Environmental effect on health: Air pollution and smoke

Marianne Frieri; Krishan Kumar; Anthony Boutin

doi:10.4103/2468-5690.198620

REVIEW ARTICLE

Year : 2016 | Volume : 1 | Issue : 4 | Page : 126-129

Environmental effect on health: Air pollution and smoke

Marianne Frieri¹, Krishan Kumar², Anthony Boutin³
¹ Division of Allergy Immunology, Department of Medicine, Nassau University Medical Center, NY 11554, USA
² Division of Pediatric, Department of Emergency Medicine, Nassau University Medical Center, NY 11554, USA
³ Division of Adult Emergency Medicine, Department of Emergency Medicine, Nassau University Medical Center, 2201 Hempstead Turnpike, NY 11554, USA

Date of Submission	01-Sep-2016
Date of Acceptance	25-Dec-2016
Date of Web Publication	18-Jan-2017

Correspondence Address:
Marianne Frieri
Nassau University Medical Center, Department of Medicine, 2201 Hempstead Turnpike, East Meadow, New York, 11554
USA

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/2468-5690.198620

Abstract

This review has discussed various topics related to environmental health. The major findings highlighted are air pollution, children and adult vulnerability, cytokines related to interleukin-33, thymic stromal lymphopoietin, tobacco smoke related to neonates, women, and their families, and perinatal outcomes. The Emergency Department was also highlighted related to asthma and air pollution concentrations within the emergency department, admissions for respiratory effects in pediatrics, and in patients with asthma that often present to the emergency department for treatment for acute exacerbations.

Keywords: Air pollution, cytokines, emergency department, environment, perinatal outcome, tobacco smoke

How to cite this article:
Frieri M, Kumar K, Boutin A. Environmental effect on health: Air pollution and smoke. Environ Dis 2016;1:126-9

How to cite this URL:
Frieri M, Kumar K, Boutin A. Environmental effect on health: Air pollution and smoke. Environ Dis [serial online] 2016 [cited 2023 Mar 26];1:126-9. Available from: http://www.environmentmed.org/text.asp?2016/1/4/126/198620

Air pollution in children

Exposure to air pollutants is one of the factors responsible for hospitalizations due to respiratory diseases. Children are especially vulnerable to respiratory injury induced by exposure to air pollutants. In this literature study, periods of up to 7 days were studied and were evaluated for the lagged effects of exposure to air pollutants on the daily number of children and adolescents visiting the emergency room (ER) for the treatment of lower respiratory obstructive diseases (LROD), in the city of Sγo Paulo, Brazil. ^[1] Daily records of LROD-related ER visits by children and adolescents under the age of 19, from January 2000 to December 2007 were included in the study. An acute effect at the same day of exposure to air pollutants was observed. The cumulative effects of air pollutants on the number of LROD-related ER visits was almost threefold greater than the one observed on the same day of exposure to particulate matter (PM ₁₀ ), SO ₂ , and nitrogen dioxide (NO ₂ ) mainly in children aged 5 years and under. The 7-day cumulative effect of SO ₂ reached 11.0% increase in visits. This study highlighted the effects of intermediate term. ^[1]

Air pollution and neurobehavioral changes

Children's neuropsychological abilities are in a developmental stage, and recent air pollution exposure and neurobehavioral performance are scarcely studied. ^[2] A panel study monitored at school, recent inside classroom PM ≤2.5 or 10 μm exposure (PM _2.5, PM ₁₀ ) on each examination day. At the child's residence, recent and chronic exposures to PM _2.5 , PM ₁₀ , and black carbon were modeled. Differential neurobehavioral changes were robustly and adversely associated them with recent or chronic ambient exposure to PM air pollution at residence, i.e. with recent exposure for visual information processing speed (pattern comparison test) and with chronic exposure for sustained and selective attention were noted. ^[2]

Over many years, extensive evidence has shown that air pollution affects cardiovascular and respiratory morbidity and mortality in both adults and children across the world. ^{[3],[4],[5],[6]}

Air pollution has also been consistently and widely associated with elevated risks of adverse pregnancy outcomes such low birth weight, ^[7],[8] preterm delivery, ^[9],[10] intrauterine growth retardation, ^[11],[12] and congenital disabilities. More recently, there have been studies examining the link between air pollution and adverse neurological outcomes. ^[12]

Health effects of air pollution

Heath issues caused by air pollution such as PM are much concerned and focused among air, water, and soil pollutions because humans breathe air for whole life span. Physical and chemical characteristics of PM _2.5 and PM ₁₀ and dose-response associations of PM ₁₀ , PM _2.5 and their components with mortality and risk of cardiopulmonary diseases, early health damages such as the decrease of lung functions and heart rate variability were evaluated ^[13] DNA damage, and the roles of genetic variations and epigenetic changes in lung functions and heart rate variability, DNA damage related to PMs and their components were also evaluated. ^[13] It is well established that short-term exposure to ambient air pollutants can exacerbate asthma; however, the role of early life or long-term exposure is less clear. The association between severe asthma exacerbations with both birth and annual exposure to outdoor air pollutants with a population-based cohort of children with asthma in the province of Quebec Canada was studied. ^[14] These authors stated their results support the conclusion, within the limitation of there study, that asthma exacerbations in asthmatic children are mainly associated with time dependent residential exposures.

Cytokines: Interleukin-33 and Thymic Stromal Lymphopoietin

Cytokines are very relevant to air pollution as reviewed in the literature below related to interleukin-33 (IL-33) and thymic stromal lymphopoietin (TSLP). The epithelial cell-derived cytokines, TSLP, and IL-33 have received attention for their role in allergic responses. The objectives were to assess correlations among IL-33, TSLP, and immunoglobulin E (IgE) in umbilical cord blood samples and identify prenatal predictors of these biomarkers. The observed statistically significant association between maternal allergy and joint elevation of levels of TSLP and IL-33 suggests that maternal allergy has an influence on these biomarkers that is detectable at birth. Neonates with elevated cord blood levels of TSLP and IL-33 may represent an immunologically distinct subset. These cytokines were associated with maternal and infant characteristics that reflect underlying inflammation and/or increased risk of allergic disease development. Thus, cord blood levels of TSLP and IL-33 warrant further investigation as potential predictive factors for inflammatory and allergic disease. Given what is known regarding the integral role of TSLP and IL-33 in allergic disease and inflammatory processes, the present findings also raise interesting questions regarding in utero coordinated regulation of these cytokines and motivate further research on this topic.

Average and trimester-specific exposures to ambient measures of NO ₂ and (PM _2.5 ) were associated with elevated cord blood concentrations of IgE and two epithelial cell-produced cytokines: IL-33 and TSLP. ^[15] Statistically significant associations between maternal NO ₂ exposure and elevated cord blood concentrations of both IL-33 and TSLP among girls but not boys have been reported. Thus, maternal NO ₂ exposure may impact the development of the newborn immune system as measured by cord blood concentrations of these two cytokines. ^[15]

The Fetal Immune System Related To Interleukin-33 and Thymic Stromal Lymphopoietin

The fetal immune system is a critical window of development. The epithelial cell-derived cytokines, TSLP, and IL-33 have received attention for their role in allergic responses but not been studied during this critical window. This study assessed correlations among IL-33, TSLP, and IgE in umbilical cord blood samples and identified prenatal predictors of these biomarkers. ^[16] In this population of Canadian women and infants, TSLP and IL-33 were detectable in cord blood, more strongly correlated with each other than with IgE and associated with maternal characteristics indicative of inflammatory responses. This study motivated investigation into the value of cord blood IL-33 and TSLP levels as childhood allergy predictors and raised interesting questions regarding in utero coordinated regulation of these cytokines. ^[16]

Tobacco smoke and perinatal outcomes

Tobacco smoke exposure is clearly related to perinatal outcomes as reviewed in the literature below. A retrospective cohort study was conducted in Newfoundland and Labrador, Canada, on the effects of environmental tobacco smoke (ETS) on perinatal outcomes. Women who self-reported exposure to ETS were compared with those who reported no exposure. Univariate analyses and multivariate linear and logistic regression analyses (adjusting for maternal age, parity, partnered status, work status, level of education, body mass index, alcohol use, illicit drug use, and gestational age) were performed, and odds ratios (adjusted differences) with 95% confidence intervals were calculated. ^[17] Measures were birthweight, birth length, head circumference, and stillbirth. Secondary outcomes included gestational age at delivery, preterm birth <37 and <34 weeks of gestation, prelabor rupture of membranes, Apgar score, endotracheal intubation for resuscitation, neonatal intensive care unit admission, congenital anomalies, respiratory distress syndrome, intraventricular hemorrhage, neonatal bacterial sepsis, jaundice, and neonatal metabolic abnormalities.

A total of 11,852 women were included: 1202 exposed to ETS and 10,650 not exposed. Exposure to ETS was an independent risk factor for lower mean birth weight, smaller head circumference, shorter birth length, trends toward preterm birth <34 weeks, and neonatal sepsis. Thus, exposure of nonsmoking pregnant women to ETS is associated with a number of adverse perinatal outcomes including lower birth weight, smaller head circumference, and stillbirth, as well as shorter birth length. This information is important for women, their families, and healthcare providers and reinforces the continued need for increased public policy and education on prevention of exposure to ETS. ^[17]

The emergency department and air pollution

Air pollution can cause respiratory symptoms or exacerbate preexisting respiratory diseases, especially in children. This study looked at the short-term association of air pollution concentrations with ER admissions for respiratory reasons in pediatrics (age 0-18 years). A daily number of ER admissions in a children's hospital, concentrations of urban background PM _2.5 , NO ₂ , O ₃ , and total aeroallergens were collected in Turin, Northwest Italy, for the period August 1, 2008-December 31, 2010 (883 days). The associations between exposures and ER admissions were estimated. Overall, these findings confirmed adverse short-term health effects of air pollution on the risk of ER admission in children and encouraged a careful management of the urban environment to health protection. ^[18]

Over the last decades, the prevalence of respiratory diseases, especially asthma and allergies, has increased considerably, especially in industrialized countries. ^[19],[20] The etiology of respiratory diseases is multifactorial and includes, among others, interactions between genetic predisposition and environmental factors. ^[21] The environmental dynamics, characterized by climate change, qualitative and quantitative aspects of chemical air pollution and airborne pollens, may partially explain the increased incidence of respiratory symptoms and respiratory diseases during the last years. ^[22]

Asthma and the emergency department

Asthma is one of the most common chronic pediatric diseases. Patients with asthma often present to the emergency department for treatment for acute exacerbations. These patients may not have a primary care physician or primary care home and thus are seeking care in the emergency department. ^[23] Asthma care in the emergency department is multifaceted to treat patients with asthma appropriately and provide quality care. National and international guidelines exist to help drive clinical care. Treatment of patients with asthma should include the acute exacerbation, long-term management of controller medications, and controlling triggers in the home environment. The current state of asthma research in emergency medicine in the US was discussed some of the resources being used to help provide a medical home and improve care for patients who suffer from acute asthma exacerbations. ^[23]

Many children with asthma are repeatedly exposed to asthma and allergy triggers in their environments that exacerbate their asthma symptoms. This includes exposure to poor air quality (tobacco smoke exposure) ^[24] traffic-related air pollution, ^[25] animal dander, dust mites, mold, and a lack of air-conditioning. Many of these environmental factors, as well as the weather fluctuations of temperature and humidity exist. ^[26]

Conclusion

This review has highlighted environmental health issues, air pollution related to traffic, physical, and chemical factors, PM, adverse neurological outcomes, two important cytokines, tobacco smoke, perinatal outcomes, and the emergency department related to asthma, exacerbations, environmental allergens, animal dander, dust mites, mold, lack of air-conditioning, and weather fluctuations of temperature and humidity.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1.	Schvartsman C, Pereira LA, Braga AL, Farhat SC. Seven-day cumulative effects of air pollutants increase respiratory ER visits up to threefold. Pediatr Pulmonol 2016;[Epub ahead of print].
2.	Saenen ND, Provost EB, Viaene MK, Vanpoucke C, Lefebvre W, Vrijens K, et al. Recent versus chronic exposure to particulate matter air pollution in association with neurobehavioral performance in a panel study of primary schoolchildren. Environ Int 2016;95:112-9.
3.	Bernstein JA, Alexis N, Barnes C, Bernstein IL, Bernstein JA, Nel A, et al. Health effects of air pollution. J Allergy Clin Immunol 2004;114:1116-23.
4.	Dockery DW. Epidemiologic evidence of cardiovascular effects of particulate air pollution. Environ Health Perspect 2001;109 Suppl 4:483-6.
5.	Patel MM, Miller RL. Air pollution and childhood asthma: Recent advances and future directions. Curr Opin Pediatr 2009;21:235-42.
6.	Dockery DW, Pope CA 3 ^rd . Acute respiratory effects of particulate air pollution. Annu Rev Public Health 1994;15:107-32.
7.	Xu X, Sharma RK, Talbott EO, Zborowski JV, Rager J, Arena VC, et al. PM10 air pollution exposure during pregnancy and term low birth weight in Allegheny County, PA, 1994-2000. Int Arch Occup Environ Health 2011;84:251-7.
8.	Wang X, Ding H, Ryan L, Xu X. Association between air pollution and low birth weight: A community-based study. Environ Health Perspect 1997;105:514-20.
9.	Darrow LA, Klein M, Flanders WD, Waller LA, Correa A, Marcus M, et al. Ambient air pollution and preterm birth: A time-series analysis. Epidemiology 2009;20:689-98.
10.	Parker JD, Mendola P, Woodruff TJ. Preterm birth after the Utah Valley Steel Mill closure: A natural experiment. Epidemiology 2008;19:820-3.
11.	Rich DQ, Demissie K, Lu SE, Kamat L, Wartenberg D, Rhoads GG. Ambient air pollutant concentrations during pregnancy and the risk of fetal growth restriction. J Epidemiol Community Health 2009;63:488-96.
12.	Choi H, Rauh V, Garfinkel R, Tu Y, Perera FP. Prenatal exposure to airborne polycyclic aromatic hydrocarbons and risk of intrauterine growth restriction. Environ Health Perspect 2008;116:658-65.
13.	Wu TC. Prevention and control of air pollution needs to strengthen further study on health damage caused by air pollution. Zhonghua Yu Fang Yi Xue Za Zhi 2016;50:665-7.
14.	Tétreault LF, Doucet M, Gamache P, Fournier M, Brand A, Kosatsky T, et al. Severe and moderate asthma exacerbations in asthmatic children and exposure to ambient air pollutants. Int J Environ Res Public Health 2016;13. pii: E771.
15.	Ashley-Martin J, Lavigne E, Arbuckle TE, Johnson M, Hystad P, Crouse DL, et al. Air pollution during pregnancy and cord blood immune system biomarkers. J Occup Environ Med 2016;58:979-86.
16.	Ashley-Martin J, Dodds L, Arbuckle TE, Levy AR, Platt RW, Marshall JS. Predictors of interleukin-33 and thymic stromal lymphopoietin levels in cord blood. Pediatr Allergy Immunol 2015;26:161-7.
17.	Crane JM, Keough M, Murphy P, Burrage L, Hutchens D. Effects of environmental tobacco smoke on perinatal outcomes: A retrospective cohort study. BJOG 2011;118:865-71.
18.	Bono R, Romanazzi V, Bellisario V, Tassinari R, Trucco G, Urbino A, et al. Air pollution, aeroallergens and admissions to pediatric emergency room for respiratory reasons in Turin, Northwestern Italy. BMC Public Health 2016;16:722.
19.	Asher MI, Montefort S, Björkstén B, Lai CK, Strachan DP, Weiland SK, et al. Worldwide time trends in the prevalence of symptoms of asthma, allergic rhinoconjunctivitis, and eczema in childhood: ISAAC Phases One and Three repeat multicountry cross-sectional surveys. Lancet 2006;368:733-43.
20.	de Marco R, Cappa V, Accordini S, Rava M, Antonicelli L, Bortolami O, et al. Trends in the prevalence of asthma and allergic rhinitis in Italy between 1991 and 2010. Eur Respir J 2012;39:883-92.
21.	Decramer M, Janssens W, Miravitlles M. Chronic obstructive pulmonary disease. Lancet London Engl 2012;379:1341-51.
22.	Huynh BT, Tual S, Turbelin C, Pelat C, Cecchi L, D′Amato G, et al. Short-term effects of airborne pollens on asthma attacks as seen by general practitioners in the Greater Paris area, 2003-2007. Prim Care Respir J 2010;19:254-9.
23.	Johnson LH, Chambers P, Dexheimer JW. Asthma-related emergency department use: Current perspectives. Open Access Emerg Med 2016;8:47-55.
24.	Kit BK, Simon AE, Brody DJ, Akinbami LJ. US prevalence and trends in tobacco smoke exposure among children and adolescents with asthma. Pediatrics 2013;131:407-14.
25.	Newman NC, Ryan PH, Huang B, Beck AF, Sauers HS, Kahn RS. Traffic-related air pollution and asthma hospital readmission in children: A longitudinal cohort study. J Pediatr 2014;164:1396-402.
26.	Mireku N, Wang Y, Ager J, Reddy RC, Baptist AP. Changes in weather and the effects on pediatric asthma exacerbations. Ann Allergy Asthma Immunol 2009;103:220-4.