Air pollution and lung diseases in adults

Short-time exposure to air pollutants and in particular to sulfur dioxide, nitrogen oxides and photochemical oxidants may cause respiratory symptoms similar to acute bronchial asthma. In healthy adults however the concentrations required to evoke significant bronchial obstruction lie still above the level of atmospheric air pollution usually observed in our country. In contrast patients with preexisting pulmonary diseases or with impaired bronchopulmonary defense mechanisms may show harmful reactions even at concentrations which actually occur in urban and rural atmospheres. In addition there is evidence of on increased prevalence of chronic obstructive pulmonary diseases in countries with high chemical pollution indicating that long-term exposure of ambient air pollution may cause chronic illness as well. Since air pollution is accepted to produce adverse health effects, emergent efforts are required to improve air quality in order to avoid further injuries in man.     

Association of indoor and outdoor air pollutant level with respiratory problems among children in an industrial area of Delhi, India

The authors conducted this prospective study at the Shahdara industrial area of Delhi, India. They examined the effects of indoor and outdoor air pollutant levels on respiratory health in 394 children aged 7 to 15 years. The majority of children had a history of respiratory problems, including cough (62.7%), sputum production (24.4%), shortness of breath (32.0%), wheezing (25.6%), common cold (44.4%), and throat congestion (43.1%). The association of indoor and outdoor air pollutant levels showed that outdoor SO2 and NO2 was significantly higher than indoor SO2 and NO2 levels, whereas the mean indoor level of suspended particulate matter (SPM) was significantly higher than outdoor SPM level. Indoor SPM level also was significantly higher in homes of children with a history of respiratory illness than homes of children having no history of respiratory illness. Results suggest that both indoor and outdoor particulate exposure may be important risk factors in the development of respiratory illness in children.     

Daily air pollution effects on children's respiratory symptoms and peak expiratory flow

To identify acute respiratory health effects associated with air pollution due to coal combustion, a subgroup of elementary school-aged children was selected from a large cross-sectional study and followed daily for eight months. Children were selected to obtain three equal-sized groups: one without respiratory symptoms, one with symptoms of persistent wheeze, and one with cough or phlegm production but without persistent wheeze. Parents completed a daily diary of symptoms from which illness constellations of upper respiratory illness (URI) and lower respiratory illness (LRI) and the symptom of wheeze were derived. Peak expiratory flow rate (PEFR) was measured daily for nine consecutive weeks during the eight-month study period. Maximum hourly concentrations of sulfur dioxide, nitrogen dioxide, ozone, and coefficient of haze for each 24-hour period, as well as minimum hourly temperature, were correlated with daily URI, LRI, wheeze, and PEFR using multiple regression models adjusting for illness occurrence or level of PEFR on the immediately preceding day. Respiratory illness on the preceding day was the most important predictor of current illness. A drop in temperature was associated with increased URI and LRI but not with increased wheeze or with a decrease in level of PEFR. No air pollutant was strongly associated with respiratory illness or with level of PEFR, either in the group of children as a whole, or in either of the symptomatic subgroups; the pollutant concentrations observed, however, were uniformly lower than current ambient air quality standards. Moreover, since exposure estimation based on monitoring of ambient air likely results in misclassification of the true exposure, the negative findings of this study must be interpreted cautiously.     

Bioaerosol lung damage in a worker with repeated exposure to fungi in a water-damaged building.

There has been increased concern over health effects related to potential exposure of building occupants to bioaerosols. We report the case of a worker with a respiratory illness related to bioaerosol exposure in a water-damaged building with extensive fungal contamination. We performed environmental tests to evaluate potential exposure to fungi, and we used mycotoxin-specific IgG antibody in serologic studies in the attempt to evaluate exposure to mycotoxins. Extensive fungal contamination was documented in many areas of the building. Penicillium, Aspergillus, and Stachybotrys species were the most predominant fungi found in air sampling. Our serologic test was not useful in differentiating workers who were probably occupationally exposed to mycotoxins from those who were not; however, it did yield evidence that individuals may make specific IgG antibodies to macrocyclic tricothecene mycotoxins. Further research is needed concerning health effects related to bioaerosol exposures, particularly regarding markers of exposure to specific fungi that may produce mycotoxins. In the absence of clinical tools specific for evaluation of mycotoxin-related illness, a systematic clinical approach for evaluating persons with suspected building-related respiratory illness is warranted.     

Heat illness. III. Acclimatization.

In this third paper on heat illness, the position of acclimatization in prevention of heat illness is reviewed. Both short and long-term acclimatization are considered, the former in more detail with discussion of present knowledge of the differences arising from artificial and natural acclimatization, the effects of training, water intake and increasing salt intake, and climatic chamber and vapour-barrier suit acclimatization. The possibility of the development of a safe drug to accelerate acclimatization is considered remote. The effects of age and acclimatization in the healthy and unhealthy elderly and the very young are reviewed briefly as is also the possibility that air conditioning may have an adverse effect on acclimatization.     

Subject-domain approach to the study of air pollution effects on schoolchildren's illness absence

In this paper, the authors propose a new statistical modeling technique, the subject-domain approach, which is theoretically proven to be equivalent to the time-domain approach in detecting an association between exposure and response with time trends. The authors use an empirical data set from a school absence monitoring study conducted during the 1994-1995 school year in Taiwan to demonstrate this subject-domain approach's application to environmental epidemiologic studies. Because the subject-domain models can control the influential personal confounding factors in the models, they show greater statistical power than the traditional time-domain approaches in determining the relation between air pollution and illness absences. The authors' models found that the schoolchildren's risks of illness absence were significantly related to acute exposures to nitrogen dioxide and nitrogen oxides with a 1-day lag (p < 0.01) at levels below the World Health Organization's guidelines. By contrast, the authors could not detect significant associations between air pollution and schoolchildren's absenteeism using time-domain approaches. Such findings imply that the models built on subject domain may be a general solution to the problem of the ecologic fallacy, which is commonly encountered in environmental and social epidemiologic studies.     

A case of sick building syndrome in a Japanese office worker

The adverse health effects caused by indoor air pollution are termed "sick building syndrome". We report such a patient whose symptoms appeared in the workplace. A 36-year-old female office worker developed nausea and headache during working hours in a refurbished office. After eight months of seeking help at other clinics or hospitals without improvement, she was referred to our hospital. At that time she reacted to the smells of various chemicals outside of the office building. Biochemical findings were all within normal ranges. Specific IgE antibody to cedar pollen was positive and the ratio of TH1/TH2 was 4.5. In the Eye Tracking Test (ETT), vertical eye movement was saccadic. Her anxiety level was very high according to the State-Trait Anxiety Inventory (STAI) questionnaire. Subjective symptoms, ETT findings and anxiety levels on STAI gradually improved during two years of follow-up. One year after the onset of her illness, the formaldehyde concentrations in the building air ranged from 0.017-0.053 ppm. Even though relatively low, chemical exposure from building materials such as formaldehyde induced a range of symptoms. Also, lack of recognition by superiors and doctors that sick building syndrome might have been the source of her illness coupled with her high state of anxiety may have exacerbated her symptoms and led to the onset of multiple chemical sensitivity. Thus psychosocial factors may contribute to sick building syndrome in the workplace.     

Outdoor air pollution and acute respiratory infections among children in developing countries

Acute respiratory infections (ARIs) are the most common cause of illness and death in children in the developing world. This review focuses on outdoor air pollutants associated with pediatric ARI mortality and morbidity. Studies were identified using MEDLINE and other electronic databases. Four studies showed an increase in infant mortality in relation to outdoor air pollution. Short-term follow-up and time-series studies suggest that air pollutants act as risk factors for respiratory infection. Air pollution exposure increases the incidence of upper- and lower-respiratory infections in children. Because complex pollution mixtures are present in the studied urban areas, pollutant levels at which ARI risk would be expected to increase cannot be determined. Children may be at greater risk, given the poor environmental and nutritional conditions prevalent in developing countries.     

Public views on the links between air pollution and health in Northeast England

We investigated how public perceptions of the links between air pollution and health varied with contextual factors describing individuals and their locality. Information was collected via postal surveys on 2744 adults resident in five neighborhoods in Northeast England. Perceptions were compared by individual factors (health status, age, and gender) and locality factors (relative deprivation, proximity to industry and district-Teesside or Sunderland, with different amounts of heavy industry). There was relatively little variation in views about air pollution and health links between neighborhoods. The greatest contrasts were found when comparing those living near or further from industry and between the two districts. Any differences were related more to awareness of illness in the neighborhood thought to be affected by air pollution, rather than belief that a particular disease was linked to air pollution. Chronic illness status and age were sometimes found to be associated with perceptions of disease affected by air pollution, but gender and material deprivation were not central to differences in risk perceptions among the population studied. In understanding public perceptions about the links between air quality and health, research should focus on the characteristics of places as well as of people.     

On chronic illness and quality of life: A conceptual framework

In this paper I focus on the topic of chronic illness in the context of quality of life. I offer a conceptual explanation of these notions and then try to systematise the various species of suffering connected with chronic illness. Suffering in illness rarely attracts systematic analysis. Part of the reason for this is that the topic is in a way an aspect of common sense. It has an air of self-evidence and seems not to require analysis. However, it is my contention that the nature of human suffering is not at all selfevident. In many ways we know very little about the content and extent of suffering. And, although it may not be sensible to borrow traditional scientific techniques for the study of suffering, we need as much intellectual penetration and rigorous analysis in order to clarify the nature of suffering as for any other scientific investigation. Moreover, there are good reasons for saying that we ought to direct much more of our attention to this humanistic aspect of medicine. We ought to remember that the existence of suffering is one of the main motives, if indeed not the most important motive, for undertaking the medical enterprise.     

The impact of urban street tree species on air quality and respiratory illness: A spatial analysis of large-scale,high-resolution urban data

Urban trees play a key role in reducing greenhouse gas emissions, cleaning air, promoting physical activity, and improving mental health. However, it is still largely unknown how the density and species of urban street trees may impact local public health. This study demonstrates how open data mining and large-scale spatial data integration can contribute to deeper insights into the effects of urban forestry. We analyze the impact of the spatial distribution of street trees by species in New York City by combining crowd-sourced tree census data – which includes geolocation, species, size, and condition for each of 652,169 street trees – with pollen activity, allergen severity, land use, housing conditions, and neighborhood demographic data. We further integrate neighborhood asthma hospitalization and emergency department visit rates and air quality data (PM2.5) to investigate how street trees impact local air quality and the prevalence of acute respiratory illness. Using a geographically weighted regression model, the results indicate that although a greater concentration of trees contributes to better local air quality, species with severe allergenicity can increase local asthma hospitalization rates in vulnerable populations, controlling for other covariates.     

Air pollution and school absenteeism among children in Mexico City.

To determine the acute effects of ozone exposure, the authors conducted a short follow-up study of respiratory illness in a population of 111 preschool children frequently exposed to ozone levels that regularly exceed 0.120 parts per million (ppm). The children attended a private kindergarten in the southwestern part of Mexico City. Parents completed a questionnaire on demographic data, medical history, and potential sources of indoor air pollution. To determine the relation of ozone and respiratory-related school absenteeism, the authors used a logistic regression model for longitudinal data. During the 3-month follow-up, 50% of the children had at least one respiratory-related absenteeism period, and 11.7% had two or more. Children exposed for 2 consecutive days to high ozone levels (> or = 0.13 ppm) had a 20% increment in the risk of respiratory illness. For children exposed for 2 consecutive days to a high ozone level and the previous day to low temperature (< or = 5.1 degrees C), the risk reached 40% (odds ratio = 1.44, 95% confidence interval 1.37-1.52). This study suggests that ozone exposure might be positively associated with the risk of respiratory illness in children and that it may have an interactive effect with low temperature exposure.     

2017—2018年潍坊市流感样病例与气象因素相关性分析

目的 探讨潍坊市流感样病例与气象因素的关联性。方法 收集整理2017—2018年潍坊市流感样病例监测数据及气象数据,通过绘制散点图和建立广义相加模型分析气象因素与流感样病例的关系,Spearman秩相关分析不同年龄层人群流感样病例与气象因素的关系。结果 潍坊市流感流行高峰主要集中在周均温差为8 ℃~12 ℃、周平均相对湿度为65%~88%、周平均风速为1.50~2.50 m/s的天气条件下。0~15岁人群流感样病例就诊比受周平均气温、周平均气压、周平均相对湿度、周均温差、周平均风速影响显著(r=-0.457、-0.430、0.361、0.337、-0.410,P<0.001);60~岁人群流感样病例就诊比受周平均气温、周平均气压影响显著(r=-0.448、0.401,P<0.001)。广义相加模型显示,周平均风速(RR:0.994,95%CI:0.990~0.996)、周均温差(RR:1.023,95%CI:1.017~1.028)周平均相对湿度(RR:1.003,95%CI:1.001~1.006)均与流感样病例就诊比有相关性。结论 潍坊市流感样病例与气象因素有一定的相关性。     

Airborne endotoxin is associated with respiratory illness in the first 2 years of life

To determine the influence of endotoxin on the incidence of acute respiratory illness during the first 2 years of life, we carried out a longitudinal follow-up study, beginning at birth, of 332 children born in Prince Edward Island, Canada. We measured 5-day averaged air endotoxin in the homes of children, whose parents provided information by daily symptom diaries and twice-monthly telephone contact for up to 2 years. Endotoxin concentration was 0.49 +/- 3.49 EU/m3 (geometric mean +/- geometric SD), and number of annualized illness episodes was 6.83 +/- 2.80 (mean +/- SD). A doubling of the air endotoxin concentration was associated with an increase of 0.32 illness episodes per year (p = 0.0003), adjusted for age, year of study, breast-feeding, environmental tobacco smoke, child care attendance, indoor temperature, and income. Indoor mold surface area and fungal ergosterol were not significantly associated with endotoxin. Airborne endotoxin appears to be a risk factor for clinically symptomatic respiratory illnesses during the first 2 years of life independent of indoor fungus.     

Mass psychogenic systemic illness in school children in relation to the Tokyo photochemical smog

To clarify the pathogenic mechanism of epidemics with acute systemic neurobehavioral illness associated with photochemical air pollution in Japan, we re-examined our past records in sixteen junior high school children, and compared them with major epidemics that occurred in 1970-1972 during which time Japanese society faced a new and unusual type of air pollution ("Tokyo smog"). Dysfunction of alveolar-arterial gas exchange, together with respiratory alkalosis, was newly found in these children, who suffered from chest discomfort, ocular irritation, emotional distress, tetany, and unconsciousness. It was concluded that anxiety reaction, precipitated by the physical effects of photochemical oxidants and athletic performance, possibly led to many outbreaks of mass psychogenic systemic illness (hyperventilation syndrome) among school children.     

Volatile organic compounds, respirable dust, and personal factors related to prevalence and incidence of sick building syndrome in primary schools

Possible relations between incidence and prevalence of sick building syndrome (SBS), indoor exposures, and personal factors were studied in a four year longitudinal study among personnel (n = 129) in six primary schools. The mean concentration of carbon dioxide was above the recommended value of 0.08 microliter/l (800 ppm) in all schools, indicating a poor outdoor air supply. Indoor concentration of volatile hydrocarbon (VOC) was enhanced at high room temperatures. Respirable dust, but not concentration of VOC was enhanced at lower ventilation rates and high air humidity. Chronic SBS was related to VOC, previous wall to wall carpeting in the schools, hyper-reactivity, and psychosocial factors. Incidence of new SBS was related to concentration of respirable dust, current smoking, and the psychosocial climate. Remission of hyperreactivity, decrease in sick leave owing to airway illness, removal of carpeting in the schools, and moving from new to old dwellings resulted in a decrease in SBS score. It is concluded that SBS is of multifactorial origin, related to a variety of factors and exposures. The total concentration of hydrocarbons is a simple and convenient measure of exposure, which also seems to be a predictor of chronic symptoms. Further investigations on the effect of temperature, ventilation, and air humidity on SBS should consider how these factors may influence the chemical composition of the air. Because poor air quality in schools could also affect the children, it may have implications for the state of health of a large proportion of the population.     

Volatile organic compounds, respirable dust, and personal factors related to prevalence and incidence of sick building syndrome in primary schools.

Possible relations between incidence and prevalence of sick building syndrome (SBS), indoor exposures, and personal factors were studied in a four year longitudinal study among personnel (n = 129) in six primary schools. The mean concentration of carbon dioxide was above the recommended value of 0.08 microliter/l (800 ppm) in all schools, indicating a poor outdoor air supply. Indoor concentration of volatile hydrocarbon (VOC) was enhanced at high room temperatures. Respirable dust, but not concentration of VOC was enhanced at lower ventilation rates and high air humidity. Chronic SBS was related to VOC, previous wall to wall carpeting in the schools, hyper-reactivity, and psychosocial factors. Incidence of new SBS was related to concentration of respirable dust, current smoking, and the psychosocial climate. Remission of hyperreactivity, decrease in sick leave owing to airway illness, removal of carpeting in the schools, and moving from new to old dwellings resulted in a decrease in SBS score. It is concluded that SBS is of multifactorial origin, related to a variety of factors and exposures. The total concentration of hydrocarbons is a simple and convenient measure of exposure, which also seems to be a predictor of chronic symptoms. Further investigations on the effect of temperature, ventilation, and air humidity on SBS should consider how these factors may influence the chemical composition of the air. Because poor air quality in schools could also affect the children, it may have implications for the state of health of a large proportion of the population.     

大气污染对小学生健康的影响

  目的  了解大气污染物浓度增高对学龄儿童疾病、症状和因病缺课产生的影响,为防止大气污染对学生健康的危害提供参考。  方法  于2014—2017年每年冬季,对杭州某小学792名四年级学生进行健康问卷调查,每日连续开展发病和症状监测。采用基于Pearson回归的广义相加模型分析单污染物浓度增高引起的健康影响,多因素Logistic回归模型分析家庭、居住环境与大气污染物浓度增加对学生健康的综合影响。  结果  415名(52.4%)小学生有既往病史,265名(33.5%)有过敏史。调查期间,PM_2.5、PM₁₀、SO₂和NO₂的平均质量体积浓度分别为(81.0±2.8)(122.2±3.9)(17.9±0.6)(68.9±1.4)μg/m3。PM_2.5、PM₁₀和NO₂滞后3 d时对学生发生疾病和因病缺课的影响最为明显,各污染物每增加10 μg/m3,发生疾病风险RR值分别为1.02(1.01~1.02),1.04(1.03~1.06)和1.03(1.02~1.04)。SO₂滞后5 d对学生健康影响最为显著。父亲本科及以上文化水平与小学生冬季发生疾病(OR=0.83)和症状(OR=0.84)呈负相关;1年内家具更换(OR=1.78)、宠物饲养(OR=1.94)、1年内反复呼吸道感染(OR=1.82)、1年前过敏性鼻炎(OR=2.24)、冠心病/高血压家族史(OR=1.46)、室内活动时间(OR=1.02)、大气PM₁₀浓度(OR=1.09)与小学生冬季产生症状呈正相关(P值均 < 0.05)。  结论  大气污染物浓度增高对小学生发生疾病、症状以及因病缺课有影响且存在滞后效应。父亲本科及以上文化水平是学生健康的保护因素,室内环境污染和室外大气污染均可导致学生疾病和症状的发生。     

Indoor nitrogen dioxide and childhood respiratory illness

Abstract: Nitrogen dioxide is produced from the combustion of fossil fuels and as an emission from gas-fired appliances, and is also a component of tobacco smoke. Nitrogen dioxide has been shown in experimental animals to be toxic to the respiratory tract. A number of recent studies have suggested that children exposed to significant levels of nitrogen dioxide in the home may be more susceptible to respiratory illness than children exposed to normal ambient levels. Respiratory illness is a major cause of morbidity in children everywhere. Here, we review the available evidence of this association and explore methodological issues in measurement of nitrogen dioxide exposure— misclassification of subjects, symptom bias and confounding. It has recently been shown that some New South Wales school rooms, where unflued gas heaters are often used as a source of warmth, have nitrogen dioxide levels which are above recommended ambient levels for outside air. This has underlined the need for setting standards for indoor levels of various pollutants, and cohort studies are suggested, to include personal monitoring and prospective data collection techniques.     

大气环境质量对学龄儿童呼吸健康的影响

目的研究大气环境质量对学龄儿童呼吸健康的影响。方法根据南宁市环境监测站的常规监测资料,选择分别位于南宁市重污染区、中污染区和轻污染区的3所小学的全体学生为研究对象。空气质量采用上海大气质量指数进行评价;疾病资料通过流行病学调查和问卷调查收集。结果重污染区学生支气管炎、肺炎、哮喘、鼻炎、扁桃体炎的患病率高于轻污染区(P<0.05)。用非条件Logistic回归模型计算了以上几种呼吸系统疾病的OR值和95%的可信区间,通过调整性别、年龄、家庭用煤、家庭成员吸烟、父母亲呼吸系统病史、大气污染等因素,在控制了其他因素后,大气重污染区学龄儿童患呼吸系统疾病的危险性显著高于轻污染区(P<0.05或P<0.01)。父母亲呼吸系统疾病史、家庭成员吸烟、家庭燃煤也是危险因素。结论大气污染能引起学龄儿童的呼吸系统健康的损害。