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. 1995 Feb;50(2):149–155. doi: 10.1136/thx.50.2.149

Effects of air pollution on symptoms and peak expiratory flow measurements in subjects with obstructive airways disease.

B G Higgins 1, H C Francis 1, C J Yates 1, C J Warburton 1, A M Fletcher 1, J A Reid 1, C A Pickering 1, A A Woodcock 1
PMCID: PMC473907  PMID: 7701453

Abstract

BACKGROUND--Evidence from laboratory studies suggests that air pollution can produce bronchoconstriction and respiratory symptoms in selected subjects, but the relevance of these findings to exposure to natural pollution is unclear. This study was performed to determine whether air pollution at typical levels found in the UK has demonstrable effects on respiratory function and symptoms in subjects with airways disease. METHODS--Seventy five adult patients with diagnoses of asthma or chronic obstructive pulmonary disease (COPD) were studied for a period of four weeks during which they kept records of their peak expiratory flow (PEF) rates, symptoms (wheeze, dyspnoea, cough, throat and eye irritation), and bronchodilator use. Thirty six patients in whom the provocative dose of methacholine causing a 20% fall in FEV1 was below 12.25 mumol were classified as reactors. Ambient air pollution was measured with absorption spectroscopy. RESULTS--There were modest but significant increases in PEF variability, bronchodilator use, and wheeze with increasing sulphur dioxide levels; bronchodilator use, dyspnoea, eye irritation, and minimum PEF readings were related to ozone levels. In the subgroup of reactors falls in mean and minimum peak flow and increases in wheeze, dyspnoea, and bronchodilator use were associated with increases in levels of both sulphur dioxide and ozone. Some associations were seen with pollution levels on the same day, but for others the pollution effects appeared to be delayed by 24 or 48 hours. Pollution levels did not breach the WHO guide levels during the course of the study. CONCLUSIONS--Increases in environmental levels of ozone and sulphur dioxide are associated with adverse changes in peak flow measurements and both ocular and respiratory symptoms in subjects with obstructive airways disease. Although the peak flow and symptom changes were modest, they occurred at pollution levels below current WHO guide levels.

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Selected References

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  1. Avol E. L., Linn W. S., Shamoo D. A., Valencia L. M., Anzar U. T., Venet T. G., Hackney J. D. Respiratory effects of photochemical oxidant air pollution in exercising adolescents. Am Rev Respir Dis. 1985 Sep;132(3):619–622. doi: 10.1164/arrd.1985.132.3.619. [DOI] [PubMed] [Google Scholar]
  2. Balmes J. R., Fine J. M., Sheppard D. Symptomatic bronchoconstriction after short-term inhalation of sulfur dioxide. Am Rev Respir Dis. 1987 Nov;136(5):1117–1121. doi: 10.1164/ajrccm/136.5.1117. [DOI] [PubMed] [Google Scholar]
  3. Bates D. V., Baker-Anderson M., Sizto R. Asthma attack periodicity: a study of hospital emergency visits in Vancouver. Environ Res. 1990 Feb;51(1):51–70. doi: 10.1016/s0013-9351(05)80182-3. [DOI] [PubMed] [Google Scholar]
  4. Bates D. V., Sizto R. Air pollution and hospital admissions in Southern Ontario: the acid summer haze effect. Environ Res. 1987 Aug;43(2):317–331. doi: 10.1016/s0013-9351(87)80032-4. [DOI] [PubMed] [Google Scholar]
  5. Bauer M. A., Utell M. J., Morrow P. E., Speers D. M., Gibb F. R. Inhalation of 0.30 ppm nitrogen dioxide potentiates exercise-induced bronchospasm in asthmatics. Am Rev Respir Dis. 1986 Dec;134(6):1203–1208. doi: 10.1164/arrd.1986.134.6.1203. [DOI] [PubMed] [Google Scholar]
  6. Bethel R. A., Epstein J., Sheppard D., Nadel J. A., Boushey H. A. Sulfur dioxide-induced bronchoconstriction in freely breathing, exercising, asthmatic subjects. Am Rev Respir Dis. 1983 Dec;128(6):987–990. doi: 10.1164/arrd.1983.128.6.987. [DOI] [PubMed] [Google Scholar]
  7. Braun-Fahrländer C., Ackermann-Liebrich U., Schwartz J., Gnehm H. P., Rutishauser M., Wanner H. U. Air pollution and respiratory symptoms in preschool children. Am Rev Respir Dis. 1992 Jan;145(1):42–47. doi: 10.1164/ajrccm/145.1.42. [DOI] [PubMed] [Google Scholar]
  8. Bylin G., Lindvall T., Rehn T., Sundin B. Effects of short-term exposure to ambient nitrogen dioxide concentrations on human bronchial reactivity and lung function. Eur J Respir Dis. 1985 Mar;66(3):205–217. [PubMed] [Google Scholar]
  9. Goldstein I. F., Lieber K., Andrews L. R., Kazembe F., Foutrakis G., Huang P., Hayes C. Acute respiratory effects of short-term exposures to nitrogen dioxide. Arch Environ Health. 1988 Mar-Apr;43(2):138–142. doi: 10.1080/00039896.1988.9935842. [DOI] [PubMed] [Google Scholar]
  10. Hazucha M. J., Ginsberg J. F., McDonnell W. F., Haak E. D., Jr, Pimmel R. L., Salaam S. A., House D. E., Bromberg P. A. Effects of 0.1 ppm nitrogen dioxide on airways of normal and asthmatic subjects. J Appl Physiol Respir Environ Exerc Physiol. 1983 Mar;54(3):730–739. doi: 10.1152/jappl.1983.54.3.730. [DOI] [PubMed] [Google Scholar]
  11. Henry R. L., Bridgman H. A., Wlodarczyk J., Abramson R., Adler J. A., Hensley M. J. Asthma in the vicinity of power stations: II. Outdoor air quality and symptoms. Pediatr Pulmonol. 1991;11(2):134–140. doi: 10.1002/ppul.1950110210. [DOI] [PubMed] [Google Scholar]
  12. Horstman D. H., Folinsbee L. J., Ives P. J., Abdul-Salaam S., McDonnell W. F. Ozone concentration and pulmonary response relationships for 6.6-hour exposures with five hours of moderate exercise to 0.08, 0.10, and 0.12 ppm. Am Rev Respir Dis. 1990 Nov;142(5):1158–1163. doi: 10.1164/ajrccm/142.5.1158. [DOI] [PubMed] [Google Scholar]
  13. Horstman D., Roger L. J., Kehrl H., Hazucha M. Airway sensitivity of asthmatics to sulfur dioxide. Toxicol Ind Health. 1986 Sep;2(3):289–298. doi: 10.1177/074823378600200307. [DOI] [PubMed] [Google Scholar]
  14. Kinney P. L., Ware J. H., Spengler J. D. A critical evaluation of acute ozone epidemiology results. Arch Environ Health. 1988 Mar-Apr;43(2):168–173. doi: 10.1080/00039896.1988.9935847. [DOI] [PubMed] [Google Scholar]
  15. Kleinman M. T., Bailey R. M., Linn W. S., Anderson K. R., Whynot J. D., Shamoo D. A., Hackney J. D. Effects of 0.2 ppm nitrogen dioxide on pulmonary function and response to bronchoprovocation in asthmatics. J Toxicol Environ Health. 1983 Oct-Dec;12(4-6):815–826. doi: 10.1080/15287398309530472. [DOI] [PubMed] [Google Scholar]
  16. Koenig J. Q., Covert D. S., Marshall S. G., Van Belle G., Pierson W. E. The effects of ozone and nitrogen dioxide on pulmonary function in healthy and in asthmatic adolescents. Am Rev Respir Dis. 1987 Nov;136(5):1152–1157. doi: 10.1164/ajrccm/136.5.1152. [DOI] [PubMed] [Google Scholar]
  17. Kreit J. W., Gross K. B., Moore T. B., Lorenzen T. J., D'Arcy J., Eschenbacher W. L. Ozone-induced changes in pulmonary function and bronchial responsiveness in asthmatics. J Appl Physiol (1985) 1989 Jan;66(1):217–222. doi: 10.1152/jappl.1989.66.1.217. [DOI] [PubMed] [Google Scholar]
  18. Krzyzanowski M., Quackenboss J. J., Lebowitz M. D. Relation of peak expiratory flow rates and symptoms to ambient ozone. Arch Environ Health. 1992 Mar-Apr;47(2):107–115. doi: 10.1080/00039896.1992.10118763. [DOI] [PubMed] [Google Scholar]
  19. Linn W. S., Avol E. L., Peng R. C., Shamoo D. A., Hackney J. D. Replicated dose-response study of sulfur dioxide effects in normal, atopic, and asthmatic volunteers. Am Rev Respir Dis. 1987 Nov;136(5):1127–1134. doi: 10.1164/ajrccm/136.5.1127. [DOI] [PubMed] [Google Scholar]
  20. Linn W. S., Bailey R. M., Shamoo D. A., Venet T. G., Wightman L. H., Hackney J. D. Respiratory responses of young adult asthmatics to sulfur dioxide exposure under simulated ambient conditions. Environ Res. 1982 Oct;29(1):220–232. doi: 10.1016/0013-9351(82)90022-6. [DOI] [PubMed] [Google Scholar]
  21. Linn W. S., Shamoo D. A., Anderson K. R., Whynot J. D., Avol E. L., Hackney J. D. Effects of heat and humidity on the responses of exercising asthmatics to sulfur dioxide exposure. Am Rev Respir Dis. 1985 Feb;131(2):221–225. doi: 10.1164/arrd.1985.131.2.221. [DOI] [PubMed] [Google Scholar]
  22. Lippmann M. Health effects of ozone. A critical review. JAPCA. 1989 May;39(5):672–695. doi: 10.1080/08940630.1989.10466554. [DOI] [PubMed] [Google Scholar]
  23. Ostro B. D., Lipsett M. J., Mann J. K., Krupnick A., Harrington W. Air pollution and respiratory morbidity among adults in southern California. Am J Epidemiol. 1993 Apr 1;137(7):691–700. doi: 10.1093/oxfordjournals.aje.a116729. [DOI] [PubMed] [Google Scholar]
  24. Ransom M. R., Pope C. A., 3rd Elementary school absences and PM10 pollution in Utah Valley. Environ Res. 1992 Aug;58(2):204–219. doi: 10.1016/s0013-9351(05)80216-6. [DOI] [PubMed] [Google Scholar]
  25. Ransom M. R., Pope C. A., 3rd Elementary school absences and PM10 pollution in Utah Valley. Environ Res. 1992 Aug;58(2):204–219. doi: 10.1016/s0013-9351(05)80216-6. [DOI] [PubMed] [Google Scholar]
  26. Roemer W., Hoek G., Brunekreef B. Effect of ambient winter air pollution on respiratory health of children with chronic respiratory symptoms. Am Rev Respir Dis. 1993 Jan;147(1):118–124. doi: 10.1164/ajrccm/147.1.118. [DOI] [PubMed] [Google Scholar]
  27. Rubinstein I., Bigby B. G., Reiss T. F., Boushey H. A., Jr Short-term exposure to 0.3 ppm nitrogen dioxide does not potentiate airway responsiveness to sulfur dioxide in asthmatic subjects. Am Rev Respir Dis. 1990 Feb;141(2):381–385. doi: 10.1164/ajrccm/141.2.381. [DOI] [PubMed] [Google Scholar]
  28. Samet J. M., Bishop Y., Speizer F. E., Spengler J. D., Ferris B. G., Jr The relationship between air pollution and emergency room visits in an industrial community. J Air Pollut Control Assoc. 1981 Mar;31(3):236–240. doi: 10.1080/00022470.1981.10465214. [DOI] [PubMed] [Google Scholar]
  29. Schwartz J., Slater D., Larson T. V., Pierson W. E., Koenig J. Q. Particulate air pollution and hospital emergency room visits for asthma in Seattle. Am Rev Respir Dis. 1993 Apr;147(4):826–831. doi: 10.1164/ajrccm/147.4.826. [DOI] [PubMed] [Google Scholar]
  30. Schwartz J. What are people dying of on high air pollution days? Environ Res. 1994 Jan;64(1):26–35. doi: 10.1006/enrs.1994.1004. [DOI] [PubMed] [Google Scholar]
  31. Schwartz J., Wypij D., Dockery D., Ware J., Zeger S., Spengler J., Ferris B., Jr Daily diaries of respiratory symptoms and air pollution: methodological issues and results. Environ Health Perspect. 1991 Jan;90:181–187. doi: 10.1289/ehp.90-1519478. [DOI] [PMC free article] [PubMed] [Google Scholar]
  32. Sheppard D., Wong W. S., Uehara C. F., Nadel J. A., Boushey H. A. Lower threshold and greater bronchomotor responsiveness of asthmatic subjects to sulfur dioxide. Am Rev Respir Dis. 1980 Dec;122(6):873–878. doi: 10.1164/arrd.1980.122.6.873. [DOI] [PubMed] [Google Scholar]
  33. Whittemore A. S., Korn E. L. Asthma and air pollution in the Los Angeles area. Am J Public Health. 1980 Jul;70(7):687–696. doi: 10.2105/ajph.70.7.687. [DOI] [PMC free article] [PubMed] [Google Scholar]
  34. Yan K., Salome C., Woolcock A. J. Rapid method for measurement of bronchial responsiveness. Thorax. 1983 Oct;38(10):760–765. doi: 10.1136/thx.38.10.760. [DOI] [PMC free article] [PubMed] [Google Scholar]

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