Cool and dry weather enhances the effects of air pollution on emergency IHD hospital admissions

Background

Associations between ambient pollution and cardiovascular morbidity including ischemic heart disease (IHD) have been confirmed. Weather factors such as temperature, season and relative humidity (RH) may modify the effects of pollution. We conducted this study to examine the effects of air pollution on emergency IHD hospital admissions varied across seasons and RH levels, and to explore the possible joint modification of weather factors on pollution effects.

Methods

Daily time series of air pollution concentrations, mean temperature and RH were collected from IHD hospital admissions from 1998 to 2007 in Hong Kong. We used generalized additive Poisson models with interaction term to estimate the pollution effects varied across seasons and RH levels, after adjusting for time trends, weather conditions, and influenza outbreaks.

Results

An increase in the detrimental effects of air pollution in cool season and on low humidity days was observed. In the cool and dry season, a 10 μg/m³ increment of lag₀₃ exposure was associated with an increase of emergency IHD admissions by 1.82% (95% CI: 1.24–2.40%), 3.89% (95% CI: 3.08–4.70%), and 2.19% (95% CI: 1.33–3.06%) for particles with an aerodynamic diameter less than 10 μm (PM₁₀), nitrogen dioxide (NO₂), and ozone (O₃), respectively. The effects of pollutants decreased greatly and lost statistical significance in the warm and humid season.

Conclusions

We found season and RH jointly modified the associations between ambient pollution and IHD admissions, resulting in increased IHD admissions in the cool and dry season and reduced admissions in the warm and humid season.     

Drug overdose emergency room admissions.

The incidence and patterns of drug overdose admissions to the University of Michigan Medical Center Emergency Suite were studied for the first 3 months of each year from 1956 to 1970. Among variables investigated with regard to age, sex, and time comparisons were types of drugs used, purpose of ingestions, medical condition on arrival, disposition after emergency care, and history of treatment for emotional problems. The continuing escalation in drug overdose emergencies, primarily related to intentional self-poisoning, reflects the growing social health problems of drug use proliferation and rise in suicide attempts over the past two decades. Emergency room resources are being increasingly taxed by the psychological and medical care needs of these cases. Renewed effort toward primary prevention is essential.     

Visits to the emergency room for asthma attacks and short-term variations in air pollution. A case-crossover study

BACKGROUND: The 'case-crossover' design is a strategy fitted to studying transient effects of intermittent exposure on acute-onset disease occurring shortly after exposure. It has the important advantage of eliminating most confounding variables, allowing a stronger causality inference. OBJECTIVES: The objective of the study was to evaluate the relationships between emergency room (ER) visits for asthma attacks and gaseous air pollution changes. METHODS: The study included 549 individuals, 3-49 years old, visiting the ER during 1 year. Exposure to gaseous air pollutants (SO2, NO2, O3) on the same day and up to 4 days before was computed according to the patient's address. The statistical analysis included meteorological data as potential confounding variables. RESULTS: No association could be shown between ER visits and SO2 or NO2 levels. In contrast, there was a statistically significant association between ER visits and mean O3 levels, on the day of admission and also on D -2 and D -3. For an increase of 10 microg/m3, the risk of requiring an ER admission increased by 6-10%. CONCLUSIONS: Using this new strategy, we confirmed that ozone changes lead to a moderate increase in risk of requiring an ER admission in asthmatic subjects.     

Urban air pollution and emergency admissions for cerebrovascular diseases in Taipei, Taiwan.

AIMS: This study was designed to evaluate the association between urban air pollutants and emergency admissions for cerebrovascular diseases. METHODS AND RESULTS: Daily emergency admissions for cerebrovascular diseases (ICD-9-CM, 430-437) to the National Taiwan University Hospital were regressed against daily concentrations of carbon monoxide (CO), nitrogen dioxide (NO(2)), sulphur dioxide (SO(2)), ozone (O(3)), and particulate matters with aerodynamic diameter <2.5 (PM(2.5)) and 10 microm (PM(10)) from 12 April 1997 to 31 December 2002 in Taipei metropolitan areas by the Poisson regression models adjusting for meteorological conditions and temporal trends. Single-pollutant models showed O(3) lagged 0 day, CO lagged 2 days, and PM(2.5) and PM(10) lagged 3 days were significantly associated with increasing emergency admissions for cerebrovascular diseases and CO lagged 2 days was significantly associated with increasing emergency admissions for strokes (ICD-9-CM, 430-434). Such association remained significant for O(3), CO, and cerebrovascular admissions after adjusting for PM(2.5) and PM(10) in two-pollutant models. The odds ratios were 1.021-1.022 per 31.3 ppb O(3) and 1.023-1.031 per 0.8 ppm CO, respectively. However, only CO was significantly associated with emergency admissions for stroke in the three-pollutant models with CO, O(3), and PM(2.5) or PM(10). CONCLUSION: Emergency admissions for cerebrovascular diseases among adults were positively associated with increasing urban air pollution levels of O(3) lagged 0 day and CO lagged 2 days in Taipei.     

Short-term health effects of particulate and photochemical air pollution in asthmatic children.

In a previous panel study in Paris, France, detrimental effects of moderately high levels of winter air pollution on the symptoms and lung function of asthmatic children were demonstrated. A new study was conducted, with the aim of assessing the short-term effects of photo-oxidant and particulate air pollution on childhood asthma during spring and early summer in Paris. Eighty-two medically diagnosed asthmatic children were followed up for 3 months. Outcomes included the incidence and prevalence of asthma attacks, nocturnal cough, supplementary use of beta2-agonists, symptoms of airway irritation, and peak expiratory flow (PEF) value and its variability. The statistical methods controlled for the lack of independence between daily health outcomes, temporal trends and pollen and weather conditions. Black smoke and nitrogen dioxide (NO2) were associated with increases in the occurrence of nocturnal cough and respiratory infections. Ozone (O3) was associated with an increase in the occurrence of asthma attacks and respiratory infections and with changes in lung function, as shown by an increase in PEF variability and a decrease in PEF. Statistically significant interactions were demonstrated between O3 and temperature and between O3 and pollen count for asthma attacks. O3 levels had a greater effect on additional bronchodilator use and on irritations of the eyes, nose and throat on days on which no steroids were used. Particulate matter was associated with eye irritation only. This study showed that, although within international air quality standards, the prevailing levels of photo-oxidant and particulate pollution in spring and early summer had measurable short-term effects on children with mild-to-moderate asthma.     

Outdoor air pollution and emergency room visits at a hospital in Delhi

Several reports from large metropolitan cities have indicated significant association between acute morbidity and mortality from cardio-respiratory disorders and daily levels of major pollutants in the ambient air. Despite the wide-spread public concern about the adverse health effects of air pollution, there is substantial uncertainty regarding the effects of these pollutants at a concentration typical of Delhi, which is one of the ten most polluted cities in the world and the most polluted city in India. This study was undertaken to correlate the daily levels of various pollutants with the number of patients visiting the All India Institute of Medical Sciences (AIIMS, New Delhi) casualty for aggravation of certain defined cardiorespiratory disorders. Daily counts of patients visiting the emergency room of the AIIMS for acute asthma, acute exacerbation of chronic obstructive airway disease (COAD) and acute coronary event was obtained in prospective manner from January 1997 to December 1998. Daily mean levels of ambient CO, NOx and SO2 were monitored along with temperature and humidity. Data was analysed using one day time lag for events of interest. Time series analysis was undertaken using Poisson regression and population averaged general estimation equation, correcting for auto-correlation, days of the weak and season. The ambient levels of pollutants exceeded the national air quality standards on most of the days, over the two year period. Further, emergency room visits for asthma, COAD and acute coronary events increased by 21.30%, 24.90% and 24.30% respectively on account of higher than acceptable levels of pollutants. It is concluded that there is considerable burden of cardiorespiratory diseases in Delhi due to high levels of ambient air pollution.     

Prediction of alcohol-related casualties among emergency room admissions

Logistic regression models are used to determine the predictive value on injury status of drinking-in-the-event variables, quantity and frequency of alcohol consumption, alcohol-related problems, and demographic characteristics among 1,896 emergency room patients interviewed and breathalyzed at San Francisco General Hospital. Being young, White compared to Black, a positive admission breathalyzer reading, drinking prior to the event, and binge drinking were predictive of admission to the emergency room for an injury compared to a non-injury problem. A positive breathalyzer reading, more frequent usual drinking, blackouts, and a previous accident while drinking were predictive of drinking prior to the presenting injury event.     

Demographic characteristics of emergency room admissions of acute drug reactions.

This study investigated a sample of persons treated for acute drug reactions (overdoses) in a hospital emergency room setting to determine the general characteristics of these drug abusers and the incidence of drugs responsible for their admission. Detailed information is provided on the race and sex composition of these drug-abusing patients and comparisons are made with the general population of the area serviced by the hospital. The sample consisted of 506 persons who entered Jackson Memorial Hospital, Miami, Dade County, Florida during January-June 1972. A profile of the typical admission for emergency care of a nonfatal overdose reveals a White female who is 18-24 hears old and who has overdosed on a single legally manufactured and distributed substance, usually a sedative.     

Effects of atmospheric sulphur dioxide and particulate matter concentrations on emergency room admissions due to asthma in Ankara

Recent studies have associated short-term exposure to respirable particulate matter (PM(10)) and sulphur dioxide (SO(2)) with peak flow decrements, increased symptoms of respiratory irritation, increased use of asthma medications, and increased admission and hospitalization for asthma. To further delineate the association between SO(2), PM(10) exposure and asthmatic response, we compiled daily records of asthma emergency room visits from our hospital and data of meteorological conditions, SO(2) and PM(10) concentrations in Ankara area. Weekly averages of daily counts of emergency room visits for asthma were significantly associated with average weekly SO(2) and PM(10) exposure on previous week (r= 0.328, p= 0.017 and r= 0.355, p= 0.009 respectively). Admission to emergency room for asthma count was also negatively correlated with ambient temperature (r= -0.496, p= 0.0001) and strong wind existence (X(2)= 3.930, p= 0.047) on previous days. It was also positively correlated with ambient relative humidity (r= 0.531, p= 0.0001). We observed that numbers of emergency visits due to asthma were higher in winter months, April and September. In winter and early spring period there was concordance between asthma emergency admissions with air pollutants levels. During this period ambient temperatures were low as well. There were two discordance points in monthly variation of air pollution and asthma visits. We thought that first asthma visits peak was related to allergic pollens during April and second peak was due to opening of schools and increasing of respiratory infections for this reason during September. The general pattern of our results confirms that even low levels of air pollution encountered in Ankara are linked to short-term increases in the number of people visiting emergency department for asthma.     

室外大气污染与支气管哮喘

近 2 0年来 ,欧、美、日本及其它诸多国家和地区均报道支气管哮喘 (简称哮喘 )发病率逐年上升且程度加重 ,而在工业城市这种趋势更为明显。其原因是多方面的 ,很多报道认为 ,室外大气中非抗原物质 ,主要包括ＳＯ2 、ＮＯ2 、Ｏ3 、悬浮颗粒物质 (ＰＭ)及金属离子 (Ｃｕ、Ｎｉ、Ｐｂ)等的污染是其中一个重要原因。这些物质可引起人体肺功能、气道反应性、免疫系统的变化 ,增强哮喘患者对抗原的敏感性 ,增加哮喘发病率并使症状加重[1 10 ] 。但也有研究认为 ,这些物质对哮喘无明显影响[1] 。为进一步了解非抗原污染物对哮喘的影响 ,近年来许多…     

Outdoor air pollution and asthma

PURPOSE OF REVIEW: The relation between outdoor air pollution and asthma has always been a major focus of research. The evidence that current levels of air pollution in many countries result in increased morbidity and mortality is fairly consistent. With rapid urbanization in many communities, traffic exhausts have become the major source of pollution, and many recent research studies have attempted to investigate the detrimental effects of this type of pollution. This paper reviews the recent evidence of the possible detrimental effects of ambient air pollution on the inception and morbidity of asthma. RECENT FINDINGS: Traffic related pollution has been confirmed in both cross-sectional and longitudinal studies to be associated with increased asthma morbidity and cardiopulmonary mortality. There is also evidence that pollutants such as ozone and traffic exhausts may be responsible for new incident cases of asthma. Among the particulate pollution, research investigating the ultrafine particles and the bacterial components suggested that these particles may have important role in asthma morbidity. SUMMARY: More research studies are needed to reveal how various air pollutants may interact with the host systems, such as the immune system, leading to increased morbidity in susceptible individuals. Reduction of the current levels of ambient air pollution should be an integral part of the overall effort in minimizing asthma morbidity or mortality in the community.     

Associations of daily pediatric asthma emergency department visits with air pollution in Newark,NJ: utilizing time-series and case-crossover study designs

Objective: Asthma is one of the most common chronic diseases affecting children. This study assesses the associations of ozone and fine particulate matter (PM_2.5) with pediatric emergency department visits in the urban environment of Newark, NJ. Two study designs were utilized and evaluated for usability. Methods: We obtained daily emergency department visits among children aged 3–17 years with a primary diagnosis of asthma during April to September for 2004–2007. Both a time-stratified case-crossover study design with bi-directional control sampling and a time-series study design were utilized. Lagged effects (1-d through 5-d lag, 3-d average, and 5-d average) of ozone and PM_2.5 were explored and a dose–response analysis comparing the bottom 5th percentile of 3-d average lag ozone with each 5 percentile increase was performed. Results: Associations of interquartile range increase in same-day ozone were similar between the time-series and case-crossover study designs (RR?=?1.08, 95% CI 1.04–1.12) and (OR?=?1.10, 95% CI 1.06–1.14), respectively. Similar associations were seen for 1-day lag and 3-day average lag ozone levels. PM_2.5 was not associated with the outcome in either study design. Dose–response assessment indicated a statistically significant and increasing association around 50–55 ppb consistent for both study designs. Conclusions: Ozone was statistically positively associated with pediatric asthma ED visits in Newark, NJ. Our results were generally comparable across the time-series and case-crossover study designs, indicating both are useful to assess local air pollution impacts.     

The effect of air pollution on inner-city children with asthma.

The effect of daily ambient air pollution was examined within a cohort of 846 asthmatic children residing in eight urban areas of the USA, using data from the National Cooperative Inner-City Asthma Study. Daily air pollution concentrations were extracted from the Aerometric Information Retrieval System database from the Environment Protection Agency in the USA. Mixed linear models and generalized estimating equation models were used to evaluate the effects of several air pollutants (ozone, sulphur dioxide (SO2), nitrogen dioxide (NO2) and particles with a 50% cut-off aerodynamic diameter of 10 microm (PM10) on peak expiratory flow rate (PEFR) and symptoms in 846 children with a history of asthma (ages 4-9 yrs). None of the pollutants were associated with evening PEFR or symptom reports. Only ozone was associated with declines in morning % PEFR (0.59% decline (95% confidence interval (CI) 0.13-1.05%) per interquartile range (IQR) increase in 5-day average ozone). In single pollutant models, each pollutant was associated with an increased incidence of morning symptoms: (odds ratio (OR)=1.16 (95% CI 1.02-1.30) per IQR increase in 4-day average ozone, OR=1.32 (95% CI 1.03-1.70) per IQR increase in 2-day average SO2, OR=1.48 (95% CI 1.02-2.16) per IQR increase in 6-day average NO2 and OR=1.26 (95% CI 1.0-1.59) per IQR increase in 2-day average PM10. This longitudinal analysis supports previous time-series findings that at levels below current USA air-quality standards, summer-air pollution is significantly related to symptoms and decreased pulmonary function among children with asthma.     

Effect of dust storm events on daily emergency admissions for respiratory diseases

Background and objective: The harmful effect of dust storm on lung health is controversial. This study aimed to assess any associations between dust storms and emergency hospital admissions due to respiratory disease in Hong Kong. Methods: Data on daily emergency admissions for respiratory diseases to major hospitals in Hong Kong, and indices of air pollutants and meteorological variables from January 1998 to December 2002 were obtained from several government departments. We identified five dust storm days during the study period. Independent t‐tests were used to compare the mean daily number of admissions on dust storm and non‐dust storm days. Case‐crossover analysis using the Poisson regression was used to examine the effects of PM₁₀ to emergency hospital admissions due to respiratory diseases. Results: Significant increases in emergency hospital admission due to COPD were found 2 days after dust storm episode. The relative risk of PM₁₀ for lag 2 days was 1.05 (95% CI: 1.01–1.09) per 10 µg/m³. Conclusions: Dust storms have an adverse effect on emergency hospital admission for COPD in Hong Kong. This also suggests the adverse effect of coarse particles on lung health.     

: Short-term effects of exposure to particulate matter on hospital admissions for asthma and chronic obstructive pulmonary disease

We investigated the effects of particulate matter (PM) factors on hospitalization rates for asthma and chronic obstructive pulmonary disease (COPD).We obtained data on pollutants—PM₁₀, PM_2.5—in Seoul, South Korea. We also investigated data for asthma and COPD exacerbation that required hospitalization from 2006 to 2016. We used a time-stratified case-crossover design and generalized additive models with log transformation to assess adjusted risk, and conditional logistic regression was performed to analyze these data.Our study showed that PM₁₀ and PM_2.5, on different best lag days, were associated with increased risks of COPD or asthma hospitalization. The odds ratios (ORs) for each per-unit increase in PM₁₀ and PM_2.5 were higher in patients with male asthma (PM₁₀: OR, 1.012; 95% confidence interval [CI], 1.008–1.016 and PM_2.5: OR, 1.015; 95% CI, 1008–1.023), preschool asthma (PM₁₀: OR, 1.015; 95% CI, 1.006–1.015 and PM_2.5: OR, 1.015; 95% CI, 1.009–1.024), male COPD (PM₁₀: OR, 1.012; 95% CI, 1.005–1.019 and PM_2.5: OR, 1.013; 95% CI, 1.000–1.026), and senior COPD (PM₁₀: OR, 1.016; 95% CI, 1.008–1.024 and PM_2.5: OR, 1.022; 95% CI, 1.007–1.036).Increasing PM levels increased hospitalizations for asthma and COPD. Additionally, the consequences may be different according to age and sex, and PM_2.5 may have a more significant effect on airway disease patients than PM₁₀.     

Respiratory viral infections and effects of meteorological parameters and air pollution in adults with respiratory symptoms admitted to the emergency room

Background

Respiratory viral infections (RVIs) are the most common causes of respiratory infections. The prevalence of respiratory viruses in adults is underestimated. Meteorological variations and air pollution are likely to play a role in these infections.

Objectives

The objectives of this study were to determine the number of emergency visits for influenza-like illness (ILI) and severe acute respiratory infection (SARI) and to evaluate the association between ILI/SARI, RVI prevalence, and meteorological factors/air pollution, in the city of Porto Alegre, Brazil, from November 2008 to October 2010.

Methods

Eleven thousand nine hundred and fifty-three hospitalizations (adults and children) for respiratory symptoms were correlated with meteorological parameters and air pollutants. In a subset of adults, nasopharyngeal aspirates were collected and analyzed through IFI test. The data were analyzed using time-series analysis.

Results

Influenza-like illness and SARI were diagnosed in 3698 (30·9%) and 2063 (17·7%) patients, respectively. Thirty-seven (9·0%) samples were positive by IFI and 93 of 410 (22·7%) were IFI and/or PCR positive. In a multivariate logistic regression model, IFI positivity was statistically associated with absolute humidity, use of air conditioning, and presence of mold in home. Sunshine duration was significantly associated with the frequency of ILI cases. For SARI cases, the variables mean temperature, sunshine duration, relative humidity, and mean concentration of pollutants were singnificant.

Conclusions

At least 22% of infections in adult patients admitted to ER with respiratory complaints were caused by RVI. The correlations among meteorological variables, air pollution, ILI/SARI cases, and respiratory viruses demonstrated the relevance of climate factors as significant underlying contributors to the prevalence of RVI.