Hanna Boogaard

Respiratory health effects of ultrafine and fine particle exposure in cyclists

Objectives Monitoring studies have shown that commuters are exposed to high air pollution concentrations, but there is limited evidence of associated health effects. We carried out a study to investigate the acute respiratory health effects of air pollution related to commuting by bicycle. Methods Twelve healthy adults cycled a low- and a high-traffic intensity route during morning rush hour in Utrecht, The Netherlands. Exposure to traffic-related air pollution was characterised by measurements of PM10, soot and particle number. Before, directly after and 6 h after cycling we measured lung function (FEV1, FVC, PEF), exhaled NO (FENO) and respiratory symptoms. The association between post- minus pre-exposure difference in health effects and exposure during cycling was evaluated with linear regression models. Results The average particle number concentration was 59% higher, while the average soot concentration was 39% higher on the high-traffic route than on the low-traffic route. There was no difference for PM10. Contrary to our hypothesis, associations between air pollution during cycling and lung function changes immediately after cycling were mostly positive. Six hours after cycling, associations between air pollution exposure and health were mostly negative for lung function changes and positive for changes in exhaled NO, although non-significant. Conclusions We found substantial differences in ultrafine particle number and soot exposure between two urban cycling routes. Exposure to ultrafine particles and soot during cycling was weakly associated with increased exhaled NO, indicative of airway inflammation, and decrements in lung function 6 h after exposure. A limitation of the study was the relatively small sample size.

Expert elicitation on ultrafine particles: likelihood of health effects and causal pathways

BackgroundExposure to fine ambient particulate matter (PM) has consistently been associated with increased morbidity and mortality. The relationship between exposure to ultrafine particles (UFP) and health effects is less firmly established. If UFP cause health effects independently from coarser fractions, this could affect health impact assessment of air pollution, which would possibly lead to alternative policy options to be considered to reduce the disease burden of PM. Therefore, we organized an expert elicitation workshop to assess the evidence for a causal relationship between exposure to UFP and health endpoints.MethodsAn expert elicitation on the health effects of ambient ultrafine particle exposure was carried out, focusing on: 1) the likelihood of causal relationships with key health endpoints, and 2) the likelihood of potential causal pathways for cardiac events. Based on a systematic peer-nomination procedure, fourteen European experts (epidemiologists, toxicologists and clinicians) were selected, of whom twelve attended. They were provided with a briefing book containing key literature. After a group discussion, individual expert judgments in the form of ratings of the likelihood of causal relationships and pathways were obtained using a confidence scheme adapted from the one used by the Intergovernmental Panel on Climate Change.ResultsThe likelihood of an independent causal relationship between increased short-term UFP exposure and increased all-cause mortality, hospital admissions for cardiovascular and respiratory diseases, aggravation of asthma symptoms and lung function decrements was rated medium to high by most experts. The likelihood for long-term UFP exposure to be causally related to all cause mortality, cardiovascular and respiratory morbidity and lung cancer was rated slightly lower, mostly medium. The experts rated the likelihood of each of the six identified possible causal pathways separately. Out of these six, the highest likelihood was rated for the pathway involving respiratory inflammation and subsequent thrombotic effects.ConclusionThe overall medium to high likelihood rating of causality of health effects of UFP exposure and the high likelihood rating of at least one of the proposed causal mechanisms explaining associations between UFP and cardiac events, stresses the importance of considering UFP in future health impact assessments of (transport-related) air pollution, and the need for further research on UFP exposure and health effects.

Concentration Response Functions for Ultrafine Particles and All-Cause Mortality and Hospital Admissions: Results of a European Expert Panel Elicitation

Toxicological studies have provided evidence of the toxicity of ultrafine particles (UFP), but epidemiological evidence for health effects of ultrafines is limited. No quantitative summary currently exists of concentration-response functions for ultrafine particles that can be used in health impact assessment. The goal was to specify concentration-response functions for ultrafine particles in urban air including their uncertainty through an expert panel elicitation. Eleven European experts from the disciplines of epidemiology, toxicology, and clinical medicine selected using a systematic peer-nomination procedure participated. Using individual ratings supplemented with group discussion, probability distributions of effect estimates were obtained for all-cause mortality and cardiovascular and respiratory hospital admissions. Experts judged the small database of epidemiological studies supplemented with experimental studies sufficient to quantify effects of UFP on all-cause mortality and to a lesser extent hospital admissions. Substantial differences in the estimated UFP health effect and its uncertainty were found between experts. The lack of studies on long-term exposure to UFP was rated as the most important source of uncertainty. Effects on hospital admissions were considered more uncertain. This expert elicitation provides the first quantitative evaluation of estimates of concentration response functions between urban air ultrafine particles and all-cause mortality and hospital admissions.

Contrasts in oxidative potential and other particulate matter characteristics collected near major streets and background locations.

Background: Measuring the oxidative potential of airborne particulate matter (PM) may provide a more health-based exposure measure by integrating various biologically relevant properties of PM into a single predictor of biological activity. Objectives: We aimed to assess the contrast in oxidative potential of PM collected at major urban streets and background locations, the associaton of oxidative potential with other PM characteristics, and the oxidative potential in different PM size fractions. Methods: Measurements of PM with aerodynamic diameter ≤ 10 μm (PM10), PM with aerodynamic diameter ≤ 2.5 μm (PM2.5), soot, elemental composition, and oxidative potential of PM were conducted simultaneously in samples from 8 major streets and 10 urban and suburban background locations in the Netherlands. Six 1-week measurements were performed at each location over a 6-month period in 2008. Oxidative potential was measured as the ability to generate hydroxyl radicals in the presence of hydrogen peroxide in all PM10 samples and a subset of PM2.5 samples. Results: The PM10 oxidative potential of samples from major streets was 3.6 times higher than at urban background locations, exceeding the contrast for PM mass, soot, and all measured chemical PM characteristics. The contrast between major streets and suburban background locations was even higher (factor of 6.5). Oxidative potential was highly correlated with soot, barium, chromium, copper, iron, and manganese. Oxidative potential of PM10 was 4.6 times higher than the oxidative potential of PM2.5 when expressed per volume unit and 3.1 times higher when expressed per mass unit. Conclusions: The oxidative potential of PM near major urban roads was highly elevated compared with urban and suburban background locations, and the contrast was greater than that for any other measured PM characteristic.

Do the health benefits of cycling outweigh the risks

Although from a societal point of view a modal shift from car to bicycle may have beneficial health effects due to decreased air pollution emissions and increased levels of physical activity, shifts in individual adverse health effects such as higher exposure to air pollution and risk of a traffic accident may prevail. We have summarized the literature for air pollution, traffic accidents, and physical activity using systematic reviews supplemented with recent key studies. We quantified the impact on all-cause mortality when 500,000 people would make a transition from car to bicycle for short trips on a daily basis in the Netherlands. We estimate that beneficial effects of increased physical activity are substantially larger (3-14 months gained) than the potential mortality effect of increased inhaled air pollution doses (0.8-40 days lost) and the increase in traffic accidents (5-9 days lost). Societal benefits are even larger because of a modest reduction in air pollution and traffic accidents. On average, the estimated health benefits of cycling were substantially larger than the risks relative to car driving for individuals shifting their mode of transport.

Comparison of short-term exposure to particle number, PM10 and soot concentrations on three (sub) urban locations.

Recent interest has focused on the health effects of ultrafine particles because of the documented toxicity and the larger concentration contrast near motorways of UFP than for PM10 or PM2.5. There are only few studies that have measured UFP at inner-city streets simultaneously with other PM components. The aim of this study was to compare the contrast of UFP, PM(10) and soot measured simultaneously at 3 inner-city locations, namely a moderately busy street (15,000 vehicles/day), a city and a suburban background location. Simultaneously, measurements of particle number concentrations (PNC), PM(10) and soot have been conducted on three locations in and around Utrecht, a medium-sized city in the Netherlands for 20 weekdays in autumn 2008. Measurements were done for 6-h during afternoon and early evening. The mean PNC at the street location was more than 3 times higher than at the two background locations. The contrast was similar for soot concentrations. In PM(10) concentrations less contrast was found, namely 1.8 times. Mean PNC concentrations were poorly correlated with PM(10) and soot. At the street location, high temporal variation of PNC concentrations occurred within each sampling day, probably related to variations in traffic volumes, high-emission individual vehicles and wind direction. Temporal variation was smaller at the two background locations. Occasional unexplained short-term peaks occurred at the suburban background location. A relatively high correlation between PNC minute values at the two background locations was found, pointing to similar area-wide sources. Typically low correlations were found with the street locations, consistent with the dominant impact of local traffic. A large contrast between two background locations and a moderately busy urban street location was found for PNC and soot, comparable to previous studies of much busier motorways. Temporal variation of PNC was higher at the street location and uncorrelated with background variations.

Respiratory effects of a reduction in outdoor air pollution concentrations.

Background: Air pollution has been associated with respiratory health effects. There is little direct evidence that reductions in air pollution related to abatement policies lead to actual improvement in respiratory health. We assessed whether a reduction in (traffic policy-related) air pollution concentrations was associated with changes in respiratory health. Methods: Air pollution concentrations and respiratory health were measured in 2008 and 2010 at eight busy urban streets and at four suburban background control locations. Respiratory function was assessed twice in 661 residents by spirometry and measurements of airway resistance. Nitric oxide (NO) in exhaled air was measured as a marker for airway inflammation. Results: Air pollution concentrations were lower in 2010 than in 2008. The declines in pollutants varied among locations, with the largest decline observed in a street with a large reduction in traffic intensity. In regression analyses adjusted for important covariates, reductions in concentrations of soot, NO2, NOx, Cu, and Fe were associated with increases in forced vital capacity (FVC) (∼1% increase per interquartile range [IQR] decline). Airway resistance decreased with a decline in particulate matter (PM10) and PM2.5 (9% per IQR), although these associations were somewhat less consistent. No associations were found with exhaled NO. Results were driven largely by one street where traffic-related air pollution showed the largest reduction. Forced expiratory volume and FVC improved by 3% to 6% in residents of this street compared with suburban background residents. This was accompanied by a suggestive reduction in airway resistance. Conclusions: Reductions in air pollution may lead to small improvements in respiratory function.