Pollution effects on asthmatic children in Europe, the PEACE study.
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Air Pollution↗
Biomedical subjects
G Hoek
Publications and source records attributed to G Hoek.
Personal exposure to fine particulate matter in elderly subjects: relation between personal, indoor, and outdoor concentrations.
The time-series correlation between ambient levels, indoor levels, and personal exposure to PM2.5 was assessed in panels of elderly subjects with cardiovascular disease in Amsterdam, the Netherlands, and Helsinki, Finland. Subjects were followed for 6 months with biweekly clinical visits. Each subject's indoor and personal exposure to PM2.5 was measured biweekly, during the 24-hr period preceding the clinical visits. Outdoor PM2.5 concentrations were measured at fixed sites. The absorption coefficients of all PM2.5 filters were measured as a marker for elemental carbon (EC). Regression analyses were conducted for each subject separately, and the distribution of the individual regression and correlation coefficients was investigated. Personal, indoor, and ambient concentrations were highly correlated within subjects over time. Median Pearson's R between personal and outdoor PM2.5 was 0.79 in Amsterdam and 0.76 in Helsinki. For absorption, these values were 0.93 and 0.81 for Amsterdam and Helsinki, respectively. The findings of this study provide further support for using fixed-site measurements as a measure of exposure to PM2.5 in epidemiological time-series studies.
Aged↗
Daily mortality and air pollution in The Netherlands.
We studied the association of daily mortality with short-term variations in the ambient concentrations of major gaseous pollutants and PM in the Netherlands. The magnitude of the association in the four major urban areas was compared with that in the remainder of the country. Daily cause-specific mortality counts, air quality, temperature, relative humidity, and influenza data were obtained from 1986 to 1994. The relationship between daily mortality and air pollution was modeled using Poisson regression analysis. We adjusted for potential confounding due to long-term and seasonal trends, influenza epidemics, ambient temperature and relative humidity, day of the week, and holidays, using generalized additive models. Influenza episodes were associated with increased mortality up to 3 weeks later. Daily mortality was significantly associated with the concentration of all air pollutants. An increase in the PM10 concentration by 100 micrograms/m3 was associated with a relative risk (RR) of 1.02 for total mortality. The largest RRs were found for pneumonia deaths. Ozone had the most consistent, independent association with mortality. Particulate air pollution (e.g., PM10, black smoke [BS]) was not more consistently associated with mortality than were the gaseous pollutants SO2 and NO2. Aerosol SO4(-2), NO3-, and BS were more consistently associated with total mortality than was PM10. The RRs for all pollutants were substantially larger in the summer months than in the winter months. The RR of total mortality for PM10 was 1.10 for the summer and 1.03 for the winter. There was no consistent difference between RRs in the four major urban areas and the more rural areas.
Adolescent↗
Effects of ambient air pollution on upper and lower respiratory symptoms and peak expiratory flow in children.
BACKGROUND: Previous epidemiological studies have shown acute effects of increased amounts of ambient air pollution on the prevalence of respiratory symptoms in children with respiratory disorders. We investigated whether children with bronchial hyperresponsiveness (BHR) and relatively high serum concentrations of total IgE (>60 kU/L, the median value) are susceptible to air pollution. METHODS: We collected data from children during three winters (1992-95) in rural and urban areas of the Netherlands. Lower respiratory symptoms (wheeze, attacks of wheezing, shortness of breath), upper respiratory symptoms (sore throat, runny or blocked nose), and peak expiratory flow were recorded daily for 3 months. The acute effects of airborne particulate matter with a diameter of less than 10 microm, black smoke, sulphur dioxide, and nitrogen dioxide were estimated by logistic regression. FINDINGS: 459 (73%) of 632 children had complete data. Of these, 26% had BHR and relatively high (above median) serum total IgE, 36% had no BHR and total IgE of 60 kU/L or less, 15% had BHR and total IgE of 60 kU/L or less, and 23% had a total IgE of more than 60 kU/L but no BHR. In children with BHR and relatively high serum total IgE the prevalence of lower respiratory symptoms increased significantly by between 32% and 139% for each 100 microm/m3 increase in particulate matter, and between 16% and 131% for each 40 microm/m3 increase in black smoke, SO2, or NO2. Decrease in peak expiratory flow of more than 10% in that group was more common with increased airborne particulate matter and black smoke. There were no consistent positive or negative associations between increased air pollution and prevalence of respiratory symptoms or decrease in peak expiratory flow in the other three groups of children. INTERPRETATION: Children with BHR and relatively high concentrations of serum total IgE are susceptible to air pollution. Although our odds ratios were rather low (range 1.16-2.39) the overall effect of air pollution on public health is likely to be substantial since these odds ratios refer to large numbers of people.
Air Pollutants↗
Self-reporting versus parental reporting of acute respiratory symptoms of children and their relation to pulmonary function and air pollution.
BACKGROUND: Studies of acute effects of outdoor air pollution on acute respiratory symptoms in children generally rely on reports by parents. Little is known about the validity of parental reporting of symptoms of their children. We therefore compared symptoms reported by the parents with self-reported symptoms and measured pulmonary function of 741 7-11-year-old Dutch children. We also analysed the association of symptoms reported by the child or parent and outdoor air pollution. METHODS: The parents of the children completed a daily diary of symptoms of their children for about 3 months. The children reported presence of acute respiratory symptoms in the preceding week before a pulmonary function test was conducted (6-10 test days). RESULTS: Children reported between 80% and 220% more acute respiratory symptoms than their parents for them in the same period. The agreement between symptom reports by the parent and the child was low to moderate (Kappa between 0.22 for eye irritation and 0.43 for fever). Presence of cough reported by child or parent was associated with similar small decrements in forced vital capacity (FVC), forced expiratory volume in one second (FEV1.0) and especially peak expiratory flow (PEF) and maximal mid-expiratory flow (FEF25-75). The largest pulmonary function decrements were found when symptoms were reported by both parent and child. Symptoms reported by either child or parent were not associated with air pollution. CONCLUSIONS: Symptom reports of the children were more prevalent but did not agree well with parental reports. The similar association with pulmonary function suggested that self-reported symptoms were neither superior nor inferior to symptoms reported by the parents.
Acute Disease↗
Acute effects of urban air pollution on respiratory health of children with and without chronic respiratory symptoms.
OBJECTIVES: To investigate to what extent different components of air pollution are associated with acute respiratory health effects in children with and without chronic respiratory symptoms. METHODS: During three consecutive winters starting in 1992-3, peak expiratory flow (PEF) and respiratory symptoms were registered daily in panels of children of 7-11 years old with and without symptoms, living in urban areas with high traffic intensity in The Netherlands. Simultaneously, panels of children living in non-urban areas were studied. Daily measurements of particles with aerodynamic diameter < 10 microns (PM10), black smoke (BS), sulphate, SO2, and NO2 were performed in both areas. RESULTS: The contrast in particle concentrations (PM10, BS, and sulphate) between urban and non-urban areas was small, but there was more contrast in the concentrations of SO2 and NO2. In children with symptoms from both areas, significant associations were found between PM10, BS, and sulphate concentrations and the prevalence of symptoms of the lower respiratory tract (LRS) and decrements in PEF. Particle concentrations were also associated with use of bronchodilators in the urban areas, but not in the non-urban areas. After stratification by use of medication, stronger associations were found in children who used medication than in children who did not use medication. The magnitude of the estimated effects was in the order of a twofold increase in the use of bronchodilators, a 50% increase in LRS, and an 80% increase in decrements in PEF for a 100 micrograms/m3 increase in the 5 day mean PM10 concentration. In children without symptoms, significant associations were found between concentrations of PM10 and BS and decrements in PEF in both areas, but these associations were smaller than those for children with symptoms. No associations with respiratory symptoms were found. CONCLUSIONS: The results suggest that children with symptoms are more susceptible to the effects of particulate air pollution than children without symptoms, and that use of medication for asthma does not prevent the adverse effects of particulate air pollution in children with symptoms.
Air Pollution↗
Inhomogeneity in response to air pollution in European children (PEACE project).
OBJECTIVES: The PEACE study is a multicentre panel study of the acute effects of particles with a 50% cut off aerodynamic diameter of 10 microns (PM10), black smoke (BS), sulphur dioxide (SO2), and nitrogen dioxide (NO2) on respiratory health of children with chronic respiratory symptoms. In the complete panels no consistent association between air pollution and respiratory health was found. The study evaluated whether potentially more sensitive subgroups in the panels did show effects of air pollution. METHODS: To evaluate heterogeneity in response to air pollution, effect estimates of air pollution on peak expiratory flow (PEF) and respiratory symptoms were calculated in subgroups based on presence of chronic respiratory symptoms, use of respiratory medication, atopy, sex, and baseline lung function. RESULTS: The association between PEF and air pollution was positive in asthmatic children who used respiratory medication whereas the associations tended to be negative in children who did not use respiratory medication selected only on cough. No consistent association was found among asthmatic children who did not use medication. The association between daily prevalence of symptoms and concentrations of air pollution was not different between these subgroups. CONCLUSION: None of the predefined potentially more sensitive subgroups showed a consistent association between air pollution, PEF, and respiratory symptoms.
Air Pollutants↗
Mass concentration and elemental composition of PM10 in classrooms.
OBJECTIVES: To investigate the sources of high concentrations of particles of < 10 microns diameter (PM10) in classrooms, observed in a previous study on childhood exposure to PM10, and to study the correlation between classroom and outdoor concentrations of mass and elements of PM10. METHODS: Measurements of PM10 were conducted in two schools and outdoors in Amsterdam, the Netherlands. Averaging time was 24 hours for the outdoor measurements and both 8 hours (school time) and 24 hours for the classroom measurements. Analysis by x ray fluorescence was used to measure the elemental composition of 55 samples from the 11 days when measurements were conducted simultaneously in both classrooms and outdoors. RESULTS: For most elements, classroom concentrations were considerably higher than outdoor concentrations, especially during school hours. The highest classroom/outdoor ratios were found for the elements from soils Si, Ca, and Ti. The only measured elements that were not increased were S, Br, Pb, and Cl, which are dominated by non-crustal sources. For S, Br, and Pb, which are generally associated with particles < 1 micron, significant correlations between classroom and outdoor concentrations and between the two classrooms were found. The other elements generally had low correlations. CONCLUSIONS: The results show that the high PM10 concentrations found in our classrooms are probably due to resuspension of coarse particles or suspension of soil material. Due to these excess coarse particles, the correlation between classroom and outdoor concentrations is lower for elements associated with coarse particles than for elements associated with fine particles. As the general composition of PM10 in classrooms differs from the composition of PM10 in ambient air, the high PM10 mass concentrations in classrooms can probably not be directly compared with ambient air quality guidelines.
Air Pollutants↗
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↗
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↗
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↗
Childhood exposure to PM10: relation between personal, classroom, and outdoor concentrations.
OBJECTIVES: To investigate the validity of outdoor concentrations of particulate matter < 10 microns diameter (PM10) as a measure of exposure in time series studies, and to study the extent to which differences between personal and outdoor PM10 concentrations can be explained. METHODS: Four to eight repeated measurements of personal and outdoor PM10 concentrations were conducted for 45 children, aged 10-12 years, from four schools in Wageningen and Amsterdam, The Netherlands. Repeated PM10 measurements in the classrooms were conducted in three of the schools. Averaging time was 24 hours for the personal and outdoor measurements, and eight hours (daytime) and 24 hours for the classroom measurements. For each child separately, personal exposures were related to outdoor concentrations in a regression analysis. The distribution of the individual correlation and regression coefficients was investigated. Information about factors that might influence personal exposures was obtained by questionnaire. RESULTS: Median Pearson's correlations between personal and outdoor concentrations were 0.63 for children with parents who did not smoke and 0.59 for children with parents who smoked. For children with parents who did not smoke, excluding days with exposure to environmental tobacco smoke (ETS) improved the correlation to a median R of 0.73. The mean personal PM10 concentration was 105 micrograms/m3; on average 67 micrograms/m3 higher than the corresponding outdoor concentrations. The main part of this difference could be attributed to exposure to ETS, to high PM10 concentrations in the classrooms, and to (indoor) physical activity. CONCLUSIONS: The results show a reasonably high correlation between repeated personal and outdoor PM10 measurements within children, providing support for the use of fixed site measurements as a measure of exposure to PM10 in epidemiological time series studies. The large differences between personal and outdoor PM10 concentrations probably result from a child's proximity to particle generating sources and particles resuspended by personal activities.
Air Pollutants↗
Air pollution and daily mortality in Amsterdam.
Few data are available on the association between the present low levels of air pollution in Western Europe and mortality. Daily mortality counts and the concentrations of black smoke, inhalable particles (PM10), sulfur dioxide (SO2), carbon monoxide (CO), and ozone (O3) were available for Amsterdam from 1986 to 1992. We used Poisson regression analysis to control for seasonal and other long-term temporal patterns. Black smoke and PM10 were positively associated with increased risk of mortality. The relative risk for a 100-micrograms per m3 increase in black smoke on the same day was 1.19 [95% confidence interval (CI) = 1.02-1.38], and that for a 100-micrograms per m3 increase in PM10 was 1.06 (95% CI = 0.99-1.14). The relative risk for individuals over 64 years of age was higher. We found no consistent association between the levels of SO2 or CO and daily mortality, but ozone lagged 2 days was positively associated with daily mortality. The effect of particulates on acute mortality was independent of these pollutants. The results of the present study are consistent with the relation reported between particulate air pollution and daily mortality in other communities in Europe and the United States.
Air Pollution↗
Effect of photochemical air pollution on acute respiratory symptoms in children.
In the spring and summer of 1989, an epidemiologic study of the acute effects of photochemical air pollution on the respiratory health of 300 children 7 to 11 yr old was conducted. The children studied were a general population sample of the children living in two rural towns in the Netherlands. For these children, small pulmonary function decrements associated with ambient ozone concentrations were reported previously. In this paper, the association between photochemical ambient air pollution and acute respiratory symptoms is evaluated. Occurrence of acute respiratory symptoms was registered by the parents of the children in a diary on a daily basis. The association of symptom prevalence and incidence with air pollution was evaluated using a logistic regression model that took auto-correlation of the residuals into account. Several photochemical episodes occurred in the study period of 102 d. Hourly maximum ozone concentrations ranged from 14 to 114 ppb. Daily average PM10 concentrations ranged from 11 to 136 micrograms/m3. Levels of acid aerosol were low. No associations of daily symptom prevalence or incidence with same-day or previous day concentration levels of ozone, PM10, fine particle sulfate, or nitrate were observed.
Acute Disease↗
Acute respiratory effects of low level summer smog in primary school children.
We aimed to study the possible effects of exposure to a summer smog episode on the respiratory health of 212 school children. Furthermore, the suitability of the forced oscillation technique (FOT) to demonstrate such effects was evaluated. Acute respiratory symptoms were evaluated by questionnaire and lung function was assessed by spirometry and respiratory impedance measurements. For each child, comparisons were made between measurements performed at baseline (low levels of air pollutant: 55 micrograms.m-3 for SO2 and 58 micrograms.m-3 for NO2 (maximum 24 h means); O3 levels ranged from 2-56 micrograms.m-3 (8 h mean)); and after a summer smog episode (characterized by 8 h O3 levels > 120 micrograms.m-3 (163 micrograms.m-3) and 1 h levels > 160 micrograms.m-3 (215 micrograms.m-3). No significant effects were observed on the prevalence of acute respiratory symptoms. When individual changes in lung function indices (delta LF) were regressed on changes in previous day ozone (8 h mean) and changes in mean daily temperature (delta MTemp), using multiple linear regression analysis, a significant negative association was observed with peak expiratory flow (PEF), but not with other spirometry indices. Although significant associations were observed with reactance at 8 Hz (Xrs8), resonant frequency (f0) and frequency dependence of resistance (FD), the signs of the beta s were opposite to the direction expected when O3 adversely affected the impedance outcomes. In conclusion, in this study short-term exposure to moderately high levels of ozone did not result in clear adverse effects on the respiratory health of the children.(ABSTRACT TRUNCATED AT 250 WORDS)
Acute Disease↗
Effects of low-level winter air pollution concentrations on respiratory health of Dutch children.
During three consecutive winters acute effects of air pollution on respiratory health of more than 1000 children living in four nonindustrial communities in the Netherlands have been investigated. Each child performed between 6 and 10 pulmonary function tests on predetermined days. The occurrence of acute respiratory symptoms in the children was registered in a daily diary filled out by the parents of the children for periods of 3 months. Exposure to air pollution was characterized by the ambient concentration of sulfur dioxide, nitrogen dioxide, PM10, fine particle sulfate, fine particle nitrate, and nitrous acid. No major winter air pollution episode occurred during these winters. Concentrations of acid aerosol were low. A weak negative association between the concentrations of nitrogen dioxide, PM10, aerosol sulfate, aerosol nitrate, nitrous acid, and pulmonary function was found. Sulfur dioxide concentration was not associated with pulmonary function. No association of the concentration of the measured pollutants with daily incidence and prevalence of acute respiratory symptoms was found.
Aerosols↗