Véronique Ezratty

Repeated Nitrogen Dioxide Exposures and Eosinophilic Airway Inflammation in Asthmatics: A Randomized Crossover Study

Background: Nitrogen dioxide (NO2), a ubiquitous atmospheric pollutant, may enhance the asthmatic response to allergens through eosinophilic activation in the airways. However, the effect of NO2 on inflammation without allergen exposure is poorly studied. Objectives: We investigated whether repeated peaks of NO2, at various realistic concentrations, induce changes in airway inflammation in asthmatics. Methods: Nineteen nonsmokers with asthma were exposed at rest in a double-blind, crossover study, in randomized order, to 200 ppb NO2, 600 ppb NO2, or clean air once for 30 min on day 1 and twice for 30 min on day 2. The three series of exposures were separated by 2 weeks. The inflammatory response in sputum was measured 6 hr (day 1), 32 hr (day 2), and 48 hr (day 3) after the first exposure, and compared with baseline values measured twice 10–30 days before the first exposure. Results: Compared with baseline measurements, the percentage of eosinophils in sputum increased by 57% after exposure to 600 ppb NO2 (p = 0.003) but did not change significantly after exposure to 200 ppb. The slope of the association between the percentage of eosinophils and NO2 exposure level was significant (p = 0.04). Eosinophil cationic protein in sputum was highly correlated with eosinophil count and increased significantly after exposure to 600 ppb NO2 (p = 0.001). Lung function, which was assessed daily, was not affected by NO2 exposure. Conclusions: We observed that repeated peak exposures of NO2 performed without allergen exposure were associated with airway eosinophilic inflammation in asthmatics in a dose-related manner. Citation: Ezratty V, Guillossou G, Neukirch C, Dehoux M, Koscielny S, Bonay M, Cabanes PA, Samet JM, Mure P, Ropert L, Tokarek S, Lambrozo J, Aubier M. 2014. Repeated nitrogen dioxide exposures and eosinophilic airway inflammation in asthmatics: a randomized crossover study. Environ Health Perspect 122:850–855; http://dx.doi.org/10.1289/ehp.1307240

Fuel poverty in France: Adapting an English methodology to assess the health cost implications

Over five million households in France are estimated to be in fuel poverty and so possibly exposed to low indoor temperatures. Such exposure is a threat to health. Besides the individual’s suffering, negative health outcomes, ranging from mild respiratory conditions to death, create demands on the health sector and costs to society. The health costs associated with energy inefficient dwellings have been calculated in England using a method based on the Housing Health & Safety Rating System (HHSRS); a health-based risk assessment system, adopted in 2006 as the prescribed statutory method for appraising housing conditions in England and Wales. The aim of this study was to use the English approach to estimate the health costs attributable to energy inefficient dwellings and energy vulnerability in France, and to analyse the cost benefits of thermal upgrades. This article details the methodology used to match the English and French housing energy efficiency assessment to provide the foundation necessary for the estimation of costs. This work has demonstrated that it is practicable to adapt the English HHSRS based approach, so that it can be used in another country such as France.