Acute Effects Of Air Pollution Research Articles

Ambient air pollution and daily mortality in ten cities of India: a causal modelling study

The evidence for acute effects of air pollution on mortality in India is scarce, despite the extreme concentrations of air pollution observed. This is the first multi-city study in India that examines the association between short-term exposure to PM2·5 and daily mortality using causal methods that highlight the importance of locally generated air pollution. We applied a time-series analysis to ten cities in India between 2008 and 2019. We assessed city-wide daily PM2·5 concentrations using a novel hybrid nationwide spatiotemporal model and estimated city-specific effects of PM2·5 using a generalised additive Poisson regression model. City-specific results were then meta-analysed. We applied an instrumental variable causal approach (including planetary boundary layer height, wind speed, and atmospheric pressure) to evaluate the causal effect of locally generated air pollution on mortality. We obtained an integrated exposure-response curve through a multivariate meta-regression of the city-specific exposure-response curve and calculated the fraction of deaths attributable to air pollution concentrations exceeding the current WHO 24 h ambient PM2·5 guideline of 15 μg/m3. To explore the shape of the exposure-response curve at lower exposures, we further limited the analyses to days with concentrations lower than the current Indian standard (60 μg/m3). We observed that a 10 μg/m3 increase in 2-day moving average of PM2·5 was associated with 1·4% (95% CI 0·7-2·2) higher daily mortality. In our causal instrumental variable analyses representing the effect of locally generated air pollution, we observed a stronger association with daily mortality (3·6% [2·1-5·0]) than our overall estimate. Our integrated exposure-response curve suggested steeper slopes at lower levels of exposure and an attenuation of the slope at high exposure levels. We observed two times higher risk of death per 10 μg/m3 increase when restricting our analyses to observations below the Indian air quality standard (2·7% [1·7-3·6]). Using the integrated exposure-response curve, we observed that 7·2% (4·2%-10·1%) of all daily deaths were attributed to PM2·5 concentrations higher than the WHO guidelines. Short-term PM2·5 exposure was associated with a high risk of death in India, even at concentrations well below the current Indian PM2·5 standard. These associations were stronger for locally generated air pollutants quantified through causal modelling methods than conventional time-series analysis, further supporting a plausible causal link. Swedish Research Council for Sustainable Development.

Acute effects of air pollution on cardiovascular hospital admissions in the port district of Klang, Malaysia: A time-series analysis

Cardiovascular diseases are recognised as a significant burden on healthcare systems globally. In this study, the acute impacts of air pollution, especially from shipping emissions, on cardiovascular hospital admissions in Klang, Malaysia, a notable port district, are explored. Time-series analysis and Quasi-Poisson regressions, combined with distributed lag non-linear models, were employed to examine the relationships between daily levels of pollutants and hospital admissions for cardiovascular issues. Focus was placed on the pollutants NO2 (nitrogen dioxide), SO2 (sulphur dioxide), O3 (ozone), particulate matters with diameters ≤10 μm (PM10), particulate matters with diameters ≤2.5 μm (PM2.5), and CO (carbon monoxide), with consideration of lag effects up to 7 days. An increment of 10 μg/m3 in NO2 concentrations was associated with a 7.32% increase in cardiovascular admissions on the exposure day, with statistically significant elevations in relative risks at lag 0 were observed for admissions among patients with ischaemic heart disease, those aged less than 65 years, and male patients. At lag 4, an association was identified between O3 levels and an increase in relative risk of 1.0513 for hypertensive diseases. Two-pollutant models further highlighted significant interactions between NO2 and PM10, which influenced overall cardiovascular admissions, admissions due to ischaemic heart disease, and particularly affected patients below 65 years old and males, especially at earlier lags. Additionally, interactions involving NO2 and O3 were noted, impacting overall cardiovascular admissions, as well as admissions among patients aged less than 65 years and male patients. The findings underscore the severe health risks posed by air pollution in port areas, highlighting the urgent need for targeted interventions to mitigate these effects. Stricter air quality regulations in port cities are supported by the results to protect public health.

Air pollution, weather and positive airway pressure treatment adherence in adults with sleep apnea: a retrospective community-based repeated-measures longitudinal study.

We assessed the relation between air pollution, weather, and adherence to positive airway pressure (PAP) therapy in a retrospective community-based repeated-measures study of adults with obstructive sleep apnea who purchased PAP devices from a registered provider between 2013 and 2017 (Ottawa, Ontario, Canada) and had at least one day of data. Daily PAP-derived data, air pollution, and weather databases were linked using postal code. The exposures were mean nocturnal (8:00 p.m. to 8:00 a.m.) (i) residential concentrations of nitrogen dioxide (NO2 ), fine particulate matter <=2.5 μm (PM2.5 ), ozone (O3 ), and Air Quality Health Index (AQHI), and (ii) temperature, relative humidity, and barometric pressure. Covariates in the main model were demographics, season, exposure year, and PAP therapy mode. We analysed 8148 adults (median age of 54 years and 61% men) and 2,071,588 days of data. Based on daily data, the median (interquartile range) daily PAP usage was 416 (323-487) min. Using mixed-effect regression analyses to incorporate daily data and clustering by individuals, we found a statistically significant decrease in adherence for increased levels of NO2 , PM2.5 , and AQHI. The largest effect was for NO2 : a decrease in daily PAP use while comparing the highest versus lowest quartiles (Qs) was 3.4 (95% confidence interval [CI] 2.8-3.9) min. Decreased PAP adherence was also associated with increased temperature (Q4 versus Q1: 2.6 [95% CI: 1.5-3.7] min) and decreased barometric pressure (Q1 versus Q4: 2.0 [95% CI 1.5-2.5] min). We observed modest but statistically significant acute effects of air pollution and weather on daily PAP adherence.

The impact of air pollution on hospitalization for COPD patients in China.

With the rapid development of the global economy and the acceleration of urbanization, air pollution has become a major environmental problem threatening human health. There is limited evidence on the acute effects of air pollution on chronic obstructive pulmonary disease (COPD). From 2014 to 2019, we collected data on daily admissions for COPD patients from a city in China. We used the generalized additive model together with distributed lag models to fit the associations of air pollutants with hospital admissions. We observed significant increments in the number of daily admissions (0.086-0.109%) for COPD for a unit range increase in air quality index, PM2.5 and PM10 over four lag days. The impact of air pollution on the number of daily admissions was mainly reflected in the COPD patients who were hospitalized through outpatient departments and tertiary hospitals. Short-term exposure to outdoor air pollution may induce the occurrence or exacerbation of COPD patients; therefore, government departments should strengthen the management of air pollution, improve supervision and control mechanisms, pay attention to the quality of medical services, and reduce the adverse effects of air pollution on patients' health.

Seasonal disparity of the short-term association between air pollution and gastritis outpatient visits: A large scale hospital-based study in eastern China

Evidence on associations between outdoor air pollution and the risk of digestive diseases, especially seasonal disparity, is scarce. We aimed to compare the acute effects of air pollution on outpatient visits for gastritis between warm and cold seasons in China. We collected data on six criteria air pollutants [fine particulate matter (PM2.5), inhalable particulate matter (PM10), nitrogen dioxide (NO2), sulfur dioxide (SO2), carbon monoxide (CO), and ozone (O3)], daily counts of gastritis outpatient visits, and meteorological variables during 2014–2020 (2536 days) in Hefei, China. A time-series analysis with generalized additive model was used, and potential effect modifiers were explored. Totally, 106,429 outpatient visits were recorded. The average concentrations of PM2.5, PM10, CO, NO2, SO2, and O3 were 54.82, 81.95, 886.75, 39.51, 11.81, and 84.75 μg/m3, respectively, exceeding the updated WHO Air Quality Guidelines values. Short-term PM2.5, CO, and NO2 exposures significantly increased the risk of gastritis outpatient visits and the lag response effects varied at different lag days. Each 10 μg/m3 increment of PM2.5, CO, and NO2 at lag 0 day, the excess risks of gastritis outpatient visits increased by 0.50% (95% CI: 0.04%, 0.95%), 0.05% (0%, 0.10%), and 1.50% (0.54%, 2.47%), respectively. We found insignificant differences in age-, sex- or insurance-strata but significant differences in seasonal strata with stronger effects in cold seasons. Null association of exposure to O3, SO2, or PM10 was observed. This study provided first-hand data that short-term exposure to PM2.5, CO, and NO2 but not O3, SO2, or PM10 was positively associated with gastritis outpatient visits, and such association was more evident in cold seasons, further suggesting the need for underscoring the continued efforts for public health intervention and air pollution control, especially in winter.

Effect of short-term exposure to ambient air pollutants on non-accidental mortality in emergency department visits: a time-series study.

Exposure to air pollution has been linked to an increased risk of premature mortality. However, the acute effects of air pollution on the risk of non-accidental mortality have not been extensively researched in developing countries, and the findings thus far have been inconsistent. Therefore, this study aimed to examine the association between short-term exposure to six pollutants (PM2.5, PM10, SO2, NO2, O3, and CO) and non-accidental mortality in Beijing, China. Daily data on non-accidental deaths were gathered from 1 January 2017 to 31 December 2018. Air pollution data for the same period were collected from 35 fixed-site air quality monitoring stations in Beijing. Generalized additive models (GAM) based on Poisson regression were used to investigate the association between non-accidental mortality in emergency department visits and the daily average levels of air pollutants. There were 8,676 non-accidental deaths recorded during 2017-2018. After sensitivity analysis, short-term exposure to air pollutants, particularly gaseous pollutants, was linked to non-accidental mortality. Specifically, for every 10 μg/m3 increase (5 μg/m3 in SO2, 0.5 mg/m3 in CO) of SO2 (lag 04), NO2 (lag 04), O3 (lag 05), and CO (lag 04), the relative risk (RR) values were 1.054 (95% CI: 1.009, 1.100), 1.038 (95% CI: 1.013, 1.063), 1.032 (95% CI: 1.011, 1.054), and 1.034 (95% CI: 1.004, 1.066), respectively. In terms of causes of death, short-term exposure to NO2, SO2, and O3 increased the risk of circulatory mortality. Further stratified analysis revealed that the stronger associations were presented in females for O3 while in males for CO. People aged 65 and over were strongly associated with ambient air pollution. Our study showed that ambient air pollutants were associated with non-accidental mortality. Our findings suggested that efforts to control gaseous pollution should be stepped up, and vulnerable groups should be the focus of health protection education.

Analysis of an acute effect of air pollution on cardiovascular mortality in Eastern Poland (EP-PARTICLES study)

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Science Center. Background According to WHO reports, cardiovascular diseases (CVD) are responsible for almost 18 million deaths worldwide annually. The harmful effect of air pollution on human health in highly polluted regions is well documented. However, Eastern Poland is a region with so-called "Polish smog" – air pollution causing exceptionally adverse cardiovascular effects. Purpose The aim of our study was to assess whether "Polish smog" has an impact on mortality due to CVD,. Methods All-cause deaths from 5 main cities in Eastern Poland in 2016-2020 were analyzed. Mortality data was obtained from Central Statistical Office, while air pollution concentrations (PM2.5, PM10, and NO2) were attained from Voivodeship Inspectorate for Environmental Protection. The analysis with almost 6 million person-years of follow-up with a time-stratified case-crossover design was performed. Results are reported as odds ratio (OR) and 95% Confidence Intervals (95%CI) associated with an increase of 10 μg/m3 in a daily concentration of air pollutants. The study was financed from the funds of the National Science Center granted under the contract number UMO-2021/41/B/NZ7/03716. Results We recorded 87990 all-cause deaths, including 34907, 9688, and 3776 deaths due to CVD, acute coronary syndromes (ACS), and ischemic stroke (IS) respectively. A 10 μg/m3 increase in all analyzed air pollutants was associated with an increase in mortality due to CVD on the day of exposure (PM2.5 OR 1.034, 95%CI 1.027-1.041, p&amp;lt;0.001; PM10 OR 1.033, 95% CI 1.027-1.039, p&amp;lt;0.001; NO2 OR=1.083, 95%CI 1.073-1.094, p&amp;lt;0.001) [Figure 1]. Moreover, a similar effect was also noted on LAG 1 and LAG 2 (LAG 1: PM2.5 OR 1.028, 95%CI 1.021-1.036, p&amp;lt;0.001; PM10 OR 1.025, 95% CI 1.02-1.031, p&amp;lt;0.001; NO2 OR=1.082, 95%CI 1.069-1.094, p&amp;lt;0.001 and LAG 2: PM2.5 OR 1.024, 95%CI 1.017-1.032, p&amp;lt;0.001; PM10 OR 1.023, 95% CI 1.017-1.029, p&amp;lt;0.001; NO2 OR=1.075, 95%CI 1.063-1.087, p&amp;lt;0.001). An increase in PM level caused increased mortality due to ACS on LAG 0 [(PM2.5 OR=1.029, 95%CI 1.011-1.047, p=0.002; PM10 OR=1.015, 95%CI 1-1.029, p=0.049)] [Figure 2]. On LAG 1 we recorded an increase in both IS- (PM2.5 OR=1.03, 95%CI 1.001-1.058, p=0.04) and ACS-related mortality (PM2.5 OR=1.028, 95%CI 1.01-1.047, p=0.003; PM10 OR=1.026, 95%CI 1.011-1.041, p=0.001; NO2 OR=1.036, 95%CI 1.003-1.07, p=0.04). These effects were the most noticeable in women (ACS: PM2.5 OR=1.032, 95%CI 1.006-1.058, p=0.01; PM10 OR=1.028, 95%CI 1.008-1.05, p=0.01) and in older adults (ACS: PM2.5 OR=1.03, 95%CI 1.01-1.05, p=0.003; PM10 OR=1.027, 95% CI 1.011-1.043, p&amp;lt;0.001 and IS: PM2.5 OR=1.037, 95%CI 1.007-1.069, p=0.01; PM10 OR=1.025, 95%CI 1.001-1.05, p=0.04). Conclusions "Polish smog" has a significant impact on CVD-related mortality. The negative influence of PMs was observed on mortality due to ACS and IS, whereas NO2 affected only ACS-related mortality. The most vulnerable subgroups to air pollution were women and people over 65 years old.

Acute effects of air pollution on type II diabetes mellitus hospitalization in Lanzhou, China.

Studies on the effects of short-term air pollution exposure on hospitalization for type 2 diabetes mellitus (T2DM) are relatively scarce in developing regions. The time-series study was used to explore the acute effects of air pollutants on hospitalization for T2DM in Lanzhou, China. A distribution lag nonlinear model based on the generalized additive model was used to analyze the hospitalization impact of air pollution on T2DM. Stratified analysis by gender, age and season was obtained. The results were indicated as the relative risk (RR) with 95% confidence interval (CI) for single-day lags (from lag0 to lag7) and cumulative lag days (from lag0-1 to lag0-7). The strongest correlations (RR, 95% CI) of hospitalization for T2DM and PM10 (RR = 1.003, 95% CI 1.000, 1.001) at lag7 and NO2 (RR = 1.022, 95% CI 1.000, 1.045) at lag0-4 were observed for an increase of 10µg/m3 in the concentrations and CO (RR = 1.091, 95% CI 1.017, 1.170) at lag0-4 for an increase of 1mg/m3 in the concentration. The hazardous impacts of PM10, NO2 and CO were greater for females, people aged ≥ 65years and in the cold season. However, there was no significant association between PM2.5, SO2 and O38h and the number of hospitalizations for T2DM.

Acute Effects of Ambient Air Pollution on Asthma Emergency Department Visits in Ten U.S. States.

Previous studies of short-term ambient air pollution exposure and asthma morbidity in the United States have been limited to a small number of cities and/or pollutants and with limited consideration of effects across ages. To estimate acute age group-specific effects of fine and coarse particulate matter (PM), major PM components, and gaseous pollutants on emergency department (ED) visits for asthma during 2005-2014 across the United States. We acquired ED visit and air quality data in regions surrounding 53 speciation sites in 10 states. We used quasi-Poisson log-linear time-series models with unconstrained distributed exposure lags to estimate site-specific acute effects of air pollution on asthma ED visits overall and by age group (1-4, 5-17, 18-49, 50-64, and y), controlling for meteorology, time trends, and influenza activity. We then used a Bayesian hierarchical model to estimate pooled associations from site-specific associations. Our analysis included asthma ED visits. We observed positive associations for multiday cumulative exposure to all air pollutants examined [e.g., 8-d exposure to : rate ratio of 1.016 with 95% credible interval (CI) of (1.008, 1.025) per increase, : 1.014 (95% CI: 1.007, 1.020) per increase, organic carbon: 1.016 (95% CI: 1.009, 1.024) per increase, and ozone: 1.008 (95% CI: 0.995, 1.022) per increase]. and ozone showed stronger effects at shorter lags, whereas associations of traffic-related pollutants (e.g., elemental carbon and oxides of nitrogen) were generally stronger at longer lags. Most pollutants had more pronounced effects on children ( y old) than adults; had strong effects on both children and the elderly ( y old); and ozone had stronger effects on adults than children. We reported positive associations between short-term air pollution exposure and increased rates of asthma ED visits. We found that air pollution exposure posed a higher risk for children and older populations. https://doi.org/10.1289/EHP11661.

Acute effects of ambient air pollution on daily neurology clinic visits for vertigo: a time-series study in Wuhan, China

This study aimed to disclose the relationship between ambient air pollution and neurology clinic visits (NCVs) for vertigo. A time-series study was conducted to examine relationships between six different criteria air pollutants (SO2, NO2, PM2.5, PM10, CO, and O3) and daily NCVs for vertigo in Wuhan, China, from January 1st, 2017 to November 30th, 2019. Stratified analyses were computed according to gender, age, and season. A total of 14,749 records of NCVs for vertigo were enrolled in this study. Data showed that the increase in daily NCVs for vertigo corresponding to 10μg/m3 increase of respective pollutants are: SO2 (- 7.60%; 95% CI: - 14.25 to - 0.44%), NO2 (3.14%; 95% CI: 0.23 to 6.13%), PM2.5 (0.53%; 95% CI: - 0.66 to 1.74%), PM10 (1.32%; 95% CI: - 0.36 to 3.06%), CO (0.00%; 95% CI: - 0.12 to 0.13%), and O3 (0.90%; 95% CI: - 0.01% to 1.83%). Males were more susceptible to acute exposure to SO2 and NO2, compared to females (SO2: - 11.91% vs. - 4.16%; NO2: 3.95% vs. 2.92%), whereas the acute effect of O3 exposure was more significantly obvious in females than males (0.94% vs. 0.87%). Moreover, correlations between daily NCVs for vertigo and acute exposure to SO2, NO2, and O3 were all stronger in individuals under 50years old (SO2: - 12.75% vs. - 4.41%; NO2: 4.55% vs. 2.75%; O3: 1.27% vs. 0.70%). Short-term exposure to PM2.5 was more significantly associated with daily NCVs for vertigo in cool seasons (1.62% vs. - 0.68%), while the correlation between CO exposure and daily NCVs for vertigo was stronger in warm seasons (0.21% vs. - 0.03%). Our study demonstrated acute exposure to ambient NO2 and O3 positively associated with daily NCVs for vertigo. Acute effects of air pollution on daily NCVs for vertigo varied according to gender, age, and season.

Application of smart devices in investigating the effects of air pollution on atrial fibrillation onset

Few studies have examined the link between short-term exposure to air pollutants and atrial fibrillation (AF) episodes. This study aims to examine the association of hourly criteria air pollutants with AF episodes. We employ a smart device-based photoplethysmography technology to screen AF from 2018 to 2021. Hourly concentrations of six criteria air pollutants are matched to the onset hour of AF for each participant. We adopt a time-stratified case-crossover design to capture the acute effects of air pollutants on AF episodes, using conditional logistic regression models. Subgroup analyses are conducted by age, gender, and season. A total of 11,906 episodes of AF are identified in 2976 participants from 288 Chinese cities. Generally, the strongest associations of air pollutants are present at lag 18–24 h, with positive and linear exposure-response relationships. For an interquartile range increase in inhalable particles, fine particles, nitrogen dioxide, and carbon monoxide, the odds ratio (OR) of AF is 1.19 [95% confidential interval (CI): 1.03, 1.37], 1.38 (95%CI: 1.14, 1.67), 1.60 (95%CI: 1.16, 2.20) and 1.48 (95%CI: 1.19, 1.84), respectively. The estimates are robust to the adjustment of co-pollutants, and they are larger in females, older people, and in cold seasons. There are insignificant associations for sulfur dioxide and ozone. This nationwide case-crossover study demonstrates robust evidence of significant associations between hourly exposure to air pollutants and the onset of AF episodes, which underscores the importance of ongoing efforts to further improve air quality as an effective target for AF prevention.

Acute effects of air pollution and extreme temperatures on cause-specific mortality in Italy. Results of the BIGEPI project.

Air pollution and extreme temperatures have been associated with multiple adverse health effects, especially on the cardiovascular and respiratory systems. The evidence of a relationship between daily exposures and mortality from metabolic, nervous and mental causes needs to be strengthened. The aim of this study is to investigate the association between daily exposure to fine particulate matter (PM2.5) and extreme temperatures (heat and cold) with cause-specific mortality in the entire Italian population. The daily counts of deaths from natural, cardiovascular, respiratory, metabolic, diabetes, nervous and mental causes were provided by Istat at the municipal level for the period 2006-2015. Through the application of machine-learning models based on satellite data and spatiotemporal variables, population-weighted exposures to daily mean PM2.5 (2013-2015) and air temperature (2006-2015) were estimated at municipality level. Time-series models adjusted for seasonal and long-term trends were applied, and associations between the above exposures and different causes of death at the national level were estimated. The study found a marked effect of PM2.5 on deaths from nervous causes, with a % increase of risk (IR%) of 6.55% (95% confidence interval: 3.38%-9.81%) per PM2.5 increases of 10 µg/m3. The study also highlighted significant effects of low and high temperatures on all study outcomes. The effects were greater for high temperatures. In particular, the effects of heat, expressed as a % increase in risk per temperature increase from the 75th to the 99th percentile, show the highest associations with mortality from nervous causes (58.3%; 95%CI: 49.7%-67.5%), mental causes (48.4%; 95%CI: 40.4%-56.9%), respiratory causes 45.8%; 95%CI: 39.7%-52.1%) and metabolic causes (36.9%; 95%CI: 30.6%-43.5%). The study showed a strong association between daily exposure to PM2.5 and extreme temperatures, especially heat, with mortality outcomes, especially those under-investigated, such as diabetes, metabolic, nervous and mental causes.

Trends in Spatiotemporal Exposure to Air Pollutants and Adult Cardiovascular Emergency Room Visits in the Greater Pittsburgh, Pennsylvania, USA

Introduction The acute effects of air pollution and cardiovascular disease (CVD) have been studied, but very few studies have focused on spatiotemporally modeled exposure to air pollutants at the population level. This study aims to examine the short-term association of fine particulate matter (PM2.5), Ozone (O3), Nitrogen Dioxide (NO2) and Sulfur Dioxide (SO2) and CVD emergency room visits (ERV) in Allegheny County for a 13-year period using a case-crossover study design. Aim We sought to estimate the effects of acute exposure to these four pollutants adjusting for temperature on CVD ERV and to compare outcomes in 1999-2005 compared to 2006-2011. Methods Land-use regression was used to model the ground level exposures to PM2.5, O3, NO2 and SO2. CVD ER visits were requested from the local hospitals of the two health networks in Allegheny County, which operate the majority of the ER services. The discharge International Classification of Diseases-9 (ICD-9) codes were used to identify the CVD cases and CVD subgroups. We linked the Zone Improvement Plan (ZIP) code level air pollution data with the patients’ ZIP code (residence) to determine the individual level exposure estimation of both case days and control days. Conditional logistic regression with multi-pollutant and distributed lags of 0-3-days was applied to estimate the effect of acute exposure of these pollutants to CVD ER visits (ERV), adjusting for temperature. Results In the overall analyses, for every interquartile increase of O3 exposure (25.52 ppb), there was a 6.6% (95% CI: 0.8%-12.7%) increase in the odds of an acute myocardial infarction ERV. This was consistent across both time periods. Among women and Black ERV, we observed an association of PM2.5 with acute myocardial infarction, and with ischemic heart disease. Some of these associations persisted in the later years of the study period. The gaseous pollutants (NO2, SO2 and O3) were shown to increase risk of cardiovascular events in both time periods. Conclusion We found an association of PM2.5 and NO2 with CVD ER visits, and this association persisted in the stratified analyses, as well as in the later years with lower exposure levels. The findings suggest that further actions to reduce the pollution level in this area should be taken. Ozone and NO2 were related to increased risk for all CVD, ischemic heart disease (IHD) and acute myocardial infarction (AMI) underscoring the importance of gaseous pollutants and their effect on coronary heart disease (CHD) risk.

Ambient air pollutants and pulmonary function in children after COVID-19 pandemic

BACKGROUND AND AIM: The acute effects of air pollutants on pulmonary function remain unclear. After COVID-19 spreads, fear drives patients away from hospitals. Smartphone applications may help asthma care. This study investigated the acute effects of ambient air pollution on pulmonary function among asthma in children by smartphone applications. METHODS: We designed a smartphone app to provide timely support for patients with asthma. Peak expiratory flow (PEF) recordings were made twice daily and was corrected by age and gender. The severity of asthma by GINA guideline and asthma control test (ACT) test score were also monitored. Ambient air pollution parameters of particulate matter (PM), ozone(O3), oxides of nitrogen (NO2),carbon monoxide (CO), and sulfur dioxide (SO2) were measured from each nearby air monitoring station at each time while PEF recordings by linking to Global Positioning System. Allergen-specific IgE were also measured by MAST. Effects of exposure to pollutants on PEF were assessed in person-days of observations by GEE model. RESULTS: In lag 0 (the same day), PM10, NO2, CO, and SO2 were negatively correlated with PEF (p=0.030, 0.031, 0.008, 0.017). In lag1 (one day before), NO2, CO, and SO2 were found to be correlated PEF (p=0.005, 0.010, 0.025). In lag2, PM2.5, PM10, NO2, and SO2 were associated with PEF (p=0.031, 0.023, 0.031, 0.005). Analyses stratified by mite allergen sensitization revealed that PM10, NO2, CO, and SO2 air pollutant levels negatively correlated with PEF only in mite sensitization children. CONCLUSIONS: Exposure to air pollutants can lead to acute effects on the pulmonary function in children with asthma. Pollutants may reduce lung function and have different effects over time. Mite sensitization might modify the effect of air pollutant exposures on lung function on asthma. Smartphone applications are readily available tools to help individual air monitoring and asthma care after COVID-19 pandemic.

Acute Effects of Air Pollution on Ischemic Heart Disease Hospitalizations: A Population-Based Time-Series Study in Wuhan, China, 2017-2018.

Evidence of the acute effects of air pollutants on ischemic heart disease (IHD) hospitalizations based on the entire population of a megacity in central China is lacking. All IHD hospitalization records from 2017 to 2018 were obtained from the Wuhan Information Center of Health and Family Planning. Daily air pollutant concentrations and meteorological data were synchronously collected from the Wuhan Environmental Protection Bureau. A time-series study using generalized additive models was conducted to systematically examine the associations between air pollutants and IHD hospitalizations. Stratified analyses by gender, age, season, hypertension, diabetes, and hyperlipidemia were performed. In total, 139,616 IHD hospitalizations were included. Short-term exposure to air pollutants was positively associated with IHD hospitalizations. The age group ≥76 was at higher exposure risk, and the associations appeared to be more evident in cold seasons. PM2.5 and PM10 appeared to have greater effects on males and those without hypertension or diabetes, whereas NO2 and SO2 had greater effects on females and those with hypertension or diabetes. The risk of IHD hospitalization due to air pollutants was greater in people without hyperlipidemia. Our study provides new evidence of the effects of air pollution on the increased incidence of IHD in central China.

The Acute Effects of Exercising in Air Pollution: A Systematic Review of Randomized Controlled Trials.

The acute effects of air pollution (AP) exposure during physical activity have been studied. However, comprehensive systematic reviews are lacking, particularly regarding moderate-to-vigorous physical activity (MVPA). Our objective was to determine the acute health- and exercise-related effects of AP exposure during a bout of MVPA in healthy individuals. We searched for randomized controlled trials in MEDLINE, Embase, Cochrane CENTRAL, SPORTDiscus, Agricultural and Environmental Science Database, ClinicalTrials.gov, International Standard Randomised Controlled Trial Number Registry, and the World Health Organization (WHO) International Clinical Trials Registry Platform up to July 2020 without language or date restrictions. Studies including healthy subjects engaging in a bout of MVPA while exposed to one or more of the following air pollutants were eligible: particulate matter, black carbon, carbon monoxide, nitrogen dioxide, ozone, diesel exhaust, and traffic-related air pollution (TRAP). Main outcome measures were markers of pulmonary function, symptoms, cardiovascular function, cognitive function, systemic inflammation, and exercise response. The evidence was synthesized by vote counting based on direction of effect. In total, 53 studies were included in the systematic review. Studies employed a heterogeneous mix of exercise protocols, AP interventions, and measured outcomes. Pooled results suggest ozone exposure during MVPA has an adverse effect on pulmonary function (100% [95% confidence interval (CI) 88-100], p < 0.001; high-certainty evidence) and reported symptoms (88% [95% CI 69-96], p < 0.001; low-certainty evidence). The effect of exposure to carbon monoxide, nitrogen dioxide, small engine exhaust, or diesel exhaust during MVPA on health- and exercise-related outcomes is uncertain because of insufficient evidence and the low to very low certainty of available evidence. The evidence is strongest for ozone, exposure to which generally induced a reduction in pulmonary function and increased symptoms during MVPA. The research related to otheroutcomedomains remains inconclusive. Although long-term exposure to AP is proven to be hazardous, the evidence for healthy individuals to forgo MVPA during periods of high (non-ozone) pollution remains weak. Retrospectively registered in PROSPERO (CRD42020188280) on 10 July 2020.

Acute exposures to air pollutants and asthma hospitalization in the Medicaid population

BACKGROUND AND AIM: Few studies have investigated roles of air pollutants on asthma among disadvantaged population. It is also unclear whether some sub-populations or communities experience disproportionate risk from air pollutants. METHODS: We estimated risk of asthma hospitalization associated with moving average exposures to particulate matter (PM2.5), ozone (O3), and nitrogen dioxide (NO2) over lag 0 to 6 days among all individuals enrolled in Medicaid, the largest health coverage to Americans with low income or disabilities, 2000–2012, using a time-stratified case-crossover design. To assess the risk at low levels, we restricted the analysis to hospitalizations with exposure below increasingly stringent thresholds, including those well below the national standards. Further, we performed subgroup analyses by individual- and community-level characteristics. RESULTS:We found positive associations between acute PM2.5, O3, and NO2 exposures and risk of asthma hospitalization: 1-µg/m3 increase in PM2.5, 1-part per billion (ppb) increase in O3, and 1-ppb increase in NO2 was associated with 0.31% (95% confidence interval [CI], 0.27%–0.36%), 0.11% (95% CI, 0.07%−0.15%), and 0.28% (95% CI, 0.25%−0.32%) increase in risk of asthma hospitalization, respectively. At low exposure levels, we found greater risk associated with PM2.5 and NO2. Further, we found consistently higher risk for the three exposures among beneficiaries with only one hospitalization during study period and communities with lower population density, higher average BMI, and longer distance to the nearest hospital. CONCLUSIONS:Our study adds to the existing body of research on acute effects of air pollutants on asthma, bridges the gaps in environmental health disparities, and is useful in informing policy. We found increased risk of asthma hospitalization associated with acute exposures to PM2.5, O3, and NO2 among Medicaid beneficiaries, even at levels well below the national standards. Subgroup analyses suggest that beneficiaries with mild to moderate symptoms and those living in disadvantaged communities experienced disproportionately higher risk from the pollutants. KEYWORDS: Mixtures, Short-term exposure, Asthma, Environmental disparities, Socio-economic factors

Use of the electronic nose to screen for small airway dysfunction in schoolchildren

Accurate methods that can be used to detect asymptomatic children with asthma in schools are lacking. Small airway dysfunction is a precursor of asthma. The objective of this study was to use the electronic nose (E-nose) to detect small airway dysfunction in elementary schoolchildren at risk of asthma and evaluate the acute effects of air pollution on respiration. We conducted this study in an elementary school. The study recruited 40 asymptomatic students with a history of asthma and 40 age- and sex-matched children without a history of asthma to take the breath test. We used an E-nose to analyze volatile metabolites and gas chromatography-mass spectrometry to analyze common air pollutants in exhaled breath. After excluding eight subjects in pilot tests, we included 72 subjects in the final analysis of the breath test. The sensitivity of detecting small airway dysfunction with the E-nose was 0.92, the specificity was 0.95, the positive predictive value was 0.79, the negative predictive value was 0.98, the overall accuracy was 0.94, and the leave-one-out cross-validation accuracy was 0.74. The area under the curve was 0.98 (95 % confidence interval: 0.96–1.00). Methyl tert-butyl ether was the only ambient air pollutant that had a significant negative correlation with the maximum mid-expiratory flow (r = -0.33, P < 0.05). The E-nose is highly accurate at detecting small airway dysfunction in children at high risk for asthma. An analysis of exhaled breath can also be used as a personal monitoring method to assess the acute effects of air pollution on respiration.

Acute effects of air pollution on lupus nephritis in patients with systemic lupus erythematosus: A multicenter panel study in China

Air pollution may trigger systemic lupus erythematosus (SLE). However, few studies have investigated the associations between air pollution and complications of SLE, such as lupus nephritis (LN). In this study, multicenter longitudinal data from 13 hospitals in China, including 8552 SLE patients with 24,762 visits, were used. Based on the generalized estimating equation (GEE) model, we assessed the associations of LN occurrence with short-term exposures to different air pollutants including particulate matter with an aerodynamic diameter < 2.5 μm (PM2.5), sulfur dioxide (SO2), nitrogen dioxide (NO2), carbon monoxide (CO), and ozone (O3). We identified 2672 LN patients, and about half of them were from east China. Our results based on the entire data set showed that PM2.5 and NO2 were risk factors for LN within one month after exposure, with odds ratio of 1.16 (95% confidence interval (CI), 1.08–1.19) at lag 18 day and 1.19 (95% CI, 1.12–1.26) at lag 16 day relative to an interquartile range (IQR) increase in PM2.5 and NO2, respectively. This positive association between LN and NO2 was also observed for south, west, and east China. In addition, we found that the short term exposure to CO and O3 was not generally associated with LN. Finally, the negative associations of LN with SO2 were found for the entire region and east China. Our results implied that SLE patients may gain the health benefits of air quality improvement in China. Our work also provided evidence that short-term variations in air pollution may trigger LN, and further studies are needed to confirm these findings and the potential pathogenic mechanisms should be explored.

Acute effects of ambient air pollution on clinic visits of college students for upper respiratory tract infection in Wuhan, China.

Ambient air pollutants have been linked to adverse health outcomes, but evidence is still relatively rare in college students. Upper respiratory tract infection (URTI) is a common disease of respiratory system among college students. In this study, we assess the acute effect of air pollution on clinic visits of college students for URTI in Wuhan, China. Data on clinic visits due to URTI were collected from Wuhan University Hospital, meteorological factors (including daily temperature and relative humidity) provided by Wuhan Meteorological Bureau, and air pollutants by Wuhan Environmental Protection Bureau. In the presentstudy, generalized additive model with a quasi-Poisson distribution link function was used to examine the association between ambient air pollutants (fine particulate matter (PM2.5), particulate matter (PM10), sulfur dioxide (SO2), nitrogen dioxide (NO2), and ozone (O3)) and the daily number of clinic visits of college students for URTI at Wuhan University Hospital in Wuhan, China. In the meantime, the model was adjusted for the confounding effects of long-term trends, seasonality, day of the week, public holidays, vacation, and meteorological factors. The best degrees of free in model were selected based on AIC (Akaike Information Criteria). The effect modification by gender was also examined. A total of 44,499 cases with principal diagnosis of URTI were included from January 1, 2016, to December 31, 2018. In single-pollutant models, the largest increment of URTI visits were found at lag 0 day in single-day lags, and the effect values in cumulative lags were greater than those in single-day lags. PM2.5 (0.74% (95%CI: 0.05, 1.44)) at lag 0 day, PM10 (0.61% (95%CI: 0.12, 1.11)) and O3 (1.01% (95%CI: 0.24, 1.79)) at lag 0-1 days, and SO2 (9.18% (95%CI: 3.27, 15.42)) and NO2 (3.40% (95% CI:1.64, 5.19)) at lag 0-3 days were observed to be strongly and significantly associated with clinic visits for URTI. PM10 and NO2 were almost still significantly associated with URTI after controlling for the other pollutants in our two-pollutant models, where the effect value of SO2 after inclusion of O3 appeared to be the largest and the effects of NO2 were also obvious compared with the other pollutants. Subgroups analysis demonstrated that males were more vulnerable to PM10 and O3, while females seemed more vulnerable to exposure to SO2 and NO2. This study implied that short-term exposure to ambient air pollution was associated with increased risk of URTI among college students at Wuhan University Hospital in Wuhan, China. And gaseous pollutants had more negative health impact than solid pollutants. SO2 and NO2 were the major air pollutants affecting the daily number of clinic visits on URTI, to which females seemed more vulnerable than males.