nitrogen-dioxide and Emergencies

Particles, SOx, and acid aerosols are a complex group of distinct pollutants that have common sources and usually covary in concentration. During the past two decades, the chemical characteristics and the geographic distribution of sulfur oxide and particulate pollution have been altered by control strategies, specifically taller stacks for power plants, put in place in response to air pollution regulations adopted in the early 1970s. While the increasing stack heights have lowered local ambient levels, the residence time of SOx and particles in the air have been increased, thereby promoting transformation to various particulate sulfate compounds, including acidic sulfates. These sulfate particles constitute a large fraction of the total mass of smaller particles (< 3 microns in aerodynamic diameter). Epidemiologic studies have consistently provided evidence of adverse health effects of these air pollutants. Particulate and SO2 pollution were strongly implicated in the acute morbidity and mortality associated with the severe pollution episodes in Donora (Pennsylvania), London, and New York in the 1940s, 1950s, and 1960s. There is new evidence that even current ambient levels of PM10 (30 to 150 micrograms/m3) are associated with increases in daily cardiorespiratory mortality and in total mortality, excluding accidental and suicide deaths. These associations have been shown in many different communities, as widely different in particle composition and climate as Philadelphia, St. Louis, Utah Valley, and Santa Clara County, California. It has recently been shown in a long-term prospective study of adults in the United States that chronic levels of higher PM10 pollution are associated with increased mortality after adjusting for several individual risk factors. Daily fluctuations in PM10 levels have also been shown to be related to acute respiratory hospital admissions in children, to school and kindergarten absences, to decrements in peak flow rates in normal children, and to increased medication use in children and adults with asthma. Although some epidemiologic studies suggest that acid aerosols are an important toxic component of PM10, other studies do not support this hypothesis. Dockery and Pope (408) recently reviewed the epidemiologic literature for adverse effects, assuming that reported associations can be attributed to acute particle mass exposures. Combined effects were estimated as percent increase in comparable measures of mortality and morbidit

Topics: Adult; Aerosols; Air Pollutants; Air Pollution; Animals; Asthma; Biomarkers; Bronchial Hyperreactivity; Carbon Monoxide; Cardiovascular Diseases; Cattle; Cells, Cultured; Child; Emergencies; Environmental Health; Female; Hospitalization; Humans; Lead; Lung Diseases, Obstructive; Male; Models, Biological; Nitrogen Dioxide; Occupational Health; Ozone; Pregnancy; Rabbits; Rats; Respiratory Function Tests; Respiratory Tract Diseases; Sulfur Dioxide; United States

Ambient air pollution is a complex mixture of particles and gaseous pollutants. Epidemiological studies are moving toward a multipollutant approach, requiring an understanding of possible interactions among the pollutants. We aim to estimate the joint effects of particles with an aerodynamic diameter less than 10 μm (PM10) and nitrogen dioxide (NO2) on emergency hospital admissions for cardiac diseases, and to explore the possible interactions between PM10 and NO2.. We collected daily time series data from 1998 to 2007 on emergency hospital admissions for cardiac diseases in Hong Kong, as well as PM10 and NO2 concentrations. Generalized additive Poisson model was used to examine the relationship between air pollution and hospital admissions. We then used three parallel time series approaches (bivariate response surface model, joint effect model and parametric stratified model) to explore the possible interactions between PM10 and NO2.. Results showed the greatest joint effect of PM10 and NO2 on emergency cardiac hospitalizations when PM10 and NO2 concentrations were both at high levels. The effect of PM10 was significantly greatest on the days with high NO2 level, and vice versa. A 10 μg/m(3) increase of lag0 PM10 and NO2 was associated with an increase of emergency cardiac hospitalizations by 0.55% (95% CI: 0.29-0.80%) and 1.20% (95% CI: 0.87-1.53%) respectively, when the other pollutant was at high level.. We found consistent synergistic interaction between PM10 and NO2 on emergency cardiac hospitalizations in Hong Kong. These findings contribute to the development of a new paradigm for multipollutant air quality management.

Topics: Air Pollution; Emergencies; Heart Diseases; Hong Kong; Humans; Models, Theoretical; Nitrogen Dioxide; Particulate Matter; Patient Admission

Daily pollution data (collected in Graz over 16 years and in the Linz over 18 years) were used for time series studies (GAM and case-crossover) on the relationship with daily mortality (overall and specific causes of death). Diagnoses of patients who had been transported to hospitals in Linz were also available on a daily basis from eight years for time series analyses of cardiopulmonary emergencies. Increases in air pollutant levels over several days were followed by increases in mortality and the observed effects increased with the length of the exposure window considered, up to a maximum of 15 days. These mortality changes in Graz and Linz showed similar patterns like the ones found before in Vienna. A significant association of mortality could be demonstrated with NO2, PM2.5 and PM10 even in summer, when concentrations are lower and mainly related to motor traffic. Cardiorespiratory ambulance transports increased with NO2/PM2.5/PM10 by 2.0/6.1/1.7% per 10 µg/m³ on the same day. Monitoring of NO2 (related to motor traffic) and fine particulates at urban background stations predicts acute effects on cardiopulmonary emergencies and extended effects on cardiopulmonary mortality. Both components of urban air pollution are indicators of acute cardiopulmonary health risks, which need to be monitored and reduced, even below current standards.

Topics: Air Pollutants; Air Pollution; Austria; Cardiovascular Diseases; Cities; Emergencies; Environmental Exposure; Humans; Mortality; Motor Vehicles; Nitrogen Dioxide; Particulate Matter; Risk Factors; Seasons; Time Factors; Urban Population

Numerous studies have reported associations between air pollution and cardiovascular diseases. While several studies illustrate that exposures to air pollutants can elevate blood pressure, few have evaluated the clinical relevance of this relationship. Hence, we aimed to explore the associations between daily concentrations of several air pollutants and emergency department visits for hypertension.. Odds ratios (ORs) for emergency department visits for hypertension in Edmonton, Canada, from April 1992 to March 2002 were associated with pollutant levels (CO, NO(2), SO(2), O(3), and particulate matter [PM] < 10 microns [PM(10)] and < 2.5 microns [PM(2.5)] in aerodynamic diameter, respectively) by means of a case-crossover technique with time-stratified strategy to define controls. The analysis was performed for all (N = 5365), male (N = 2069), and female (N = 3296) patients and for six air pollutants lagged by 0 to 9 days. ORs and their 95% confidence intervals (CIs) were reported for an increase in an interquartile range (IQR) for each pollutant.. We observed associations for all patients and levels of NO(2) (IQR = 12.8 parts per billion; OR, 1.06; 95% CI, 1.00-1.12), SO(2) (IQR = 2.3 parts per billion; OR, 1.04; 95% CI, 1.00-1.08), and PM(10) (IQR = 15.0 μg/m(3); OR, 1.06; 95% CI, 1.01-1.11) for lag day 3, as well as for PM(10) (IQR = 15.0 μg/m(3); OR, 1.06; 95% CI, 1.01-1.11) and PM(2.5) (IQR = 6.2 μg/m(3); OR, 1.07; 95% CI, 1.01-1.11) for lag day 6.. These findings support the contention that ambient pollution can produce clinically meaningful increases in blood pressure.

Topics: Adult; Age Factors; Aged; Aged, 80 and over; Air Pollutants; Blood Pressure Determination; Canada; Confidence Intervals; Cross-Sectional Studies; Databases, Factual; Emergencies; Emergency Service, Hospital; Environmental Exposure; Environmental Monitoring; Epidemiological Monitoring; Female; Humans; Hypertension; Incidence; Logistic Models; Male; Maximum Allowable Concentration; Middle Aged; Nitrogen Dioxide; Odds Ratio; Particulate Matter; Risk Assessment; Seasons; Young Adult

We investigated whether extremely geomagnetic activity may modify the association between short-term nitrogen dioxide (NO₂) exposure and emergency hospitalization for acute coronary syndrome (ACS). A case-crossover study design was used to analyze ACS in 6,594 hospitalized patients at the Clinic of Kaunas, Lithuania. We evaluated the associations between NO₂, geomagnetic activity and the rate of emergency admissions for ACS by logistic regression controlling for seasonal variation, weekdays and meteorological factors. Ambient NO₂ pollution interquartile range increase (IQR) on the day of admission and previous day (lag 0-1) in patients below 65 years of age increase the risk of ACS equal to 24% (95% CI 0.96-1.60). Evidence of effect modification by combined NO₂ and geomagnetic activity was observed in relation to ACS, adjusted OR was 1.61; 95% CI 1.03-2.53. In conclusion, these findings suggest that geomagnetic activity variations may increase the traffic-related air pollution effect on ACS, and highlight environmental factors associated with ischemic heart disease course.

Topics: Acute Coronary Syndrome; Adult; Aged; Air Pollutants; Cities; Emergencies; Environmental Exposure; Female; Geological Phenomena; Hospitalization; Humans; Lithuania; Logistic Models; Male; Middle Aged; Myocardial Infarction; Nitrogen Dioxide; Risk Assessment; Seasons; Time Factors; Weather

Many studies have shown that ambient particulate air pollution (PM) is associated with increased risk of hospital admissions and deaths for cardiovascular or respiratory causes around the world. In general these have been analysed in association with PM(10) and ozone, whereas PM(2.5) is now the particle measure of greatest health and regulatory concern. And little has been published on associations of hospital admissions and PM components.. This study analysed hospital admissions for myocardial infarction (15 578 patients), and pneumonia (24 857 patients) in associations with fine particulate air pollution, black carbon (BC), ozone, nitrogen dioxide (NO(2)), PM not from traffic, and carbon monoxide (CO) in the greater Boston area for the years 1995-1999 using a case-crossover analysis, with control days matched on temperature.. A significant association was found between NO(2) (12.7% change (95% CI: 5.8, 18)), PM(2.5) (8.6% increase (95% CI: 1.2, 15.4)), and BC (8.3% increase (95% CI: 0.2, 15.8)) and the risk of emergency myocardial infarction hospitalisation; and between BC (11.7% increase (95% CI: 4.8, 17.4)), PM(2.5) (6.5% increase (95% CI: 1.1, 11.4)), and CO (5.5% increase (95% CI: 1.1, 9.5)) and the risk of pneumonia hospitalisation.. The pattern of associations seen for myocardial infarction and pneumonia (strongest associations with NO(2), CO, and BC) suggests that traffic exposure is primarily responsible for the association with heart attacks.

Topics: Aged; Air Pollutants; Air Pollution; Boston; Carbon; Case-Control Studies; Cross-Over Studies; Emergencies; Environmental Exposure; Female; Hospitalization; Humans; Male; Myocardial Infarction; Nitrogen Dioxide; Ozone; Pneumonia

Topics: Air Pollutants; Air Pollution; Emergencies; Eye Diseases; Humans; Nitrogen Dioxide; Nitrogen Oxides; Ozone; Paris; Sulfur Dioxide; Weather

To estimate the short-term association between air pollution levels and emergency hospital admissions for cardiovascular diseases in Valencia, within 1994-1996 period.. Daily levels of air pollution and emergency admissions for cardiovascular diseases were related to using an ecological time series design. The number of admissions was obtained from the hospital records database. Selected groups of causes were all cardiovascular diseases, heart admissions, and admissions for cerebrovascular diseases. The number of admissions for digestive diseases was used as control. Pollutants were black smoke, sulphur dioxide (SO(2)), nitrogen dioxide (NO(2)), carbon monoxide (CO) and ozone (O(3)). Magnitude of association was estimated by Poisson autoregressive regression. Estimations were calculated according the hottest (May to October) and the coldest (November to April) periods.. City of Valencia, Spain, about 750,000 inhabitants.. People being admitted to the two major hospitals in the city, with a catchment area of nearly 400,000 inhabitants.. For the whole period, a significant association for SO(2)-24 h was found so a rise in its levels of 10 microg/m(3) was associated with an increment of 3% (95%CI 0.4 to 5.7%) in the expected number of cardiovascular admissions. A significant association for black smoke, SO(2)-24 h, SO(2)-1 h, and CO-1 h was found in the hottest semester. All these associations were verified with a lag of two days. The estimates of the associations for particles, SO(2), and CO were affected by the inclusion of the other pollutants in their models. NO(2) was independently associated with cerebrovascular admissions. There were no significant associations between air pollution and admissions for digestive diseases.. Current levels of air pollution and emergency cardiovascular admissions are significantly related in Valencia.

Topics: Air Pollutants; Air Pollution; Carbon Monoxide; Cardiovascular Diseases; Emergencies; Environmental Exposure; Hospitalization; Humans; Nitrogen Dioxide; Ozone; Risk Factors; Seasons; Smoke; Spain; Sulfur Dioxide

A study was undertaken to assess the combined association between urban air pollution and emergency admissions for asthma during the years 1986-92 in Barcelona, Helsinki, Paris and London.. Daily counts were made of asthma admissions and visits to the emergency room in adults (age range 15-64 years) and children (< 15 years). Covariates were short term fluctuations in temperature and humidity, viral epidemics, day of the week effects, and seasonal and secular trends. Estimates from all the cities were obtained for the entire period and separately by warm or cold seasons using Poisson time-series regression models. Combined associations were estimated using meta-analysis techniques.. Daily admissions for asthma in adults increased significantly with increasing ambient levels of nitrogen dioxide (NO2) (relative risk (RR) per 50 micrograms/m3 increase 1.029, 95% CI 1.003 to 1.055) and non-significantly with particles measured as black smoke (RR 1.021, 95% CI 0.985 to 1.059). The association between asthma admissions and ozone (O3) was heterogeneous among cities. In children, daily admissions increased significantly with sulphur dioxide (SO2) (RR 1.075, 95% CI 1.026 to 1.126) and non-significantly with black smoke (RR 1.030, 95% CI 0.979 to 1.084) and NO2, though the latter only in cold seasons (RR 1.080, 95% CI 1.025 to 1.140). No association was observed for O3. The associations between asthma admissions and NO2 in adults and SO2 in children were independent of black smoke.. The evidence of an association between air pollution at current urban levels and emergency room visits for asthma has been extended to Europe. In addition to particles, NO2 and SO2--by themselves or as a constituent of a pollution mixture--may be important in asthma exacerbations in European cities.

Topics: Adolescent; Adult; Air Pollutants; Air Pollution; Asthma; Child; Emergencies; Europe; Humans; Middle Aged; Nitrogen Dioxide; Patient Admission; Regression Analysis; Risk Factors; Sulfur Dioxide; Urban Health

To assess the short term relationship between air pollution and the daily number of emergency hospital admissions for respiratory disease.. Data were analysed using autoregressive Poisson regression allowing for overdispersion and controlling for possible confounding factors such as seasonal and other chronological variables, meteorological factors, and influenza epidemics.. The two major cities in The Netherlands-Amsterdam (694,700 inhabitants) and Rotterdam (576,200 inhabitants).. Emergency hospital admissions for respiratory diseases, registered on a daily basis by the National Medical Registration, for the period 1977-89 were used. ICD-9 codes included were: respiratory (460-519), chronic obstructive pulmonary disease (490-492, 494, 496), and asthma (493). The mean (range) of the total daily number of admissions for these three classifications were as follows: 6.70 (0-23), 1.74 (0-9) and 1.13 (0-7) respectively in Amsterdam and 4.79 (0-19), 1.57 (0-9), and 0.53 (0-5) in Rotterdam. Air pollution measurements were provided by the National Institute of Public Health and Environmental Protection. In The Netherlands, air pollution is at a low to moderate ("summer type") or a low ("winter type") level. The levels in Amsterdam and Rotterdam did not differ much for the "summer type". For 1977-89 the mean (range) values of ozone (O3), the "summer type" pollutant (O3-8 h), were 86 (0-252) micrograms/m3 in Amsterdam and 82 (0-286) micrograms/m3 in Rotterdam. The mean (range) of the values "winter type", pollutant, sulphur dioxide (SO2-24 h), were 38 (0-381) micrograms/m3 in Amsterdam and 50 (1-379) micrograms/m3 in Rotterdam. For black smoke (BS-24 h), values were 14 (1-84) micrograms/m3 and 28 (1-144) micrograms/m3 respectively (1986-89).. Ozone had a non-significant positive effect on the number of respiratory emergency admissions in summer in people aged > or = 65 years (relative risk for a 100 micrograms/m3 increase in O3-8 h of 1.127 (0.983, 1.292) in Amsterdam and a significant positive effect of 1.344 (1.097, 1.647) in 1977-81 in Rotterdam). Sulphur dioxide did not show any clear effects; in Amsterdam a significant negative effect was even found. The same was true for nitrogen dioxide in Amsterdam; in Rotterdam, however, nitrogen dioxide showed non-significant positive effects (RR 0.965, 1.342). Black smoke did not show any clear effects in Amsterdam; in Rotterdam it was positively but not significantly related to the number of admissions.. The results show that the relation between short term air pollution and emergency hospital admissions is not always consistent at these rather low levels of daily hospital admissions and of air pollution.

Topics: Adolescent; Adult; Aged; Air Pollutants; Air Pollution; Emergencies; Hospitalization; Humans; Middle Aged; Netherlands; Nitrogen Dioxide; Odds Ratio; Ozone; Regression Analysis; Respiration Disorders; Smoke; Sulfur Dioxide

To investigate whether air pollution levels in London have short term effects on hospital admissions for respiratory disease.. Poisson regression analysis of daily counts of hospital admissions, adjusting for effects of trend, seasonal and other cyclical factors, day of the week, holidays, influenza epidemic, temperature, humidity, and autocorrelation. Pollution variables were particulates (black smoke: BS), sulphur dioxide (SO2), ozone (O3), and nitrogen dioxide (NO2), lagged 0-3 days.. All immediate admissions for respiratory disease (ICD 460-519) to hospitals in London health districts in the five years April 1987 to February 1992 for all ages and the 0-14, 15-64, and 65+ age groups.. O3 (lagged one day) was significantly associated with an increase in daily admissions among all age groups, except the 0-14 group, and this effect was stronger in the "warm" season (April-September). In this season, the relative risks of admission associated with an increase in 8 hour O3 levels of 29 ppb (10th to 90th centile) were 1.0483 (95% CI 1.0246, 1.0726), 1.0294 (0.9930,1.0672), 1.0751 (1.0354,1.1163), and 1.0616 (1.0243,1.1003) for all ages and age groups 0-14, 15-64, and 65+ respectively. Very few significant associations were observed with the other pollutants, though these tended to be positive. Controlling for other pollutants made little difference to the O3 coefficients. There was evidence of a threshold at about 40-60 ppb O3 (maximum hourly or maximum 8 hour).. O3 levels in London have a small but significant effect on hospital admissions for respiratory disease at all ages. The possible role of aerollergen as a confounding factor needs to be examined. Unlike other cities where similar effects have been reported, little or no effect of particulates was observed in London.

Topics: Acute Disease; Adolescent; Adult; Aged; Air Pollutants; Air Pollution; Child; Child, Preschool; Emergencies; Hospitalization; Humans; Infant; Infant, Newborn; London; Middle Aged; Nitrogen Dioxide; Odds Ratio; Ozone; Regression Analysis; Respiration Disorders; Seasons; Smoke; Sulfur Dioxide

Several studies have assessed the association between urban air pollutants and hospital admissions or emergency room visits for asthma with inconsistent results. The objective of this study was to assess the relation between levels of black smoke, sulphur dioxide, nitrogen dioxide, and ozone and adult emergency room visits for asthma in Barcelona, Spain during the five year period 1985-9.. The daily number of emergency room visits for asthma was obtained from a register of respiratory emergencies designed to study the asthma outbreaks occurring in Barcelona. The association between asthma visits and levels of pollutants was assessed separately for summers and winters with Poisson regression models controlling for meteorological and time related variables.. Black smoke was associated with asthma visits in summer but not in winter. The relative risk (RR) of asthma visits for a 25 micrograms/m3 increase of current day concentrations of black smoke was 1.082 (95% CI 1.011 to 1.157). The mean current and previous three day levels of black smoke led to a stronger association (RR = 1.114 (95% CI 1.010 to 1.160). In addition, nitrogen dioxide was associated with asthma visits in both summer (RR = 1.045, 95% CI 1.009 to 1.081) and winter (RR = 1.056, 95% CI 1.011 to 1.104). These associations were slightly higher for the previous day's level of nitrogen dioxide. No associations were found for sulphur dioxide or for ozone.. This study provides further evidence of the effect of particulate pollution on asthma, and it suggests that nitrogen dioxide may have a role in the exacerbation of bronchial asthma in adults.

Topics: Adolescent; Adult; Air Pollution; Asthma; Emergencies; Humans; Middle Aged; Nitrogen Dioxide; Ozone; Patient Admission; Risk Factors; Seasons; Smoke; Spain; Sulfur Dioxide; Urban Population

There were many reports about the relationship between the air pollution and the incidence of asthma. In Japan some of the concentrations of air pollutants, for example, SO2, CO, have been reduced in these ten-twenty years. However the concentrations of suspended particulate material (SPM) and NO2 have not been reduced, and the incidence of bronchial asthma have been increasing gradually. The relationship between the concentrations of NO2, SPM and the number of patients admitted to our hospital because of asthmatic attack was studied. The concentration of each air pollutant was measured at the air quality monitoring stations in Minami-ku and Jonan-ku Fukuoka, Japan. Between Jan, 1988 and Dec. 1991, 3661 patients with asthmatic attacks were admitted to our hospital. The relationship between the monthly averaged one-hour mean value for a day, and monthly max. of one-hour mean. value for a day, and one-day max. value for a month of NO2 and SPM and the numbers of asthmatic attack patients admitted was evaluated. There was a statistically significant relationship between concentrations of NO2 and SPM levels and the numbers of asthmatic patients admitted aged 6 or less. However, there was no such a relationship when the patients were aged between 7 and 20. These results suggested that the airways of asthmatic patients in the age of 6 or less might be more sensitive to NO2 and SPM than that of those patients in the age of 7 to 20.

Topics: Adolescent; Adult; Air Pollution; Asthma; Child; Child, Preschool; Emergencies; Female; Hospitalization; Humans; Incidence; Infant; Japan; Male; Nitrogen Dioxide

The effects of low levels of air pollution and weather conditions on the number of patients admitted to hospitals for exacerbation of chronic bronchitis or emphysema (n = 2807) was studied in Helsinki during a 3-year period, 1987-1989. The daily number of admissions via the emergency room was significantly associated with prevailing levels of sulfur dioxide (SO2) and nitrogen dioxide (NO2) in Poisson regressions controlled for weather, season, time trends, and day of the week, whereas the total number of admissions (via the emergency room and otherwise) was not significantly associated with these pollutants. The effect of SO2 was observed only among those under 65 years old; a significant peak of admissions was seen during the same day (RR, 1.31 for a 2.7-fold increase in SO2; 95% CI, 1.01-1.70; P = 0.039), and another after a 3-day lag (RR, 1.39; 95% CI, 1.05-1.86; P = 0.021). The effect of NO2 was strongest after a 6-day lag and was significant only among those over 64 years old (RR, 1.31; 95% CI, 1.03-1.66; P = 0.022). The average of mean 24-hr concentrations of NO2 was 39 micrograms/m3 (0.021 ppm) and that for SO2 was 19 micrograms/m3 (0.0067 ppm). No relationship was found between admissions and the concentrations of total suspended particulates (TSP) or ozone (O3), the temperature, or the relative humidity. However, the number of admissions among those over 64 years of age was significantly lower, irrespective of temperature, during the summer than during other seasons. The mean daily concentration of O3 was fairly low (22 micrograms/m3 or 0.011 ppm), but that of TSP was high, 76 micrograms/m3. the mean temperature was low, +4.7 degrees C. These results suggest that SO2 and NO2 concentrations lower than those given as guidelines in many countries, and lower than previously shown, may increase the incidence of symptoms in some patients with chronic bronchitis or emphysema.

Topics: Adult; Age Factors; Aged; Air Pollution; Bronchitis; Chronic Disease; Confidence Intervals; Emergencies; Finland; Hospitalization; Humans; Incidence; Longitudinal Studies; Middle Aged; Nitrogen Dioxide; Ozone; Pulmonary Emphysema; Regression Analysis; Risk Factors; Seasons; Sulfur Dioxide; Weather