The effect of outdoor fungal spore concentrations on daily asthma severity.

The relationship between day-to-day changes in asthma severity and combined exposures to community air pollutants and aeroallergens remains to be clearly defined. We examined the effects of outdoor air pollutants, fungi, and pollen on asthma. Twenty-two asthmatics ages 9-46 years were followed for 8 weeks (9 May-3 July 1994) in a semirural Southern California community around the air inversion base elevation (1,200 ft). Daily diary responses included asthma symptom severity (6 levels), morning and evening peak expiratory flow rates (PEFR), and as-needed beta-agonist inhaler use. Exposures included 24-hr outdoor concentrations of fungi, pollen, and particulate matter with a diameter < 10 microns (PM10; maximum = 51 micrograms/m3) and 12-hour day-time personal ozone (O3) measurements (90th percentile = 38 ppb). Random effects longitudinal regression models controlled for autocorrelation and weather. Higher temperatures were strongly protective, probably due to air conditioning use and diminished indoor allergens during hot, dry periods. Controlling for weather, total fungal spore concentrations were associated with all outcomes: per minimum to 90th percentile increase of nearly 4,000 spores/m3, asthma symptom scores increased 0.36 (95% CI, 0.16-0.56), inhaler use increased 0.33 puffs (95% CI, -0.02-0.69), and evening PEFR decreased 12.1 l/min (95% CI, -1.8-22.3). These associations were greatly enhanced by examining certain fungal types (e.g., Alternaria, basidiospores, and hyphal fragments) and stratifying on 16 asthmatics allergic to tested deuteromycete fungi. There were no significant associations to low levels of pollen or O3, but inhaler use was associated with PM10 (0.15 inhaler puffs/10 micrograms/m3; p < 0.02). These findings suggest that exposure to fungal spores can adversely effect the daily respiratory status of some asthmatics.     

Prenatal and Childhood Traffic-Related Pollution Exposure and Childhood Cognition in the Project Viva Cohort (Massachusetts,USA)

Background

Influences of prenatal and early-life exposures to air pollution on cognition are not well understood.

Objectives

We examined associations of gestational and childhood exposure to traffic-related pollution with childhood cognition.

Methods

We studied 1,109 mother–child pairs in Project Viva, a prospective birth cohort study in eastern Massachusetts (USA). In mid-childhood (mean age, 8.0 years), we measured verbal and nonverbal intelligence, visual motor abilities, and visual memory. For periods in late pregnancy and childhood, we estimated spatially and temporally resolved black carbon (BC) and fine particulate matter (PM_2.5) exposures, residential proximity to major roadways, and near-residence traffic density. We used linear regression models to examine associations of exposures with cognitive assessment scores, adjusted for potential confounders.

Results

Compared with children living ≥ 200 m from a major roadway at birth, those living < 50 m away had lower nonverbal IQ [–7.5 points; 95% confidence interval (CI): –13.1, –1.9], and somewhat lower verbal IQ (–3.8 points; 95% CI: –8.2, 0.6) and visual motor abilities (–5.3 points; 95% CI: –11.0, 0.4). Cross-sectional associations of major roadway proximity and cognition at mid-childhood were weaker. Prenatal and childhood exposure to traffic density and PM_2.5 did not appear to be associated with poorer cognitive performance. Third-trimester and childhood BC exposures were associated with lower verbal IQ in minimally adjusted models; but after adjustment for socioeconomic covariates, associations were attenuated or reversed.

Conclusions

Residential proximity to major roadways during gestation and early life may affect cognitive development. Influences of pollutants and socioeconomic conditions on cognition may be difficult to disentangle.

Citation

Harris MH, Gold DR, Rifas-Shiman SL, Melly SJ, Zanobetti A, Coull BA, Schwartz JD, Gryparis A, Kloog I, Koutrakis P, Bellinger DC, White RF, Sagiv SK, Oken E. 2015. Prenatal and childhood traffic-related pollution exposure and childhood cognition in the Project Viva cohort (Massachusetts, USA). Environ Health Perspect 123:1072–1078; http://dx.doi.org/10.1289/ehp.1408803     

Asthma exacerbation is associated with particulate matter source factors in children in New York City

Exposure to fine particulate matter (PM_2.5) is linked with asthma exacerbation; however, the role played by specific PM sources is not well understood. Our objective was to investigate the associations between daily cough and wheeze symptoms in a panel of asthmatic children and PM source factors determined by receptor modeling using positive matrix factorization (PMF). We studied 36 children with moderate-to-severe asthma in New York City over both a warm and a cold season. Exposure to ambient air pollutants, including PM_2.5 elements and elemental and organic carbon fractions, was characterized. The mean ambient PM_2.5 concentration for the study periods was 12.0?±?6.7 μg/m³. Six factors were resolved using PMF, including oil, road dust, ships, regional, salt, and traffic. When adjusted for ozone, cough and wheeze symptoms were most strongly associated with the regional and salt factors. Results using tracer elements (as determined from PMF analyses) showed some inconsistency, with two tracers for road dust (K and Si) showing associations in opposite directions to each other. Positive associations were also observed for S, which is a tracer of regional PM. Significant negative associations were observed for the oil factor and one of its tracers (Zn). Mostly nonsignificant associations were found for carbon fractions, with the exception of pyrolized carbon and two elemental carbon fractions. Our results indicate that asthma symptoms are associated with regional and salt factors. In this study, the regional factor was comprised of sulfate as well as carbon-containing PM, the latter which is likely derived from both anthropogenic and biogenic sources.     

Efficacy and safety of high dose versus low dose furosemide with or without dopamine infusion: The Dopamine in Acute Decompensated Heart Failure II (DAD-HF II) Trial

Aims

The role of low-dose dopamine infusion in patients with acute decompensated heart failure (ADHF) remains controversial. We aim to evaluate the efficacy and safety of high- versus low-dose furosemide with or without low-dose dopamine infusion in this patient population.

Methods and results

161 ADHF patients (78 years; 46% female; ejection fraction 31%) were randomized to 8-hour continuous infusions of: a) high-dose furosemide (HDF, n = 50, 20 mg/h), b) low-dose furosemide and low-dose dopamine (LDFD, n = 56, 5 mg/h and 5 μg kg^− 1 min^− 1 respectively), or c) low-dose furosemide (LDF, n = 55, furosemide 5 mg/h). The main outcomes were 60-day and one-year all-cause mortality (ACM) and hospitalization for HF (HHF). Dyspnea relief (Borg index), worsening renal function (WRF, rise in serum creatinine (sCr) ≥ 0.3 mg/dL), and length of stay (LOS) were also assessed. The urinary output at 2, 4, 6, 8, and 24 h was not significantly different in the three groups. Neither the ACM at day 60 (4.0%, 7.1%, and 7.2%; P = 0.74) or at one year (38.1%, 33.9% and 32.7%, P = 0.84) nor the HHF at day 60 (22.0%, 21.4%, and 14.5%, P = 0.55) or one year (60.0%, 50.0%, and 47%, P = 0.40) differed between HDF, LDFD, and LDF groups, respectively. No differences in the Borg index or LOS were noted. WRF was higher in the HDF than in LDFD and LDF groups at day 1 (24% vs. 11% vs. 7%, P < 0.0001) but not at sCr peak (44% vs. 38% vs. 29%, P = 0.27). No significant differences in adverse events were noted.

Conclusions

In ADHF patients, there were no significant differences in the in-hospital and post-discharge outcomes between high- vs. low-dose furosemide infusion; the addition of low-dose dopamine infusion was not associated with any beneficial effects.     

Air Pollution Exposure and Abnormal Glucose Tolerance during Pregnancy: The Project Viva Cohort

Background: Exposure to fine particulate matter (PM with diameter ≤ 2.5 μm; PM_2.5) has been linked to type 2 diabetes mellitus, but associations with hyperglycemia in pregnancy have not been well studied.Methods: We studied Boston, Massachusetts–area pregnant women without known diabetes. We identified impaired glucose tolerance (IGT) and gestational diabetes mellitus (GDM) during pregnancy from clinical glucose tolerance tests at median 28.1 weeks gestation. We used residential addresses to estimate second-trimester PM_2.5 and black carbon exposure via a central monitoring site and spatiotemporal models. We estimated residential traffic density and roadway proximity as surrogates for exposure to traffic-related air pollution. We performed multinomial logistic regression analyses adjusted for sociodemographic covariates, and used multiple imputation to account for missing data.Results: Of 2,093 women, 65 (3%) had IGT and 118 (6%) had GDM. Second-trimester spatiotemporal exposures ranged from 8.5 to 15.9 μg/m³ for PM_2.5 and from 0.1 to 1.7 μg/m³ for black carbon. Traffic density was 0–30,860 vehicles/day × length of road (kilometers) within 100 m; 281 (13%) women lived ≤ 200 m from a major road. The prevalence of IGT was elevated in the highest (vs. lowest) quartile of exposure to spatiotemporal PM_2.5 [odds ratio (OR) = 2.63; 95% CI: 1.15, 6.01] and traffic density (OR = 2.66; 95% CI: 1.24, 5.71). IGT also was positively associated with other exposure measures, although associations were not statistically significant. No pollutant exposures were positively associated with GDM.Conclusions: Greater exposure to PM_2.5 and other traffic-related pollutants during pregnancy was associated with IGT but not GDM. Air pollution may contribute to abnormal glycemia in pregnancy.Citation: Fleisch AF, Gold DR, Rifas-Shiman SL, Koutrakis P, Schwartz JD, Kloog I, Melly S, Coull BA, Zanobetti A, Gillman MW, Oken E. 2014. Air pollution exposure and abnormal glucose tolerance during pregnancy: the Project Viva Cohort. Environ Health Perspect 122:378–383; http://dx.doi.org/10.1289/ehp.1307065     

Associations of Fine Particulate Matter Species with Mortality in the United States: A Multicity Time-Series Analysis

Background: Epidemiological studies have examined the association between PM_2.5 and mortality, but uncertainty remains about the seasonal variations in PM_2.5-related effects and the relative importance of species.Objectives: We estimated the effects of PM_2.5 species on mortality and how infiltration rates may modify the association.Methods: Using city–season specific Poisson regression, we estimated PM_2.5 effects on approximately 4.5 million deaths for all causes, cardiovascular disease (CVD), myocardial infarction (MI), stroke, and respiratory diseases in 75 U.S. cities for 2000–2006. We added interaction terms between PM_2.5 and monthly average species-to-PM_2.5 proportions of individual species to determine the relative toxicity of each species. We combined results across cities using multivariate meta-regression, and controlled for infiltration.Results: We estimated a 1.18% (95% CI: 0.93, 1.44%) increase in all-cause mortality, a 1.03% (95% CI: 0.65, 1.41%) increase in CVD, a 1.22% (95% CI: 0.62, 1.82%) increase in MI, a 1.76% (95% CI: 1.01, 2.52%) increase in stroke, and a 1.71% (95% CI: 1.06, 2.35%) increase in respiratory deaths in association with a 10-μg/m³ increase in 2-day averaged PM_2.5 concentration. The associations were largest in the spring. Silicon, calcium, and sulfur were associated with more all-cause mortality, whereas sulfur was related to more respiratory deaths. County-level smoking and alcohol were associated with larger estimated PM_2.5 effects.Conclusions: Our study showed an increased risk of mortality associated with PM_2.5, which varied with seasons and species. The results suggest that mass alone might not be sufficient to evaluate the health effects of particles.Citation: Dai L, Zanobetti A, Koutrakis P, Schwartz JD. 2014. Associations of fine particulate matter species with mortality in the United States: a multicity time-series analysis. Environ Health Perspect 122:837–842; http://dx.doi.org/10.1289/ehp.1307568     

Relationships among personal, indoor, and outdoor fine and coarse particle concentrations for individuals with COPD

This study characterizes the personal, indoor, and outdoor PM2.5, PM10, and PM2.5-10 exposures of 18 individuals with chronic obstructive pulmonary disease (COPD) living in Boston, MA. Monitoring was performed for each participant for six consecutive days in the winters of 1996 or 1997 and for six to twelve days in the summer of 1996. On each day, 12-h personal, indoor, and outdoor samples of PM2.5 and PM10 were collected simultaneously. Home characteristic information and time-activity patterns were also obtained. Personal exposures were higher than corresponding indoor and outdoor concentrations for all particle measures and for all seasons, except for winter indoor PM2.5-10 levels, which were higher than personal and outdoor levels. Higher personal exposures may be due to the proximity of the individuals to particle sources, such as cooking and cleaning. Indoor concentrations were associated with both outdoor concentrations and personal exposures (as determined by individual least square regression analyses), with associations strongest for PM2.5. Indoor PM2.5 concentrations were significantly associated with outdoor and personal levels for 12 and 15 of the 17 individuals, respectively. Both the strength and magnitude of the associations varied by individual. Also, personal PM2.5, but not PM2.5-10, exposures were associated with outdoor levels, with 10 of the 17 subjects having significant associations. The strength of the personal-outdoor association for PM2.5 was strongly related to that for indoor and outdoor levels, suggesting that home characteristics and indoor particulate sources were key determinants of the personal-outdoor association for PM2.5. Air exchange rates were found to be important determinants of both indoor and personal levels. Again, substantial interpersonal variability in the personal-outdoor relationship was found, as personal exposures varied by as much as 200% for a given outdoor level.     

Characterization of indoor particle sources: A study conducted in the metropolitan Boston area

An intensive particle monitoring study was conducted in homes in the Boston, Massachusetts, area during the winter and summer of 1996 in an effort to characterize sources of indoor particles. As part of this study, continuous particle size and mass concentration data were collected in four single-family homes, with each home monitored for one or two 6-day periods. Additionally, housing activity and air exchange rate data were collected. Cooking, cleaning, and the movement of people were identified as the most important indoor particle sources in these homes. These sources contributed significantly both to indoor concentrations (indoor-outdoor ratios varied between 2 and 33) and to altered indoor particle size distributions. Cooking, including broiling/baking, toasting, and barbecuing contributed primarily to particulate matter with physical diameters between 0.02 and 0.5 microm [PM((0.02-0.5))], with volume median diameters of between 0.13 and 0.25 microm. Sources of particulate matter with aerodynamic diameters between 0.7 and 10 microm [PM((0.7-10))] included sautéing, cleaning (vacuuming, dusting, and sweeping), and movement of people, with volume median diameters of between 3 and 4.3 microm. Frying was associated with particles from both PM((0.02-0.5)) and PM((0.7-10)). Air exchange rates ranged between 0.12 and 24.3 exchanges/hr and had significant impact on indoor particle levels and size distributions. Low air exchange rates (< 1 exchange/hr) resulted in longer air residence times and more time for particle concentrations from indoor sources to increase. When air exchange rates were higher (> 1 exchange/hr), the impact of indoor sources was less pronounced, as indoor particle concentrations tracked outdoor levels more closely.