Ryan W. Allen

Pulmonary Effects of Indoor- and Outdoor-Generated Particles in Children with Asthma

Most particulate matter (PM) health effects studies use outdoor (ambient) PM as a surrogate for personal exposure. However, people spend most of their time indoors exposed to a combination of indoor-generated particles and ambient particles that have infiltrated. Thus, it is important to investigate the differential health effects of indoor- and ambient-generated particles. We combined our recently adapted recursive model and a predictive model for estimating infiltration efficiency to separate personal exposure (E) to PM2.5 (PM with aerodynamic diameter ≤2.5 μm) into its indoor-generated (Eig) and ambient-generated (Eag) components for 19 children with asthma. We then compared Eig and Eag to changes in exhaled nitric oxide (eNO), a marker of airway inflammation. Based on the recursive model with a sample size of eight children, Eag was marginally associated with increases in eNO [5.6 ppb per 10-μg/m3 increase in PM2.5; 95% confidence interval (CI), −0.6 to 11.9; p = 0.08]. Eig was not associated with eNO (−0.19 ppb change per 10μg/m3). Our predictive model allowed us to estimate Eag and Eig for all 19 children. For those combined estimates, only Eag was significantly associated with an increase in eNO (Eag: 5.0 ppb per 10-μg/m3 increase in PM2.5; 95% CI, 0.3 to 9.7; p = 0.04; Eig: 3.3 ppb per 10-μg/m3 increase in PM2.5; 95% CI, −1.1 to 7.7; p = 0.15). Effects were seen only in children who were not using corticosteroid therapy. We conclude that the ambient-generated component of PM2.5 exposure is consistently associated with increases in eNO and the indoor-generated component is less strongly associated with eNO.

An Air Filter Intervention Study of Endothelial Function among Healthy Adults in a Woodsmoke-impacted Community

RATIONALE Particulate air pollution is associated with cardiovascular morbidity. One hypothesized mechanism involves oxidative stress, systemic inflammation, and endothelial dysfunction. OBJECTIVES To assess an interventions impact on particle exposures and endothelial function among healthy adults in a woodsmoke-impacted community. We also investigated the underlying role of oxidative stress and inflammation in relation to exposure reductions. METHODS Portable air filters were used in a randomized crossover intervention study of 45 healthy adults exposed to consecutive 7-day periods of filtered and nonfiltered air. MEASUREMENTS AND MAIN RESULTS Reactive hyperemia index was measured as an indicator of endothelial function via peripheral artery tonometry, and markers of inflammation (C-reactive protein, interleukin-6, and band cells) and lipid peroxidation (malondialdehyde and 8-iso-prostaglandin F(2α)) were quantified. Air filters reduced indoor fine particle concentrations by 60%. Filtration was associated with a 9.4% (95% confidence interval, 0.9-18%) increase in reactive hyperemia index and a 32.6% (4.4-60.9%) decrease in C-reactive protein. Decreases in particulate matter and the woodsmoke tracer levoglucosan were associated with reduced band cell counts. There was limited evidence of more pronounced effects on endothelial function and level of systemic inflammation among males, overweight participants, younger participants, and residents of wood-burning homes. No associations were noted for oxidative stress markers. CONCLUSIONS Air filtration was associated with improved endothelial function and decreased concentrations of inflammatory biomarkers but not markers of oxidative stress. Our results support the hypothesis that systemic inflammation and impaired endothelial function, both predictors of cardiovascular morbidity, can be favorably influenced by reducing indoor particle concentrations.

Fine Particulate Matter Air Pollution, Proximity to Traffic, and Aortic Atherosclerosis

Background: The initiation and acceleration of atherosclerosis is hypothesized as a physiologic mechanism underlying associations between air pollution and cardiovascular effects. Despite toxicologic evidence, epidemiologic data are limited. Methods: In this cross-sectional analysis we investigated exposure to fine particulate matter (PM2.5) and residential proximity to major roads in relation to abdominal aortic calcification, a sensitive indicator of systemic atherosclerosis. Aortic calcification was measured by computed tomography among 1147 persons, in 5 US metropolitan areas, enrolled in the Multi-Ethnic Study of Atherosclerosis. The presence and quantity of aortic calcification were modeled using relative risk regression and linear regression, respectively, with adjustment for potential confounders. Results: We observed a slightly elevated risk of aortic calcification (RR = 1.06; 95% confidence interval = 0.96–1.16) with a 10 &mgr;g/m3 contrast in PM2.5. The PM2.5-associated risk of aortic calcification was stronger among participants with long-term residence near a PM2.5 monitor (RR = 1.11; 1.00–1.24) and among participants not recently employed outside the home (RR = 1.10; 1.00–1.22). PM2.5 was not associated with an increase in the quantity of aortic calcification (Agatston score) and no roadway proximity effects were noted. There was indication of PM2.5 effect modification by lipid-lowering medication use, with greater effects among users, and PM2.5 associations were observed most consistently among Hispanics. Conclusions: Although we did not find persuasive associations across our full study population, associations were stronger among participants with less exposure misclassification. These findings support the hypothesis of a relationship between particulate air pollution and systemic atherosclerosis.

Prospective study of particulate air pollution exposures, subclinical atherosclerosis, and clinical cardiovascular disease: The Multi-Ethnic Study of Atherosclerosis and Air Pollution (MESA Air).

The Multi-Ethnic Study of Atherosclerosis and Air Pollution (MESA Air) was initiated in 2004 to investigate the relation between individual-level estimates of long-term air pollution exposure and the progression of subclinical atherosclerosis and the incidence of cardiovascular disease (CVD). MESA Air builds on a multicenter, community-based US study of CVD, supplementing that study with additional participants, outcome measurements, and state-of-the-art air pollution exposure assessments of fine particulate matter, oxides of nitrogen, and black carbon. More than 7,000 participants aged 45-84 years are being followed for over 10 years for the identification and characterization of CVD events, including acute myocardial infarction and other coronary artery disease, stroke, peripheral artery disease, and congestive heart failure; cardiac procedures; and mortality. Subcohorts undergo baseline and follow-up measurements of coronary artery calcium using computed tomography and carotid artery intima-medial wall thickness using ultrasonography. This cohort provides vast exposure heterogeneity in ranges currently experienced and permitted in most developed nations, and the air monitoring and modeling methods employed will provide individual estimates of exposure that incorporate residence-specific infiltration characteristics and participant-specific time-activity patterns. The overarching study aim is to understand and reduce uncertainty in health effect estimation regarding long-term exposure to air pollution and CVD.

Modeling the residential infiltration of outdoor PM2.5 in the multi-ethnic study of atherosclerosis and air pollution (MESA Air)

Background: Epidemiologic studies of fine particulate matter [aerodynamic diameter ≤ 2.5 μm (PM2.5)] typically use outdoor concentrations as exposure surrogates. Failure to account for variation in residential infiltration efficiencies (Finf) will affect epidemiologic study results. Objective: We aimed to develop models to predict Finf for > 6,000 homes in the Multi-Ethnic Study of Atherosclerosis and Air Pollution (MESA Air), a prospective cohort study of PM2.5 exposure, subclinical cardiovascular disease, and clinical outcomes. Methods: We collected 526 two-week, paired indoor–outdoor PM2.5 filter samples from a subset of study homes. PM2.5 elemental composition was measured by X-ray fluorescence, and Finf was estimated as the indoor/outdoor sulfur ratio. We regressed Finf on meteorologic variables and questionnaire-based predictors in season-specific models. Models were evaluated using the R2 and root mean square error (RMSE) from a 10-fold cross-validation. Results: The mean ± SD Finf across all communities and seasons was 0.62 ± 0.21, and community-specific means ranged from 0.47 ± 0.15 in Winston-Salem, North Carolina, to 0.82 ± 0.14 in New York, New York. Finf was generally greater during the warm (> 18°C) season. Central air conditioning (AC) use, frequency of AC use, and window opening frequency were the most important predictors during the warm season; outdoor temperature and forced-air heat were the best cold-season predictors. The models predicted 60% of the variance in 2-week Finf, with an RMSE of 0.13. Conclusions: We developed intuitive models that can predict Finf using easily obtained variables. Using these models, MESA Air will be the first large epidemiologic study to incorporate variation in residential Finf into an exposure assessment.

From good intentions to proven interventions: effectiveness of actions to reduce the health impacts of air pollution.

Background Associations between air pollution and a multitude of health effects are now well established. Given ubiquitous exposure to some level of air pollution, the attributable health burden can be high, particularly for susceptible populations. Objectives An international multidisciplinary workshop was convened to discuss evidence of the effectiveness of actions to reduce health impacts of air pollution at both the community and individual level. The overall aim was to summarize current knowledge regarding air pollution exposure and health impacts leading to public health recommendations. Discussion During the workshop, experts reviewed the biological mechanisms of action of air pollution in the initiation and progression of disease, as well as the state of the science regarding community and individual-level interventions. The workshop highlighted strategies to reduce individual baseline risk of conditions associated with increased susceptibility to the effects of air pollution and the need to better understand the role of exposure duration in disease progression, reversal, and adaptation. Conclusion We have identified two promising and largely unexplored strategies to address and mitigate air pollution–related health impacts: reducing individual baseline risk of cardiovascular disease and incorporating air pollution–related health impacts into land-use decisions.

Indoor/Outdoor Relationships, Trends, and Carbonaceous Content of Fine Particulate Matter in Retirement Homes of the Los Angeles Basin

Abstract Hourly indoor and outdoor fine particulate matter (PM2.5), organic and elemental carbon (OC and EC, respectively), particle number (PN), ozone (O3), carbon monoxide (CO), and nitrogen oxide (NOx) concentrations were measured at two different retirement communities in the Los Angeles, CA, area as part of the Cardiovascular Health and Air Pollution Study. Site A (group 1 [G1]) was operated from July 6 to August 20, 2005 (phase 1 [P1]) and from October 19 to December 10, 2005 (P2), whereas site B (group 2 [G2]) was operated from August 24 to October 15, 2005 (P1), and from January 4 to February 18, 2006 (P2). Overall, the magnitude of indoor and outdoor measurements was similar, probably because of the major influence of outdoor sources on indoor particle and gas levels. However, G2 showed a substantial increase in indoor OC, PN, and PM2.5 between 6:00 and 9:00 a.m., probably from cooking. The contributions of primary and secondary OC (SOA) to measured outdoor OC were estimated from collected OC and EC concentrations using EC as a tracer of primary combustion-generated OC (i.e., “EC tracer method”). The study average outdoor SOA accounted for 40% of outdoor particulate OC (40–45% in the summer and 32–40% in the winter). Air exchange rates (hr-1) and infiltration factors (F inf; dimensionless) at each site were also determined. Estimated F inf and measured particle concentrations were then used in a single compartment mass balance model to assess the contributions of indoor and/or outdoor sources to measured indoor OC, EC, PM2.5, and PN. The average percentage contributions of indoor SOA of outdoor origin to measured indoor OC were ∼35% (during G1P1 and G1P2) and ∼45% (for G2P1 and G2P2). On average, 36% (G2P1) to 44% (G1P1) of measured indoor OC was composed of outdoor-generated primary OC.

A land use regression model for ultrafine particles in Vancouver, Canada

Methods to characterize chronic exposure to ultrafine particles (UFP) can help to clarify potential health effects. Since UFP are not routinely monitored in North America, spatiotemporal models are one potential exposure assessment methodology. Portable condensation particle counters were used to measure particle number concentrations (PNC) to develop a land use regression (LUR) model. PNC, wind speed and direction were measured for sixty minutes at eighty locations during a two-week sampling campaign. We conducted continuous monitoring at four additional locations to assess temporal variation. LUR modeling utilized 135 potential geographic predictors including: road length, vehicle density, restaurant density, population density, land use and others. A novel approach incorporated meteorological data through wind roses as alternates to traditional circular buffers. The range of measured (sixty-minute median) PNC across locations varied seventy-fold (1500-105000 particles/cm(3), mean [SD] = 18200 [15900] particles/cm(3)). Correlations between PNC and concurrently measured two-week average NOX concentrations were 0.6-0.7. A PNC LUR model (R(2) = 0.48, leave-one-out cross validation R(2) = 0.32) including truck route length within 50 m, restaurant density within 200 m, and ln-distance to the port represents the first UFP LUR model in North America. Models incorporating wind roses did not explain more variability in measured PNC.

Intercity transferability of land use regression models for estimating ambient concentrations of nitrogen dioxide

Land use regression (LUR) is a method for predicting the spatial distribution of traffic-related air pollution. To facilitate risk and exposure assessment, and the design of future monitoring networks and sampling campaigns, we sought to determine the extent to which LUR can be used to predict spatial patterns in air pollution in the absence of dedicated measurements. We evaluate the transferability of one LUR model to two other geographically comparable areas with similar climates and pollution types. The source model, developed in 2003 to estimate ambient nitrogen dioxide (NO2) concentrations in Vancouver (BC, Canada) was applied to Victoria (BC, Canada) and Seattle (WA, USA). Model estimates were compared with measurements made with Ogawa® passive samplers in both cities. As part of this study, 42 locations were sampled in Victoria for a 2-week period in June 2006. Data obtained for Seattle were collected for a different project at 26 locations in March 2005. We used simple linear regression to evaluate the fit of the source model under three scenarios: (1) using the same variables and coefficients as the source model; (2) using the same variables as the source model, but calculating new coefficients for local calibration; and (3) developing site-specific equations with new variables and coefficients. In Scenario 1, we found that the source model had a better fit in Victoria (R2=0.51) than in Seattle (R2=0.33). Scenario 2 produced improved R2-values in both cities (Victoria=0.58, Seattle=0.65), with further improvement achieved under Scenario 3 (Victoria=0.61, Seattle=0.72). Although it is possible to transfer LUR models between geographically similar cities, success may depend on the between-city consistency of the input data. Modest field sampling campaigns for location-specific model calibration can help to produce transfer models that are equally as predictive as their sources.

Changes in Lung Function and Airway Inflammation Among Asthmatic Children Residing in a Woodsmoke-Impacted Urban Area

Fine particulate matter (PM2.5) is associated with respiratory effects, and asthmatic children are especially sensitive. Preliminary evidence suggests that combustion-derived particles play an important role. Our objective was to evaluate effect estimates from different PM2.5 exposure metrics in relation to airway inflammation and lung function among children residing in woodsmoke-impacted areas of Seattle. Nineteen children (ages 6–13 yr) with asthma were monitored during the heating season. We measured 24-h outdoor and personal concentrations of PM2.5 and light-absorbing carbon (LAC). Levoglucosan (LG), a marker of woodsmoke, was also measured outdoors. We partitioned PM2.5 exposure into its ambient-generated (Eag) and nonambient (Ena) components. These exposure metrics were evaluated in relation to daily changes in exhaled nitric oxide (FENO), a marker of airway inflammation, and four lung function measures: midexpiratory flow (MEF), peak expiratory flow (PEF), forced expiratory volume in the first second (FEV1), and forced vital capacity (FVC). Eag, but not Ena, was correlated with combustion markers. Significant associations with respiratory health were seen only among participants not using inhaled corticosteroids. Increases in FENO were associated with personal PM2.5, personal LAC, and Eag but not with ambient PM2.5 or its combustion markers. In contrast, MEF and PEF decrements were associated with ambient PM2.5, its combustion markers, and Eag, but not with personal PM2.5 or personal LAC. FEV1 was associated only with ambient LG. Our results suggest that lung function may be especially sensitive to the combustion-generated component of ambient PM2.5, whereas airway inflammation may be more closely related to some other constituent of the ambient PM2.5 mixture.