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Clinical Studies on the Impact of Air Pollutants on Human Health

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Epidemiology & Public Health".

Deadline for manuscript submissions: closed (31 March 2021) | Viewed by 28865

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Prof. Dr. Artur Badyda

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Department of Informatics and Environment Quality Research, Faculty of Building Services, Hydro- and Environmental Engineering, Warsaw University of Technology, 00-661 Warszawa, Poland
Interests: environment (air pollution in particular, but also noise pollution): atmospheric pollution (PM, PAHs, heavy metals, gaseous pollutants); environmental data analysis; environmental engineering; environmental epidemiology; environmental exposure; environmental health; environmental impact assessment; environmental management; environmental monitoring; environmental pollution; environmental protection; environmental toxicology; renewable energy sources; health (respiratory diseases (asthma, COPD) in particular, but also allergies and cardiovascular diseases (IHD)): airway obstruction; health impact assessment; health risk assessment; environmental medicine; exposure assessment; pulmonary function test
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Dr. Tamara Schikowski

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Head of the Working Group of Environmental Epidemiology at the Leibniz Research Institute of Environmental Medicine (IUF), Düsseldorf, Germany
Interests: environmental exposure; air pollution; temperature; health effects; lung health; neurocognitive
Special Issues, Collections and Topics in MDPI journals

Prof. Dr. Andrzej Chcialowski

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Clinic of Infectious Diseases and Allergology, Military Institute of Medicine, 04-141 Warsaw, Poland
Interests: environmental pollution; lung function testing; local bronchial and general inflammatory processes; cardio-pulmonary effect
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

The World Health Organization (WHO) indicates that 92% of the global population live in conditions that do not meet the WHO air quality guidelines set for the protection of human health, especially as regards particulate matter. This is therefore one of the most important global problems, which also contributes to 7.6% of all deaths worldwide. Large epidemiological programs in recent decades have shown that these particles (fine and ultrafine above all), penetrating deep into the respiratory and cardiovascular system, increase the risk of some clinical or subclinical symptoms, e.g., cough, wheezing, dyspnoea, and conjunctiva irritation, of allergies, myocardial infarction, and stroke, as well as of the appearance and/or exacerbation of chronic respiratory (including COPD and asthma), cardiovascular, neurodegenerative diseases, and diabetes.

This Special Issue will focus on presenting the results of clinical and epidemiological studies on risk factors associated with air pollution, which affect morbidity, exacerbation of existing diseases, and mortality. Particular emphasis should be placed on people from sensitive groups exposed to various air pollutants, such as pregnant women, children, the elderly, and those suffering from chronic pulmonary or cardiovascular diseases.

Prof. Dr. Artur Badyda
Dr. Tamara Schikowski
Prof. Dr. Andrzej Chciałowski
Guest Editors

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Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

Environmental exposure (air pollution, temperature)
Respiratory and cardiovascular health
Local and general inflammatory processes
Exacerbations of diseases
Neuro-cognition
Morbidity
Mortality

Published Papers (11 papers)

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Research

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17 pages, 1949 KiB

Open AccessArticle

Air Pollutants’ Concentrations Are Associated with Increased Number of RSV Hospitalizations in Polish Children

by August Wrotek, Artur Badyda, Piotr O. Czechowski, Tomasz Owczarek, Piotr Dąbrowiecki and Teresa Jackowska

J. Clin. Med. 2021, 10(15), 3224; https://doi.org/10.3390/jcm10153224 - 22 Jul 2021

Cited by 18 | Viewed by 2140

Abstract

Respiratory syncytial virus (RSV) contributes significantly to pediatric hospitalizations. An association between air pollution and an increased number of RSV cases has been suggested. We sought to evaluate the short-term impact of air pollutants on RSV hospitalizations in Polish children in the period 2010–2019. Daily concentrations of PM₁₀ and PM_2.5 (particulate matter with an aerodynamic diameter less than or equal to 10 μm and 2.5 μm, respectively) and nitrogen dioxide (NO₂) were analyzed in general regression models (GRM) to establish their influence and full interaction scheme. Significant seasonal and annual periodicity among 53,221 hospitalizations was observed; finally, data from the 2012–2019 RSV high-risk seasons created models for seven agglomerations. The addition of PM_2.5, PM₁₀, and NO₂ to the basic model for RSV seasonality explained 23% (4.9–31%, univariate model) to 31.4% (8.4–31%, multivariate model) of the variance in RSV hospitalizations. A 10 μg/m³ increase in PM_2.5, PM₁₀, and NO₂ concentrations was associated with 0.134 (0.087–0.16), 0.097 (0.031–0.087), and 0.212 (0.04–0.29) average increases in hospitalizations, respectively. In the multivariate models, PM_2.5, PM₁₀, and NO₂ alone, as well as PM_2.5–NO₂, PM_2.5–PM₁₀, and PM₁₀–NO₂ interactions, were associated with hospitalizations in some of the locations, while the metaregression showed statistically significant interactions between each of the pollutants, and between the pollutants and the year of the study. The inclusion of PM_2.5, PM₁₀, and NO₂ in GRM explains a significant number of RSV hospitalizations. The pollutants act alone and interact together in a varied manner. Reducing air contamination might decrease the costs of hospital healthcare. Full article

(This article belongs to the Special Issue Clinical Studies on the Impact of Air Pollutants on Human Health)

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10 pages, 2529 KiB

Open AccessArticle

The Awareness of Pulmonologists and Patients with Respiratory Diseases about the Impact of Air Pollution on Health in Poland

by Tadeusz M. Zielonka

J. Clin. Med. 2021, 10(12), 2606; https://doi.org/10.3390/jcm10122606 - 12 Jun 2021

Cited by 2 | Viewed by 1820

Abstract

Within the European Union, air pollution is highest in Poland. The aim of this study was to compare the awareness of Polish pulmonologists and that of patients with respiratory diseases about the impact of air pollution on health. It was a crossover study with voluntary and anonymous participation. The study included 309 pulmonologists and 262 patients with respiratory diseases. The majority of the patients declared good knowledge about the impact of air pollution on health, and only 16% of the pulmonologists declared sufficient knowledge on this topic. The main sources of information on air pollution were radio and television for patients and the medical press for doctors. Doctors rarely informed patients about the impact of air pollution on their disease. Patients followed information on the quality of air in their areas more often than doctors. Polish patients’ knowledge about the main sources of air pollution in their areas was higher than the knowledge of pulmonologists. Patients declared knowledge of air pollution standards twice as often as doctors. Patients with respiratory diseases are interested in the effects of air pollution on their health. Polish patients’ knowledge about air pollution and its health effects is higher than that of the specialists treating them. Professional education of Polish pulmonologists in this field is needed. Full article

(This article belongs to the Special Issue Clinical Studies on the Impact of Air Pollutants on Human Health)

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10 pages, 1569 KiB

Open AccessArticle

The Influence of Air Pollution on the Development of Allergic Inflammation in the Airways in Krakow’s Atopic and Non-Atopic Residents

by Ewa Czarnobilska, Małgorzata Bulanda, Daniel Bulanda and Marcel Mazur

J. Clin. Med. 2021, 10(11), 2383; https://doi.org/10.3390/jcm10112383 - 28 May 2021

Cited by 4 | Viewed by 1987

Abstract

Until now, the simultaneous influence of air pollution assessed by measuring the objective marker of exposition (1-hydroxypirene, 1-OHP) and atopy on the development of allergic airway diseases has not been studied. The aim of this study was to determine the pathomechanism of the allergic response to PM2.5 in atopic and non-atopic patients. We investigated the changes in peripheral blood basophil activity of patients after stimulation with the birch pollen allergen alone, the allergen combined with PM2.5 (BP), PM2.5 alone, a concentration of 1-OHP in urine, and a distance of residence from the main road in 30 persons. Activation by dust alone was positive for all concentrations in 83% of atopic and 75% of non-atopic assays. In the group of people with atopy, the simultaneous activation of BP gave a higher percentage of active basophils compared to the sum of activation with dust and birch pollen alone (B + P) for all concentrations. The difference between BP and B + P was 117.5 (p = 0.02) at a PM concentration of 100 μg. Such a relationship was not observed in the control group. The correlation coefficient between the distance of residence from major roads and urinary 1-OHP was 0.62. A Pearson correlation analysis of quantitative variables was performed, and positive correlation results were obtained in the atopy group between BP and 1-OH-P. Exposure to birch pollen and PM2.5 has a synergistic effect in sensitized individuals. The higher the exposure to pollutants, the higher the synergistic basophil response to the allergen and PM in atopic patients. Full article

(This article belongs to the Special Issue Clinical Studies on the Impact of Air Pollutants on Human Health)

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8 pages, 600 KiB

Open AccessArticle

Impact of Air Pollution on Lung Function among Preadolescent Children in Two Cities in Poland

by Piotr Dąbrowiecki, Łukasz Adamkiewicz, Dominika Mucha, Piotr Oskar Czechowski, Mateusz Soliński, Andrzej Chciałowski and Artur Badyda

J. Clin. Med. 2021, 10(11), 2375; https://doi.org/10.3390/jcm10112375 - 28 May 2021

Cited by 15 | Viewed by 3194

Abstract

Ambient air pollution impairs lung development in children, particularly in industrialized areas. The air quality in Zabrze, a city located in the Upper Silesian Industrial Region of Poland, is among the worst in Europe. We compared lung function and the frequency of respiratory or allergic symptoms between children living in Zabrze and those living in Gdynia, a city on the Baltic coast, which has the best long-term air quality in Poland. We enrolled children aged 9–15 years from both cities who were able to perform a spirometry. The following spirometry variables were measured for all participants: forced vital capacity (FVC), forced expiratory volume during the first second of expiration (FEV1), FEV1/FVC index, and peak expiratory flow (PEF). The frequencies of respiratory or allergic symptoms were taken from a survey completed by the participants’ parents. In total, 258 children from Gdynia and 512 children from Zabrze were examined. The mean values of FVC, FEV1, and PEF were significantly greater among children in Gdynia than those reported in Zabrze (p ≤ 0.032), and the frequencies of seasonal rhinorrhea (p = 0.015) or coughing episodes (p = 0.022) were significantly higher in Zabrze than in Gdynia. In conclusion, lung function was significantly impaired in children living in Zabrze, an area which is associated with poor air quality. Strategies to improve air quality in the Silesia region are urgently needed. Full article

(This article belongs to the Special Issue Clinical Studies on the Impact of Air Pollutants on Human Health)

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16 pages, 2112 KiB

Open AccessArticle

Air Pollution Increases the Incidence of Upper Respiratory Tract Symptoms among Polish Children

by Aleksandra Ratajczak, Artur Badyda, Piotr Oskar Czechowski, Adam Czarnecki, Michał Dubrawski and Wojciech Feleszko

J. Clin. Med. 2021, 10(10), 2150; https://doi.org/10.3390/jcm10102150 - 16 May 2021

Cited by 28 | Viewed by 2812

Abstract

A substantial proportion of airway disease’s global burden is attributable to exposure to air pollution. This study aimed to investigate the association between air pollution, assessed as concentrations of particulate matter PM2.5 and PM10 on the upper respiratory tract symptoms (URTS) in children. A nation-wide, questionnaire-based study was conducted in Poland in winter 2018/2019 in a population of 1475 children, comparing URTS throughout the study period with publicly available data on airborne particulate matter. A general regression model was used to evaluate the lag effects between daily changes in PM10 and PM2.5 and the number of children reporting URTS and their severity. PM10 and PM2.5 in the single-pollutant models had significant effects on the number of children reporting URTS. The prevalence of URTS: “runny nose”, “sneezing” and “cough” was positively associated with 12-week mean PM2.5 and PM10 concentrations. In the locations with the highest average concentration of PM, the symptoms of runny nose, cough and sneezing were increased by 10%, 9% and 11%, respectively, compared to the cities with the lowest PM concentrations. This study showed that moderate-term exposure (12 week observation period) to air pollution was associated with an increased risk of URTS among children aged 3–12 years in Poland. These findings may influence public debate and future policy at the national and international levels to improve air quality in cities and improve children’s health. Full article

(This article belongs to the Special Issue Clinical Studies on the Impact of Air Pollutants on Human Health)

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9 pages, 1726 KiB

Open AccessArticle

Effect of Severe External Airborne Agents’ Exposure on Dementia

by Seunghyun Lee, Joon Yul Choi, Jin-Ha Yoon and Wanhyung Lee

J. Clin. Med. 2020, 9(12), 4069; https://doi.org/10.3390/jcm9124069 - 17 Dec 2020

Cited by 2 | Viewed by 1622

Abstract

The impact of occupational and environmental exposure to external airborne agents on cognitive function, especially in incidence of dementia, is understudied. The present study was conducted to elucidate the association between severe external airborne agents’ exposure and incidence of dementia among an elderly population and to explore the effects of exposure to severe external airborne agents on preclinical dementia using the screening test of dementia. From the National Health Insurance Service-Health Screening Cohort (NHIS-HealS, 2002–2015), 514,580 participants were used for data analysis. We estimated the standardized incidence ratio (SIR) according to the exposure to external airborne agents. Of the total participants (n = 514,580), 1340 (0.3%) experienced severe external airborne agents exposure, and 26,050 (5.1%) had been diagnosed with dementia. The SIRs (95%CI) of dementia in Alzheimer’s disease, vascular dementia, dementia in other diseases, and unspecific dementia were 1.24 (1.01–1.49), 0.88 (0.37–1.32), 1.16 (0.01–2.77), and 0.69 (0.36–1.02), respectively. The risk of testing positive in the dementia screening significantly increased with exposure to severe external airborne agents after adjusting for all confounding variables. This study found that exposure to severe external airborne agents is a potential risk factor for dementia, especially in Alzheimer’s disease. It is essential to create international awareness regarding the effect of airborne agents’ exposure on dementia. Full article

(This article belongs to the Special Issue Clinical Studies on the Impact of Air Pollutants on Human Health)

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12 pages, 2812 KiB

Open AccessArticle

The 10-Year Study of the Impact of Particulate Matters on Mortality in Two Transit Cities in North-Eastern Poland (PL-PARTICLES)

by Łukasz Kuźma, Emil Julian Dąbrowski, Anna Kurasz, Hanna Bachórzewska-Gajewska and Sławomir Dobrzycki

J. Clin. Med. 2020, 9(11), 3445; https://doi.org/10.3390/jcm9113445 - 27 Oct 2020

Cited by 4 | Viewed by 1579

Abstract

The detrimental influence of air pollution on mortality has been established in a series of studies. The majority of them were conducted in large, highly polluted cities—there is a lack of studies from small, relatively clean regions. The aim was to analyze the short-term impact of particulate matters (PMs) on mortality in north-eastern Poland. Time-stratified case-crossover design was performed for mortality in years 2008–2017. Daily concentrations of PM_2.5 (28.4 µg/m³, interquartile range (IQR) = 25.2) vs. (12.6 µg/m³, IQR = 9.0) and PM₁₀ (29.0 µg/m³, IQR = 18.0) vs. (21.7 µg/m³, IQR = 14.5) were higher in Łomża than Suwałki (p < 0.001). Impact of PM_2.5 on mortality was recorded in Łomża (odds ratio (OR) for IQR increase 1.061, 1.017–1.105, p = 0.06, lag 0) and Suwałki (OR for IQR increase 1.044, 1.001–1.089, p = 0.004, lag 0). PM₁₀ had an impact on mortality in Łomża (OR for IQR increase 1.028, 1.000–1.058, p = 0.049, lag 1). Cardiovascular mortality was affected by increase of PM_2.5 in Łomża (1.086, 1.020–1.156, p = 0.01) and Suwałki (1.085, 1.005–1.171, p = 0.04). PM_2.5 had an influence on respiratory mortality in Łomża (1.163, 1.021–1.380, p = 0.03, lag 1). In the whole studied region, despite differences in the air quality, the influence of PMs on mortality was observed. Full article

(This article belongs to the Special Issue Clinical Studies on the Impact of Air Pollutants on Human Health)

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12 pages, 681 KiB

Open AccessArticle

Adipokines as Biomarkers of Atopic Dermatitis in Adults

by Andrzej Kazimierz Jaworek, Jacek C. Szepietowski, Krystyna Szafraniec, Magdalena Jaworek, Przemysław Hałubiec, Anna Wojas-Pelc and Mieczysław Pokorski

J. Clin. Med. 2020, 9(9), 2858; https://doi.org/10.3390/jcm9092858 - 04 Sep 2020

Cited by 22 | Viewed by 2735

Abstract

Atopic dermatitis (AD) is characterized by chronic, relapsing, pruritic skin inflammation and does not have a well-understood pathogenesis. In this study, we addressed the contribution of adipokines to AD eczema based on the assessment of blood levels of adiponectin, resistin, leptin, lipocalin-2, and vaspin in adult non-obese patients suffering from chronic extrinsic childhood-onset AD. We investigated 49 AD patients with a median age of 37 years. The control group consisted of 30 age-matched healthy subjects. Adipokines were assessed in the serum by ELISA assays and the severity of AD with the SCORing Atopic Dermatitis (SCORAD) index. We found that adiponectin and resistin decreased and leptin appreciably increased in AD patients when compared to those in healthy subjects. Further, the levels of adiponectin and resistin were inversely related to the intensity of eczema. In conclusion, apart from the formerly investigated role of leptin in AD, this study points to adiponectin and resistin as the potential candidate adipokine biomarkers involved in shaping eczema intensity and severity, which may help predict disease exacerbations and enable the development of effective targeted therapeutic interventions. Full article

(This article belongs to the Special Issue Clinical Studies on the Impact of Air Pollutants on Human Health)

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11 pages, 268 KiB

Open AccessArticle

Gender Differences in Association between Air Pollution and Daily Mortality in the Capital of the Green Lungs of Poland–Population-Based Study with 2,953,000 Person-Years of Follow-Up

by Łukasz Kuźma, Krzysztof Struniawski, Szymon Pogorzelski, Hanna Bachórzewska-Gajewska and Sławomir Dobrzycki

J. Clin. Med. 2020, 9(8), 2351; https://doi.org/10.3390/jcm9082351 - 23 Jul 2020

Cited by 24 | Viewed by 2417

Abstract

(1) Introduction: air pollution is considered to be one of the main risk factors for public health. According to the European Environment Agency (EEA), air pollution contributes to the premature deaths of approximately 500,000 citizens of the European Union (EU), including almost 5000 inhabitants of Poland every year. (2) Purpose: to assess the gender differences in the impact of air pollution on the mortality in the population of the city of Bialystok—the capital of the Green Lungs of Poland. (3) Materials and Methods: based on the data from the Central Statistical Office, the number—and causes of death—of Białystok residents in the period 2008–2017 were analyzed. The study utilized the data recorded by the Provincial Inspectorate for Environmental Protection station and the Institute of Meteorology and Water Management during the analysis period. Time series regression with Poisson distribution was used in statistical analysis. (4) Results: A total of 34,005 deaths had been recorded, in which women accounted for 47.5%. The proportion of cardiovascular-related deaths was 48% (n = 16,370). An increase of SO₂ concentration by 1-µg/m³ (relative risk (RR) 1.07, 95% confidence interval (CI) 1.02–1.12; p = 0.005) and a 10 °C decrease of temperature (RR 1.03, 95% CI 1.01–1.05; p = 0.005) were related to an increase in the number of daily deaths. No gender differences in the impact of air pollution on mortality were observed. In the analysis of the subgroup of cardiovascular deaths, the main pollutant that was found to have an effect on daily mortality was particulate matter with a diameter of 2.5 μm or less (PM2.5); the RR for 10-µg/m³ increase of PM2.5 was 1.07 (95% CI 1.02–1.12; p = 0.01), and this effect was noted only in the male population. (5) Conclusions: air quality and atmospheric conditions had an impact on the mortality of Bialystok residents. The main air pollutant that influenced the mortality rate was SO₂, and there were no gender differences in the impact of this pollutant. In the male population, an increased exposure to PM2.5 concentration was associated with significantly higher cardiovascular mortality. These findings suggest that improving air quality, in particular, even with lower SO₂ levels than currently allowed by the World Health Organization (WHO) guidelines, may benefit public health. Further studies on this topic are needed, but our results bring questions whether the recommendations concerning acceptable concentrations of air pollutants should be stricter, or is there a safe concentration of SO₂ in the air at all. Full article

(This article belongs to the Special Issue Clinical Studies on the Impact of Air Pollutants on Human Health)

13 pages, 795 KiB

Open AccessArticle

Prospective Association of Air-Purifier Usage during Pregnancy with Infant Neurodevelopment: A Nationwide Longitudinal Study—Japan Environment and Children’s Study (JECS)

by Kenta Matsumura, Kei Hamazaki, Akiko Tsuchida, Hidekuni Inadera and The Japan Environment and Children’s Study (JECS) Group

J. Clin. Med. 2020, 9(6), 1924; https://doi.org/10.3390/jcm9061924 - 19 Jun 2020

Cited by 3 | Viewed by 2735

Abstract

Fetal exposure to particulate matter (PM) is associated with infant developmental delay likely via neuroinflammation and prefrontal cortex lesions; however, whether air-purifier usage, which can reduce indoor PM levels, is related to infant developmental delay remains unknown. We therefore examined the prospective relationship between air-purifier usage during pregnancy and infant developmental delay by analyzing 82,441 mother–infant pairs using a simple yes/no questionnaire. Developmental delays at 6 and 12 months were assessed in five areas using the Ages and Stages Questionnaire, Third Edition. A generalized linear mixed model analysis was used to derive adjusted odds ratios (AORs) and 95% confidence intervals (95% CIs) while controlling for 20 covariates. The analysis revealed that air-purifier usage was associated with developmental delays in fine motor (AOR: 0.91, 95% CI: 0.83–0.99) and problem solving (AOR: 0.83, 95% CI: 0.77–0.90) at 6 months and in communication (AOR: 0.86, 95% CI: 0.79–0.93), fine motor (AOR: 0.87, 95% CI: 0.82–0.92), problem solving (AOR: 0.83, 95% CI: 0.77–0.88), and personal–social (AOR: 0.79, 95% CI: 0.72–0.86) at 12 months. In conclusion, a negative association exists between air-purifier usage during pregnancy and infant neurodevelopmental delay that strengthens with time. Our results outline the potential role of air purifiers in inhibiting infant neurodevelopmental delay. Full article

(This article belongs to the Special Issue Clinical Studies on the Impact of Air Pollutants on Human Health)

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Review

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15 pages, 675 KiB

Open AccessReview

Air Pollution—An Overlooked Risk Factor for Idiopathic Pulmonary Fibrosis

by Sebastian Majewski and Wojciech J. Piotrowski

J. Clin. Med. 2021, 10(1), 77; https://doi.org/10.3390/jcm10010077 - 28 Dec 2020

Cited by 22 | Viewed by 4591

Abstract

Air pollution is a major environmental risk to health and a global public health concern. In 2016, according to the World Health Organization (WHO), ambient air pollution in cities and rural areas was estimated to cause 4.2 million premature deaths. It is estimated that around 91% of the world’s population lives in places where air pollution exceeds the limits recommended by the WHO. Sources of air pollution are multiple and context-specific. Air pollution exposures are established risk factors for development and adverse health outcomes in many respiratory diseases, including asthma, chronic obstructive pulmonary disease (COPD), or lung cancer. However, possible associations between air pollution and idiopathic pulmonary fibrosis (IPF) have not been adequately studied and air pollution seems to be an underrecognized risk factor for IPF. This narrative review describes potential mechanisms triggered by ambient air pollution and their possible roles in the initiation of the pathogenic process and adverse health effects in IPF. Additionally, we summarize the most current research evidence from the clinical studies supporting links between air pollution and IPF. Full article

(This article belongs to the Special Issue Clinical Studies on the Impact of Air Pollutants on Human Health)

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