All but quiet on the particulate front.
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Air Pollutants↗
Biomedical subjects
B Brunekreef
Publications and source records attributed to B Brunekreef.
Modulation of the acute respiratory effects of winter air pollution by serum and dietary antioxidants: a panel study.
This study investigated whether a high dietary intake or serum concentration of antioxidant (pro-) vitamins could attenuate the acute respiratory effects of air pollution in panels of adults (n = 227) aged 50-70 yrs with chronic respiratory symptoms in two winters starting in 1993/1994. Subjects performed daily peak expiratory flow (PEF) measurements in the morning and evening and reported the occurrence of respiratory symptoms in two regions (urban and nonurban) each winter. Logistic regression analysis was used with the prevalences of large PEF decrements as dependent variables and air pollution levels as independent variables. Analyses were performed separately for subjects below and above the median levels of serum beta-carotene and the intake of dietary vitamin C and beta-carotene. Subjects with low levels of serum beta-carotene more often had large PEF decrements when particles <10 microm in diameter or black smoke levels which were higher compared to subjects with high levels of serum beta-carotene. The same results tended to be observed for dietary vitamin C or beta-carotene, but there were less significant air pollution effects in the low dietary antioxidant group. The results suggest that serum beta-carotene and to a lesser extent dietary vitamin C and beta-carotene may attenuate peak expiratory flow decrements due to air pollution in subjects with chronic respiratory symptoms.
Aged↗
Personal sampling of particles in adults: relation among personal, indoor, and outdoor air concentrations.
To investigate the validity of outdoor particulate matter with a 50% cutoff diameter of 10-microm (PM10) concentrations as a measure of exposure in time series studies, the association between personal and outdoor concentrations, within subjects, over time was investigated. Repeated measurements of personal, indoor, and outdoor PM10 were conducted among 37 nonsmoking, 50- to 70-year-old adults, living in Amsterdam, Netherlands, 1994. Regression analyses were conducted for each subject separately, and the distribution of the individual regression and correlation coefficients was investigated. Furthermore, the extent to which differences among personal, indoor, and outdoor concentrations could be explained was studied. The median Pearson's R between personal and outdoor concentrations was 0.50. Excluding days with exposure to environmental tobacco smoke (ETS) improved the correlation to a median R of 0.71. The estimated cross-sectional correlations were lower, 0.34 and 0.50, respectively. Outdoor concentrations (mean, 42 microg/m3) exceeded indoor concentrations (mean, 35 microg/m3) but underestimated personal exposures (mean, 62 microg/m3). The major part of the difference between personal and outdoor concentrations could be attributed to exposure to ETS, living along a busy road, and time spent in a vehicle. The results show a reasonably high correlation between personal and outdoor PM10 within individuals, providing support for the use of ambient PM10 concentrations as a measure of exposure in epidemiologic studies linking the day-to-day variation in particulate matter air pollution to the day-to-day variation in health endpoints such as mortality, hospital admissions, respiratory symptoms, and lung function.
Aged↗
Validation of a screening questionnaire for atopy with serum IgE tests in a population of pregnant Dutch women.
BACKGROUND: We have started a large birth cohort study in which pregnant women with and without atopy are differentially included. In view of the large number of subjects to be screened (12000), a simple questionnaire was developed for the assessment of atopy in pregnant women. OBJECTIVE: The objective of our study was to evaluate the efficacy of a questionnaire using serum IgE tests. METHODS: During a antenatal visit to the midwife clinic, 175 expecting mothers completed a questionnaire and from each subject blood was obtained in which total and specific IgE against house dust mite, cat, dog, birch and grass was determined. RESULTS: When atopy was defined as the presence of a positive test for IgE against at least one allergen, seven questions from the questionnaire had a sensitivity and specificity of 55.0% and 88.7%, respectively. With the use of the questionnaire it was possible to select about 50% of the subjects with specific IgE to one or more common inhalant allergens. The positive predictive value of the screening questions was 71.7%. Taking total IgE into account did not change these results. CONCLUSION: The screening questionnaire is an efficient tool for differential inclusion of subjects with and without atopy in epidemiological studies.
Allergens↗
Home dampness and respiratory health status in european children.
BACKGROUND: Living in a damp home has been associated with impaired respiratory health in previous studies, but objective data on lung function variability and atopy have been lacking from most studies. OBJECTIVES: Data collected in the winter of 1993-1994 in the framework of the PEACE study (Pollution Effects on Asthmatic Children in Europe) were used to study the association between home dampness and Peak Flow (PEF) variability, frequency of respiratory symptoms and relief medication use during the period of observation. METHODS: Children were selected with a screening questionnaire on the basis of positive answers to questions on symptoms of asthma and chronic cough. Children were instructed to perform PEF measurements with Miniwright PEF meters twice daily over a period of 2 months. Parents kept diaries on respiratory symptoms and medication use of their children. Data on demographic and housing characteristics were derived from a parent-administered questionnaire. As indicators for home dampness reported moisture stains and moulds were used. Children were tested for atopy with skin-prick tests. Data from 1614 children from 13 centres in 10 different countries were available for analysis. Linear regression models and prevalence rate ratios were used to investigate the association between home dampness and PEF variability and the period prevalence of cough, phlegm, lower and upper respiratory symptoms and bronchodilator use. RESULTS: In atopic children, PEF variability was positively related to self-reported moulds but not to moisture stains. The period prevalence of cough and upper respiratory symptoms was significantly higher in children living in houses with reported moulds, compared with 'dry' homes. CONCLUSIONS: These results show that self-reported moulds in homes are associated with objective as well as subjective markers of airway lability in European children with chronic respiratory symptoms.
Adolescent↗
Inappropriate use of daily mortality analyses to estimate longer-term mortality effects of air pollution.
BACKGROUND: To avoid the usual problems of multi-population correlation studies of air pollution and mortality, and for reasons of convenience, daily time-series mortality studies within single populations have recently become popular in air pollution epidemiology. Such studies describe how the short-term distribution of deaths relates to short-term fluctuations in air pollution levels. The regression-based risk coefficients from these acute-effects studies have been widely used to estimate the excess annual mortality within a population with a specified average level of air pollution. Such calculations are inappropriate. Since daily time-series data provide no simple direct information about the degree of life-shortening associated with the excess daily deaths (many of which are thought to be due to exacerbation of well-advanced disease, especially cardiovascular disease), such data cannot contribute to the estimation of the effects of air pollution upon chronic disease incidence and long-term death rates. Yet it is that category of effect that is of most public health importance. CONCLUSION: Such effects are best estimated from long-term cohort studies that incorporate good knowledge of local (or personal) exposure to air pollutants and of potential confounders. Time-series studies, properly evaluated, can identify the existence of acute toxic effects of transient peak levels of air pollution; they are thus useful for monitoring acute toxicity and for identifying the most noxious pollutants. However, to quantify the long-term health impacts of air pollution we cannot use acute-effects data.
Air Pollution↗
Acute effects of ozone on pulmonary function of cyclists receiving antioxidant supplements.
OBJECTIVES: To identify whether acute lung function effects of ozone can be modulated by antioxidant vitamin supplementation. METHODS: Amateur cyclists (n = 26) were studied in the summer of 1994 in The Netherlands. Repeated lung function measurements were performed with a rolling seal spirometer after training sessions or competitive races on four to 14 occasions. The cyclists were assigned to two study groups. The supplementation group (n = 12) received antioxidant supplements (15 mg beta-carotene, 75 mg vitamin E, and 650 mg vitamin C) once a day for three months. The control group did not receive supplementation. For each subject, lung function after exercise was regressed on the previous eight hour mean ozone concentration. The individual regression coefficients were pooled for each study group and weighted with the inverse of the variance. RESULTS: The eight hour mean ozone concentration was 101 micrograms/m3 (30 to 205 micrograms/m3). For the supplementation group, there was no effect of ozone on FVC, FEV1, peak expiratory flow (PEF), and maximal mid-expiratory flow (MMEF). For the control group the mean coefficients were negative, except for MMEF. The difference between the groups was 2.08 (95% confidence interval (95% CI) 1.31 to 2.85) ml/microgram/m3 for FVC, 1.66 (95% CI 0.62 to 2.70) for FEV1, 6.83 (95% CI 3.17 to 10.49) for PEF, and 0.42 (95% CI -1.38 to 2.22) for MMEF. CONCLUSION: The results suggest that antioxidant vitamin supplementation protects against acute effects of ozone on lung function in heavily exercising amateur cyclists.
Adolescent↗
Antioxidant supplementation and respiratory functions among workers exposed to high levels of ozone.
Ozone exposure has been related to adverse respiratory effects, in particular to lung function decrements. Antioxidant vitamins are free-radical scavengers and could have a protective effect against photo-oxidant exposure. To evaluate whether acute effects of ozone on lung functions could be attenuated by antioxidant vitamin supplementation, we conducted a randomized trial using a double-blind crossover design. Street workers (n = 47) of Mexico City were randomly assigned to take daily a supplement (75 mg vitamin E, 650 mg vitamin C, 15 mg beta carotene) or a placebo and were followed from March to August 1996. Pulmonary function tests were done twice a week at the end of the workday. During the follow-up, the mean 1-h maximum ozone level was 123 ppb (SD = 40). During the first phase, ozone levels were inversely associated with FVC (beta = -1.60 ml/ppb), FEV1 (beta = -2.11 ml/ppb), and FEF25-75 (beta = -4.92 ml/ppb) (p < 0.05) in the placebo group but not in the supplement group. The difference between the two groups was significant for FVC, FEV1, and FEF25-75 (p < 0.01). During the second phase, similar results were observed, but the lung function decrements in the placebo group were smaller, suggesting that the supplementation may have had a residual protective effect on the lung. These results need to be confirmed in larger supplementation studies.
Adolescent↗
Peak expiratory flow variability, bronchial responsiveness, and susceptibility to ambient air pollution in adults.
Bronchial hyperresponsiveness (BHR) and peak expiratory flow (PEF) variability are associated expressions of airway lability, yet probably reflect different underlying pathophysiologic mechanisms. We investigated whether both measures can be used interchangeably to identify subjects who are susceptible to ambient air pollution. Data on BHR (>= 20% fall in FEV1), PEF variability (ampl%mean PEF > 5% on any day during an 8-d period with low air pollution levels) and diary data on upper and lower respiratory symptoms, cough, and phlegm were collected in 189 subjects (48-73 yr). The acute effects (lag0) of particulate matter with a diameter less than 10 micrometers (PM10), black smoke, SO2 and NO2 on the prevalence of symptoms were estimated with logistic regression. In subjects with airway lability, both when expressed as PEF variability (69%) and BHR (28%), the prevalence of symptoms increased significantly with increasing levels of air pollution, especially in those with the greater PEF variability (n = 55, 29%). We found no such consistent positive associations in adults without airway lability. PEF variability, and to a smaller extent BHR, can be used to identify adults who are susceptible to air pollution. Though odds ratios were rather low (ranging from 1.13 to 1.41), the impact on public health can be substantial because it applies to large populations.
Acute Disease↗
Work-related changes in peak expiratory flow among laboratory animal workers.
Laboratory animal workers are at risk of developing allergic symptoms, of which asthmatic symptoms are the most severe. The aim was to study the relationship between allergic symptoms due to working with rats and variability and changes in peak expiratory flow (PEF). Several indices were used on the basis of the amplitude of the PEF or the differences in PEF between days with and without exposure to rat aeroallergens. Of the 398 rat workers, 73% completed PEF readings on at least 9 days, of whom 208 had PEF readings on working days with and without contact with animals. The overall prevalence rate of allergic symptoms (asthmatic, eye, nose and/or skin) among rat workers during the handling of rats was 17.3%. Asthmatic symptoms were reported by 6.7%. The PEF of the workers who reported asthmatic symptoms due to working with rats decreased significantly on days working with the animals (difference between the minimum PEF averaged over working days with animals and over days without animals (deltaPEFmin-min) = -73 L x min(-1)), compared to the workers without symptoms (2.2 L x min(-1)). This effect was more pronounced among workers with a late asthmatic response, i.e. the presence of asthmatic symptoms several hours after working with rats (deltaPEFmin-min = -11.6 L x min(-1)). Multiple regression analyses showed that only those with asthmatic symptoms several hours after working with rats and those with allergic symptoms had an increased deltaPEFmin-min. In addition, workers with asthmatic symptoms were also more likely to have a higher PEF variability than workers without asthmatic symptoms. However, no difference in PEF variability between days with and without animals contact was observed. This study shows that the peak expiratory flow of workers who reported asthmatic symptoms due to working with rats decreased significantly on days working with laboratory animals.
Adult↗
Association between PM10 and decrements in peak expiratory flow rates in children: reanalysis of data from five panel studies.
Panel studies have found 1-3% increases in reports of acute respiratory symptoms associated with each 10 microg x m(-3) increase in ambient concentrations of particles with a 50% cut-off aerodynamic diameter of 10 microm (PM10). Statistically significant decrements in population mean peak expiratory flow (PEF) have also been observed but their magnitude is only about 0.1% for the same exposure. This study evaluated whether this difference is due to the different measurement scales used for the expression of the effects of air pollution on PEF and respiratory symptoms. The association between the prevalence of large decrements in PEF (more than 10% or 20% below the median) and PM10 concentrations was analysed using data from five recent panel studies. The effect estimates were compared to the effect estimates from original studies based on the population mean PEF. The decrement in the population mean PEF for an increase of 10 microg x m(-3) of the same-day PM10 concentration was 0.07%, averaged over all panels. A significant relative increase of 2.7% (95% confidence interval 1.6-3.8) in the prevalence of PEF decrements greater than 10% was associated with the same exposure. In conclusion, defining the peak expiratory flow response by the prevalence of large decrements provides effect estimates of a comparable magnitude to effect estimates for the prevalence of reports of acute lower respiratory symptoms.
Air Pollutants↗
Daily variations in air pollution and respiratory health in a multicentre study: the PEACE project. Pollution Effects on Asthmatic Children in Europe.
The Pollution Effects on Asthmatic Children in Europe (PEACE) study is a multicentre study of the acute effects of particles with a 50% cut-off aerodynamic diameter of 10 microm (PM10), black smoke (BS), sulphur dioxide (SO2) and nitrogen dioxide (NO2) on the respiratory health of children with chronic respiratory symptoms. The study was conducted in the winter of 1993/1994 by 14 research centres in Europe. A total of 2,010 children, divided over 28 panels in urban and suburban locations, was followed for at least 2 months. Exposure to air pollution was monitored on a daily basis. Health status was monitored by daily peak expiratory flow (PEF) measurements and a symptom diary. The association between respiratory health and air pollution levels was calculated with time series analysis. Combined effect estimates of air pollution on PEF or the daily prevalence of respiratory symptoms and bronchodilator use were calculated from the panel-specific effect estimates. Fixed effect models were used and, in cases of heterogeneity, random effect models. No clear associations between PM10, BS, SO2 or NO2 and morning PEF, evening PEF, prevalence of respiratory symptoms or bronchodilator use could be detected. Only previous day PM10 was negatively associated with evening PEF, but only in locations where BS was high compared to PM10 concentrations. There were no consistent differences in effect estimates between subgroups based on urban versus suburban, geographical location or mean levels of PM10, BS, SO2 and NO2. The lack of association could not be attributed to a lack of statistical power, low levels of exposure or incorrect trend specifications. In conclusion, the PEACE project did not show effects of particles with a 50% cut-off aerodynamic diameter of 10 microm, black smoke, sulphur dioxide or nitrogen dioxide on morning or evening peak expiratory flow or the daily prevalence of respiratory symptoms and bronchodilator use.
Air Pollution↗
Asthma severity and susceptibility to air pollution.
Exacerbations of asthma have been associated with exposure to ozone or particles with a 50% cut-off aerodynamic diameter of 10 microm (PM10). We postulated in this study that the association of summertime air pollution (i.e. ozone and PM10) with acute respiratory symptoms, medication use and peak expiratory flow differs among patients grouped according to asthma severity. During the summer of 1995, effects of ambient air pollution on these parameters were studied in a panel of 60 nonsmoking patients with intermittent to severe persistent asthma. These patients were recruited from our Pulmonary Out-patient Clinic. Subgroup analysis was performed on the degree of hyperresponsiveness and lung steroid use before the start of the study, as indictors for the severity of asthma. Associations of the parameters studied with ozone, PM10, nitrogen dioxide (NO2), sulphur dioxide (SO2) and black smoke were evaluated using time series analysis. Several episodes with increased summertime air pollution occurred during the 96 day study period. Eight hour average ozone concentrations exceeded the World Health Organization (WHO) Air Quality Guidelines (120 microg x m(-3)) on 16 occasions. Daily mean levels of PM10 were moderately elevated (range 16-98 microg x m(-3)). Levels of the other measured pollutants were low. There was a consistent, positive association of the prevalence of shortness of breath (maximal relative risk (RRmax) 1.18) with ozone, PM10, black smoke and NO2. In addition, bronchodilator use was associated with both ozone and PM10 levels (RRmax 1.16). Stratification by airway hyperresponsiveness and steroid use did not affect the magnitude of the observed associations. No associations with peak expiratory flow measurements were found. We conclude that the severity of asthma is not an indicator for the sensitivity to air pollution.
Adult↗
[Relationship between air pollution due to traffic, decreased lung function and airway symptoms in children].
OBJECTIVE: To assess whether air pollution by traffic was related to lung function and chronic respiratory symptoms in children living. DESIGN: Descriptive. SETTING: The province of South Holland, the Netherlands. METHODS: In the period May through July of 1995 pulmonary function tests and questionnaires were obtained from 1,092 and 1,068 children respectively in six city districts near busy motorways in the province of South Holland. In the same period, indoor measurements were performed at 12 schools of NO2, black smoke and PM10 dust density. Lung function data were analysed by multiple linear regression and respiratory symptoms were analysed by multiple logistic regression. As independent variables, distance between motorway and home, passenger car traffic density and lorry traffic density on the motorway, and black smoke and NO2 concentrations in schools were taken. RESULTS: Significant differences in lung function and respiratory symptoms were found between children living in different city districts. Lung function as well as symptoms were associated with lorry traffic density on the motorway. The validity of these findings was supported by associations between black smoke concentrations (representative for diesel soot) and lung function as well as respiratory symptoms. In contrast, there was no association between passenger car traffic counts or NO2 and lung function or respiratory symptoms. CONCLUSION: The results suggest that air pollution by lorry traffic can lead to reduced lung function and to an increased prevalence of chronic respiratory symptoms in children living near major motorways.
Air Pollutants↗
Motor vehicle exhaust and chronic respiratory symptoms in children living near freeways.
To examine whether motor vehicle exhaust from freeways has an effect on respiratory health of children, a cross-sectional study was conducted. Children attending schools situated less than 1000 m from major freeways in the Province of South Holland were asked to participate. The selected freeways carry between 80,000 and 150,000 vehicles per day. Separate counts for truck traffic indicated a range from 8000 to 17,500 trucks per day. At a total of 13 schools, 1498 children were asked to participate. From these children, 1068 usable questionnaires were obtained. Chronic respiratory symptoms reported in the questionnaire were analyzed with logistic regression. Distance from the freeway and (truck) traffic intensity were used as exposure variables. Cough, wheeze, runny nose, and doctor-diagnosed asthma were significantly more often reported for children living within 100 m from the freeway. Truck traffic intensity and the concentration of black smoke measured in schools were found to be significantly associated with chronic respiratory symptoms. These relationships were more pronounced in girls than in boys.
Air Pollutants↗
House dust mite avoidance measures improve peak flow and symptoms in patients with allergy but without asthma: a possible delay in the manifestation of clinical asthma?
BACKGROUND: Asthma caused by allergy to house dust mite is a growing problem. Patients with allergy who do not have asthma (yet) might develop asthma depending on exposure to precipitating factors. OBJECTIVE: We sought to determine whether house dust mite avoidance measures have an effect on the development of asthma. METHODS: Patients with allergy (n = 29) who had no diagnosis of asthma (FEV1 of 99.1% +/- 10.6% of predicted, peak flow variability of 5.21% +/- 3.41%, reversibility of FEV1 after 400 microg salbutamol of 3.92% +/- 3.75% according to the reference values) were randomly allocated (subjects blinded) to a treatment (n = 16) and a placebo group (n = 13). House dust mite avoidance treatment consisted of applying Acarosan (Allergopharma, J. Ganzer KG, Hamburg, Germany) (the placebo group used water) to the floors (living room, bedroom), and the use of covers for mattresses and bedding that were impermeable to house dust mite (the placebo group used cotton covers for mattresses only). We tested whether the intervention had an effect on peak flow parameters and asthma symptom scores during 6 weeks of treatment. RESULTS: Significant improvements were seen in the treatment group in symptom scores (Borg score) for disturbed sleep, breathlessness, wheeze, and overall symptom score. Slight but statistically significant improvements in peak flow (morning, evening, and variability) were seen in the treatment group also. No significant changes were seen in the placebo group. CONCLUSIONS: Although this study is not long enough to study the development of asthma, the results indicates that house dust mite avoidance measures had an effect on peak flow parameters and asthma symptoms in patients with allergy but without asthma. These findings might implicate that a shift in developing clinically manifest asthma could be achieved with house dust mite avoidance measures. To give a better answer to whether preventing the development of asthma is possible, larger studies with a longer follow-up period are necessary.
Adolescent↗
Air pollution from truck traffic and lung function in children living near motorways.
The contribution of motorized traffic to air pollution is widely recognized, but relatively few studies have looked at the respiratory health status of subjects living near busy roads. We studied children in six areas located near major motorways in the Netherlands. We measured lung function in the children, and we assessed their exposure to traffic-related air pollution using separate traffic counts for automobiles and trucks. We also measured air pollution in the children's schools. Lung function was associated with truck traffic density but had a lesser association with automobile traffic density. The association was stronger in children living closest (< 300 m) to the motorways. Lung function was also associated with the concentration of black smoke, measured inside the schools, as a proxy for diesel exhaust particles. The associations were stronger in girls than in boys. The results indicate that exposure to traffic-related air pollution, in particular diesel exhaust particles, may lead to reduced lung function in children living near major motorways.
Child↗
Air pollution and life expectancy: is there a relation?
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Air Pollution↗