Association between outdoor air pollution and chronic rhinosinusitis patient reported outcomes

Where There is Smoke: An Updated Review of Environmental Contributions to Chronic Rhinosinusitis

PURPOSE

The pathogenesis of chronic rhinosinusitis (CRS) is thought to include a complex interaction between environmental exposures and host immune responses that generates a self-perpetuating inflammatory process. As molecular pathways continue to be explored, the impact of environmental exposures on CRS pathogenesis and exacerbation must not be overlooked. This review will explore the association between environmental exposures and CRS, specifically focusing on tobacco smoke, occupational inhalational exposures, air pollution, particulate matter, and wildfire smoke.

MAJOR FINDINGS

Tobacco smoke is associated with increased prevalence of CRS symptoms and formal diagnosis with worse surgical outcomes observed in both adults and children exposed to tobacco smoke. Numerous occupational exposures have been associated with increased sinonasal symptoms, though exposures and disease definitions are often poorly characterized. Pollution and microparticle exposure has been associated with an increased likelihood of CRS diagnosis, as well as increased need for surgery. Last, while wildfire smoke has been attributed to increased hospital and emergency room visits for respiratory-related complaints, no primary research has yet been performed regarding CRS and wildfire smoke, though in-vitro studies support an association.

CONCLUSIONS

Population-based studies bolstered by in-vitro mechanistic data support an association between numerous environmental exposures and the onset and severity of CRS.

Association between air pollution and allergic upper respiratory diseases: a meta-analysis

The prevalence of allergic upper respiratory diseases is rising, and while air pollution may worsen them, study results vary, and comprehensive analyses are lacking. This study aimed to systematically evaluate the link between air pollution and these diseases (allergic rhinitis, asthma and chronic sinusitis (with/without nasal polyps)) to provide evidence for reducing their prevalence. A systematic search of PubMed, Embase, Web of Science and Scopus was conducted to find studies published up to 1 September 2024, regarding association between air pollution and allergic upper respiratory diseases. Meta-analyses calculated odds ratios and 95% confidence intervals for the outcomes. Sensitivity and subgroup analyses were performed to explore heterogeneity, and publication bias was assessed using Egger and Begg tests with funnel plots. We included 64 studies with 12 440 647 participants. The prevalence of allergic rhinitis, asthma and chronic sinusitis due to air pollution was 16%, 11% and 12%, respectively. Allergic rhinitis was linked to nitrogen dioxide (NO2) (OR 1.083), particulate matter with aerodynamic diameter <10 µm (PM10) (OR 1.026) and <2.5 µm (PM2.5) (OR 1.104), sulfur dioxide (SO2) (OR 1.116), ozone (OR 1.058) and carbon monoxide (CO) (OR 1.070). Asthma was associated with NO2 (OR 1.146), PM2.5 (OR 1.087), PM10 (OR 1.037), polluted air (OR 1.038), ozone (OR 1.032), SO2 (OR 1.090) and CO (OR 1.184). Chronic sinusitis was linked to PM2.5 (OR 1.135), polluted air (OR 1.767), NO2 (OR 1.091), SO2 (OR 1.08), CO (OR 1.13), PM10 (OR 1.22) and oxides of nitrogen (OR 1.18). Subgroup analyses showed that age (especially the young), region (especially in Europe), gender (especially men) and pollutant concentration (particularly high levels of pollution) affected these associations. Air pollution is positively correlated with prevalence of allergic rhinitis and asthma, increasing risk of allergic upper respiratory tract diseases.

Characterizing air pollution exposure methodologies in rhinology: a scoping review

ABST RACTCharacterization of air pollution assessment methodologies in rhinologic disease research is lacking. A scoping review was thus conducted to survey exposure methods in studies examining common rhinologic conditions: allergic rhinitis (AR) and chronic rhinosinusitis (CRS). Several medical databases were queried for variables relating to (1) adults with a diagnosis of CRS or AR and (2) air pollution exposure. Data was extracted for pollutants assessed, method of quantifying exposure, assessment of residential stability, inclusion of authors with expertise in environmental exposure assessment, and disease-related outcomes. Thirty-four articles were included for analysis - 16 for AR and 18 for CRS. Fifteen studies originated from East Asia, 10 from North America, and 6 from Europe. The most common pollutant studied was PM2.5 (28 studies), with most studies investigating multiple pollutants. Twenty-one studies used a nearby air monitor to quantify exposure, 9 studies reported whether subjects had residential stability for the period assessed, and 17 studies included authors with climate science background. Timeframes included both acute and chronic exposure. Current methods to quantify air pollution exposure in rhinology vary considerably and inconsistently employ expertise from environmental scientists. Future investigations may benefit from multidisciplinary collaboration, reporting of residential stability, and standardized reporting metrics.

The Role of the Environment and Occupational Exposures in Chronic Rhinosinusitis

PURPOSE OF REVIEW

The purpose of the review is to summarize the current literature and evaluate how different environmental exposures may contribute to the development and course of chronic rhinosinusitis (CRS). The review aims to explore the relationship between host factors and environmental exposures in the pathogenesis of CRS.

RECENT FINDINGS

Recent studies have helped establish the role of air pollutants, tobacco smoke, occupational exposures, and microplastics in the pathogenesis of CRS. These exposures have been shown to cause epithelial dysfunction and promote inflammation through different mechanisms and to different degrees. The pathogenesis of CRS is complex and multifactorial, with environmental exposures playing a key role in its onset and exacerbation. Research indicates that pollutants can damage the sinonasal epithelial barrier and disrupt the microbiome, leading to increased inflammation. A deeper understanding of the mechanisms behind this inflammatory process and its link to environmental exposures could enhance strategies for preventing and treating CRS.

Observational study of ground-level ozone and climatic factors in Craiova, Romania, based on one-year high-resolution data

Air pollution is a multifaceted issue affecting people's health, environment, and biodiversity. Gaining comprehension of the interactions between natural and anthropocentric pollutant concentrations and local climate is challenging. This study aims to address the following two questions: (1) What is the influential mechanism of climatic and anthropogenic factors on the ground-level ozone (O3) concentrations in an urban environment during different seasons? (2) Can the ozone weekend effect be observed in a medium-sized city like Craiova, and under which conditions? In order to answer these questions, ozone interactions with meteorological parameters (temperature, pressure, relative humidity) and pollutant concentrations (particulate matter, carbon dioxide, volatile organic compounds, formaldehyde, nitrogen dioxide, nitric oxide and carbon monoxide) is evaluated based on a one-year dataset given by a low-cost sensor and one-year dataset provided by the National Environment Agency. Using two statistical analysis programs, Python and SPSS, a good understanding of the correlations between these variables and ozone concentration is obtained. The SPSS analysis underscores the significant impact of three meteorological factors and nine other pollutants on the ozone level. A positive correlation is noticed in the summer when sunlight is intense and photochemical reactions are elevated. The relationship between temperature and ozone concentration is strong and positive, as confirmed by Spearman's rho correlation coefficient (r = 0.880). A significant negative correlation is found between relative humidity and ozone (r = -0.590). Moreover, the analysis shows that particulate matter concentrations exhibit a significant negative correlation with ozone (r ≈ -0.542), indicating that higher particulate matter concentrations reduce ozone levels. Volatile organic compounds show a significant negative correlation with ozone (r = -0.156). A negative relationship between ozone and carbon dioxide (r = -0.343), indicates that elevated carbon dioxide levels might also suppress ozone concentrations. A significant positive correlation between nitrogen dioxide and ozone (r = 0.060), highlights the role of nitrogen dioxide in the production of ozone through photochemical reactions. However, nitric oxide shows a negative correlation with ozone (r = -0.055) due to its role in ozone formation. Carbon monoxide has no statistically significant effect on ozone concentration. To observe the differences between weekdays and weekends, T-Test was used. Even though significant differences were observed in temperature, humidity, carbon dioxide, volatile organic compounds, nitrogen dioxide, nitric oxide and carbon monoxide levels between weekdays and weekends, the T-Test did not highlight a significant weekend ozone effect in a mid-sized city as Craiova. Using Python, the daily values were calculated and compared with the limit values recommended by the World Health Organization (WHO) and European Environment Agency (EEA). The WHO O3 recommended levels were exceeded for 13 times in one year. This study offers a comprehensive understanding of ozone pollution in a mid-sized city as Craiova, serving as a valuable reference for local decision-makers. It provides critical insights into the seasonal dynamics of ozone levels, emphasizing the significant role of temperature in ozone formation and the complex interactions between various pollutants and meteorological factors.

Short-term effects of air pollutants and meteorological factors on outpatients with allergic airway disease in Ningbo, China, 2015-2021

OBJECTIVES

The allergic airway disease, such as allergic rhinitis, chronic rhinosinusitis, asthma, is a general term of a range of inflammatory disorders affecting the upper and lower airways and lung parenchyma. This study aimed to investigate the short-term effects of air pollutants and meteorological factors on AAD-related daily outpatient visits.

STUDY DESIGN

An ecological study.

METHODS

Data on outpatient visits due to AAD (n = 4,554,404) were collected from the platform of the Ningbo Health Information from January 1, 2015 to December 31, 2021. A Quasi-Poisson generalized additive regression model was established to analyze the lag effects of air pollution on daily outpatient visits for AAD. Restricted cubic spline functions were used to explore the potential non-linear relationships between air pollutants and meteorological and daily outpatient visits for AAD.

RESULTS

PM2.5, PM10, SO2, NO2, or CO were associated with daily outpatient visits for AAD, and there was a significant increasing trend in the cumulative lag effects. SO2 had the largest effect at Lag07, with a 25.3% (95% CI: 21.6%-29.0%) increase in AAD for every 10 μg/m3 increase in exposure concentration. Subgroup analysis showed that the 0-18 years old age group had the strongest effects, especially for AR, and all effects were stronger in the cold season.

CONCLUSIONS

Given that patients aged 0-18 are more susceptible to environmental changes, protective measures specifically for children should be taken during dry and cold weather conditions with poor air quality.

Relationship between chronic rhinosinusitis and risk of obstructive sleep apnea

The relationship between obstructive sleep apnea (OSA) and chronic rhinosinusitis (CRS) has not yet been fully elucidated. Therefore, the objective of this study was to evaluate the connection between OSA risk and CRS by investigating associations between the STOP-Bang questionnaire and presence of CRS in a nationwide, population-based study. This is a cross-sectional study based on the Korean National Health and Nutrition Examination Survey (KNHANES). We evaluated 10,081 subjects who completed both the STOP-Bang and CRS-related questionnaires. Among the total subjects, 390 (3.9%) were CRS patients. The median STOP-Bang score was 3.0 [2.0; 4.0] in CRS patients, compared to 2.0 [1.0; 3.0] in subjects without CRS. In a low-risk group according to the STOP-Bang questionnaire, 3.1% of subjects were CRS patients. However, a gradual increase was observed among different risk groups. In the higher risk group, CRS patients accounted for 5.3% (P < 0.001). Among the four main symptoms of CRS (nasal obstruction, nasal discharge, facial pain/pressure, and decreased sense of smell), nasal obstruction (4.1 to 7.3%) and a decreased sense of smell (1.9 to 3.3%) increased with higher STOP-Bang scores. This study found that the proportion of patients with CRS was significantly higher in the group at a higher STOP-Bang score in the general population. Among symptoms of CRS, nasal obstruction and anosmia were found to be associated with an increased STOP-Bang score.

Association between trimester-specific prenatal air pollution exposure and placental weight of twins

INTRODUCTION

This study investigates the association between maternal exposure to particulate matter (PM10) and nitric dioxide (NO2) during the first, second and third trimester and placental weight and birth weight/placental weight (BW/PW) ratio in twins at birth.

METHODS

Cross-sectional data of 3340 twins from the East Flanders Prospective Twin Survey was used. Air pollutant exposure was estimated via spatial temporal interpolation. Univariable and multivariable mixed model analyses with a random intercept to account for the relatedness of newborns were conducted for twins with separate placentas. Twin pairs with one placental mass were studied with linear and logistic regression.

RESULTS

In the third trimester, for each 10 μm/m3 increase in PM10 or NO2 placental weight decreased -19.7 g (95%-C.I. -35.1; -4.3) and -17.7 g (95%-C.I. -30.4; -0.5) respectively, in moderate to late preterm twins with separate placentas. Consequently, BW/PW ratio increased with higher air pollution exposure. PM10 exposure in the last week of pregnancy was associated with a higher odds ratio (OR) of 1.20 (95%-C.I. 1.00; 1.44) for a "small for gestational age placenta" (placental weight <10th percentile). Conversely, first trimester air pollutant exposure was associated with lower ORs of 0.55 (95%-C.I. 0.35; 0.88) and 0.60 (95%-C.I. 0.42; 0.84).

DISCUSSION

The association of PM10 and NO2 on placental weight is trimester-specific, differs for twins with one versus two placentas and is most pronounced in moderate to late preterm twins. Longitudinal studies are needed to better understand the relationship between air pollutant exposure and placental weight evolution across different trimesters.

Understanding exposomes and its relation with cancer risk in Malaysia based on epidemiological evidence: a narrative review

The prevalence of cancer is increasing globally, and Malaysia is no exception. The exposome represents a paradigm shift in cancer research, emphasizing the importance of a holistic approach that considers the cumulative effect of diverse exposures encountered throughout life. The exposures include dietary factors, air and water pollutants, occupational hazards, lifestyle choices, infectious agents and social determinants of health. The exposome concept acknowledges that each individual's cancer risk is shaped by not only their genetic makeup but also their unique life experiences and environmental interactions. This comprehensive review was conducted by systematically searching scientific databases such as PubMed, Scopus and Google Scholar, by using the keywords "exposomes (environmental exposures AND/OR physical exposures AND/OR chemical exposures) AND cancer risk AND Malaysia", for relevant articles published between 2010 and 2023. Articles addressing the relationship between exposomes and cancer risk in the Malaysian population were critically evaluated and summarized. This review aims to provide an update on the epidemiological evidence linking exposomes with cancer risk in Malaysia. This review will provide an update for current findings and research in Malaysia related to identified exposomes-omics interaction and gap in research area related to the subject matter. Understanding the interplay between complex exposomes and carcinogenesis holds the potential to unveil novel preventive strategies that may be beneficial for public health.

Real-life studies and registries of severe asthma: The advent of digital technology

Severe asthma is a chronic and heterogeneous disease that negatively affects the quality of life of our patients and health care utilization. Given the remaining burden of uncontrolled disease in many of these patients, better understanding of its epidemiology, disease mechanisms, effectiveness of novel therapies such as biologics are still highly needed. Asthma treatment guidelines are largely informed by randomized controlled trials (RCTs) and meta analyses of RCTs, however inclusion criteria of many efficacy RCTs of asthma treatments often exclude a high number of patients with asthma in the community. Data from real-life studies and registries of severe asthma can complement efficacy studies by not only providing evidence on how a treatment performs in everyday clinical practice, post marketing safety information, data to support subsequent clinical trial design, but also helping to delineate the natural history of a disease and supporting important translational research endeavors. In the current review, we summarise available national and international collaborative studies and registries, the variables studies and the novel data and insights they provide. The key source of information for most asthma registries are real-life data from patient's electronic health records. Advent of digital technology in collecting data and their analysis is obvious and we draw attention to generation of new knowledge from registries of severe asthma to improve current diagnostic and therapeutic guidelines and asthma control.

Chronic Occupational Exposure to Traffic Pollution Is Associated with Increased Carotid Intima-Media Thickness in Healthy Urban Traffic Control Police

Urban traffic officers in many low- and middle-income countries are exposed to high levels of traffic-related air pollutants (TRAP) while working vehicle control on heavily congested streets. The impact of chronic TRAP exposure on the cardiovascular health, including the carotid intima-media thickness (CIMT), of this outdoor occupational group remains unclear. This cross-sectional study compared the average mean and maximum CIMT measurements of two groups of relatively young, healthy traffic police (32 ± 7 years; 77% male) in Quito, Ecuador, who were without clinical evidence of serious cardiovascular or other disease. Previously published background data on PM10 (a TRAP surrogate) indicated that street levels of the pollutant were several orders of magnitude higher at the street intersections worked by traffic police compared to those working only in an office. Accordingly, officers permanently assigned to daily traffic control duties requiring them to stand 0-3 m from heavily trafficked street intersections were assigned to the high exposure group (n = 61). The control group (n = 54) consisted of officers from the same organization who were permanently assigned to office duties inside an administration building. Mean and maximum CIMT were measured with ultrasound. General linear models were used to compare the CIMT measurements of the high exposure and control groups, adjusting for covariates. The adjusted average mean and maximum CIMT measures of the high exposure group were increased by 11.5% and 10.3%, respectively, compared to the control group (p = 0.0001). These findings suggest that chronic occupational exposure to TRAP is associated with increased CIMT in traffic police. This is important since even small increases in arterial thickening over time may promote earlier progression to clinical disease and increased premature mortality risk.