantino
- UK Small Area Health Statistics Unit, MRC Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
- The Alan Turing Institute, London, UK
| | - Bethan Davies
- UK Small Area Health Statistics Unit, MRC Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
- National Institute for Health and Care Research Health Protection Research Unit in Chemical and Radiation Threats and Hazards, School of Public Health, Imperial College London, London, UK
| | - Richard W Atkinson
- Population Health Research Institute, St George’s, University of London, London, UK
| | - Daniela Fecht
- UK Small Area Health Statistics Unit, MRC Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
- National Institute for Health and Care Research Health Protection Research Unit in Chemical and Radiation Threats and Hazards, School of Public Health, Imperial College London, London, UK
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Dunn J, Coravos A, Fanarjian M, Ginsburg GS, Steinhubl SR. Remote digital health technologies for improving the care of people with respiratory disorders. Lancet Digit Health 2024; 6:e291-e298. [PMID: 38402128 PMCID: PMC10960683 DOI: 10.1016/s2589-7500(23)00248-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 10/01/2023] [Accepted: 11/30/2023] [Indexed: 02/26/2024]
Abstract
Respiratory diseases are a leading cause of morbidity and mortality globally. However, existing systems of care, built around scheduled appointments, are not well designed to support the needs of people with chronic and acute respiratory conditions that can change rapidly and unexpectedly. Home-based and personal digital health technologies (DHTs) allow implementation of new models of care catering to the unique needs of individuals. The high number of respiratory triggers and unique responses to them require a personalised solution for each patient. The real-world, repetitive monitoring capabilities of DHTs enable identification of the normal operating characteristics for each individual and, therefore, recognition of the earliest deviations from that state. However, despite this potential, the number of clinical efficacy studies of DHTs is quite small. Evaluation of clinical effectiveness of DHTs in improving health quality in real-world settings is urgently needed.
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Affiliation(s)
- Jessilyn Dunn
- Biomedical Engineering Department, Duke University, Durham, NC, USA
| | | | | | - Geoffrey S Ginsburg
- Department of Medicine, Duke University, Durham, NC, USA; All of Us Research Program, National Institutes of Health, Bethesda, MD, USA
| | - Steven R Steinhubl
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, USA.
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Mah J, Ritchie AI, Finney LJ. Selected updates on chronic obstructive pulmonary disease. Curr Opin Pulm Med 2024; 30:136-140. [PMID: 38099447 DOI: 10.1097/mcp.0000000000001042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
PURPOSE OF REVIEW Chronic obstructive pulmonary disease (COPD) is preventable disease and yet it remains the third greatest cause of death worldwide. This review focuses on recent updates in COPD research which have had an impact on our understanding of the epidemiology and pathophysiology of COPD. RECENT FINDINGS Epidemiological studies of COPD have moved towards trying to understand the global impact of COPD particularly in low- and middle-income countries where disease prevalence continues to increase. In addition, we are beginning to uncover the impact of air pollution on COPD development with recent work showing a relationship between air pollution and COPD exacerbations. Advances in understanding early origins and early development of COPD have the potential to intervene earlier in the disease course to prevent disease progression. Although biomarkers such as peripheral blood eosinophilia have led to trials of biologic agents in COPD suggesting we may be entering an exciting new biologic era in COPD. SUMMARY Recent advances suggest there may be a relationship between air pollution and COPD exacerbations. This requires further research to influence environmental policy. New clinical trials of biologics targeting TH2 inflammation in COPD suggest that targeted treatments with biologics may be a possibility COPD.
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Affiliation(s)
- Jordina Mah
- National Heart and Lung Institute, Imperial College London, London
| | - Andrew I Ritchie
- National Heart and Lung Institute, Imperial College London, London
- Early Clinical Development, Respiratory and Immunology, Clinical, BioPharmaceuticals R&D, AstraZeneca, Cambridge
| | - Lydia J Finney
- National Heart and Lung Institute, Imperial College London, London
- Imperial College Healthcare NHS Trust, UK
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Singh A, Morley GL, Coignet C, Leach F, Pope FD, Neil Thomas G, Stacey B, Bush T, Cole S, Economides G, Anderson R, Abreu P, Bartington SE. Impacts of ambient air quality on acute asthma hospital admissions during the COVID-19 pandemic in Oxford City, UK: a time-series study. BMJ Open 2024; 14:e070704. [PMID: 38262660 PMCID: PMC10806833 DOI: 10.1136/bmjopen-2022-070704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 12/14/2023] [Indexed: 01/25/2024] Open
Abstract
OBJECTIVES The study aims to investigate the short-term associations between exposure to ambient air pollution (nitrogen dioxide (NO2), particulate matter pollution-particles with diameter<2.5 µm (PM2.5) and PM10) and incidence of asthma hospital admissions among adults, in Oxford, UK. DESIGN Retrospective time-series study. SETTING Oxford City (postcode areas OX1-OX4), UK. PARTICIPANTS Adult population living within the postcode areas OX1-OX4 in Oxford, UK from 1 January 2015 to 31 December 2021. PRIMARY AND SECONDARY OUTCOME MEASURES Hourly NO2, PM2.5 and PM10 concentrations and meteorological data for the period 1 January 2015 to 31 December 2020 were analysed and used as exposures. We used Poisson linear regression analysis to identify independent associations between air pollutant concentrations and asthma admissions rate among the adult study population, using both single (NO2, PM2.5, PM10) and multipollutant (NO2 and PM2.5, NO2 and PM10) models, where they adjustment for temperature and relative humidity. RESULTS The overall 5-year average asthma admissions rate was 78 per 100 000 population during the study period. The annual average rate decreased to 46 per 100 000 population during 2020 (incidence rate ratio 0.58, 95% CI 0.42 to 0.81, p<0.001) compared to the prepandemic years (2015-2019). In single-pollutant analysis, we observed a significantly increased risk of asthma admission associated with each 1 μg/m3 increase in monthly concentrations of NO2 4% (95% CI 1.009% to 1.072%), PM2.5 3% (95% CI 1.006% to 1.052%) and PM10 1.8% (95% CI 0.999% to 1.038%). However, in the multipollutant regression model, the effect of each individual pollutant was attenuated. CONCLUSIONS Ambient NO2 and PM2.5 air pollution exposure increased the risk of asthma admissions in this urban setting. Improvements in air quality during COVID-19 lockdown periods may have contributed to a substantially reduced acute asthma disease burden. Large-scale measures to improve air quality have potential to protect vulnerable people living with chronic asthma in urban areas.
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Affiliation(s)
- Ajit Singh
- School of Geography Earth and Environmental Sciences, University of Birmingham, Birmingham, UK
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Gabriella L Morley
- Institute of Microbiology and Infection, University of Birmingham, Birmingham, UK
| | - Cécile Coignet
- NHS Oxfordshire Clinical Commissioning Group, Oxford, UK
| | - Felix Leach
- Department of Engineering Science, University of Oxford, Oxford, UK
| | - Francis D Pope
- School of Geography Earth and Environmental Sciences, University of Birmingham, Birmingham, UK
| | - Graham Neil Thomas
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | - Tony Bush
- Department of Engineering Science, University of Oxford, Oxford, UK
- Apertum, Oxfordshire, UK
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Sebastião BF, Hortelão RM, Granadas SS, Faria JM, Pinto JR, Henriques HR. Air quality self-management in asthmatic patients with COPD: An integrative review for developing nursing interventions to prevent exacerbations. Int J Nurs Sci 2024; 11:46-56. [PMID: 38352284 PMCID: PMC10859576 DOI: 10.1016/j.ijnss.2023.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 11/16/2023] [Accepted: 12/07/2023] [Indexed: 02/16/2024] Open
Abstract
Objectives Asthma-chronic obstructive pulmonary disease (COPD) overlap (ACO) patients experience a lower quality of life, frequent exacerbations, and worse pulmonary function. Environmental management is essential in a complex chronic condition, as pollutant exposure can worsen symptoms and increase morbidity and mortality. We aimed to identify evidence that informs nursing interventions in promoting self-management of air quality in asthmatic people with COPD. Methods We conducted an integrative review in March of 2023. We searched the databases CINAHL, MEDLINE, Academic Search Complete, Cochrane Database of Systematic Reviews (CDSR), Scopus, Web of Science, Joanna Briggs Institute (JBI) Evidence-Based Practice Database, and Google Scholar. We included articles whose participants were adults with asthma, COPD, or both; the intervention was air quality management and the outcome of any exacerbations. We excluded editorials, letters, commentaries, opinion papers, position papers, study protocols, conference abstracts, and reviews. Data extraction and synthesis were performed, categorizing interventions according to nursing actions. Methodological quality assessment was conducted using the JBI Critical Appraisal Checklist tools. The review protocol was registered at Open Science Framework (https://doi.org/10.17605/OSF.IO/5Y4KW). Results We included five articles from different countries. The interventions promoting air quality self-management for individuals with asthma and COPD included vigilance interventions (health professional regular visits, assessment of symptoms), monitoring interventions (measurement of indoor and outdoor trigger factors), and educational interventions (air quality alerts, allergen avoidance). Policy interventions such as smoke-free policies and comprehensive strategies to improve air quality were also identified. These areas of focus represent critical components of nurses' interventions and can integrate the fundamental patterns of knowing in nursing. Although the studies reveal heterogeneous interventions and the methodological quality is variable, these interventions showed potential for preventing exacerbations, reducing emergency department visits, and minimizing hospitalizations. Conclusions The study emphasizes the need for a comprehensive approach involving nurses in multidisciplinary teams to air quality self-management. They can use these results to inform their interventions and ways of knowing, benefiting individuals with asthma and COPD. Further research is needed to expand the evidence base and refine these interventions.
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Affiliation(s)
- Bruna F. Sebastião
- Nursing School of Lisbon, Lisbon, Portugal
- Hospital Center of Central Lisbon, Portugal
| | - Raquel M. Hortelão
- Nursing School of Lisbon, Lisbon, Portugal
- CUF Tejo Hospital, Lisbon, Portugal
| | - Sara S. Granadas
- Nursing School of Lisbon, Lisbon, Portugal
- University Hospital Center of Northern Lisbon, Lisbon, Portugal
| | - José M. Faria
- Nursing School of Lisbon, Lisbon, Portugal
- Hospital Center of Central Lisbon, Portugal
- Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), Lisbon, Portugal
| | - Joana R. Pinto
- Nursing School of Lisbon, Lisbon, Portugal
- Hospital Center of Central Lisbon, Portugal
- Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), Lisbon, Portugal
| | - Helga Rafael Henriques
- Nursing School of Lisbon, Lisbon, Portugal
- Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), Lisbon, Portugal
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Tran HM, Tsai FJ, Lee YL, Chang JH, Chang LT, Chang TY, Chung KF, Kuo HP, Lee KY, Chuang KJ, Chuang HC. The impact of air pollution on respiratory diseases in an era of climate change: A review of the current evidence. THE SCIENCE OF THE TOTAL ENVIRONMENT 2023; 898:166340. [PMID: 37591374 DOI: 10.1016/j.scitotenv.2023.166340] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 07/27/2023] [Accepted: 08/14/2023] [Indexed: 08/19/2023]
Abstract
The impacts of climate change and air pollution on respiratory diseases present significant global health challenges. This review aims to investigate the effects of the interactions between these challenges focusing on respiratory diseases. Climate change is predicted to increase the frequency and intensity of extreme weather events amplifying air pollution levels and exacerbating respiratory diseases. Air pollution levels are projected to rise due to ongoing economic growth and population expansion in many areas worldwide, resulting in a greater burden of respiratory diseases. This is especially true among vulnerable populations like children, older adults, and those with pre-existing respiratory disorders. These challenges induce inflammation, create oxidative stress, and impair the immune system function of the lungs. Consequently, public health measures are required to mitigate the effects of climate change and air pollution on respiratory health. The review proposes that reducing greenhouse gas emissions contribute to slowing down climate change and lessening the severity of extreme weather events. Enhancing air quality through regulatory and technological innovations also helps reduce the morbidity of respiratory diseases. Moreover, policies and interventions aimed at improving healthcare access and social support can assist in decreasing the vulnerability of populations to the adverse health effects of air pollution and climate change. In conclusion, there is an urgent need for continuous research, establishment of policies, and public health efforts to tackle the complex and multi-dimensional challenges of climate change, air pollution, and respiratory health. Practical and comprehensive interventions can protect respiratory health and enhance public health outcomes for all.
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Affiliation(s)
- Huan Minh Tran
- Ph.D. Program in Global Health and Health Security, College of Public Health, Taipei Medical University, Taipei, Taiwan; Faculty of Public Health, Da Nang University of Medical Technology and Pharmacy, Viet Nam
| | - Feng-Jen Tsai
- Ph.D. Program in Global Health and Health Security, College of Public Health, Taipei Medical University, Taipei, Taiwan
| | - Yueh-Lun Lee
- Department of Microbiology and Immunology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Jer-Hwa Chang
- School of Respiratory Therapy, College of Medicine, Taipei Medical University, Taipei, Taiwan; Division of Pulmonary Medicine, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Li-Te Chang
- Department of Environmental Engineering and Science, Feng Chia University, Taichung, Taiwan
| | - Ta-Yuan Chang
- Department of Occupational Safety and Health, College of Public Health, China Medical University, Taichung, Taiwan
| | - Kian Fan Chung
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Han-Pin Kuo
- Division of Pulmonary Medicine, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Kang-Yun Lee
- Division of Pulmonary Medicine, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Division of Pulmonary Medicine, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Kai-Jen Chuang
- School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan; Department of Public Health, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Hsiao-Chi Chuang
- School of Respiratory Therapy, College of Medicine, Taipei Medical University, Taipei, Taiwan; National Heart and Lung Institute, Imperial College London, London, UK; Division of Pulmonary Medicine, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan; Cell Physiology and Molecular Image Research Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
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9
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Byrwa-Hill BM, Morphew TL, Presto AA, Fabisiak JP, Wenzel SE. Living in environmental justice areas worsens asthma severity and control: Differential interactions with disease duration, age at onset, and pollution. J Allergy Clin Immunol 2023; 152:1321-1329.e5. [PMID: 37156327 PMCID: PMC10626048 DOI: 10.1016/j.jaci.2023.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 03/24/2023] [Accepted: 04/14/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND Impoverished and historically marginalized communities often reside in areas with increased air pollution. OBJECTIVE We evaluated the association between environmental justice (EJ) track and asthma severity and control as modified by traffic-related air pollution (TRAP). METHODS We performed a retrospective study of 1526 adult asthma patients in Allegheny County, Pa, enrolled in an asthma registry during 2007-20. Asthma severity and control were determined using global guidelines. EJ tract designation was based on residency in census tracts with ≥30% non-White and/or ≥20% impoverished populations. TRAP exposures (NO2 and black carbon) for each census tract were normalized into pollution quartiles. Generalized linear model analyses determined the effect of EJ tract and TRAP on asthma. RESULTS TRAP exposure in the highest quartile range was more frequent among patients living in an EJ tract (66.4% vs 20.8%, P < .05). Living in an EJ tract increased the odds of severe asthma in later onset asthma. The odds of uncontrolled asthma increased with disease duration in all patients living in EJ tracts (P < .05). Living in the highest quartile of NO2 also increased the odds of uncontrolled asthma in patients with severe disease (P < .05), while there was no effect of TRAP on uncontrolled asthma in patients with less severe disease (P > .05). CONCLUSIONS Living in an EJ tract increased the odds of severe and uncontrolled asthma and was influenced by age at onset, disease duration, and potentially by TRAP exposure. This study underscores the need to better understand the complex environmental interactions that affect lung health in groups that have been economically and/or socially marginalized.
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Affiliation(s)
- Brandy M Byrwa-Hill
- Department of Environmental and Occupational Health, University of Pittsburgh School of Public Health, Pittsburgh, Pa.
| | - Tricia L Morphew
- Morphew Consulting, Bothell, Wash; Community Partners in Asthma Care, McMurray, Pa
| | - Albert A Presto
- Center for Atmospheric Particle Studies, Department of Mechanical Engineering, Carnegie Mellon University, Pittsburgh, Pa
| | - James P Fabisiak
- Department of Environmental and Occupational Health, University of Pittsburgh School of Public Health, Pittsburgh, Pa; University of Pittsburgh Asthma and Environmental Lung Health Institute@UPMC, Pittsburgh
| | - Sally E Wenzel
- Department of Environmental and Occupational Health, University of Pittsburgh School of Public Health, Pittsburgh, Pa; University of Pittsburgh Asthma and Environmental Lung Health Institute@UPMC, Pittsburgh
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10
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McCarron A, Semple S, Braban CF, Gillespie C, Swanson V, Price HD. Personal exposure to fine particulate matter (PM 2.5) and self-reported asthma-related health. Soc Sci Med 2023; 337:116293. [PMID: 37837949 DOI: 10.1016/j.socscimed.2023.116293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 08/01/2023] [Accepted: 09/28/2023] [Indexed: 10/16/2023]
Abstract
PM2.5 (fine particulate matter ≤2.5 μm in diameter) is a key pollutant that can produce acute asthma exacerbations and longer-term deterioration of respiratory health. Individual exposure to PM2.5 is unique and varies across microenvironments. Low-cost sensors (LCS) can collect data at a spatiotemporal resolution previously unattainable, allowing the study of exposures across microenvironments. The aim of this study is to investigate the acute effects of personal exposure to PM2.5 on self-reported asthma-related health. Twenty-eight non-smoking adults with asthma living in Scotland collected PM2.5 personal exposure data using LCS. Measurements were made at a 2-min time resolution for a period of 7 days as participants conducted their typical daily routines. Concurrently, participants were asked to keep a detailed time-activity diary, logging their activities and microenvironments, along with hourly information on their respiratory health and medication use. Health outcomes were modelled as a function of hourly PM2.5 concentration (plus 1- and 2-h lag) using generalized mixed-effects models adjusted for temperature and relative humidity. Personal exposures to PM2.5 varied across microenvironments, with the largest average microenvironmental exposure observed in private residences (11.5 ± 48.6 μg/m3) and lowest in the work microenvironment (2.9 ± 11.3 μg/m3). The most frequently reported asthma symptoms, wheezing, chest tightness and cough, were reported on 3.4%, 1.6% and 1.6% of participant-hours, respectively. The odds of reporting asthma symptoms increased per interquartile range (IQR) in PM2.5 exposure (odds ratio (OR) 1.29, 95% CI 1.07-1.54) for same-hour exposure. Despite this, no association was observed between reliever inhaler use (non-routine, non-exercise related) and PM2.5 exposure (OR 1.02, 95% CI 0.71-1.48). Current air quality monitoring practices are inadequate to detect acute asthma symptom prevalence resulting from PM2.5 exposure; to detect these requires high-resolution air quality data and health information collected in situ. Personal exposure monitoring could have significant implications for asthma self-management and clinical practice.
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Affiliation(s)
- Amy McCarron
- Biological and Environmental Sciences, University of Stirling, FK9 4LA, UK.
| | - Sean Semple
- Institute for Social Marketing and Health, University of Stirling, FK9 4LA, UK.
| | | | - Colin Gillespie
- Scottish Environment Protection Agency (SEPA), Stirling, FK9 4TZ, UK.
| | | | - Heather D Price
- Biological and Environmental Sciences, University of Stirling, FK9 4LA, UK.
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Miravitlles M, Bhutani M, Hurst JR, Franssen FME, van Boven JFM, Khoo EM, Zhang J, Brunton S, Stolz D, Winders T, Asai K, Scullion JE. Implementing an Evidence-Based COPD Hospital Discharge Protocol: A Narrative Review and Expert Recommendations. Adv Ther 2023; 40:4236-4263. [PMID: 37537515 PMCID: PMC10499689 DOI: 10.1007/s12325-023-02609-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 07/06/2023] [Indexed: 08/05/2023]
Abstract
Discharge bundles, comprising evidence-based practices to be implemented prior to discharge, aim to optimise patient outcomes. They have been recommended to address high readmission rates in patients who have been hospitalised for an exacerbation of chronic obstructive pulmonary disease (COPD). Hospital readmission is associated with increased morbidity and healthcare resource utilisation, contributing substantially to the economic burden of COPD. Previous studies suggest that COPD discharge bundles may result in fewer hospital readmissions, lower risk of mortality and improvement of patient quality of life. However, evidence for their effectiveness is inconsistent, likely owing to variable content and implementation of these bundles. To ensure consistent provision of high-quality care for patients hospitalised with an exacerbation of COPD and reduce readmission rates following discharge, we propose a comprehensive discharge protocol, and provide evidence highlighting the importance of each element of the protocol. We then review care bundles used in COPD and other disease areas to understand how they affect patient outcomes, the barriers to implementing these bundles and what strategies have been used in other disease areas to overcome these barriers. We identified four evidence-based care bundle items for review prior to a patient's discharge from hospital, including (1) smoking cessation and assessment of environmental exposures, (2) treatment optimisation, (3) pulmonary rehabilitation, and (4) continuity of care. Resource constraints, lack of staff engagement and knowledge, and complexity of the COPD population were some of the key barriers inhibiting effective bundle implementation. These barriers can be addressed by applying learnings on successful bundle implementation from other disease areas, such as healthcare practitioner education and audit and feedback. By utilising the relevant implementation strategies, discharge bundles can be more (cost-)effectively delivered to improve patient outcomes, reduce readmission rates and ensure continuity of care for patients who have been discharged from hospital following a COPD exacerbation.
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Affiliation(s)
- Marc Miravitlles
- Pneumology Department, Vall d'Hebron University Hospital/Vall d'Hebron Research Institute (VHIR), Vall d'Hebron Barcelona Hospital Campus, Pg. Vall d'Hebron 119-129, 08035, Barcelona, Spain.
| | - Mohit Bhutani
- Division of Pulmonary Medicine, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - John R Hurst
- UCL Respiratory, University College London, London, UK
| | - Frits M E Franssen
- Department of Respiratory Medicine, Maastricht University Medical Center, Maastricht, Netherlands
| | - Job F M van Boven
- Department of Clinical Pharmacy & Pharmacology, Groningen Research Institute for Asthma and COPD (GRIAC), University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Ee Ming Khoo
- Department of Primary Care Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
- International Primary Care Respiratory Group, Leicester, UK
| | - Jing Zhang
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | | | - Daiana Stolz
- Clinic of Respiratory Medicine and Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Tonya Winders
- Global Allergy and Airways Patient Platform, Vienna, Austria
| | - Kazuhisa Asai
- Department of Respiratory Medicine, Osaka Metropolitan University, Osaka, Japan
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Aithal SS, Sachdeva I, Kurmi OP. Air quality and respiratory health in children. Breathe (Sheff) 2023; 19:230040. [PMID: 37377853 PMCID: PMC10292770 DOI: 10.1183/20734735.0040-2023] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 03/14/2023] [Indexed: 06/29/2023] Open
Abstract
Air pollution is a leading modifiable risk factor for various cardio-respiratory outcomes globally, both for children and for adults. Children are particularly susceptible to the adverse effects of air pollution due to various physiological and behavioural factors. Children are at a higher risk of outcomes such as acute respiratory infections, asthma and decreased lung function due to air pollution exposure; the risk varies in different geographical regions, depending on the source of air pollution, duration of exposures and concentration. Prenatal exposure to air pollution may also contribute to adverse respiratory outcomes later in life.
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Affiliation(s)
| | - Ishaan Sachdeva
- Department of Mathematics and Sciences, Brock University, St. Catharines, ON, Canada
| | - Om P. Kurmi
- Department of Medicine, Division of Respirology, McMaster University, Hamilton, ON, Canada
- Firestone Institute for Respiratory Health, St. Joseph's Healthcare, McMaster University, Hamilton, ON, Canada
- Faculty Centre for Intelligent Healthcare, Coventry University, Coventry, UK
- Nexus Institute of Research and Innovation, Lalitpur, Nepal
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13
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Cheng C, Han C, Fang Q, Liu Y, Chi X, Li X. Associations between air pollutants and hospital admissions for chronic obstructive pulmonary disease in Jinan: potential benefits from air quality improvements. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2023; 30:46435-46445. [PMID: 36717420 PMCID: PMC9887246 DOI: 10.1007/s11356-023-25567-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 01/19/2023] [Indexed: 06/01/2023]
Abstract
Evidence between air pollution and chronic obstructive pulmonary disease (COPD) is inconsistent and limited in China. In this study, we aim to examine the associations between air pollutants and hospital admissions for COPD, hoping to provide practical advice for prevention and control of COPD. Hospital admissions for COPD were collected from a Grade-A tertiary hospital in Jinan from 2014 to 2020. A generalized additive model (GAM) was used to examine the associations between air pollutants and hospital admissions for COPD. Stratified analysis was also conducted for gender, age (20-74 and ≥75 years), and season (warm and cold). The avoidable number of COPD hospital admissions was calculated when air pollutants were controlled under national and WHO standards. Over the study period, a total of 4,012 hospital admissions for COPD were recorded. The daily hospital admissions of COPD increased by 2.36% (95%CI: 0.13-4.65%) and 2.39% (95%CI: 0.19-4.65%) for per 10 μg/m3 increase of NO2 and SO2 concentrations at lag2, respectively. There was no statistically significant difference in health effects caused by increased concentrations of PM2.5, PM10, CO, and O3. The health effects of increased SO2 concentration were stronger in women, the ≥75 years old people and the cold season. About 2 (95%CI: 0-3), 64 (95%CI: 4-132) and 86 (95%CI: 6-177) COPD admissions would be avoided when the SO2 concentration was controlled below the NAAQS-II (150 μg/m3), NAAQS-I (50 μg/m3), and WHO's AQG2021 standard (40 μg/m3), respectively. These findings suggest that short-term exposure to NO2 and SO2 was associated with increased risks of daily COPD admissions, especially for females and the elderly. The control of SO2 and NO2 under the national and WHO standards could avoid more COPD admissions and obtain greater health benefits.
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Affiliation(s)
- Chuanlong Cheng
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, 44# Wenhuaxi Road, Lixia District, Jinan, 250012, Shandong, China
| | - Chuang Han
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, 44# Wenhuaxi Road, Lixia District, Jinan, 250012, Shandong, China
| | - Qidi Fang
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, 44# Wenhuaxi Road, Lixia District, Jinan, 250012, Shandong, China
| | - Ying Liu
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, 44# Wenhuaxi Road, Lixia District, Jinan, 250012, Shandong, China
| | - Xiangyu Chi
- Department of Geriatric Respiratory Disease, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Xiujun Li
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, 44# Wenhuaxi Road, Lixia District, Jinan, 250012, Shandong, China.
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Witt C, Liebers U. Urbane Hitze- und Luftbelastung - was muss der Kliniker wissen? PNEUMO NEWS 2023; 15:38-45. [PMID: 37128240 PMCID: PMC10132920 DOI: 10.1007/s15033-023-3476-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Affiliation(s)
- Christian Witt
- Charité/CCM/Infektiol./Pneumologie, Klinik f. Infektiologie u. Pneumologie/Ambulante Pneumologie, Sauerbruchweg 3, 10117 Berlin, Deutschland
| | - Uta Liebers
- Charité - Universitätsmedizin Berlin, Klinik f. Infektiologie u. Pneumologie/Ambulante Pneumologie, Charitéplatz 1, 10117 Berlin, Deutschland
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15
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Wypych-Ślusarska A, Grot M, Kujawińska M, Nigowski M, Krupa-Kotara K, Oleksiuk K, Głogowska-Ligus J, Grajek M. Respiratory Symptoms, Allergies, and Environmental Exposures in Children with and without Asthma. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11180. [PMID: 36141448 PMCID: PMC9517590 DOI: 10.3390/ijerph191811180] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 09/02/2022] [Accepted: 09/03/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Epidemiological data concerning the level of asthma morbidity indicate that in Poland, asthma is diagnosed in 5-10% of the pediatric population. Aim The purpose of this study was to compare the prevalence of respiratory symptoms and allergies in a group of children with and without asthma and to evaluate the association between exposure to environmental factors and the prevalence of bronchial asthma in a pediatric population. MATERIAL AND METHODS A cross-sectional study was conducted on a group of 995 children attending primary schools in the province of Silesia in 2018-2019. The research tool was an anonymous questionnaire developed based on the form used in The International Study of Asthma and Allergies in Childhood (ISAAC). Children's health status, the prevalence of bronchial asthma, and the performance of allergic skin tests were assessed based on parents' indications in a questionnaire. Environmental exposures such as mold and dampness in apartments or ETS were similarly assessed. Analyses were performed using Statistica 13.0; p < 0.05. RESULTS A total of 88 subjects (8.8%) suffered from bronchial asthma. Parents of children with asthma, compared to parents of children without the disease, were more likely to rate their children's health as rather good (43.2% vs. 38.0%) or average (21.6% vs. 3.1%). All analyzed respiratory symptoms, as well as allergies, were statistically more frequent in children with bronchial asthma. CONCLUSIONS The parent's subjective assessment of the child's health varied significantly according to the asthma diagnosis. Asthma is also associated with other diseases: allergic reactions to pollen, house dust, hay fever, and AD (atopic dermatitis) were statistically significantly more frequent among children diagnosed with bronchial asthma.
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Affiliation(s)
- Agata Wypych-Ślusarska
- Department of Epidemiology, Faculty of Health Sciences in Bytom, Medical University of Silesia in Katowice, 40-055 Katowice, Poland
| | - Martina Grot
- Department of Epidemiology, Faculty of Health Sciences in Bytom, Medical University of Silesia in Katowice, 40-055 Katowice, Poland
| | - Maria Kujawińska
- Department of Epidemiology, Faculty of Health Sciences in Bytom, Medical University of Silesia in Katowice, 40-055 Katowice, Poland
| | - Maciej Nigowski
- Department of Epidemiology, Faculty of Health Sciences in Bytom, Medical University of Silesia in Katowice, 40-055 Katowice, Poland
| | - Karolina Krupa-Kotara
- Department of Epidemiology, Faculty of Health Sciences in Bytom, Medical University of Silesia in Katowice, 40-055 Katowice, Poland
| | - Klaudia Oleksiuk
- Department of Epidemiology, Faculty of Health Sciences in Bytom, Medical University of Silesia in Katowice, 40-055 Katowice, Poland
| | - Joanna Głogowska-Ligus
- Department of Epidemiology, Faculty of Health Sciences in Bytom, Medical University of Silesia in Katowice, 40-055 Katowice, Poland
| | - Mateusz Grajek
- Department of Public Health, Department of Public Health Policy, Faculty of Health Sciences in Bytom, Medical University of Silesia in Katowice, 40-055 Katowice, Poland
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