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"Air pollution"
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Impact of air pollution on the burden of chronic respiratory diseases in China: time for urgent action
In China, where air pollution has become a major threat to public health, public awareness of the detrimental effects of air pollution on respiratory health is increasing—particularly in relation to haze days. Air pollutant emission levels in China remain substantially higher than are those in developed countries. Moreover, industry, traffic, and household biomass combustion have become major sources of air pollutant emissions, with substantial spatial and temporal variations. In this Review, we focus on the major constituents of air pollutants and their impacts on chronic respiratory diseases. We highlight targets for interventions and recommendations for pollution reduction through industrial upgrading, vehicle and fuel renovation, improvements in public transportation, lowering of personal exposure, mitigation of the direct effects of air pollution through healthy city development, intervention at population-based level (systematic health education, intensive and individualised intervention, pre-emptive measures, and rehabilitation), and improvement in air quality. The implementation of a national environmental protection policy has become urgent.
Journal Article
Improved childhood asthma control after exposure reduction interventions for desert dust and anthropogenic air pollution: the MEDEA randomised controlled trial
IntroductionElevated particulate matter (PM) concentrations of anthropogenic and/or desert dust origin are associated with increased morbidity among children with asthma.ObjectiveThe Mitigating the Health Effects of Desert Dust Storms Using Exposure-Reduction Approaches randomised controlled trial assessed the impact of exposure reduction recommendations, including indoor air filtration, on childhood asthma control during high desert dust storms (DDS) season in Cyprus and Greece.Design, participants, interventions and settingPrimary school children with asthma were randomised into three parallel groups: (a) no intervention (controls); (b) outdoor intervention (early alerts notifications, recommendations to stay indoors and limit outdoor physical activity during DDS) and (c) combined intervention (same as (b) combined with indoor air purification with high efficiency particulate air filters in children’s homes and school classrooms. Asthma symptom control was assessed using the childhood Asthma Control Test (c-ACT), spirometry (forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC)) and fractional exhaled nitric oxide (FeNO).ResultsIn total, 182 children with asthma (age; mean=9.5, SD=1.63) were evaluated during 2019 and 2021. After three follow-up months, the combined intervention group demonstrated a significant improvement in c-ACT in comparison to controls (β=2.63, 95% CI 0.72 to 4.54, p=0.007), which was more profound among atopic children (β=3.56, 95% CI 0.04 to 7.07, p=0.047). Similarly, FEV1% predicted (β=4.26, 95% CI 0.54 to 7.99, p=0.025), the need for any asthma medication and unscheduled clinician visits, but not FVC% and FeNO, were significantly improved in the combined intervention compared with controls.ConclusionRecommendations to reduce exposure and use of indoor air filtration in areas with high PM pollution may improve symptom control and lung function in children with asthma.Trial registration number NCT03503812.
Journal Article
Control of toxicity of fine particulate matter emissions in China
Fine particulate matter (particulate matter with a diameter of 2.5 μm or less; PM
2.5
) causes millions of premature deaths globally
1
, but not all particles are equally harmful
2
,
3
–
4
. Current air-pollution control strategies, prioritizing PM
2.5
mass reduction, have provided considerable health benefits but further refinements based on differences in the toxicity of various emission sources may provide greater benefits
5
,
6
–
7
. Here we integrated field measurements with air-quality modelling to assess the unequal toxicities of PM
2.5
from various anthropogenic sources. Our findings revealed that the toxicity per unit of PM
2.5
mass differed substantially between major sources, differing by up to two orders of magnitude. PM
2.5
from solid fuel combustion in residential stoves had the highest toxicity, followed by those from the metallurgy industry, brake wear, diesel vehicles, petrol vehicles, the cement industry and power plants. We further analysed the source contributions of toxicity-adjusted PM
2.5
emissions and population exposures in China. From 2005 to 2021, both the PM
2.5
mass and relative-potency-adjusted emissions substantially decreased. Although industrial sources contributed 57.5% to the reduction in PM
2.5
mass emissions, the reduction in relative potency-adjusted emissions was driven by residential combustion (approximately 80%). Clean-air policies should consider the differing toxicities of PM
2.5
when formulating source-specific emission control regulations. This study proposes a cellular toxicity-based framework for PM
2.5
reduction that could address the specific health risks in diverse regions, but further epidemiological studies will be required to confirm their relevance to human health outcomes and their application to public policy.
A relative potency-adjusted inventory of fine-particulate matter (PM
2.5
) established in China reveals sectoral and regional disparities in PM
2.5
emissions, exposures and associated toxic potencies.
Journal Article
Effects of a large-scale distribution of water filters and natural draft rocket-style cookstoves on diarrhea and acute respiratory infection: A cluster-randomized controlled trial in Western Province, Rwanda
Unsafe drinking water and household air pollution (HAP) are major causes of morbidity and mortality among children under 5 in low and middle-income countries. Household water filters and higher-efficiency biomass-burning cookstoves have been widely promoted to improve water quality and reduce fuel use, but there is limited evidence of their health effects when delivered programmatically at scale.
In a large-scale program in Western Province, Rwanda, water filters and portable biomass-burning natural draft rocket-style cookstoves were distributed between September and December 2014 and promoted to over 101,000 households in the poorest economic quartile in 72 (of 96) randomly selected sectors in Western Province. To assess the effects of the intervention, between August and December, 2014, we enrolled 1,582 households that included a child under 4 years from 174 randomly selected village-sized clusters, half from intervention sectors and half from nonintervention sectors. At baseline, 76% of households relied primarily on an improved source for drinking water (piped, borehole, protected spring/well, or rainwater) and over 99% cooked primarily on traditional biomass-burning stoves. We conducted follow-up at 3 time-points between February 2015 and March 2016 to assess reported diarrhea and acute respiratory infections (ARIs) among children <5 years in the preceding 7 days (primary outcomes) and patterns of intervention use, drinking water quality, and air quality. The intervention reduced the prevalence of reported child diarrhea by 29% (prevalence ratio [PR] 0.71, 95% confidence interval [CI] 0.59-0.87, p = 0.001) and reported child ARI by 25% (PR 0.75, 95% CI 0.60-0.93, p = 0.009). Overall, more than 62% of households were observed to have water in their filters at follow-up, while 65% reported using the intervention stove every day, and 55% reported using it primarily outdoors. Use of both the intervention filter and intervention stove decreased throughout follow-up, while reported traditional stove use increased. The intervention reduced the prevalence of households with detectable fecal contamination in drinking water samples by 38% (PR 0.62, 95% CI 0.57-0.68, p < 0.0001) but had no significant impact on 48-hour personal exposure to log-transformed fine particulate matter (PM2.5) concentrations among cooks (β = -0.089, p = 0.486) or children (β = -0.228, p = 0.127). The main limitations of this trial include the unblinded nature of the intervention, limited PM2.5 exposure measurement, and a reliance on reported intervention use and reported health outcomes.
Our findings indicate that the intervention improved household drinking water quality and reduced caregiver-reported diarrhea among children <5 years. It also reduced caregiver-reported ARI despite no evidence of improved air quality. Further research is necessary to ascertain longer-term intervention use and benefits and to explore the potential synergistic effects between diarrhea and ARI.
Clinical Trials.gov NCT02239250.
Journal Article
Air pollution: a global problem needs local fixes
Researchers must find the particles that are most dangerous to health in each place so policies can reduce levels of those pollutants first, urge Xiangdong Li and colleagues.
Researchers must find the particles that are most dangerous to health in each place so policies can reduce levels of those pollutants first, urge Xiangdong Li and colleagues.
Photographers take photos on the roof of a building in heavy smog in Zhengzhou, China
Journal Article