Ritul Kamal

Particulate matter in ambient air and its association with alterations in lung functions and respiratory health problems among outdoor exercisers in National Capital Region, India

Regular exercise improves physiological processes and yields positive health outcomes. However, it is relatively less known that exposure to air pollution during outdoor exercises may actually exacerbate several health problems. The present cross–sectional study was undertaken to assess the particulate matter (PM) in the ambient air and its association with lung functions, pulse rate and respiratory problems among 378 outdoor exercisers in the National Capital Region (NCR), India. Lung functions were measured using a Spirometer (PIKO–1, PIKO–6) and respiratory problems were recorded through a questionnaire–based survey. Concentrations of particulate matter smaller than 2.5 and 1 microns were monitored at 10 locations across the study area using an online automated ambient air monitoring instrument–HAZ–DUST (EPAM–5000). Decline in Forced Expiratory Volume in 1 sec–FEV1 (p<0.001) and Peak Expiratory Flow Rate–PEFR (p<0.001) was observed among the outdoor exercisers compared to the Indian reference values. Ambient air monitoring showed higher PM2.5 concentrations at all the study locations compared to the recommended permissible levels for residential areas in India. Risk of FEV1 (%) predicted cases with <80% showed an increase from 2.32% to 8.69% among the exercisers with respect to PM1 concentration from lower to higher limit at the study locations. Similarly, PEFR showed an increased risk of predicted cases <80% from 0.78% to 2.91% among outside exercisers for lower to higher limit of PM1 concentration. Cases with FEV1 predicted <80% increased from 2.56% to 13.98% and for PEFR from 0.96% to 5.24% among outdoor exercisers for the corresponding lower to higher limits of PM2.5 concentrations. The study demonstrates that outdoor exercisers in locations with high PM concentrations are at a risk of lung function impairment. These impairments are due to deposition of PM in the smaller and larger airways.

Gender Disparity in Lung Function Abnormalities among a Population Exposed to Particulate Matter Concentration in Ambient Air in the National Capital Region, India

Background The World Health Organization (WHO) global air quality study shows that 27 Indian cities, including New Delhi, are among the one hundred cities with the worst air quality globally. The scope of airway obstruction cases among residents in locations with critical air pollution levels like particulate matter (PM) pollutants PM2.5 and PM1 has not been addressed in the National Capital region, India. Objectives The present cross-sectional study was undertaken to assess the forced expiratory volume in one second (FEV1) % predicted abnormalities among residents living in the National Capital Region, India with respect to their exposure to particulate matter pollutants (PM1, PM2.5) in ambient air. Methods Eight hundred and fifty-four residents, including 433 men and 421 women ranging in age from 18-70 years, living in the National Capital Region (NCR) of India participated in the study. Particulate matter concentrations in ambient air (PM2.5 and PM1) were monitored at 10 residential locations in the National Capital Region, India (New Okhla Industrial Development Authority (NOIDA) and Gurgaon). The lung function test (FEV1) was conducted using a spirometer. Results The Indian Air Quality Index showed either very poor or severe levels for PM2.5 at all study locations. A significant negative linear relationship was found between higher concentrations of PM1 and reduced FEV1% predicted values (r = -0.8, p < 0.05). The prevalence of airway obstruction cases (79.6%, odds ratio 1.96, confidence interval 1.42-2.71) was higher (p<0.001) among female subjects compared to their male counterparts. Even though there was a significant decline in FEV1% predicted among 80% of cases in women, only 19.24% cases were in the moderate category and 6.18% cases in the severe category. The severe category of FEV1% predicted cases showed greater respiratory symptoms than the other two categories, which denotes higher risk among those in the severe category. The present study shows that obstruction cases increased from 1.97 to 7.40% and 2.73 to 14.93% in women, with a corresponding increase in PM1 and PM2.5 from the minimum to maximum concentration. Conclusions Since the women in this study were non-smokers, the PM in ambient air can be considered to be the major reason for the decline in lung function. The sources of PM pollutants in the study locations are large scale infrastructural development activities such as building and road construction activities. Narrowed lung airways can alter the airway caliber or resistance and flow rates proportional to the airway radius, especially in smaller airways. The present study suggests the need for policy makers and stake holders to take the necessary steps to identify PM sources and reduce the emissions of PM concentrations in ambient air.

Association between PAHs biomarkers and kidney injury biomarkers among kitchen workers with microalbuminuria: A cross-sectional pilot study

BACKGROUND To study the association between kidney injury biomarkers and urinary OH-PAH metabolites in kitchen workers, with microalbuminuria. METHODS A cross-sectional pilot study was conducted among 120 male kitchen workers in a mega kitchen located at Coimbatore, India. Personal and sub-clinical details of study subjects were collected using a questionnaire. Albumin, creatinine, and albumin-creatinine ratio (ACR) were measured using urine dipstick test for the determination of microalbuminuria. Urinary hydroxylated PAHs metabolites (1-NAP, 9-HF, 3-HF, 2-HF, 9-PHN, and 1-OHP) were measured using GC-MS/MS and urinary kidney biomarkers (uNGAL, uCyst-C, uKIM-1, uOPN, and uTIMP-1) were measured using Multiplex Reader. RESULTS Concentrations of urinary PAHs metabolites (1-NAP, 3-HF, 2-HF, 9-PHN, and 1-OHP) and kidney biomarkers (uKIM-1, uTIMP-1, uCyst-C and uNGAL) were significantly higher among kitchen workers with MAU compared to non-kitchen workers with MAU. Urinary kidney biomarkers viz., uKIM-1, uTIMP-1, uCyst-C, uNGAL, and uOPN showed higher median concentration among the kitchen workers with MAU compared to kitchen workers without MAU. Significant positive correlation was observed for 9-HF with uKIM-1 and uTIMP-1 and 1-OHP with uKIM-1. ACR was also well correlated with urinary kidney biomarkers. ROC analysis showed higher sensitivity and specificity for uKIM-1, uCyst-C, and uNGAL as biomarkers for early prediction of acute kidney injury among kitchen workers. CONCLUSIONS The PAHs exposure among kitchen workers can lead to kidney injury. This was evident from the association of OH-PAHs and kidney injury biomarkers in kitchen workers with microalbuminuria.