Ultrafine Particles from Traffic Emissions and Children's Health (UPTECH) in Brisbane, Queensland (Australia): study design and implementation

Ultrafine Particles and Hospital Visits for Chronic Lower Respiratory Diseases in New York State

Rationale: Exposure to particulate matter is associated with various adverse health outcomes. Ultrafine particles (UFPs; diameter <0.1 μm) are a unique public health challenge because of their size. However, limited studies have examined their impacts on human health, especially across seasons and demographic characteristics. Objectives: To evaluate the effect of UFP exposure on the risk of visiting the emergency department (ED) for a chronic lower respiratory disease (CLRD) in New York State in 2013-2018. Methods: We used a case-crossover design and conditional logistic regression to estimate how UFP exposure led to CLRD-related ED visits. GEOS-Chem Advanced Particle Microphysics, a state-of-the-art chemical transport model with a size-resolved particle microphysics model, generated air pollution simulation data. We then matched UFP exposure estimates to geocoded health records for asthma, bronchiectasis, chronic bronchitis, emphysema, unspecified bronchitis, and other chronic airway obstructions in New York State from 2013 through 2018. In addition, we assessed interactions with age, ethnicity, race, sex, meteorological factors, and season. Results: Each 1-(interquartile range [IQR]) increase in UFP exposure led to a 0.37% increased risk of a respiratory-related ED visit on lag 0-0, or the day of the ED visits, (95% confidence interval [CI], 0.23-0.52%) and a 1.81% increase on lag 0-6, or 6 days before the ED visit, (95% CI, 1.58-2.03%). The highest risk was in the emphysema subtype (lag 0-5, 4.18%; 95% CI, 0.16-8.37%), followed by asthma (lag 0-6, 2.00%), chronic bronchitis (lag 0-6, 1.78%), other chronic airway obstructions (lag 0-6, 1.60%), and unspecified bronchitis (lag 0-6, 1.49%). We also found significant interactions between UFP health impacts and season (Fall, 3.29%), temperature (<90th percentile, 2.27%), relative humidity (>90th percentile, 4.63%), age (children aged <18 yr, 3.19%), and sex (men, 2.06%) on lag 0-6. Conclusions: In this study, UFP exposure increased CLRD-related ED visits across all seasons and demographic characteristics, yet these associations varied according to various factors, which requires more research.

Ultrafine particle exposure and biomarkers of effect on small airways in children

The small size and large surface area of ultrafine particles (UFP) enhance their ability to deposit in the lung periphery and their reactivity. The Ultrafine Particles from Traffic Emissions and Children's Health (UPTECH) cross-sectional study was conducted in 8-11-year-old schoolchildren attending 25 primary (elementary) schools, randomly selected from the Brisbane Metropolitan Area, Queensland, Australia. Main study findings outlined indirect evidence of distal airway deposition (raised C reactive protein) but as yet, there is no direct evidence in the literature of effects of UFP exposure on peripheral airway function. We present further UPTECH study data from two sensitive peripheral airway function tests, Oscillometry and Multiple Breath Nitrogen Washout (MBNW), performed in 577 and 627 children (88% and 96% of UPTECH study cohort) respectively: mean(SD) age 10.1(0.9) years, 46% male, with 50% atopy and 14% current asthma. Bayesian generalised linear mixed effects regression models were used to estimate the effect of UFP particle number count (PNC) exposure on key oscillometry (airway resistance, (Rrs), and reactance, (Xrs)) and MBNW (lung clearance index, (LCI) and functional residual capacity, (FRC)) indices. We adjusted for age, sex, and height, and potential confounders including socio-economic disadvantage, PM_2.5 and NO₂ exposure. All models contained an interaction term between UFP PNC exposure and atopy, allowing estimation of the effect of exposure on non-atopic and atopic students. Increasing UFP PNC was associated with greater lung stiffness as evidenced by a decrease in Xrs [mean (95% credible interval) -1.63 (-3.36 to -0.05)%] per 1000#.cm^-3]. It was also associated with greater lung stiffness (decrease in Xrs) in atopic subjects across all models [mean change ranging from -2.06 to -2.40% per 1000#.cm^-3]. A paradoxical positive effect was observed for Rrs across all models [mean change ranging from -1.55 to -1.70% per 1000#.cm^-3] (decreases in Rrs indicating an increase in airway calibre), which was present for both atopic and non-atopic subjects. No effects on MBNW indices were observed. In conclusion, a modest detrimental effect of UFP on peripheral airway function among atopic subjects, as assessed by respiratory system reactance, was observed extending the main UPTECH study findings which reported a positive association with a biomarker for systemic inflammation, C-reactive protein (CRP). Further studies are warranted to explore the pathophysiological mechanisms underlying increased respiratory stiffness, and whether it persists through to adolescence and adulthood.

Surrounding road density of child care centers in Australia

High surrounding road density could increase traffic-related air pollution, noise and the risk of traffic injuries, which are major public health concerns for children. We collected geographical data for all childcare centers (16,146) in Australia and provided the data on the road density surrounding them. The road density was represented by the child care center's nearest distance to main road and motorway, and the length of main road/motor way within 100~1000-meter buffer zone surrounding the child care center. We also got the data of PM2.5 concentration from 2013 to 2018 and standard Normalized Difference Vegetation Index (NDVI) data from 2013 to 2019 according to the longitude and latitude of the child care centers. This data might help researchers to evaluate the health impacts of road density on child health, and help policy makers to make transportation, educational and environmental planning decisions to protect children from exposure to traffic-related hazards in Australia.

Experimentally determined deposition of ambient urban ultrafine particles in the respiratory tract of children

A critical element of the risk assessment of exposure to airborne ambient ultrafine particles (UFP) is the quantification of respiratory tract deposition (RTD) of the particles, which is intrinsically challenging, particularly at the population scale. In this study, we used a recently proposed method to experimentally determine the RTD of urban UFP in a large group of children exposed to these particles in a school setting in Brisbane, Australia. Children are one of the most susceptible population groups; However, little is known about the deposition of UFP from urban traffic in their airways. In order to advance the knowledge in this field, the objectives of this study were: to determine the deposition of ambient urbane UFP in large number children, to catergorize the source of inhaled UFPs and hence to assess the contribution of air pollution sources to the deposition. RTD was measured in children aged 8-11 at primary schools using a flow-through chamber bag system. First, the inhaled and exhaled air was separated; then the particle number size distribution and particle number concentration were measured. The sources of inhaled UFP were categorized according to their particle number size distribution by a K means cluster technique. A total of 128 children from five schools performed the RTD measurement. The mean total deposition fraction of urban UFP in all children was 0.59 ± 0.10. Inhaled UFP were categorized into two groups: traffic and urban background, with the GMD of corresponding particle number size distribution of 20 nm and 40 nm, respectively. The total deposition fraction (mean ± SD) of UFP from these two groups was 0.68 ± 0.09 for traffic and 0.55 ± 0.08 for urban background respectively. This is the first study in which RTD was measured in a large group of children inhaling real urban UFP. First, we proved that this novel method can indeed be applied easily and quickly to a large group of people. Second, we quantified the RTD of children, thus providing an important input to the risk assessment for exposure to UFP.

Assessment of indoor air exposure among newborns and their mothers: Levels and sources of PM10, PM2.5 and ultrafine particles at 65 home environments

Significant efforts have been directed towards addressing the adverse health effects of atmospheric particles, emphasizing the relevance of indoor exposure. Homes represent an indoor environment where human spend the majority of their time. Thus, the objective of this work was to concurrently assess different matrix of indoor particles considering both mass (PM₁₀, PM_2.5) and number (N_20-1000) concentrations in indoor and outdoor air of homes (n = 65). Real-time measurements (PM₁₀, PM_2.5, UFP) were conducted simultaneously during 48 h in dwellings situated in Oporto, Portugal. In 75% of homes, indoor PM_2.5 (mean = 53 μg m^-3) exceeded limit of 25 μg m^-3, for PM₁₀ (mean = 57 μg m^-3) 41% of homes demonstrated average levels higher than 50 μg m^-3, thus indicating potential risks. Indoor PM₁₀ was mostly (82-99%) composed of PM_2.5, both PM were highly correlated (|rs|>0.9655), thus suggesting the similar origin. Indoor PM originated from infiltrations of outdoor emissions; ∼70% of homes exhibited indoor to outdoor (I/O) ratio < 1. On the contrary, UFP indoors (mean = 13.3 × 10³ # cm^-3) were higher than outdoors (mean = 10.0 × 10³ # cm^-3). Indoor UFP spatially varied as follows: kitchens > living rooms > bedrooms. UFP indoors were poorly correlated (|rs| = 0.456) with outdoor concentrations, I/O ratios showed that indoor UFP predominantly originated from indoor emission sources (combustions). Therefore, in order to reduce exposure to UFP and protect public health, the primary concerns should be focused on controlling emissions from indoor sources.

The influenza virus, SARS-CoV-2, and the airways: Clarification for the otorhinolaryngologist

The influenza virus and SARS-CoV-2 cause trivial upper and severe lower respiratory infections (Influenza virus 290,000 to 650,000 deaths/year). These viruses come into contact with the airways either by direct projection, by secondary inhalation of airborne droplets, or by handling (fomites). The objective of this article is to clarify the mechanisms of production and penetration of droplets of secretions emitted during all expiratory phenomena likely to transport these viruses and come into contact with the respiratory mucosa. The droplets>5μm follow the laws of ballistics, those<5μm follow Brownian motion and remain suspended in the air. The aerosols of droplets are very heterogeneous whether the subject is healthy or sick. During an infectious period, not all droplets contain viral RNA. If these RNAs are detectable around patients, on surfaces, and in the ambient air at variable distances according to the studies (from 0.5m to beyond the patient's room), this is without prejudice to the infectious nature (viability) of the virus and the minimum infectious dose. There is a time lag between the patient's infectious period and that of RNA detection for both viruses. Subsequently, the inhaled particles must meet the laws of fluid dynamics (filtration) to settle in the respiratory tree. All of this partly explains the contagiousness and the clinical expression of these two viruses from the olfactory cleft to the alveoli.

Indoor measurements of air pollutants in residential houses in urban and suburban areas: Indoor versus ambient concentrations

Indoor exposure to air pollutants was assessed through 99 visits to 51 homes located in downtown high-rise buildings and detached houses in suburban and rural areas. The ambient concentrations of ultrafine particles (UFP), black carbon (BC), particulate matter smaller than 2.5 μm in diameter (PM2.5), and trace elements were concurrently measured at a central monitoring site in downtown Toronto. Median hourly indoor concentrations for all measurements were 4700 particles/cm³ for UFP, 270 ng/m³ for BC, and 4 μg/m³ for PM2.5, which were lower than ambient outdoor levels by a factor of 2-3. Much higher variability was observed for indoor UFP and BC across the homes compared to ambient levels, mostly due to the influence of indoor cooking emissions. Traffic emissions appeared to have a strong influence on the indoor background (i.e., outdoor-originated) concentrations of BC, UFP, and some trace elements. Specifically, 85% and 34% of the indoor concentrations of BC and UFP were predominantly from outdoor sources, respectively. Moreover, a positive correlation was observed between indoor concentrations of BC and UFP and total road length within a 300 m buffer zone. There was no significant decrease in indoor air pollution with increasing floor level among high-rise residences. In addition to the influence of outdoor sources on indoor air quality, indoor sources contributed to elevated concentrations of K, Ca, Cr, and Cu. A factor analysis was performed on trace elements, UFP, and BC in homes to further resolve possible sources. Local traffic emissions, soil dust, biomass burning, and regional coal combustion were identified as outdoor-originated sources, while cooking emissions was a dominant indoor source. This study highlights how outdoor sources can contribute to chronic exposure in indoor environments and how indoor activities can be associated with acute exposure to temporally varying indoor-originated air pollutants.

Effects of exposure to ambient ultrafine particles on respiratory health and systemic inflammation in children

It is known that ultrafine particles (UFP, particles smaller than 0.1 μm) can penetrate deep into the lungs and potentially have adverse health effects. However, epidemiological data on the health effects of UFP is limited. Therefore, our objective was to test the hypothesis that exposure to UFPs is associated with respiratory health status and systemic inflammation among children aged 8 to 11 years. We conducted a cross-sectional study among 655 children (43.3% male) attending 25 primary (elementary) schools in the Brisbane Metropolitan Area, Australia. Ultrafine particle number concentration (PNC) was measured at each school and modelled at homes using Land Use Regression to derive exposure estimates. Health outcomes were respiratory symptoms and diagnoses, measured by parent-completed questionnaire, spirometric lung function, exhaled nitric oxide (FeNO), and serum C reactive protein (CRP). Exposure-response models, adjusted for potential personal and environmental confounders measured at the individual, home and school level, were fitted using Bayesian methods. PNC was not independently associated with respiratory symptoms, asthma diagnosis or spirometric lung function. However, PNC was positively associated with an increase in CRP (1.188-fold change per 1000 UFP cm^-3 day/day (95% credible interval 1.077 to 1.299)) and an increase in FeNO among atopic participants (1.054 fold change per 1000 UFP cm^-3 day/day (95% CrI 1.005 to 1.106)). UFPs do not affect respiratory health outcomes in children but do have systemic effects, detected here in the form of a positive association with a biomarker for systemic inflammation. This is consistent with the known propensity of UFPs to penetrate deep into the lung and circulatory system.

Automated quality control of forced oscillation measurements: respiratory artifact detection with advanced feature extraction

The forced oscillation technique (FOT) can provide unique and clinically relevant lung function information with little cooperation with subjects. However, FOT has higher variability than spirometry, possibly because strategies for quality control and reducing artifacts in FOT measurements have yet to be standardized or validated. Many quality control procedures rely on either simple statistical filters or subjective evaluation by a human operator. In this study, we propose an automated artifact removal approach based on the resistance against flow profile, applied to complete breaths. We report results obtained from data recorded from children and adults, with and without asthma. Our proposed method has 76% agreement with a human operator for the adult data set and 79% for the pediatric data set. Furthermore, we assessed the variability of respiratory resistance measured by FOT using within-session variation (wCV) and between-session variation (bCV). In the asthmatic adults test data set, our method was again similar to that of the manual operator for wCV (6.5 vs. 6.9%) and significantly improved bCV (8.2 vs. 8.9%). Our combined automated breath removal approach based on advanced feature extraction offers better or equivalent quality control of FOT measurements compared with an expert operator and computationally more intensive methods in terms of accuracy and reducing intrasubject variability.NEW & NOTEWORTHY The forced oscillation technique (FOT) is gaining wider acceptance for clinical testing; however, strategies for quality control are still highly variable and require a high level of subjectivity. We propose an automated, complete breath approach for removal of respiratory artifacts from FOT measurements, using feature extraction and an interquartile range filter. Our approach offers better or equivalent performance compared with an expert operator, in terms of accuracy and reducing intrasubject variability.

Children's well-being at schools: Impact of climatic conditions and air pollution

Human civilization is currently facing two particular challenges: population growth with a strong trend towards urbanization and climate change. The latter is now no longer seriously questioned. The primary concern is to limit anthropogenic climate change and to adapt our societies to its effects. Schools are a key part of the structure of our societies. If future generations are to take control of the manifold global problems, we have to offer our children the best possible infrastructure for their education: not only in terms of the didactic concepts, but also with regard to the climatic conditions in the school environment. Between the ages of 6 and 19, children spend up to 8h a day in classrooms. The conditions are, however, often inacceptable and regardless of the geographic situation, all the current studies report similar problems: classrooms being too small for the high number of school children, poor ventilation concepts, considerable outdoor air pollution and strong sources of indoor air pollution. There have been discussions about a beneficial and healthy air quality in classrooms for many years now and in recent years extensive studies have been carried out worldwide. The problems have been clearly outlined on a scientific level and there are prudent and feasible concepts to improve the situation. The growing number of publications also highlights the importance of this subject. High carbon dioxide concentrations in classrooms, which indicate poor ventilation conditions, and the increasing particle matter in urban outdoor air have, in particular, been identified as primary causes of poor indoor air quality in schools. Despite this, the conditions in most schools continue to be in need of improvement. There are many reasons for this. In some cases, the local administrative bodies do not have the budgets required to address such concerns, in other cases regulations and laws stand in contradiction to the demands for better indoor air quality, and sometimes the problems are simply ignored. This review summarizes the current results and knowledge gained from the scientific literature on air quality in classrooms. Possible scenarios for the future are discussed and guideline values proposed which can serve to help authorities, government organizations and commissions improve the situation on a global level.

Characteristics of Fine Particles in an Urban Atmosphere-Relationships with Meteorological Parameters and Trace Gases

Atmospheric fine particles (diameter < 1 μm) attract a growing global health concern and have increased in urban areas that have a strong link to nucleation, traffic emissions, and industrial emissions. To reveal the characteristics of fine particles in an industrial city of a developing country, two-year measurements of particle number size distribution (15.1 nm-661 nm), meteorological parameters, and trace gases were made in the city of Wuhan located in central China from June 2012 to May 2014. The annual average particle number concentrations in the nucleation mode (15.1 nm-30 nm), Aitken mode (30 nm-100 nm), and accumulation mode (100 nm-661 nm) reached 4923 cm(-3), 12193 cm(-3) and 4801 cm(-3), respectively. Based on Pearson coefficients between particle number concentrations and meteorological parameters, precipitation and temperature both had significantly negative relationships with particle number concentrations, whereas atmospheric pressure was positively correlated with the particle number concentrations. The diurnal variation of number concentration in nucleation mode particles correlated closely with photochemical processes in all four seasons. At the same time, distinct growth of particles from nucleation mode to Aitken mode was only found in spring, summer, and autumn. The two peaks of Aitken mode and accumulation mode particles in morning and evening corresponded obviously to traffic exhaust emissions peaks. A phenomenon of "repeated, short-lived" nucleation events have been created to explain the durability of high particle concentrations, which was instigated by exogenous pollutants, during winter in a case analysis of Wuhan. Measurements of hourly trace gases and segmental meteorological factors were applied as proxies for complex chemical reactions and dense industrial activities. The results of this study offer reasonable estimations of particle impacts and provide references for emissions control strategies in industrial cities of developing countries.

Variability in exposure to ambient ultrafine particles in urban schools: Comparative assessment between Australia and Spain

Ambient ultrafine particle number concentrations (PNC) have inhomogeneous spatio-temporal distributions and depend on a number of different urban factors, including background conditions and distant sources. This paper quantitatively compares exposure to ambient ultrafine particles at urban schools in two cities in developed countries, with high insolation climatic conditions, namely Brisbane (Australia) and Barcelona (Spain). The analysis used comprehensive indoor and outdoor air quality measurements at 25 schools in Brisbane and 39 schools in Barcelona. PNC modes were analysed with respect to ambient temperature, land use and urban characteristics, combined with the measured elemental carbon concentrations, NOx (Brisbane) and NO2 (Barcelona). The trends and modes of the quantified weekday average daily cycles of ambient PNC exhibited significant differences between the two cities. PNC increases were observed during traffic rush hours in both cases. However, the mid-day peak was dominant in Brisbane schools and had the highest contribution to total PNC for both indoors and outdoors. In Barcelona, the contribution from traffic was highest for ambient PNC, while the mid-day peak had a slightly higher contribution for indoor concentrations. Analysis of the relationships between PNC and land use characteristics in Barcelona schools showed a moderate correlation with the percentage of road network area and an anti-correlation with the percentage of green area. No statistically significant correlations were found for Brisbane. Overall, despite many similarities between the two cities, school-based exposure patterns were different. The main source of ambient PNC at schools was shown to be traffic in Barcelona and mid-day new particle formation in Brisbane. The mid-day PNC peak in Brisbane could have been driven by the combined effect of background and meteorological conditions, as well as other local/distant sources. The results have implications for urban development, especially in terms of air quality mitigation and management at schools.

Respiratory Health Effects of Ultrafine Particles in Children: A Literature Review

By convention, airborne particles ≤0.1 μm (100 nm) are defined as ultrafine particles (UFPs). UFPs can comprise a large number of particles in particulate matter with aerodynamic diameters ≤2.5 μm (PM_2.5). Despite the documented respiratory health effects of PM_2.5 and concerns that UFPs might be more toxic than larger particular matter, the effects of UFPs on the respiratory system are not well-described. Even less is known about the respiratory health effects of UFPs among particularly vulnerable populations including children. We reviewed studies examining respiratory health effects of UFPs in children and identified 12 relevant articles. Most (8/12) studies measured UFP exposure using central ambient monitors, and we found substantial heterogeneity in UFP definitions and study designs. No long-term studies were identified. In single pollutant models, UFPs were associated with incident wheezing, current asthma, lower spirometric values, and asthma-related emergency department visits among children. Also, higher exhaled nitric oxide levels were positively correlated with UFP dose among children with asthma or allergy to house dust mites in 1 study. Multivariate models accounting for potential co-pollutant confounding yielded no statistically significant results. Although evidence for a relationship between UFPs and children's respiratory is accumulating, the literature remains inconclusive. Interpretation of existing data is constrained by study heterogeneity, limited accounting for UFP spatial variation, and lack of significant findings from multi-pollutant models.