New Developments in Climate Change, Air Pollution, Pollen Allergy, and Interaction with SARS-CoV-2

In recent years, the environmental impacts of climate change have become increasingly evident. Extreme meteorological events are influenced by climate change, which also alter the magnitude and pattern of precipitations and winds. Climate change can have a particularly negative impact on respiratory health, which can lead to the emergence of asthma and allergic respiratory illnesses. Pollen is one of the main components of the atmospheric bioaerosol and is able to induce allergic symptoms in certain subjects. Climate change affects the onset, length, and severity of the pollen season, with effects on pollen allergy. Higher levels of carbon dioxide (CO2) can lead to enhanced photosynthesis and a higher pollen production in plants. Pollen grains can also interact with air pollutants and be affected by thunderstorms and other extreme events, exacerbating the insurgence of respiratory diseases such as allergic rhinitis and asthma. The consequences of climate change might also favor the spreading of pandemics, such as the COVID-19 one.

Second-hand smoke and fine particulate matter exposures among multi-unit housing residents in Singapore: A pilot study.

Globally, approximately 1.2 million deaths among non-smokers are attributed to second-hand smoke (SHS) per year. Multi-unit housing is becoming the common type of residential dwelling in developed cities and the issue of neighbour SHS is of rising concern especially as 'Work From Home' became the norm during and post COVID-19 pandemic. The objective of this pilot study is to measure and compare the air quality of households that are exposed to SHS and unexposed households among smoking and non-smoking households in Singapore. A total of 27 households were recruited from April to August 2021. Households were categorized into smoking households with neighbour SHS, smoking households without neighbour SHS, non-smoking households with neighbour SHS, and non-smoking household without neighbour SHS. Air quality of the households was measured using calibrated particulate matter (PM2.5) sensors for 7-16 days. Socio-demographic information and self-reported respiratory health were collected. Regression models were used to identify predictors associated with household PM2.5 concentrations and respiratory health. Mean PM2.5 concentration was significantly higher among non-smoking households with neighbour SHS (n = 5, mean = 22.2, IQR = 12.7) than in non-smoking household without neighbour SHS (n = 2, mean = 4.1, IQR = 5.8). Smoking activity at enclosed areas in homes had the lowest PM2.5 concentration (n = 7 mean = 15.9, IQR = 11.0) among the three smoking locations. Exposure to higher household PM2.5 concentration was found to be associated with poorer respiratory health. A 'smoke-free residential building' policy is recommended to tackle the issue of rising neighbour SHS complaints and health concerns in densely populated multi-unit housing in Singapore. Public education campaigns should encourage smokers to smoke away from the home to minimize SHS exposure in household members.

Parental home-based pulse oximetry monitoring for adults with intellectual disabilities at risk of serious respiratory problems including COVID-19: a brief report.

BACKGROUND: People with intellectual disabilities (ID) are at high risk of developing respiratory health issues. The COVID-19 pandemic has compounded this, with serious consequences, and for some, death. Despite home-based oxygen saturation monitoring being recommended for people with ID, there is a stark lack of evidence in the literature on its feasibility. METHOD: We conducted 3-day baseline home-based oxygen saturation monitoring, using pulse oximeters, with eight parents of nine adults with ID in Scotland. Two eligible parents also completed a further 2 weeks of monitoring, and returned an evaluation questionnaire on its feasibility. RESULTS: Baseline mean readings for eight adults with ID were within the normal range (%Sp02  ≥ 95), and for another one 94%. Fluctuations over the 3-day assessment period were experienced by six of these individuals. However, these variations were within limits which are not dangerous (lowest reading 92%), implying that parental home-based pulse oximetry monitoring is likely to be safe for adults with ID. The two parents who completed the evaluation found home-based pulse oximetry monitoring to be easy/very easy to do, and effective/very effective. CONCLUSIONS: This is the first research study, albeit with a very small sample, to report on the potential feasibility of parental home-based pulse oximetry monitoring for adults with ID. Home-based pulse oximetry monitoring appears to be safe in adults with ID at risk of developing serious respiratory problems, and not difficult for their parents to do. There is an urgent need to replicate this work, using a larger sample, to promote home-based respiratory health monitoring more widely for people with ID.

Development of Animation as a Medium for Public Health Education

One of the diseases still suffered by many Indonesian people, especially in the city of Depok, is respiratory disease. Currently, respiratory tract disease is a case with a high number of sufferers. An effort to handle these cases is to provide counseling and education for the community. This education aims to enable people to apply a healthy lifestyle independently and prevent various types of diseases. During the COVID-19 pandemic, this role was somewhat difficult to carry out due to limited movement and space. As a solution to this problem, the part of information technology is crucial. One is utilizing multimedia technology as a medium for health education for the community, namely animation. Animation can describe and visualize something so that information can be presented clearly and visually. This study aims to develop animation as a medium of health education for the community, especially in respiratory health. The animation video was generated using the MDLC (Multimedia Development Life Cycle) method. The resulting animated video can inform the public about health that focuses on the health of the respiratory system. 85 % of users stated that this animated video helps them to understand the material presented. © 2022 IEEE.

Impacts of Air Pollution and Dampness on Occupant Respiratory Health in Unplanned Houses: A Case Study of Bandung, Indonesia

This paper presents the results from field measurements and household surveys on the severity of indoor mold risk and its impact on respiratory health in a typical unplanned neighborhood of kampungs in Bandung, Indonesia. Mold risk was investigated using fungal risk detectors (n = 102), while air pollution levels were established with total suspended particulate (TSP) and particulate matter (PM2.5) (n = 38). The self-reported prevalence of respiratory diseases was obtained using a questionnaire form (ATS-DLD-78) (n = 599). The results showed that respiratory health problems were higher in the rainy season, particularly among children. Most houses suffered from severe mold risk, primarily due to extreme humid weather conditions, especially during rainy season (97%) where water leakage was prevalent (60%). In addition, the TSP and PM2.5 concentrations exceeded the WHO standards in most kampung houses, where around 58% of the houses recorded higher outdoor mean PM2.5 concentrations than indoors. Further, the path analysis showed that allergies followed by humidity rate and smell, which were affected by window-opening duration, directly impacted children’s respiratory health. Smoking behavior and building-related health problems, due to exposure to outdoor air pollution, affected the respiratory health of those aged 15 years old and over.

The impact of air pollution on COVID-19 incidence, severity, and mortality: A systematic review of studies in Europe and North America.

BACKGROUND: Air pollution is speculated to increase the risks of COVID-19 spread, severity, and mortality. OBJECTIVES: We systematically reviewed studies investigating the relationship between air pollution and COVID-19 cases, non-fatal severity, and mortality in North America and Europe. METHODS: We searched PubMed, Web of Science, and Scopus for studies investigating the effects of harmful pollutants, including particulate matter with diameter ≤2.5 or 10 µm (PM2.5 or PM10), ozone (O3), nitrogen dioxide (NO2), sulfur dioxide (SO2) and carbon monoxide (CO), on COVID-19 cases, severity, and deaths in Europe and North America through to June 19, 2021. Articles were included if they quantitatively measured the relationship between exposure to air pollution and COVID-19 health outcomes. RESULTS: From 2,482 articles screened, we included 116 studies reporting 355 separate pollutant-COVID-19 estimates. Approximately half of all evaluations on incidence were positive and significant associations (52.7%); for mortality the corresponding figure was similar (48.1%), while for non-fatal severity this figure was lower (41.2%). Longer-term exposure to pollutants appeared more likely to be positively associated with COVID-19 incidence (63.8%). PM2.5, PM10, O3, NO2, and CO were most strongly positively associated with COVID-19 incidence, while PM2.5 and NO2 with COVID-19 deaths. All studies were observational and most exhibited high risk of confounding and outcome measurement bias. DISCUSSION: Air pollution may be associated with worse COVID-19 outcomes. Future research is needed to better test the air pollution-COVID-19 hypothesis, particularly using more robust study designs and COVID-19 measures that are less prone to measurement error and by considering co-pollutant interactions.

Respiratory health of broilers following chronic exposure to airborne endotoxin.

In and around poultry farms, high concentrations of endotoxins are found that have a negative impact on the health of farmers and local residents. However, little is known about the effects of chronic exposure to endotoxins on the health of poultry. The aim of this study was to identify effects of chronic exposure to airborne endotoxins (E. coli LPS) on the immune system, respiratory tract, disease susceptibility and welfare of broilers. Effects of high (HE) and low endotoxin (LE) concentrations on natural antibody titers (NAb), performance and behavior of broilers were determined. After treatment with a respiratory virus infection, infectious bronchitis virus (IBV), mRNA expression of cytokines and Toll-like receptor (TLR) 4 in the lung, tracheal ciliary activity and lesions in the respiratory tract were determined. Endotoxin affected the immune system and respiratory tract, where HE broilers tended to have lower IgM NAb binding Phosphorylcholine-conjugated to Bovine Serum Albumin, and higher interferon (IFN)-α mRNA expression and more lesions in the nasal tissue compared to LE broilers. Furthermore, HE broilers had higher TLR4 mRNA expression compared to LE broilers. However, endotoxin did not affect NAb levels binding Keyhole Limpet Hemocyanin, IFN-ß and interleukin-10 mRNA expression, IBV replication or lesions in the lung and trachea. HE and LE broilers further had similar body weight, but HE broilers showed numerically more passive behavior compared to LE broilers. In conclusion, chronic exposure to high airborne endotoxin concentrations affects components of the immune system and respiratory tract in broilers and could therefore influence disease susceptibility.

A Strategy for Field Evaluations of Exposures and Respiratory Health of Workers at Small- to Medium-Sized Coffee Facilities.

Coffee production is a global industry with roasteries throughout the world. Workers in this industry are exposed to complex mixtures of gases, dusts, and vapors including carbon monoxide, carbon dioxide, coffee dust, allergens, alpha-diketones, and other volatile organic compounds (VOCs). Adverse respiratory health outcomes such as respiratory symptoms, reduced pulmonary function, asthma, and obliterative bronchiolitis can occur among exposed workers. In response to health hazard evaluations requests received from 17 small- to medium-sized coffee facilities across the United States, the National Institute for Occupational Safety and Health conducted investigations during 2016-2017 to understand the burden of respiratory abnormalities, exposure characteristics, relationships between exposures and respiratory effects, and opportunities for exposure mitigation. Full-shift, task-based, and instantaneous personal and area air samples for diacetyl, 2,3-pentanedione and other VOCs were collected, and engineering controls were evaluated. Medical evaluations included questionnaire, spirometry, impulse oscillometry, and fractional exhaled nitric oxide. Exposure and health assessments were conducted using standardized tools and approaches, which enabled pooling data for aggregate analysis. The pooled data provided a larger population to better address the requestors' concern of the effect of exposure to alpha-diketones on the respiratory heath of coffee workers. This paper describes the rationale for the exposure and health assessment strategy, the approach used to achieve the study objectives, and its advantages and limitations.

An Exploration of Features Impacting Respiratory Diseases in Urban Areas.

Air pollution exposure has become ubiquitous and is increasingly detrimental to human health. Small Particulate matter (PM) is one of the most harmful forms of air pollution. It can easily infiltrate the lungs and trigger several respiratory diseases, especially in vulnerable populations such as children and elderly people. In this work, we start by leveraging a retrospective study of 416 children suffering from respiratory diseases. The study revealed that asthma prevalence was the most common among several respiratory diseases, and that most patients suffering from those diseases live in areas of high traffic, noise, and greenness. This paved the way to the construction of the MOREAIR dataset by combining feature abstraction and micro-level scale data collection. Unlike existing data sets, MOREAIR is rich in context-specific components, as it includes 52 temporal or geographical features, in addition to air-quality measurements. The use of Random Forest uncovered the most important features for the understanding of air-quality distribution in Moroccan urban areas. By linking the medical data and the MOREAIR dataset, we observed that the patients included in the medical study come mostly from neighborhoods that are characterized by either high average or high variations of pollution levels.

Remote Assessment of Lung Disease and Impact on Physical and Mental Health (RALPMH): Protocol for a Prospective Observational Study.

BACKGROUND: Chronic lung disorders like chronic obstructive pulmonary disease (COPD) and idiopathic pulmonary fibrosis (IPF) are characterized by exacerbations. They are unpleasant for patients and sometimes severe enough to cause hospital admission and death. Moreover, due to the COVID-19 pandemic, vulnerable populations with these disorders are at high risk, and their routine care cannot be done properly. Remote monitoring offers a low cost and safe solution for gaining visibility into the health of people in their daily lives, making it useful for vulnerable populations. OBJECTIVE: The primary objective is to assess the feasibility and acceptability of remote monitoring using wearables and mobile phones in patients with pulmonary diseases. The secondary objective is to provide power calculations for future studies centered around understanding the number of exacerbations according to sample size and duration. METHODS: Twenty participants will be recruited in each of three cohorts (COPD, IPF, and posthospitalization COVID). Data collection will be done remotely using the RADAR-Base (Remote Assessment of Disease And Relapse) mobile health (mHealth) platform for different devices, including Garmin wearable devices and smart spirometers, mobile app questionnaires, surveys, and finger pulse oximeters. Passive data include wearable-derived continuous heart rate, oxygen saturation, respiration rate, activity, and sleep. Active data include disease-specific patient-reported outcome measures, mental health questionnaires, and symptom tracking to track disease trajectory. Analyses will assess the feasibility of lung disorder remote monitoring (including data quality, data completeness, system usability, and system acceptability). We will attempt to explore disease trajectory, patient stratification, and identification of acute clinical events such as exacerbations. A key aspect is understanding the potential of real-time data collection. We will simulate an intervention to acquire responses at the time of the event to assess model performance for exacerbation identification. RESULTS: The Remote Assessment of Lung Disease and Impact on Physical and Mental Health (RALPMH) study provides a unique opportunity to assess the use of remote monitoring in the evaluation of lung disorders. The study started in the middle of June 2021. The data collection apparatus, questionnaires, and wearable integrations were setup and tested by the clinical teams prior to the start of recruitment. While recruitment is ongoing, real-time exacerbation identification models are currently being constructed. The models will be pretrained daily on data of previous days, but the inference will be run in real time. CONCLUSIONS: The RALPMH study will provide a reference infrastructure for remote monitoring of lung diseases. It specifically involves information regarding the feasibility and acceptability of remote monitoring and the potential of real-time data collection and analysis in the context of chronic lung disorders. It will help plan and inform decisions in future studies in the area of respiratory health. TRIAL REGISTRATION: ISRCTN Registry ISRCTN16275601; https://www.isrctn.com/ISRCTN16275601. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/28873.

Greenspace exposure and COVID-19 mortality in the United States: January-July 2020.

BACKGROUND: Mortality from the novel coronavirus disease-2019 (COVID-19) continues to rise across the United States. Evidence is emerging that environmental factors may contribute to susceptibility to disease and mortality. Greenspace exposure promotes enhanced immunity and may protect against risk of mortality among those with COVID-19. OBJECTIVES: Our objective was to determine if high county level greenspace exposure is associated with reduced risk of COVID-19 mortality. METHODS: Greenspace exposure was characterized in 3049 counties across the conterminous United States using Leaf Area Index (LAI) deciles that were derived from satellite imagery via Moderate Resolution Imaging Spectroradiometer from 2011 to 2015. COVID-19 mortality data were obtained from the Center for Systems Science and Engineering at Johns Hopkins University. We used a generalized linear mixed model to evaluate the association between county level LAI and COVID-19 mortality rate in analyses adjusted for 2015-2019 county level average total county population, older population, race, overcrowding in home, Medicaid, education, and physical inactivity. RESULTS: A dose-response association was found between greenness and reduced risk of COVID-19 mortality. COVID-19 mortality was negatively associated with LAI deciles 8 [MRR = 0.82 (95% CI: 0.72, 0.93)], 9 [MRR = 0.78 (95% CI: 0.68, 0.89)], and 10 [MRR = 0.59 (95% CI: 0.50, 0.69)]. Aside from LAI decile 5, no associations were found between the remaining LAI deciles and COVID-19 mortality. Increasing prevalence of counties with older age residents, low education attainment, Native Americans, Black Americans, and housing overcrowding were significantly associated with increased risk of COVID-19 mortality, whereas Medicaid prevalence was associated with a reduced risk. DISCUSSION: Counties with a higher amount of greenspace may be at a reduced risk of experiencing mortality due to COVID-19.