Effects of Particulate Respirator Use on Cardiopulmonary Function in Elderly Women: a Quasi-Experimental Study

PM2.5-mediated cardiovascular disease in aging: Cardiometabolic risks, molecular mechanisms and potential interventions

Air pollution, particularly fine particulate matter (PM2.5) with <2.5 μm in diameter, is a major public health concern. Studies have consistently linked PM2.5 exposure to a heightened risk of cardiovascular diseases (CVDs) such as ischemic heart disease (IHD), heart failure (HF), and cardiac arrhythmias. Notably, individuals with pre-existing age-related cardiometabolic conditions appear more susceptible. However, the specific impact of PM2.5 on CVDs susceptibility in older adults remains unclear. Therefore, this review addresses this gap by discussing the factors that make the elderly more vulnerable to PM2.5-induced CVDs. Accordingly, we focused on physiological aging, increased susceptibility, cardiometabolic risk factors, CVDs, and biological mechanisms. This review concludes by examining potential interventions to reduce exposure and the adverse health effects of PM2.5 in the elderly population. The latter includes dietary modifications, medications, and exploration of the potential benefits of supplements. By comprehensively analyzing these factors, this review aims to provide a deeper understanding of the detrimental effects of PM2.5 on cardiovascular health in older adults. This knowledge can inform future research and guide strategies to protect vulnerable populations from the adverse effects of air pollution.

Health risk assessment of aerosol particles (PM2.5 and PM10) during winter crop at the agricultural site of Delhi, India

For the last few decades, air pollution in developing country like India is increasing, and it is a matter of huge concern due to its associated human health impacts. In this region, the burgeoning population, escalating urbanization and industrialization, has been cited as the major reason for such a high air pollution. The present study was carried out for health risk assessment of aerosol particles (PM10 and PM2.5) and its associated heavy metals of an agriculture farm site at Indian Agricultural Research Institute (IARI) considered to be green urban area in Delhi, India. The concentrations of both PM10 and PM2.5 varied significantly from 136 to 177 µg/m3 and 56 to 162 µg/m3, respectively at the site. In the present case, the highest PM10 and PM2.5 levels were reported in January, followed by December. The levels of ambient PM10 and PM2.5 are influenced by wind prevailing meteorology. These levels of PM10 and PM2.5 are more than the permissible limits of WHO guidelines of 15 and 5 µg/m3, respectively, thereby leading to high aerosol loadings specifically in winters. The PM concentration of the atmosphere was found to be negatively correlated with temperature during the sampling period. The concentrations of surface ozone O3 and NOx in the present study were observed to be high in February and March, respectively. The increasing air pollution in the city of Delhi poses a great risk to the human health, as the particulate matter loaded with heavy metals can enter humans via different pathways, viz., ingestion, inhalation, and absorption through skin. The mean hazard index for metals (Zn, Pb, Cd, As, Cr, and Ni) was observed within the acceptable limit (HI < 1), thereby indicating negligible non-carcinogenic effects to residing population. The carcinogenic risk assessment was conducted for Cd, Pb, and As only, as the concentrations for other metals were found to be quite low. The carcinogenic risk values were also within the limits of USEPA standards, indicating no carcinogenic risks to the health of children and adults residing near the site. This information about the PM pollution at the agricultural site and health risk assessment will serve as a baseline data in assessment of human health impacts due to air pollution at the local scale and can be used for development of mitigation strategies for tackling air pollution.

Can individual protective measures safeguard cardiopulmonary health from air pollution? A systematic review and meta-analysis

Evidence supporting the effect of individual protective measures (IPMs) on air pollution is relatively scarce. In this study, we performed a systematic review and meta-analysis to investigate the effects of air purifiers, air-purifying respirators, and cookstove changes on cardiopulmonary health outcomes. We searched PubMed, Scopus, and Web of Science until December 31, 2022, 90 articles and 39,760 participants were included. Two authors independently searched and selected the studies, extracted information, and assessed each study's quality and risk of bias. We performed meta-analyses when three or more studies were available for each IPMs, with comparable intervention and health outcome. Systematic review showed that IPMs were beneficial in children and elderly with asthma along with healthy individuals. Meta-analysis results showed a reduction in cardiopulmonary inflammation using air purifiers than in control groups (with sham/no filter) with a decrease in interleukin 6 by -0.247 μg/mL (95% confidence intervals [CI] = -0.413, -0.082). A sub-group analysis for air purifier as an IPMs in developing counties reduced fractional exhaled nitric oxide by -0.208 ppb (95% confidence intervals [CI] = -0.394, -0.022). However, evidence describing the effects of air purifying respirator and cook stove changes on cardiopulmonary outcomes remained insufficient. Therefore, air purifiers can serve as efficient IPMs against air pollution. The beneficial effect of air purifiers is likely to have a greater effect in developing countries than in developed countries.

Cardiopulmonary benefits of respirator intervention against near road ambient particulate matters in healthy young adults: A randomized, blinded, crossover, multi-city study

Wearing a respirator is generally the most convenient individual intervention against ambient particulate matter (PM), and therefore there has been considerable research into its effectiveness. However, the effects of respirator intervention under different PM concentration settings have been insufficiently elucidated. We conducted a randomized, blinded, crossover intervention study in four representative cities in China in which 128 healthy university students spent 2-h walking along a busy road wearing either a real or a sham respirator and then spent the next 5-h indoors away from traffic pollution. Lung function, blood pressure, and heart rate variability were continuously measured throughout the visit. Linear mixed-effect models were fitted to evaluate the protective effects of respirator intervention on the cardiopulmonary indicators. Results showed that the beneficial effects of respirator intervention were only occasionally significant at specific time points or in specific cities or in selected parameters. Overall, respirator intervention was associated with reduced SBP (6.2 vs. 11.5 mmHg compared to baseline, p < 0.05) and increased LF (44 vs. 35 ms² compared to baseline, p < 0.05) over the 2-h walk, but no significant effects were found over the 7-h period. Respirators have significant effect modifications on the associations between PM_2.5/PM₁₀ and the cardiopulmonary indicators, but the directions of effects were inconsistent. The intercity difference in the effects of respirator intervention was found significant, with Taiyuan and Shanghai to be the two cities with lower personal PM concentrations but more pronounced benefits. In conclusion, reducing personal exposure to PM can have some beneficial effects in some scenarios. However, respirators may not provide sufficient protection from air pollution overall, and we should avoid over-reliance on respirators and accelerate efforts to reduce emissions of pollutants in the first place. Despite standardized procedures, we found inconsistency in results across cities, consistent with the previous literature.

Effects of respirators to reduce fine particulate matter exposures on blood pressure and heart rate variability: A systematic review and meta-analysis

Particulate-filtering respirators (PFRs) have been recommended as a practical personal-level intervention to protect individuals from the health effects of particulate matter exposure. However, the cardiovascular benefits of PFRs including improvements in key surrogate endpoints remain unclear. We performed a systematic review and meta-analysis of randomized studies (wearing versus not wearing PFRs) reporting the effects on blood pressure (BP) and heart rate variability (HRV). The search was performed on January 3, 2022 to identify published papers until this date. We queried three English databases, including PubMed, Web of Science Core Collection and Scopus. Of 527 articles identified, eight trials enrolling 312 participants (mean age ± standard deviation: 36 ± 19.8; 132 female) met our inclusion criteria for analyses. Study participants wore PFRs from 2 to 48 h during intervention periods. Wearing PFRs was associated with a non-significant pooled mean difference of -0.78 mmHg (95% confidence interval [CI]: -2.06, 0.50) and -0.49 mmHg (95%CI: -1.37, 0.38) in systolic and diastolic BP (SBP and DBP). There was a marginally significant reduction of mean arterial pressure (MAP) by nearly 1.1 mmHg (95%CI: -2.13, 0.01). The use of PFRs was associated with a significant increase of 38.92 ms2 (95%CI: 1.07, 76.77) in pooled mean high frequency (power in the high frequency band (0.15-0.4 Hz)) and a reduction in the low (power in the low frequency band (0.04-0.15Hz))-to-high frequency ratio [-0.14 (95%CI: -0.27, 0.00)]. Other HRV indices were not significantly changed. Our meta-analysis demonstrates modest or non-significant improvements in BP and many HRV parameters from wearing PFRs over brief periods. However, these findings are limited by the small number of trials as well as variations in experimental designs and durations. Given the mounting global public health threat posed by air pollution, larger-scale trials are warranted to elucidate more conclusively the potential health benefits of PFRs.

Particulate respirator use and blood pressure: A systematic review and meta-analysis

People use a particulate respirator in order to reduce exposure to ambient fine particulate matter (PM_2.5). Acute exposure to PM_2.5 is known to increase blood pressure. However, systematic reviews or meta-analyses on blood pressure-related benefits of using a particulate respirator is lacking. Therefore, we reviewed randomized crossover intervention studies on blood pressure-related effects of particulate matter respirator use. We conducted a literature review of articles found on Embase, Medline, and Cochrane library on August 31, 2020. The study outcomes were systolic and diastolic blood pressure and mean arterial pressure. A random-effect model was used in the meta-analysis. Subgroup analyses, based on age (adult < 60 years, elderly ≥ 60 years), personal PM_2.5 exposure levels (High: ≥ 25 μg/m³, Low: < 25 μg/m³), and types of monitoring methods (ambulatory and resting blood pressure) were conducted. We identified 297 references, and seven studies were included in our systematic review. None of the studies used a sham respirator as control and complete allocation concealment and blinding were impossible. The use of a particulate respirator was associated with a -1.23 mmHg (95% confidence interval (CI): -2.53, 0.07) change in systolic blood pressure and a -1.57 mmHg (95% CI: -3.85, 0.71) change in mean arterial pressure. There were significant heterogeneities and possibilities for publication bias. The subgroup analyses revealed that studies involving elderly individuals, those conducted in high PM_2.5 personal exposure, and those in which resting blood pressure was monitored demonstrated a larger decrease in blood pressure resulting from respirator use. Further intervention studies with a large sample size and subjects with diverse characteristics and different personal PM_2.5 levels may add the evidence to current literature.

The impact of life behavior and environment on particulate matter in chronic obstructive pulmonary disease

BACKGROUND

The effect of exposure to particulate matter (PM) on human health is a global public health concern. To develop an effective strategy to reduce PM exposure, we performed detailed questionnaire surveys regarding the type of lifestyle required to avoid PM exposure in patients with chronic obstructive pulmonary disease (COPD). We correlated the data with real-time PM concentration during the winter season.

METHODS

We enrolled 104 patients with COPD aged 40 years or older. Detailed questionnaire surveys were conducted among participants, and internet of things-based sensors were installed at their homes to measure the indoor PM_2.5 concentration, which was continuously monitored between December 2019 and February 2020. The associations among PM_2.5 concentration, patients' lifestyles, and the impact of both concentration and lifestyle on COPD exacerbation were analyzed.

RESULTS

Mean outdoor PM_2.5 concentration was higher than mean indoor PM_2.5 concentration during the study period (21.28 ± 5.09 μg/m³ vs. 12.75 ± 7.64 μg/m³), with a mean difference of 8.53 ± 7.99 μg/m³. Among the various social factors and practices that aim to avoid exposure to PM, six practices and economic statuses were confirmed to reduce indoor PM_2.5 concentration compared to outdoor concentration; Contrarily, these practices created a significant difference between the outdoor and indoor PM_2.5 concentrations. The six practice items that showed a significant difference were 1) checking air quality forecast (the difference: -13.31 ± 1.35 μg/m³, p = 0.013), 2) indoor air filter operated (-15.43 ± 1.32 μg/m³, p < 0.001), 3) ventilating home by opening the windows (-13.14 ± 1.28 μg/m³, p = 0.013), 4) checking filters of the air filter (-13.95 ± 1.50 μg/m³, p = 0.002), 5) refraining from going out when outside PM is high (-12.52 ± 1.37 μg/m³, p = 0.039), 6) wearing a mask when going out (-13.38 ± 1.32 μg/m³, p = 0.017). The higher the household income and economic level, the more significant the difference in the PM_2.5 concentration. Severe exacerbation was more prevalent among patients with acute exacerbation as the exposure time of PM_2.5≥35 μg/m³ or PM_2.5≥75 μg/m³.

CONCLUSION

Lifestyle and economic levels can affect the indoor PM_2.5 concentration, which may impact COPD exacerbation.

Decrease in Ambient Fine Particulate Matter during COVID-19 Crisis and Corresponding Health Benefits in Seoul, Korea

Both domestic emissions and transported pollutants from neighboring countries affect the ambient fine particulate matter (PM_2.5) concentration of Seoul, Korea. Diverse measures to control the coronavirus disease 2019 (COVID-19), such as social distancing and increased telecommuting in Korea and the stringent lockdown measures of China, may reduce domestic emissions and levels of transported pollutants, respectively. In addition, wearing a particulate-filtering respirator may have decreased the absolute PM_2.5 exposure level for individuals. Therefore, this study estimated the acute health benefits of PM_2.5 reduction and changes in public behavior during the COVID-19 crisis in Seoul, Korea. To calculate the mortality burden attributable to PM_2.5, we obtained residents’ registration data, mortality data, and air pollution monitoring data for Seoul from publicly available databases. Relative risks were derived from previous time-series studies. We used the attributable fraction to estimate the number of excessive deaths attributable to acute PM_2.5 exposure during January to April, yearly, from 2016 to 2020, and the number of mortalities avoided from PM_2.5 reduction and respirator use observed in 2020. The average PM_2.5 concentration from January to April in 2020 (25.6 μg/m³) was the lowest in the last 5 years. At least −4.1 μg/m³ (95% CI: −7.2, −0.9) change in ambient PM_2.5 in Seoul was observed in 2020 compared to the previous 4 years. Overall, 37.6 (95% CI: 32.6, 42.5) non-accidental; 7.0 (95% CI: 5.7, 8.4) cardiovascular; and 4.7 (95% CI: 3.4, 6.1) respiratory mortalities were avoided due to PM_2.5 reduction in 2020. By considering the effects of particulate respirator, decreases of 102.5 (95% CI: 89.0, 115.9) non-accidental; 19.1 (95% CI: 15.6, 22.9) cardiovascular; and 12.9 (95% CI: 9.2, 16.5) respiratory mortalities were estimated. We estimated that 37 lives were saved due to the PM_2.5 reduction related to COVID-19 in Seoul, Korea. The health benefit may be greater due to the popular use of particulate-filtering respirators during the COVID-19 crisis. Future studies with daily mortality data are needed to verify our study estimates.