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Chen CS, Chan YS, Liu TC. Tracheitis hospital admissions are associated with Asia dust storm. INTERNATIONAL JOURNAL OF ENVIRONMENTAL HEALTH RESEARCH 2022; 32:1337-1343. [PMID: 33508951 DOI: 10.1080/09603123.2021.1879740] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 01/18/2021] [Indexed: 06/12/2023]
Abstract
The risks of tracheitis have been widely studied, but no investigation has yet to assess the impact of air pollutants on tracheitis hospital admissions. This research explores the relationship between Asia dust storm (ADS) and tracheitis hospital admissions, by using a Poisson time-series model on the 2000-2012 National Health Insurance Research Database (NHIRB) from Taiwan and linking air pollutants and temperature data. From a total of 126,013 tracheitis hospital admissions, the average number of daily tracheitis hospital admissions is 26.53 and increases 10% notably one day after ADS. The empirical result shows that ADS does significantly affect tracheitis hospital admissions 3 and 5 days after an event for the overall sample and 2-4 days after it for females. For the age group <45, the number significantly increases 3-4 days after ADS, revealing that ADS has a prolonged effect on tracheitis hospital admissions.
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Affiliation(s)
- Chin-Shyan Chen
- Department of Economics, National Taipei University, New Taipei City, Taiwan
| | - Yun-Shan Chan
- Department of Public Finance, National Taipei University, New Taipei City, Taiwan
| | - Tsai-Ching Liu
- Department of Public Finance, National Taipei University, New Taipei City, Taiwan
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2
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Kim Y, Park EH, Ng CFS, Chung Y, Hashimoto K, Tashiro K, Hasunuma H, Doi M, Tamura K, Moriuchi H, Nishiwaki Y, Kim H, Yi SM, Kim H, Hashizume M. Respiratory function declines in children with asthma associated with chemical species of fine particulate matter (PM 2.5) in Nagasaki, Japan. Environ Health 2021; 20:110. [PMID: 34670555 PMCID: PMC8529805 DOI: 10.1186/s12940-021-00796-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 10/07/2021] [Indexed: 05/25/2023]
Abstract
BACKGROUND The differential effects of PM2.5 fractions on children's lung function remain inconclusive. This study aimed to examine whether lung function in asthmatic children was associated with increased PM2.5 fractions in urban areas in Nagasaki prefecture, Japan, where the air pollution level is relatively low but influenced by transboundary air pollution. METHODS We conducted a multiyear panel study of 73 asthmatic children (boys, 60.3%; mean age, 8.2 years) spanning spring 2014-2016 in two cities. We collected self-measured peak expiratory flow (PEF) twice a day and daily time-series data for PM2.5 total mass and its chemical species. We fitted a linear mixed effects model to examine short-term associations between PEF and PM2.5, adjusting for individual and time-varying confounders. A generalized linear mixed effects model was also used to estimate the association for worsening asthma defined by severe PEF decline. Back-trajectory and cluster analyses were used to investigate the long-range transboundary PM2.5 in the study areas. RESULTS We found that morning PEFs were adversely associated with higher levels of sulfate (- 1.61 L/min; 95% CI: - 3.07, - 0.15) in Nagasaki city and organic carbon (OC) (- 1.02 L/min; 95% CI: - 1.94, - 0.09) in Isahaya city, per interquartile range (IQR) increase at lag1. In addition, we observed consistent findings for worsening asthma, with higher odds of severe PEF decline in the morning for sulfate (odds ratio (OR) = 2.31; 95% CI: 1.12, 4.77) and ammonium (OR = 1.73; 95% CI: 1.06, 2.84) in Nagasaki city and OC (OR = 1.51; 95% CI: 1.06, 2.15) in Isahaya city, per IQR increase at lag1. The significant chemical species were higher on days that could be largely attributed to the path of Northeast China origin (for sulfate and ammonium) or both the same path and local sources (for OC) than by other clusters. CONCLUSIONS This study provides evidence of the differential effects of PM2.5 fractions on lung function among asthmatic children in urban areas, where the Japanese national standards of air quality have been nearly met. Continuous efforts to promote mitigation actions and public awareness of hazardous transboundary air pollution are needed to protect susceptible children with asthma.
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Affiliation(s)
- Yoonhee Kim
- Department of Global Environmental Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Eun Ha Park
- Institute of Health and Environment, Seoul National University, Seoul, South Korea
| | - Chris Fook Sheng Ng
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Yeonseung Chung
- Department of Mathematical Sciences, Korea Advanced Institute of Science and Technology, Daejeon, South Korea
| | - Kunio Hashimoto
- Department of Paediatrics, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Kasumi Tashiro
- Department of Paediatrics, Isahaya General Hospital, Nagasaki, Japan
| | - Hideki Hasunuma
- Department of Public Health, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Masataka Doi
- Kenhoku Healthcare Office, Nagasaki Prefectural Government, Nagasaki, Japan
| | - Kei Tamura
- Pharmaceutical Administration Office, Nagasaki Prefectural Government, Nagasaki, Japan
| | - Hiroyuki Moriuchi
- Department of Paediatrics, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Yuji Nishiwaki
- Department of Environmental and Occupational Health, School of Medicine, Toho University, Tokyo, Japan
| | - Hwajin Kim
- Graduate School of Public Health, Seoul National University, Seoul, South Korea
| | - Seung-Muk Yi
- Graduate School of Public Health, Seoul National University, Seoul, South Korea
| | - Ho Kim
- Graduate School of Public Health, Seoul National University, Seoul, South Korea
| | - Masahiro Hashizume
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan.
- Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
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3
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Aghababaeian H, Ostadtaghizadeh A, Ardalan A, Asgary A, Akbary M, Yekaninejad MS, Stephens C. Global Health Impacts of Dust Storms: A Systematic Review. ENVIRONMENTAL HEALTH INSIGHTS 2021; 15:11786302211018390. [PMID: 34103932 PMCID: PMC8150667 DOI: 10.1177/11786302211018390] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 04/27/2021] [Indexed: 05/08/2023]
Abstract
BACKGROUND Dust storms and their impacts on health are becoming a major public health issue. The current study examines the health impacts of dust storms around the world to provide an overview of this issue. METHOD In this systematic review, 140 relevant and authoritative English articles on the impacts of dust storms on health (up to September 2019) were identified and extracted from 28 968 articles using valid keywords from various databases (PubMed, WOS, EMBASE, and Scopus) and multiple screening steps. Selected papers were then qualitatively examined and evaluated. Evaluation results were summarized using an Extraction Table. RESULTS The results of the study are divided into two parts: short and long-term impacts of dust storms. Short-term impacts include mortality, visitation, emergency medical dispatch, hospitalization, increased symptoms, and decreased pulmonary function. Long-term impacts include pregnancy, cognitive difficulties, and birth problems. Additionally, this study shows that dust storms have devastating impacts on health, affecting cardiovascular and respiratory health in particular. CONCLUSION The findings of this study show that dust storms have significant public health impacts. More attention should be paid to these natural hazards to prepare for, respond to, and mitigate these hazardous events to reduce their negative health impacts.Registration: PROSPERO registration number CRD42018093325.
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Affiliation(s)
- Hamidreza Aghababaeian
- Department of Health in Emergencies and Disasters, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- Center for Air Pollution Research (CAPR), Institute for Environmental Research (IER), Tehran University of Medical Sciences, Tehran, Iran
- Department of Nursing and Emergency, Dezful University of Medical Sciences, Dezful, Iran
| | - Abbas Ostadtaghizadeh
- Department of Health in Emergencies and Disasters, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- Center for Air Pollution Research (CAPR), Institute for Environmental Research (IER), Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Ardalan
- Department of Health in Emergencies and Disasters, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Asgary
- Disaster and Emergency Management, School of Administrative Studies, York University, Toronto, Canada
| | - Mehry Akbary
- Department of Climatology, Faculty of Geographical Sciences, Kharazmi University, Tehran, Iran
| | - Mir Saeed Yekaninejad
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Carolyn Stephens
- UCL Bartlett Development Planning Unit, London School of Hygiene & Tropical Medicine, London, UK
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4
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Kim M, Kim YM, Lee JY, Yang HK, Kim H, Ahn S, Baek SY, Kim J, Ahn K. Seasonal and monthly variation in peak expiratory flow rate in children with asthma. Asia Pac Allergy 2021; 11:e19. [PMID: 34007829 PMCID: PMC8103013 DOI: 10.5415/apallergy.2021.11.e19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 04/25/2021] [Indexed: 12/22/2022] Open
Abstract
Background Although understanding the seasonal patterns of asthma deterioration is important to prevent asthma exacerbation, previous approaches have limitations in evaluating the actual trend of asthma exacerbation. Objective This study aimed to evaluate the seasonal and monthly variations in the peak expiratory flow rate (PEFR) among children with asthma. Methods A total of 89 patients with asthma were enrolled between December 2012 and March 2015. The PEFR in the morning and evening was recorded daily, and the percentage change in PEFR from baseline was calculated. Generalized estimating equation models were constructed after adjusting for age, sex, body mass index, and sensitization to house dust mites or pollen. Results The PEFR records of 11,222 person-days showed a significant decrease in the morning and evening in autumn than in winter by -1.9% (95% confidence interval [CI], -3.73 to -0.15) and -2.1% (95% CI, -3.80 to -0.37), respectively. The morning PEFR was significantly lower in April, August, October, and December than in January with changes of -4.2% (95% CI, -7.08 to -1.23) in April, -3.1% (95% CI, -5.79 to -0.47) in August, -3.7% (95% CI, -6.09 to -1.21) in October, and -1.9% (95% CI, -3.62 to -0.12) in December. The percentage change of evening PEFR significantly decreased by -3.3% (95% CI, -6.38 to -0.25) in April and by -3.3% (95% CI, -5.56 to -1.07) in October. Conclusion The PEFR in children with asthma was lower in autumn than in winter. In terms of monthly patterns, the PEFR was significantly reduced in April and October than in January. These results can serve as a basis for preventing asthma exacerbations by developing seasonal or monthly management strategies for children with asthma.
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Affiliation(s)
- Minji Kim
- Department of Pediatrics, Chungnam National University Sejong Hospital, Sejong, Korea
| | - Young-Min Kim
- Environmental Health Center for Atopic Diseases, Samsung Medical Center, Seoul, Korea
| | - Ji Young Lee
- Department of Pediatrics, Hallym University Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Korea
| | - Hea-Kyoung Yang
- Department of Pediatrics, Oz Pediatrics Clinic, Yongin, Korea
| | - Hyunmi Kim
- Environmental Health Center for Atopic Diseases, Samsung Medical Center, Seoul, Korea
| | - Soohyun Ahn
- Department of Mathematics, Ajou University, Suwon, Korea
| | - Sun-Young Baek
- Statistics and Data Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Korea
| | - Jihyun Kim
- Environmental Health Center for Atopic Diseases, Samsung Medical Center, Seoul, Korea.,Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kangmo Ahn
- Environmental Health Center for Atopic Diseases, Samsung Medical Center, Seoul, Korea.,Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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5
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Hasunuma H, Takeuchi A, Ono R, Amimoto Y, Hwang YH, Uno I, Shimizu A, Nishiwaki Y, Hashizume M, Askew DJ, Odajima H. Effect of Asian dust on respiratory symptoms among children with and without asthma, and their sensitivity. THE SCIENCE OF THE TOTAL ENVIRONMENT 2021; 753:141585. [PMID: 32890882 DOI: 10.1016/j.scitotenv.2020.141585] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 07/28/2020] [Accepted: 08/07/2020] [Indexed: 06/11/2023]
Abstract
There has been little study on the effect of Asian dust exposure on respiratory symptoms among children who are vulnerable to environmental factors. In this panel study, we investigated the effect of Asian dust on respiratory symptoms among children with and without asthma, and their sensitivity. Children attending two elementary schools (137 total), and 23 children with asthma from cooperating medical institutions in Fukuoka prefecture were recruited. Subjects measured peak expiratory flow rate (PEF), and recorded asthma-like symptoms, cough, nasal symptoms and use of medication in a diary from April 1, 2013 to June 30, 2013. To assess exposure to Asian dust, we used Light Detection and Ranging (LIDAR) data. For the analysis of the association between Asian dust and respiratory symptoms, the case-crossover design and generalized estimating equation (GEE) models were used. Taking individual sensitivity to respiratory aggravation into consideration, the subjects were classified into three groups: children without asthma, children with asthma who do not use long-term preventive medication (CA) and children with asthma who use long-term preventive medication (CA-LTM). For CA, Asian dust exposure was significantly associated with asthma-like symptoms, with a hazard ratio of 5.17 (95%CI: 1.02=26.12) at Lag0, and the change in %maxPEF, -1.65% (95%CI:-2.82, -0.48) at Lag0. For children without asthma, a statistically significant association was found between Asian dust exposure and the change in %maxPEF, -0.56% (95%CI: -1.31, -0.08) at Lag1. However, no adverse effects were observed in CA-LTM. Temperature had significant effects on %maxPEF for three groups. Asian dust, photochemical oxidant and pollen caused simultaneously additive adverse effects on nasal symptoms for children without asthma. This study suggests the possibility that long-term preventive medication to manage asthma may suppress aggravation of respiratory symptoms due to Asian dust and may be an effective prevention.
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Affiliation(s)
- Hideki Hasunuma
- Department of Public Health, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo 663-8501, Japan; Center for Environmental Information Science, 3-2-7 Kudan-minami, Chiyoda-ku, Tokyo, 102-0074, Japan
| | - Ayano Takeuchi
- Department of Preventive Medicine and Public Health, School of Medicine, Keio University, 35 Shinanomachi, Sinjyuku-ku, Tokyo 160-8582, Japan
| | - Rintaro Ono
- Department of Pediatrics, National Hospital Organization Fukuoka National Hospital, 4-39-1 Yakatabaru, Minami-ku, Fukuoka 811-1394, Japan
| | - Yuko Amimoto
- Department of Pediatrics, Uji-Tokusyukai Medical Center, 145, Ishibashi, Makishima, Uji, Kyoto 611-0041, Japan
| | - Yoon Ha Hwang
- Busan St. Mary's Hospital, 25-14, Yongho-ro 232 beon-gil, Nam-gu, Busan 608-838, Republic of Korea
| | - Itsushi Uno
- Research Institute for Applied Mechanics, Kyushu University, 6-1 Kasuga-koen, Kasuga, Fukuoka 816-8580, Japan
| | - Atsushi Shimizu
- Center for Regional Environmental Research, National Institute for Environmental Studies, 16-2 Onogawa, Tsukuba, Ibaraki 305-8506, Japan
| | - Yuji Nishiwaki
- Department of Environmental and Occupational Health, School of Medicine, Toho University, 5-21-16 Omorinishi, Ota-ku, Tokyo 143-8540, Japan
| | - Masahiro Hashizume
- Department of Global Health Policy, School of International Health, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - David J Askew
- Department of Obstetrics and Gynecology, School of Medicine, University of Occupational and Environmental Health, 1-1, Iseigaoka, Yahatanishi-ku, Kitakyusyu, Fukuoka 807-8555, Japan
| | - Hiroshi Odajima
- Department of Pediatrics, National Hospital Organization Fukuoka National Hospital, 4-39-1 Yakatabaru, Minami-ku, Fukuoka 811-1394, Japan.
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6
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Rublee CS, Sorensen CJ, Lemery J, Wade TJ, Sams EA, Hilborn ED, Crooks JL. Associations Between Dust Storms and Intensive Care Unit Admissions in the United States, 2000-2015. GEOHEALTH 2020; 4:e2020GH000260. [PMID: 32783014 PMCID: PMC7411550 DOI: 10.1029/2020gh000260] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 06/25/2020] [Accepted: 06/26/2020] [Indexed: 05/13/2023]
Abstract
Anthropogenic climate change is influencing the incidence of dust storms and associated human exposure to coarse particulate matter (PM2.5-10) in the United States. Studies have found adverse health consequences related to dust exposure. These consequences include respiratory disease exacerbations and premature mortality, resulting in increased health care utilization. However, the impact of dust storms on critical care demand has not been studied in the United States. We seek to quantify the relationship between dust storms and surges in critical care demand by investigating the association between dust storms and intensive care unit (ICU) admissions at nearby hospitals from 2000 to 2015. ICU data were acquired from Premier, Inc. and encompass 15-20% of all ICU admissions in the United States. Dust storm, meteorology, and air pollutant data were downloaded from the U.S. National Weather Service, the U.S. National Climatic Data Center, and the U.S. Environmental Protection Agency websites, respectively. Associations between ICU admission and dust storms, controlling for temperature, dew point temperature, ambient PM2.5 and ozone, as well as seasonally varying confounders, were estimated using a distributed lag conditional Poisson model with overdispersion. We found a 4.8% (95% CI: 0.4, 9.4; p = 0.033) increase in total ICU admissions on the day of the dust storm (Lag 0) and a 9.2% (95% CI: 1.8, 17.0; p = 0.013) and 7.5% (95% CI: 0.3, 15.2; p = 0.040) increase in respiratory admissions at Lags 0 and 5. North American dust storms are associated with increases in same day and lagged demand for critical care services at nearby hospitals.
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Affiliation(s)
- C. S. Rublee
- Department of Emergency MedicineUniversity of Colorado School of MedicineAuroraCOUSA
| | - C. J. Sorensen
- Department of Emergency MedicineUniversity of Colorado School of MedicineAuroraCOUSA
| | - J. Lemery
- Department of Emergency MedicineUniversity of Colorado School of MedicineAuroraCOUSA
| | - T. J. Wade
- United States Environmental Protection AgencyChapel HillNCUSA
| | - E. A. Sams
- United States Environmental Protection AgencyChapel HillNCUSA
| | - E. D. Hilborn
- United States Environmental Protection AgencyChapel HillNCUSA
| | - J. L. Crooks
- Division of Biostatistics and BioinformaticsNational Jewish HealthDenverCOUSA
- Department of EpidemiologyColorado School of Public HealthAuroraCOUSA
- Now at National Jewish Health Main CampusDenverCOUSA
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7
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Development of a system for the detection of the inflammatory response induced by airborne fine particulate matter in rat tracheal epithelial cells. Toxicol Rep 2020; 7:900-908. [PMID: 32775214 PMCID: PMC7394921 DOI: 10.1016/j.toxrep.2020.06.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 03/30/2020] [Accepted: 06/27/2020] [Indexed: 12/05/2022] Open
Abstract
Atmospheric endotoxin level is related to inflammatory response induction Stable cell lines established to determine the expression of pro-inflammatory genes Our system serves monitoring of inflammatory response to airborne particulate matter
Exposure to airborne particulate matter (PM) is related to the increased risk of several diseases, including chronic and allergic rhinitis. We have previously shown that atmospheric endotoxin level was positively associated with the number of emergency department visits for asthma even after adjusting for meteorological factors, suggestive of the significant association between atmospheric endotoxin level and asthma exacerbation. Whether atmospheric endotoxin level is related to inflammatory response induction is, however, unclear. Here, we established stable cell lines to determine the promoter activity of the genes encoding pro-inflammatory cytokines such as tumor necrosis factor alpha, interleukin 6 (IL6), and IL33 by transfection of each reporter plasmid into rat tracheal epithelial EGV-4 T cells. These cells could measure the inflammatory response induced by endotoxin treatment more easily, rapidly, and sensitively than the conventional system using immunodetection assays. Furthermore, we revealed a relationship between atmospheric endotoxin level and inflammatory response induction. Thus, the system established herein may serve as a promising tool to monitor inflammatory response induced upon PM exposure.
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8
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Yamagishi N, Yamaguchi T, Kuga T, Taniguchi M, Khan MS, Matsumoto T, Deguchi Y, Nagaoka H, Wakabayashi K, Watanabe T. Development of a system for the detection of the inflammatory response induced by airborne fine particulate matter in rat tracheal epithelial cells. Toxicol Rep 2020; 7:859-866. [PMID: 32714841 PMCID: PMC7378315 DOI: 10.1016/j.toxrep.2020.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Exposure to airborne particulate matter (PM) is related to the increased risk of several diseases, including chronic and allergic rhinitis. We have previously shown that atmospheric endotoxin level was positively associated with the number of emergency department visits for asthma even after adjusting for meteorological factors, suggestive of the significant association between atmospheric endotoxin level and asthma exacerbation. Whether atmospheric endotoxin level is related to inflammatory response induction is, however, unclear. Here, we established stable cell lines to determine the promoter activity of the genes encoding pro-inflammatory cytokines such as tumor necrosis factor alpha, interleukin 6 (IL6), and IL33 by transfection of each reporter plasmid into rat tracheal epithelial EGV-4 T cells. These cells could measure the inflammatory response induced by endotoxin treatment more easily, rapidly, and sensitively than the conventional system using immunodetection assays. Furthermore, we revealed a relationship between atmospheric endotoxin level and inflammatory response induction. Thus, the system established herein may serve as a promising tool to monitor inflammatory response induced upon PM exposure.
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Affiliation(s)
- Nobuyuki Yamagishi
- Department of Analytics for Biomolecules, Faculty of Pharmaceutical Sciences, Setsunan University, 45-1 Nagaotoge-cho, Hirakata, Osaka 573-0101, Japan
| | - Tomoki Yamaguchi
- Department of Analytics for Biomolecules, Faculty of Pharmaceutical Sciences, Setsunan University, 45-1 Nagaotoge-cho, Hirakata, Osaka 573-0101, Japan
| | - Takahisa Kuga
- Department of Analytics for Biomolecules, Faculty of Pharmaceutical Sciences, Setsunan University, 45-1 Nagaotoge-cho, Hirakata, Osaka 573-0101, Japan
| | - Masanari Taniguchi
- Department of Analytics for Biomolecules, Faculty of Pharmaceutical Sciences, Setsunan University, 45-1 Nagaotoge-cho, Hirakata, Osaka 573-0101, Japan
| | - Mohammad Shahriar Khan
- Department of Public Health, Kyoto Pharmaceutical University, 1 Misasagishichono-cho, Yamashina-ku, Kyoto 607-8412, Japan
| | - Takahiro Matsumoto
- Department of Public Health, Kyoto Pharmaceutical University, 1 Misasagishichono-cho, Yamashina-ku, Kyoto 607-8412, Japan
| | - Yuya Deguchi
- Faculty of Pharmaceutical Sciences, Nagasaki International University, 2825-7 Huis Ten Bosch, Sasebo, Nagasaki 859-3298, Japan
| | - Hiroaki Nagaoka
- Faculty of Pharmaceutical Sciences, Nagasaki International University, 2825-7 Huis Ten Bosch, Sasebo, Nagasaki 859-3298, Japan
| | - Keiji Wakabayashi
- Department of Public Health, Kyoto Pharmaceutical University, 1 Misasagishichono-cho, Yamashina-ku, Kyoto 607-8412, Japan.,Graduate Division of Nutritional and Environmental Sciences, University of Shizuoka, 52-1 Yada, Suruga-ku, Shizuoka 422-8526, Japan
| | - Tetsushi Watanabe
- Department of Public Health, Kyoto Pharmaceutical University, 1 Misasagishichono-cho, Yamashina-ku, Kyoto 607-8412, Japan
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9
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Odajima H, Kawano T, Wakatsuki M, Akaminea Y, Okabe K, Oki T, Matsuzaki H, Murakami Y, Iwata M, Taba N, Motomura C, Honjo S, Ninomiya T. Annual changes in the prevalence of asthma may be related to air pollution in Fukuoka: 29 years of observation. ERJ Open Res 2020; 6:00166-2020. [PMID: 32613014 PMCID: PMC7322894 DOI: 10.1183/23120541.00166-2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 04/03/2020] [Indexed: 11/16/2022] Open
Abstract
The relationship between the annual changes of the prevalence of bronchial asthma (BA) and that of concentrations of air pollutants has not been reported. We studied the annual prevalence of BA, remission of BA, and wheeze in children at the same five elementary schools in Fukuoka city, Japan, in October to November from 1988 to 2016 by the same methods using the same questionnaire. Annual changes in the prevalence of asthma among boys were related to changes in the air concentrations of NO (r=0.708), NO2 (r=0.665) suspended particulate matter (SPM) (r=0.803), and smoking rate (r=0.741), but there were no such relationships among girls. Annual changes in the prevalence of wheeze were related to changes of NO, NO2, SPM, and smoking rate among boys and girls (NO: r=0.650, 0.660; NO2: r=0.556, 0.490; SPM: r=0.582, 0.518; smoking rate: r=0.656, 0.593, respectively) (all of the above are significant with p<0.05). There was no relationship between remission of BA and any of the pollutants. Annual changes in the prevalence of boys' BA and boys' and girls' wheeze among first-grade children (age 6 or 7 years) in Fukuoka were correlated with changes in the concentration of air pollutants (SPM, NO, NO2 or smoking rate). Recent decrease of asthma prevalence in this area might be related to the decreasing tendency of air pollutant concentration. The causal relationship between the two will need to be verified in the future Annual changes in the prevalence of child asthma in Fukuoka are correlated with those in the concentration of air pollutants (SPM, etc.). A recent decrease of asthma prevalence might be related to the decreasing concentration of air pollutants.https://bit.ly/2RlYXfu
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Affiliation(s)
- Hiroshi Odajima
- Dept of Pediatrics, National Hospital Organization Fukuoka National Hospital, Fukuoka, Japan
| | - Toshiaki Kawano
- Dept of Pediatrics, National Hospital Organization Fukuoka National Hospital, Fukuoka, Japan
| | - Masatoshi Wakatsuki
- Dept of Pediatrics, National Hospital Organization Fukuoka National Hospital, Fukuoka, Japan
| | - Yuko Akaminea
- Dept of Pediatrics, National Hospital Organization Fukuoka National Hospital, Fukuoka, Japan
| | - Koki Okabe
- Dept of Pediatrics, National Hospital Organization Fukuoka National Hospital, Fukuoka, Japan
| | - Tuyoshi Oki
- Dept of Pediatrics, National Hospital Organization Fukuoka National Hospital, Fukuoka, Japan
| | - Hiroshi Matsuzaki
- Dept of Pediatrics, National Hospital Organization Fukuoka National Hospital, Fukuoka, Japan
| | - Yoko Murakami
- Dept of Pediatrics, National Hospital Organization Fukuoka National Hospital, Fukuoka, Japan
| | - Mihoko Iwata
- Dept of Pediatrics, National Hospital Organization Fukuoka National Hospital, Fukuoka, Japan
| | - Naohiko Taba
- Dept of Pediatrics, National Hospital Organization Fukuoka National Hospital, Fukuoka, Japan
| | - Chikako Motomura
- Dept of Pediatrics, National Hospital Organization Fukuoka National Hospital, Fukuoka, Japan
| | - Satoshi Honjo
- Dept of Pediatrics, National Hospital Organization Fukuoka National Hospital, Fukuoka, Japan
| | - Takahito Ninomiya
- Dept of Pediatrics, National Hospital Organization Fukuoka National Hospital, Fukuoka, Japan
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10
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Hashizume M, Kim Y, Ng CFS, Chung Y, Madaniyazi L, Bell ML, Guo YL, Kan H, Honda Y, Yi SM, Kim H, Nishiwaki Y. Health Effects of Asian Dust: A Systematic Review and Meta-Analysis. ENVIRONMENTAL HEALTH PERSPECTIVES 2020; 128:66001. [PMID: 32589456 PMCID: PMC7319773 DOI: 10.1289/ehp5312] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
BACKGROUND Potential adverse health effects of Asian dust exposure have been reported, but systematic reviews and quantitative syntheses are lacking. OBJECTIVE We reviewed epidemiologic studies that assessed the risk of mortality, hospital admissions, and symptoms/dysfunction associated with exposure to Asian dust. METHODS We performed a systematic search of PubMed and Web of Science to identify studies that reported the association between Asian dust exposure and human health outcomes. We conducted separate meta-analyses using a random-effects model for mortality and hospital admissions for a specific health outcome and assessed pooled estimates for each lag when at least three studies were available for a specific lag. RESULTS We identified 89 studies that met our inclusion criteria for the systematic review, and 21 studies were included in the meta-analysis. The pooled estimates (percentage changes) of mortality from circulatory and respiratory causes for Asian dust days vs. non-Asian dust days were 2.33% [95% confidence interval (CI): 0.76, 3.93] increase at lag 0 and 3.99% (95% CI: 0.08, 8.06) increase at lag 3, respectively. The increased risk for hospital admissions for respiratory disease, asthma, and pneumonia peaked at lag 3 by 8.85% (95% CI: 0.80, 17.55), 14.55% (95% CI: 6.74, 22.94), and 8.51% (95% CI: 2.89, 14.44), respectively. Seven of 12 studies reported reduced peak expiratory flow, and 16 of 21 studies reported increased respiratory symptoms associated with Asian dust exposure. There were substantial variations between the studies in definitions of Asian dust, study designs, model specifications, and confounder controls. DISCUSSION We found evidence of increased mortality and hospital admissions for circulatory and respiratory events. However, the number of studies included in the meta-analysis was not large and further evidences are merited to strengthen our conclusions. Standardized protocols for epidemiological studies would facilitate interstudy comparisons. https://doi.org/10.1289/EHP5312.
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Affiliation(s)
- Masahiro Hashizume
- Department of Global Health Policy, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
- Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
| | - Yoonhee Kim
- Department of Global Environmental Health, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Chris Fook Sheng Ng
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Yeonseung Chung
- Department of Mathematical Sciences, Korea Advanced Institute of Science and Technology, Daejeon, South Korea
| | - Lina Madaniyazi
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
- Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
| | - Michelle L Bell
- School of Forestry and Environmental Studies, Yale University, New Haven, Connecticut, USA
| | - Yue Leon Guo
- Environmental and Occupational Medicine, National Taiwan University (NTU) and NTU Hospital, Taipei, Taiwan
| | - Haidong Kan
- Department of Environmental Health, School of Public Health, Fudan University, Shanghai, China
| | - Yasushi Honda
- Faculty of Health and Sport Sciences, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Seung-Muk Yi
- Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea
| | - Ho Kim
- Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea
| | - Yuji Nishiwaki
- Department of Environmental and Occupational Health, School of Medicine, Toho University, Tokyo, Japan
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11
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Itazawa T, Kanatani KT, Hamazaki K, Inadera H, Tsuchida A, Tanaka T, Nakayama T, Go T, Onishi K, Kurozawa Y, Adachi Y, Konishi I, Heike T, Konishi Y, Sato K, Egawa M, Takahashi Y, Watanabe M, Yasumi R, Hirabayashi K, Morita M, Konishi K, Hirooka Y, Fukumoto S, Teshima R, Inoue T, Harada T, Kanzaki S, Maegaki Y, Ohno K, Koeda T, Amano H, Masumoto T. The impact of exposure to desert dust on infants' symptoms and countermeasures to reduce the effects. Allergy 2020; 75:1435-1445. [PMID: 31886894 DOI: 10.1111/all.14166] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 09/24/2019] [Accepted: 10/08/2019] [Indexed: 01/26/2023]
Abstract
BACKGROUND The association between particulate matter (PM), including desert dust, and allergic symptoms has not been well studied. We examined whether PM exacerbated nose/eye/respiratory symptoms in infants, with a focus on the desert dust element, and assessed possible countermeasures. METHODS We conducted a panel study of 1492 infants from October 2014 to July 2016 in 3 regions in Japan as an adjunct study of the Japan Environment and Children's Study. Infants' daily symptom scores and behaviors were acquired by web-based questionnaires sent to mothers, who answered within a day using mobile phones. Odds ratios (OR) for symptom development per increased fine PM or desert dust exposure were estimated. Regular use of medications and behaviors on the day of exposure were investigated as possible effect modifiers. RESULTS Infants developed nose/eye/respiratory symptoms significantly more often in accordance with fine particulate levels (adjusted OR per 10 µg/m3 increase: 1.04, 95% confidence interval [CI]: 1.01-1.07). A model including both fine particulates and desert dust showed reduced OR for fine particulates and robust OR for desert dust (adjusted OR per 0.1/km increase: 1.16, 95% CI: 1.09-1.23). An increased OR was observed both in infants who had previously wheezed and in those who had never wheezed. Receiving information on the particulate forecast, reducing time outdoors, closing windows, and regular use of leukotriene receptor antagonists were significant effect modifiers. CONCLUSIONS Transborder desert dust arrival increased the risk of nose/eye/respiratory symptoms development in infants. Regular use of leukotriene receptor antagonists and other countermeasures reduced the risk.
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Affiliation(s)
- Toshiko Itazawa
- Department of Pediatrics Faculty of Medicine University of Toyama Toyama Japan
| | - Kumiko T. Kanatani
- Japan Environment and Children's Study Kyoto Regional Center Kyoto University Graduate School of Medicine Kyoto Japan
| | - Kei Hamazaki
- Department of Public Health Faculty of Medicine University of Toyama Toyama Japan
| | - Hidekuni Inadera
- Department of Public Health Faculty of Medicine University of Toyama Toyama Japan
| | - Akiko Tsuchida
- Department of Public Health Faculty of Medicine University of Toyama Toyama Japan
| | - Tomomi Tanaka
- Department of Pediatrics Faculty of Medicine University of Toyama Toyama Japan
| | - Takeo Nakayama
- Department of Health Informatics Kyoto University School of Public Health Kyoto Japan
| | - Tohshin Go
- Japan Environment and Children's Study Kyoto Regional Center Kyoto University Graduate School of Medicine Kyoto Japan
| | - Kazunari Onishi
- Division of Environmental Health Graduate School of Public Health St.Luke's International University Tokyo Japan
- Division of Health Administration and Promotion Faculty of Medicine Tottori University Tottori Japan
| | - Yoichi Kurozawa
- Division of Health Administration and Promotion Faculty of Medicine Tottori University Tottori Japan
| | - Yuichi Adachi
- Department of Pediatrics Faculty of Medicine University of Toyama Toyama Japan
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12
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Nakamura T, Nishiwaki Y, Hashimoto K, Takeuchi A, Kitajima T, Komori K, Tashiro K, Hasunuma H, Ueda K, Shimizu A, Odajima H, Moriuchi H, Hashizume M. Association between Asian dust exposure and respiratory function in children with bronchial asthma in Nagasaki Prefecture, Japan. Environ Health Prev Med 2020; 25:8. [PMID: 32131724 PMCID: PMC7057478 DOI: 10.1186/s12199-020-00846-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 02/12/2020] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Studies on the adverse effects of Asian dust (AD) on respiratory function in children are scarce. The objective of this study was to examine the association between AD and respiratory function by measuring peak expiratory flow rates (PEFRs) in asthmatic children. METHODS The study was carried out from March to May from 2014 through 2016. One hundred ten children with bronchial asthma were recruited from four hospitals in the Goto Islands and south Nagasaki area in Nagasaki prefecture. The parents were asked to record their children's PEFRs every morning/evening and clinical symptoms in an asthma diary. AD was assessed from light detection and ranging data, and a linear mixed-effects model was used to estimate the effects of AD on daily PEFR. Time-stratified case-crossover analyses were performed to examine the association between AD and asthma attacks defined by reduction levels in PEFR. RESULTS AD was detected on 11 days in the Goto Islands, and on 23 days in the south Nagasaki area. After adjusting for age, sex, temperature, and daily oxidants, we found a consistent association between AD and a 1.1% to 1.7% decrease in PEFR in the mornings and a 0.7% to 1.3% decrease in the evenings at a lag of 0 to 5 days. AD was not associated with the number of asthma attacks, respiratory symptoms, or other symptoms at any lag days examined. CONCLUSIONS Exposure to AD was associated with reduced PEFR, although the effects were not large enough to induce clinically apparent symptoms, in clinically well-controlled asthmatic children.
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Affiliation(s)
- Takahiro Nakamura
- Department of Environmental and Occupational Health, School of Medicine, Toho University, Tokyo, Japan
| | - Yuji Nishiwaki
- Department of Environmental and Occupational Health, School of Medicine, Toho University, Tokyo, Japan.
| | - Kunio Hashimoto
- Department of Paediatrics, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Ayano Takeuchi
- Department of Preventive Medicine and Public Health, School of Medicine, Keio University, Tokyo, Japan
| | - Tasuku Kitajima
- Department of Paediatrics, Nagasaki Goto Chuoh Hospital, Nagasaki, Japan
| | - Kazuhiro Komori
- Department of Paediatrics, Nagasaki Kamigoto Hospital, Nagasaki, Japan
| | - Kasumi Tashiro
- Department of Paediatrics, Isahaya General Hospital, Nagasaki, Japan
| | | | - Kayo Ueda
- Environmental Health Sciences, Graduate School of Global Environmental Studies, Kyoto University, Kyoto, Japan
| | - Atsushi Shimizu
- Center for Regional Environmental Research, National Institute for Environmental Studies, Ibaraki, Japan
| | - Hiroshi Odajima
- Department of Paediatrics, Fukuoka National Hospital, Fukuoka, Japan
| | - Hiroyuki Moriuchi
- Department of Paediatrics, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Masahiro Hashizume
- Department of Global Health Policy, School of International Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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13
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Hasunuma H, Ichinose T, Ueda K, Odajima H, Kanatani K, Shimizu A, Takami A, Takeuchi A, Nishiwaki Y, Watanabe M, Hashizume M. [Health Effects of Asian Dust Events: A Literature Review Update of Epidemiological Evidence]. Nihon Eiseigaku Zasshi 2020; 74. [PMID: 31875632 DOI: 10.1265/jjh.19010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Asian dust is a phenomenon involving the long-range transport of atmospheric pollutants originating from the desert areas of China and Mongolia. In recent years, the health effects of Asian dust have raised public concerns. Numerous studies on the health effects of Asian dust have been published since the last review in 2010. Thus, a literature review was conducted to shed light on the latest epidemiologic findings. PubMed and Science Direct databases were used for the review of epidemiologic studies published between June 2009 and April 2018. We identified 53 epidemiologic studies. Mortality, ambulance transportation, hospitalization/medical examination, changes in symptomatic, functional, and examination findings, as well as birth outcomes have been reported as outcomes. When the outcomes were categorized by disease, the effects of Asian dust on respiratory, cardiovascular, and allergic diseases raised concerns. The common evidences of causation between Asian dust and these diseases were the consistency of findings and temporal sequence of association. As results of research on dose-response relationships have become available, and the possibility that the health effects of Asian dust may vary depending on its chemical composition has been pointed out, further research using the exposure level indicators of Asian dust or its chemical composition should be conducted. Furthermore, with focus on the crucial issue of reducing exposure, research related to prevention and raising awareness should be further promoted.
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Affiliation(s)
| | - Takamichi Ichinose
- Department of Health Sciences, Oita University of Nursing and Health Sciences
| | - Kayo Ueda
- Graduate School of Global Environmental Studies, Kyoto University
| | | | - Kumiko Kanatani
- Graduate School of Medicine and Public Health, Kyoto University
| | - Atsushi Shimizu
- Center for Reginal Environmental Research, National Institute for Environmental Studies
| | - Akinori Takami
- Center for Reginal Environmental Research, National Institute for Environmental Studies
| | - Ayano Takeuchi
- Department of Preventive Medicine and Public Health, School of Medicine, Keio University
| | - Yuji Nishiwaki
- Department of Environmental and Occupational Health, School of Medicine, Toho University
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14
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Shimizu A, Nishizawa T, Jin Y, Sugimoto N. Various Applications of AD-Net Products for Environmental Impact Studies Related to Asian Dust. EPJ WEB OF CONFERENCES 2020. [DOI: 10.1051/epjconf/202023705011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
AD-Net, the Asian dust and aerosol lidar observation network, is operated in East Asian counties for creating useful dataset for environmental impact studies. The products from AD-Net have been utilized as the source of data assimilation in a chemical transport model, and as the index of exposure of Asian dust to human in the area. Long term observation is indispensable to estimate climatorogical change of dust density, and sustainable operation strategies are needed for further development of regional lidar network.
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15
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Michikawa T, Yamazaki S, Shimizu A, Nitta H, Kato K, Nishiwaki Y, Morokuma S. Exposure to Asian dust within a few days of delivery is associated with placental abruption in Japan: a case-crossover study. BJOG 2019; 127:335-342. [PMID: 31654606 DOI: 10.1111/1471-0528.15999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2019] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Asian dust is a natural phenomenon in which dust particles are transported from desert areas in China and Mongolia to East Asia. Short-term exposure to Asian dust has been associated with cardiovascular disease through mechanisms such as systemic inflammation. Because inflammation is a potential trigger of placental abruption, exposure may also lead to abruption. We examined whether exposure to Asian dust was associated with abruption. DESIGN A bi-directional, time-stratified case-crossover design. SETTING AND POPULATION From the Japan Perinatal Registry Network database, we identified 3014 patients who delivered singleton births in hospitals in nine Japanese prefectures from 2009 to 2014 with a diagnosis of placental abruption. METHODS Asian dust levels were measured at Light Detection and Ranging monitoring stations, and these measurements were used to define the Asian dust days. As there was no information on the onset day of abruption, we assumed this day was the day before delivery (lag1). MAIN OUTCOME MEASURES Placental abruption. RESULTS During the study period, the Asian dust days ranged from 15 to 71 days, depending on the prefecture. The adjusted odds ratio of placental abruption associated with exposure to Asian dust was 1.4 (95% confidence interval = 1.0, 2.0) for cumulative lags of 1-2 days. Even after adjustment for co-pollutant exposures, this association did not change substantially. CONCLUSIONS In this Japanese multi-area study, exposure to Asian dust was associated with an increased risk of placental abruption. TWEETABLE ABSTRACT Exposure to environmental factors such as Asian dust may be a trigger of placental abruption.
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Affiliation(s)
- T Michikawa
- Department of Environmental and Occupational Health, School of Medicine, Toho University, Tokyo, Japan.,Centre for Health and Environmental Risk Research, National Institute for Environmental Studies, Tsukuba, Japan
| | - S Yamazaki
- Centre for Health and Environmental Risk Research, National Institute for Environmental Studies, Tsukuba, Japan
| | - A Shimizu
- Centre for Regional Environmental Research, National Institute for Environmental Studies, Tsukuba, Japan
| | - H Nitta
- Centre for Health and Environmental Risk Research, National Institute for Environmental Studies, Tsukuba, Japan
| | - K Kato
- Department of Obstetrics and Gynaecology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Y Nishiwaki
- Department of Environmental and Occupational Health, School of Medicine, Toho University, Tokyo, Japan
| | - S Morokuma
- Department of Health Sciences, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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16
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Khan MS, Deguchi Y, Matsumoto T, Nagaoka H, Yamagishi N, Wakabayashi K, Watanabe T. Relationship of Asian Dust Events with Atmospheric Endotoxin and Protein Levels in Sasebo and Kyoto, Japan, in Spring. Biol Pharm Bull 2019; 42:1713-1719. [DOI: 10.1248/bpb.b19-00383] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
| | - Yuya Deguchi
- Faculty of Pharmaceutical Sciences, Nagasaki International University
| | | | - Hiroaki Nagaoka
- Faculty of Pharmaceutical Sciences, Nagasaki International University
| | | | - Keiji Wakabayashi
- Department of Public Health, Kyoto Pharmaceutical University
- Graduate Division of Nutritional and Environmental Sciences, University of Shizuoka
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17
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Ng CFS, Hashizume M, Obase Y, Doi M, Tamura K, Tomari S, Kawano T, Fukushima C, Matsuse H, Chung Y, Kim Y, Kunimitsu K, Kohno S, Mukae H. Associations of chemical composition and sources of PM 2.5 with lung function of severe asthmatic adults in a low air pollution environment of urban Nagasaki, Japan. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2019; 252:599-606. [PMID: 31185348 DOI: 10.1016/j.envpol.2019.05.117] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 05/22/2019] [Accepted: 05/22/2019] [Indexed: 05/17/2023]
Abstract
Previous studies have linked ambient PM2.5 to decreased pulmonary function, but the influence of specific chemical elements and emission sources on the severe asthmatic is not well understood. We examined the mass, chemical constituents, and sources of PM2.5 for short-term associations with the pulmonary function of adults with severe asthma in a low air pollution environment in urban Nagasaki, Japan. We recruited 35 asthmatic adults and obtained the daily record of morning peak expiratory flow (PEF) in spring 2014-2016. PM2.5 filters were extracted from an air quality monitoring station (178 days) and measured for 27 chemical elements. Source apportionment was performed using Positive Matrix Factorization (PMF). We fitted generalized linear model with generalized estimating equation (GEE) method to estimate changes in PEF (from personal monthly maximum) and odds of severe respiratory deterioration (first ≥ 15% PEF reduction within a 1-week interval) associated with mass, constituents, and sources of PM2.5, with adjustment for temperature and relative humidity. Constituent sulfate (SO42-) and PM2.5 from oil combustion and traffic were associated with reduced PEF. An interquartile range (IQR) increase in SO42- (3.7 μg/m3, average lags 0-1) was associated with a decrease of 0.38% (95% confidence interval = -0.75% to -0.001%). An IQR increase in oil combustion and traffic-sourced PM2.5 (2.64 μg/m3, lag 1) was associated with a decrease of 0.33% (-0.62% to -0.002%). We found a larger PEF decrease associated with PM2.5 from dust/soil on Asian Dust days. There was no evidence linking total mass and metals to reduced pulmonary function. The ventilatory capacity of adults with severe asthma is susceptible to specific constituents/sources of PM2.5 such as sulfate and oil combustion and traffic despite active self-management of asthma and low air pollution levels in the study location.
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Affiliation(s)
- Chris Fook Sheng Ng
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan; Department of Public Health, Environment and Society, London School of Hygiene & Tropical Medicine, London, United Kingdom; Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
| | - Masahiro Hashizume
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan; Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
| | - Yasushi Obase
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
| | - Masataka Doi
- Nagasaki Prefectural Institute of Environment and Public Health, Omura, Nagasaki, Japan
| | - Kei Tamura
- Environmental Policy Division, Nagasaki Prefectural Government, Nagasaki, Japan
| | - Shinya Tomari
- Department of Respiratory Medicine, Isahaya General Hospital, Japan Community Health Care Organization (JCHO), Isahaya, Nagasaki, Japan
| | - Tetsuya Kawano
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Chizu Fukushima
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Hiroto Matsuse
- Department of Internal Medicine, Division of Respiratory Medicine, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Yeonseung Chung
- Department of Mathematical Sciences, Korea Advanced Institute of Science and Technology, Daejeon, South Korea
| | - Yoonhee Kim
- Department of Global Environmental Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kenichi Kunimitsu
- Nagasaki Prefectural Institute of Environment and Public Health, Omura, Nagasaki, Japan
| | - Shigeru Kohno
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Hiroshi Mukae
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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18
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Khan MS, Coulibaly S, Matsumoto T, Yano Y, Miura M, Nagasaka Y, Shima M, Yamagishi N, Wakabayashi K, Watanabe T. Association of airborne particles, protein, and endotoxin with emergency department visits for asthma in Kyoto, Japan. Environ Health Prev Med 2018; 23:41. [PMID: 30153806 PMCID: PMC6114267 DOI: 10.1186/s12199-018-0731-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 08/13/2018] [Indexed: 01/23/2023] Open
Abstract
Background The health effects of biological aerosols on the respiratory system are unclear. The purpose of this study was to clarify the association of airborne particle, protein, and endotoxin with emergency department visits for asthma in Kyoto City, Japan. Methods We collected data on emergency department visits at a hospital in Kyoto from September 2014 to May 2016. Fine (aerodynamic diameter ≤ 2.5 μm) and coarse (≥ 2.5 μm) particles were collected in Kyoto, and protein and endotoxin levels were analyzed. The association of the levels of particles, protein, endotoxin, and meteorological factors (temperature, relative humidity, wind speed, and air pressure) with emergency department visits for asthma was estimated. Results There were 1 to 15 emergency department visits for asthma per week, and the numbers of visits increased in the autumn and spring, namely many weeks in September, October, and April. Weekly concentration of protein in fine particles was markedly higher than that in coarse particles, and protein concentration in fine particles was high in spring months. Weekly endotoxin concentrations in fine and coarse particles were high in autumn months, including September 2014 and 2015. Even after adjusting for meteorological factors, the concentrations of coarse particles and endotoxin in both particles were significant factors on emergency department visits for asthma. Conclusions Our results suggest that atmospheric coarse particles and endotoxin are significantly associated with an increased risk of asthma exacerbation. Electronic supplementary material The online version of this article (10.1186/s12199-018-0731-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Mohammad Shahriar Khan
- Department of Public Health, Kyoto Pharmaceutical University, 1 Misasagi-Shichonocho, Yamashinaku, Kyoto, 607-8412, Japan
| | - Souleymane Coulibaly
- Department of Public Health, Kyoto Pharmaceutical University, 1 Misasagi-Shichonocho, Yamashinaku, Kyoto, 607-8412, Japan
| | - Takahiro Matsumoto
- Department of Public Health, Kyoto Pharmaceutical University, 1 Misasagi-Shichonocho, Yamashinaku, Kyoto, 607-8412, Japan
| | - Yoshitaka Yano
- Education and Research Center for Clinical Pharmacy, Kyoto Pharmaceutical University, 5 Misasagi-Nakauchcho, Yamashinaku, Kyoto, 607-8414, Japan
| | - Makoto Miura
- Rakuwakai Otowa Hospital, 2 Otowachinji-cho, Yamashinaku, Kyoto, 607-8062, Japan
| | - Yukio Nagasaka
- Rakuwakai Otowa Hospital, 2 Otowachinji-cho, Yamashinaku, Kyoto, 607-8062, Japan
| | - Masayuki Shima
- Department of Public Health, Hyogo College of Medicine, 1-1 Mukogawacho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Nobuyuki Yamagishi
- Faculty of Pharmaceutical Sciences, Setsunan University, 45-1 Nagaotogecho, Hirakata, Osaka, 573-0101, Japan
| | - Keiji Wakabayashi
- Department of Public Health, Kyoto Pharmaceutical University, 1 Misasagi-Shichonocho, Yamashinaku, Kyoto, 607-8412, Japan.,Graduate Division of Nutritional and Environmental Sciences, University of Shizuoka, 52-1 Yada, Suruga-ku, Shizuoka, 422-8526, Japan
| | - Tetsushi Watanabe
- Department of Public Health, Kyoto Pharmaceutical University, 1 Misasagi-Shichonocho, Yamashinaku, Kyoto, 607-8412, Japan.
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19
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Onishi K, Sekiyama TT, Nojima M, Kurosaki Y, Fujitani Y, Otani S, Maki T, Shinoda M, Kurozawa Y, Yamagata Z. Prediction of health effects of cross-border atmospheric pollutants using an aerosol forecast model. ENVIRONMENT INTERNATIONAL 2018; 117:48-56. [PMID: 29727752 DOI: 10.1016/j.envint.2018.04.035] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 03/31/2018] [Accepted: 04/20/2018] [Indexed: 05/21/2023]
Abstract
Health effects of cross-border air pollutants and Asian dust are of significant concern in Japan. Currently, models predicting the arrival of aerosols have not investigated the association between arrival predictions and health effects. We investigated the association between subjective health symptoms and unreleased aerosol data from the Model of Aerosol Species in the Global Atmosphere (MASINGAR) acquired from the Japan Meteorological Agency, with the objective of ascertaining if these data could be applied to predicting health effects. Subjective symptom scores were collected via self-administered questionnaires and, along with modeled surface aerosol concentration data, were used to conduct a risk evaluation using generalized estimating equations between October and November 2011. Altogether, 29 individuals provided 1670 responses. Spearman's correlation coefficients were determined for the relationship between the proportion of the participants reporting the maximum score of two or more for each symptom and the surface concentrations for each considered aerosol species calculated using MASINGAR; the coefficients showed significant intermediate correlations between surface sulfate aerosol concentration and respiratory, throat, and fever symptoms (R = 0.557, 0.454, and 0.470, respectively; p < 0.01). In the general estimation equation (logit link) analyses, a significant linear association of surface sulfate aerosol concentration, with an endpoint determined by reported respiratory symptom scores of two or more, was observed (P trend = 0.001, odds ratio [OR] of the highest quartile [Q4] vs. the lowest [Q1] = 5.31, 95% CI = 2.18 to 12.96), with adjustment for potential confounding. The surface sulfate aerosol concentration was also associated with throat and fever symptoms. In conclusion, our findings suggest that modeled data are potentially useful for predicting health risks of cross-border aerosol arrivals.
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Affiliation(s)
- Kazunari Onishi
- Center for Birth Cohort Studies, Interdisciplinary Graduate School of Medicine, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi 409-3898, Japan.
| | - Tsuyoshi Thomas Sekiyama
- Meteorological Research Institute, 1-1 Nagamine, Tsukuba 305-0052, Japan; Arid Land Research Center, Tottori University, 1390 Hamasaka, Tottori 680-0001, Japan
| | - Masanori Nojima
- Center for Translational Research, The Institute of Medical Science Hospital, The University of Tokyo, 4-6-1 Shirokanedai, Minato-ku 108-8639, Japan
| | - Yasunori Kurosaki
- Arid Land Research Center, Tottori University, 1390 Hamasaka, Tottori 680-0001, Japan
| | - Yusuke Fujitani
- Division of Health Administration and Promotion, Department of Social Medicine, Faculty of Medicine, Tottori University, 86 Nishi-cho, Yonago 683-8503, Japan
| | - Shinji Otani
- International Platform for Dryland Research and Education, Tottori University, 1390 Hamasaka, Tottori 680-0001, Japan
| | - Takashi Maki
- Meteorological Research Institute, 1-1 Nagamine, Tsukuba 305-0052, Japan
| | - Masato Shinoda
- Graduate School of Environmental Studies, Nagoya University, Furo-cho, Chikusa-ku, Nagoya 464-8601, Japan
| | - Youichi Kurozawa
- Division of Health Administration and Promotion, Department of Social Medicine, Faculty of Medicine, Tottori University, 86 Nishi-cho, Yonago 683-8503, Japan
| | - Zentaro Yamagata
- Center for Birth Cohort Studies, Interdisciplinary Graduate School of Medicine, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi 409-3898, Japan; Department of Health Sciences, School of Medicine, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi 409-3898, Japan
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Kurai J, Watanabe M, Noma H, Iwata K, Taniguchi J, Sano H, Tohda Y, Shimizu E. Estimation of the effects of heavy Asian dust on respiratory function by definition type. Genes Environ 2017; 39:25. [PMID: 29118866 PMCID: PMC5664575 DOI: 10.1186/s41021-017-0085-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 09/06/2017] [Indexed: 11/10/2022] Open
Abstract
Background The adverse effects of Asian dust (AD) on health have been demonstrated in earlier studies, but there is no standardized definition for heavy–AD. This study aimed to examine which definition of heavy–AD has the most adverse effect on respiratory function. Methods One–hundred–and–thirty–seven adults with asthma, and 384 school children self-measured their morning peak expiratory flow (PEF). The four definitions of heavy–AD are: (1) the definition provided by the Japan Meteorological Agency (JMA), (2) daily median AD particle level ≥ 0.07 km−1, obtained through light detection and ranging (LIDAR) (3) hourly AD particle level ≥ 0.1 km−1, and (4) hourly level ≥ 0.07 km−1. Linear mixed models were used to estimate the effects of heavy–AD, by definition type, on daily PEF values. Results In adults with asthma, as per the JMA’s definition, significantly reduced PEF were observed on heavy–AD days (lag 0), lag 0–1, and lag 0–3. In school children, after a heavy–AD event, as defined by the JMA, PEF significantly decreased on lag 0–1, lag 0–2, and lag 0–3. However, as per the other definitions, there was no significant decrease in the PEF in the adults and children. Conclusion The associations between heavy–AD and respiratory function differed between these definitions.
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Affiliation(s)
- Jun Kurai
- Department of Respiratory Medicine and Rheumatology, Faculty of Medicine, Tottori University, 36-1 Nishi-cho, Yonago, Tottori 683-8504 Japan
| | - Masanari Watanabe
- Department of Respiratory Medicine and Rheumatology, Faculty of Medicine, Tottori University, 36-1 Nishi-cho, Yonago, Tottori 683-8504 Japan
| | - Hisashi Noma
- Department of Data Science, The Institute of Statistical Mathematics, 10-3 Midori-cho, Tachikawa, Tokyo, 190-8562 Japan
| | - Kyoko Iwata
- Department of Respiratory Medicine and Rheumatology, Faculty of Medicine, Tottori University, 36-1 Nishi-cho, Yonago, Tottori 683-8504 Japan.,Mio Fertility Clinic, Reproductive Centre, Tottori, Japan
| | - Jumpei Taniguchi
- Department of Respiratory Medicine and Rheumatology, Faculty of Medicine, Tottori University, 36-1 Nishi-cho, Yonago, Tottori 683-8504 Japan
| | - Hiroyuki Sano
- Department of Respiratory Medicine and Allergology, Kinki University Faculty of Medicine, 377-2 Ohnohigashi, Osakasayama, 589-0014 Japan
| | - Yuji Tohda
- Department of Respiratory Medicine and Allergology, Kinki University Faculty of Medicine, 377-2 Ohnohigashi, Osakasayama, 589-0014 Japan
| | - Eiji Shimizu
- Department of Respiratory Medicine and Rheumatology, Faculty of Medicine, Tottori University, 36-1 Nishi-cho, Yonago, Tottori 683-8504 Japan
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Association of Short-Term Exposure to Ambient Fine Particulate Matter with Skin Symptoms in Schoolchildren: A Panel Study in a Rural Area of Western Japan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14030299. [PMID: 28335405 PMCID: PMC5369135 DOI: 10.3390/ijerph14030299] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 02/23/2017] [Accepted: 03/11/2017] [Indexed: 01/19/2023]
Abstract
Numerous studies have unmasked the deleterious effects of particulate matter less than 2.5 μm (PM2.5) on health. However, epidemiologic evidence focusing on the effects of PM2.5 on skin health remains limited. An important aspect of Asian dust (AD) in relationship to health is the amount of PM2.5 contained therein. Several studies have demonstrated that AD can aggravate skin symptoms. The current study aimed to investigate the effects of short-term exposure to PM2.5 and AD particles on skin symptoms in schoolchildren. A total of 339 children recorded daily skin symptom scores during February 2015. Light detection and ranging were used to calculate AD particle size. Generalized estimating equation logistic regression analyses were used to estimate the associations among skin symptoms and the daily levels of PM2.5 and AD particles. Increases in the levels of PM2.5 and AD particles were not related to an increased risk of skin symptom events, with increases of 10.1 μg/m³ in PM2.5 and 0.01 km-1 in AD particles changing odds ratios by 1.03 and 0.99, respectively. These results suggest that short-term exposure to PM2.5 and AD does not impact skin symptoms in schoolchildren.
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Lee SW, Lee S, Sheen YH, Ha EK, Choi SH, Yang MS, Hwang S, Kim SS, Choi JH, Han MY. Seasonal Cycle and Relationship of Seasonal Rhino- and Influenza Virus Epidemics With Episodes of Asthma Exacerbation in Different Age Groups. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2017; 9:517-525. [PMID: 28913991 PMCID: PMC5603480 DOI: 10.4168/aair.2017.9.6.517] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 05/20/2017] [Accepted: 06/07/2017] [Indexed: 12/17/2022]
Abstract
Purpose Seasonal variations in asthma exacerbation (AE) are associated with respiratory virus outbreaks and the return of children to school after vacation. This study aims to elucidate the period, phase, and amplitude of seasonal cycles of AE in 5 different age groups with regard to rhino- and influenza virus epidemics in Korea. Methods The number of daily emergency department (ED) visits for AE in all age groups of Korea and the nationwide weekly incidence of rhino- and influenza virus, were obtained for 2008-2012. Fourier regression was used to model rhythmicity, and the Cosinor method was used to determine the amplitude and phase of the cycles in each age group. The cross-correlation function (CCF) between AE and the rhino- and influenza virus epidemics was also calculated. Results There were 157,559 events of AE (0.62 events/1,000 individuals/year) during the study period. There were spring and fall peaks of AE in children and adults, but only 1 winter peak in the elderly. The amplitude of the AE peak in infants was higher in spring than in fall (9.16 vs 3.04, P<0.010), and the fall peak was approximately 1 month later in infants than in school children (October 11 vs November 13, P<0.010). The association between AE and rhinovirus was greatest in school children (rho=0.331), and the association between AE and influenza virus was greatest in those aged ≥60 years (rho=0.682). Conclusions The rhythmicity, amplitude, and phase of the annual cycle of AE differed among different age groups. The patterns of AE were related to the annual rhino- and influenza virus epidemics.
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Affiliation(s)
- Seung Won Lee
- Department of Pediatrics, CHA University School of Medicine, Seongnam, Korea
| | - Shinhae Lee
- Department of Pediatrics, CHA University School of Medicine, Seongnam, Korea
| | - Youn Ho Sheen
- Department of Pediatrics, CHA Gangnam Medical Center, CHA University School of Medicine, Seoul, Korea
| | - Eun Kyo Ha
- Department of Pediatrics, CHA University School of Medicine, Seongnam, Korea
| | - Sun Hee Choi
- Department of Pediatrics, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
| | - Min Suk Yang
- Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - Sohyun Hwang
- Department of Biomedical Science, CHA University School of Medicine, Seongnam, Korea
| | - Sung Soon Kim
- Division of Respiratory Viruses Center for Infectious Diseases, National Institutes of Health, Korea Centers for Disease Control and Prevention, Cheongju, Korea
| | - Jang Hoon Choi
- Division of Respiratory Viruses Center for Infectious Diseases, National Institutes of Health, Korea Centers for Disease Control and Prevention, Cheongju, Korea
| | - Man Yong Han
- Department of Pediatrics, CHA University School of Medicine, Seongnam, Korea.
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Diao M, Min J, Guo F, Zhang CL. Effects of salbutamol aerosol combined with magnesium sulfate on T-lymphocyte subgroup and Th1/Th2 cytokines of pediatric asthma. Exp Ther Med 2016; 13:117-120. [PMID: 28123478 PMCID: PMC5245138 DOI: 10.3892/etm.2016.3912] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 11/09/2016] [Indexed: 01/18/2023] Open
Abstract
The aim of the study was to analyze the effects of the intravenous infusion of salbutamol aerosol combined with magnesium sulfate in the treatment of pediatric asthma and the subsequent effects on the levels of T-lymphocyte subgroups and Th1/Th2 cytokines. A total of 86 patients with pediatric asthma, first diagnosed and treated at the Xuzhou Children's Hospital, were continuously selected and randomly divided into an observation group of 44 cases and control group of 42 cases. The patients in the control group were treated with budesonide atomization inhalation, while the children in the observation group were treated with intravenous infusion of salbutamol aerosol combined with magnesium sulfate. The therapeutic effects in the groups were compared. After treatment, the levels of serum CD3+ and CD8+ decreased when compared to before treatment; the levels of CD4+ and CD4+/CD8+ also increased, but the observation group had more significant improvement. Differences were statistically significant (P<0.05). After treatment, the levels of serum interleukin-2 (IL-2) and interferon-γ (IFN-γ) increased when compared to before, while levels of IL-4 and IL-6 decreased, and the observation group had more significant improvement. The differences were statistically significant (P<0.05). After treatment, the levels of VT, t-PTEF/t-E, MTIF/MTEF and TEF75/PTEF increased when compared to before; the observation group had more significant improvement. The differences were statistically significant (P<0.05). The effective rate and degree of treatment for the observation group were significantly higher than those of the control group and differences were statistically significant (P<0.05). The intravenous infusion of salbutamol aerosol combined with magnesium sulfate in the treatment of pediatric asthma can significantly improve therapeutic effects and lung functions, improve immune functions and relieve inflammatory reactions. Therefore, it indicates better clinical application and promotion value.
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Affiliation(s)
- Min Diao
- Department of Respiratory Medicine, Xuzhou Children's Hospital, Xuzhou, Jiangsu 221002, P.R. China
| | - Jie Min
- Department of Respiratory Medicine, Xuzhou Children's Hospital, Xuzhou, Jiangsu 221002, P.R. China
| | - Fei Guo
- Department of Respiratory Medicine, Xuzhou Children's Hospital, Xuzhou, Jiangsu 221002, P.R. China
| | - Chong-Lin Zhang
- Department of Respiratory Medicine, Xuzhou Children's Hospital, Xuzhou, Jiangsu 221002, P.R. China
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