WEDNESDAY, Nov. 29, 2023 (HealthDay News) -- It's not just bumper-to-bumper highway traffic that's causing your blood pressure to spike during your daily commute.

New research shows that the exhaust fumes spewing from all those vehicles triggers a significant increase in car passengers’ blood pressure.

The observed increase is comparable to the effect of a high-salt diet, researchers found, and the effect can last up to 24 hours.

“The body has a complex set of systems to try to keep blood pressure to your brain the same all the time. It’s a very complex, tightly regulated system, and it appears that somewhere, in one of those mechanisms, traffic-related air pollution interferes with blood pressure," said researcher Dr. Joel Kaufman, a University of Washington physician and professor of environmental and occupational health sciences.

For the study, his team drove healthy adults ages 22 to 45 three times through rush-hour Seattle traffic while monitoring their blood pressure.

Unfiltered road air was allowed to enter the car on two of the drives, while on the third the car was equipped with high-quality HEPA filters that screened out 86% of the air pollution from traffic.

Breathing unfiltered air resulted in blood pressure increases of more than 4.5 millimeters of mercury, compared to the drives with filtered air, researchers said.

The increase occurred rapidly, peaking about an hour into the drive, and it held steady for at least 24 hours.

The findings were published Nov. 28 in the Annals of Internal Medicine.

“We know that modest increases in blood pressure like this, on a population level, are associated with a significant increase in cardiovascular disease,” Kaufman said in a university news release. “There is a growing understanding that air pollution contributes to heart problems. The idea that roadway air pollution at relatively low levels can affect blood pressure this much is an important piece of the puzzle we’re trying to solve.”

Long-term exposure to highway air pollution already has been linked to increased rates of heart disease, asthma, lung cancer and death, researchers said in background notes.

Traffic-related air pollution is also the main reason why air quality is worse in some neighborhoods and better in others.

“This study is exciting because it takes the gold-standard design for laboratory studies and applies it in an on-roadway setting, answering an important question about the health effects of real-world exposures," said lead researcher Michael Young, a former University of Washington postdoctoral fellow. "Studies on this topic often have a challenging time separating the effects of pollution from other roadway exposures like stress and noise, but with our approach the only difference between drive days was air pollution concentration."

"The findings are valuable because they can reproduce situations that millions of people actually experience every day,” Young added.

More information

The U.S. Environmental Protection Agency has more about air pollution and heart disease.

SOURCE: University of Washington, news release, Nov. 29, 2023

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Introduction

Chronic obstructive pulmonary disease (COPD) is a prevalent chronic respiratory condition that represents the third leading cause of death worldwide.1,2 According to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2023 definition, COPD is a

Heterogeneous lung condition characterized by chronic respiratory symptoms (dyspnea, cough, expectoration, and/or exacerbations) due to abnormalities of the airways (bronchitis, bronchiolitis) and/or alveoli (emphysema) that cause persistent, often progressive, airflow obstruction.2

People with HIV (PWH) are particularly vulnerable to the development and progression of COPD, with both higher rates of COPD and an earlier and more rapid decline in lung function than in the general population, even after accounting for cigarette smoking and other known risk factors, such as intravenous drug use.3–7 The exact mechanisms that underlie HIV-associated COPD are incompletely known, but environmental exposures, heightened immune activation and systemic inflammation, accelerated aging, a predilection for the development of pneumonia, and alterations in the lung microbiome likely play important roles (Figure 1).8–11 The purpose of this review is to describe what is currently understood about the epidemiology and pathobiology of COPD among PWH, to indicate selected areas of active investigation, and to outline screening, diagnostic, prevention, and treatment strategies.

Figure 1 Drivers of COPD in PWH.

Epidemiology

Prevalence

As survival among PWH has improved with the use of antiretroviral therapy (ART), COPD has become an increasingly important comorbidity. PWH develop an earlier and more rapid decline in lung function, even after adjustment for traditional risk factors.3,5–7,12–15 A recent retrospective study evaluating comorbidities in PWH based on hospital discharge data found that COPD was the most common comorbidity across the 10-year study period and that COPD prevalence was higher among PWH than among those without HIV (23.5% versus 14.0%).16 Prevalence estimates of COPD among PWH have ranged from 3.4% to over 40% in prior studies; notably, most of these have been conducted in Europe and North America.17,18 Part of this heterogeneity is due to differences in COPD classification methods, such as self-report, International Classification of Diseases (ICD) diagnostic codes, use of CT scans, and spirometry.17,19 For example, a systematic review and meta-analysis by Bigna et al evaluating the global prevalence of COPD among PWH found that the prevalence varied from 5.6% to 10.6% depending on the diagnostic criteria used, with a higher prevalence when using spirometric criteria instead of self-report or ICD diagnostic codes.4

Geography

COPD in PWH occurs anywhere PWH reside. However, the risk factors for the development of COPD in PWH vary regionally due to differences in age, rates and duration of tobacco smoking, exposure to biomass fuels, and prevalence of tuberculosis, all of which have been implicated in COPD development.2,20–22 While the majority of studies on COPD in PWH have been conducted in the US and Europe, most PWH live in sub-Saharan Africa, where there is a high prevalence of both tuberculosis (TB) and exposure to biomass fuels, and where patients are typically younger and less likely to smoke tobacco. While earlier studies suggested that ART itself may be a risk factor for worsening lung function,23,24 Kunisaki et al conducted a multinational randomized controlled trial (RCT) in the modern ART era and did not find a difference in lung function based on timing of ART initiation.25

Biologic Sex

Biologic sex may also contribute to differences in COPD trajectories among PWH. In one study of longitudinal lung function changes in PWH, female sex was associated with distinct lung function trajectories, including baseline low diffusing capacity for carbon monoxide (DLco).26 In a study by McNeil et al of virally suppressed adults with HIV and their seronegative counterparts in Uganda, women with HIV demonstrated an accelerated FEV1 decline as compared to women without HIV, a finding that was not seen among men with and without HIV.27 Interestingly, in a large US-based cross-sectional analysis comparing women with and without HIV, women with HIV had a lower DLco than women without HIV, but there were no differences in spirometric outcomes by HIV status.28,29 In another study including the same cohort of women, baseline COPD prevalence was similar among men with and without HIV and women with and without HIV, but COPD incidence was higher among men with HIV when compared to men without HIV.30 In contrast, Abelman et al found in a post-pneumonia Ugandan cohort that women with HIV had over three-fold higher odds of COPD on spirometry compared to men with HIV, a sex-based difference not found in women and men without HIV.31 Further work is currently underway to investigate whether these reported HIV-associated sex-specific differences in COPD rates are driven by immunologic, hormonal, or environmental factors.

Risk Factors for COPD in PWH

There are many risk factors for the development of COPD in PWH including HIV itself,5,32 cigarette smoking and other inhalational exposures, air pollution, opportunistic infections and pneumonia, microbiome alterations,33,34 accelerated aging,35–38 and socioeconomic factors.39 This section focuses on the major drivers, such as smoking, as well as potential risk factors under investigation, such as chronic cytomegalovirus (CMV) coinfection.

Smoking

Smoking is the key risk factor for COPD in PWH. Smoking is more prevalent among PWH compared to their seronegative counterparts.40–42 However, studies of co-exposure to HIV and tobacco smoke suggest that PWH who smoke may also be more susceptible to smoking-induced lung damage than HIV-uninfected people who smoke. For example, Diaz et al found emphysema to be more prevalent among smokers with HIV as compared to smokers without HIV.43 Further, in a longitudinal multi-center cohort of 13,687 veterans with and without HIV, Crothers et al found that the prevalence and incidence of both COPD and lung cancer were higher among those with HIV compared to those without HIV despite similar levels of smoking.5 Importantly, among PWH on ART, smoking may reduce life expectancy more than HIV itself.44–46 While the pathophysiologic mechanism driving this HIV-associated difference is incompletely known, recent work suggests that, among PWH, tobacco smoke suppresses alveolar macrophage production of T-cell recruiting chemokines. This impairs the migration of cytotoxic T cells from the airway mucosa into the alveolar space, leading to localized airway mucosa inflammation and tissue destruction.47

Air Pollution

Air pollution – the leading environmental cause of death globally48 – is now the greatest threat to human health,49 and COPD is a leading cause of the nearly 7 million annual deaths attributed to air pollution.48,50 Air pollution results from a variety of human-related activities and natural events that include emissions from vehicles, factories, and power plants; traffic-related products; biomass fuel burning (ie, charcoal, firewood, animal dung, crop residues) for cooking and heating; dust storms; forest fires; and volcanic eruptions. The dominant pollution sources vary by region. Traffic- and industry-related sources drive exposure in high-income countries and urban settings, while biomass-related sources drive exposure in low- and middle-income countries and rural settings.51 Air pollution causes acute and chronic lung dysfunction, structural lung abnormalities, submaximal lung growth in childhood and adolescence, and augments lung disease risk in vulnerable populations.52–63 Even small acute increases in fine particulate matter (PM2.5) exposure worsen mortality,64 and there is no “safe” level of exposure.65 Biomass-associated COPD, compared to tobacco-associated COPD, is characterized by more small airways disease and fibrosis, less emphysema, higher DLco, and less airflow obstruction – in effect, a more fibrotic and less emphysematous phenotype.66–69 Exposure to biomass fuel smoke has also been associated with defective bacterial phagocytosis.70 In addition, PM2.5 exposure may also potentiate TB risk,21,71,72 which by itself is a risk factor for COPD and an important consideration in TB-endemic regions.

Similar to the influence of tobacco smoke, PWH may be more susceptible to air pollution-associated lung damage. For example, among PWH living in San Francisco, exposure to higher levels of outdoor air pollution was associated with increased susceptibility to Pneumocystis infection.73–75 Using ambulatory carbon monoxide (CO) sensors to measure personal air pollution exposure among 260 adults with and without HIV in rural Uganda, North et al found that exposure to short-term CO levels that exceed WHO air quality guidelines was associated with self-reported respiratory symptoms among PWH but not among HIV-uninfected comparators.76 Characterizing air pollution exposure among PWH and exploring the potentially outsized influence of air pollution exposure on lung health in this population is an area of ongoing investigation. As global smoking prevalence continues to decline and rapid industrialization and urbanization progresses, air pollution is poised to replace tobacco as the leading cause of chronic lung disease,77–79 and a multifaceted approach that also focuses on this often overlooked risk factor for lung disease among PWH is critical.

Opportunistic Infections and Pneumonia

PWH have historically had higher rates of pneumonia, and while incidence of bacterial pneumonia has decreased with the advent of ART,80,81 it remains common in this population.82–84 In the current era, PWH have similar rates of acute respiratory infections as people without HIV, but PWH experience more severe disease.85 Pneumonia has been associated with higher rates of COPD and lung function abnormalities in PWH.86–89 For example, Drummond et al conducted a US-based multi-center study evaluating spirometry in adults with and without HIV and found that participants with airflow obstruction were more likely to have a history of bacterial pneumonia and Pneumocystis jirovecii (PJP) infection.90 Specifically, PJP, an opportunistic infection that occurs in PWH with CD4 counts <200 cells/mm,3 elevated HIV RNA, and colonization by Pneumocystis have each been associated with higher risk of COPD among PWH.88,91,92 There are numerous contributors to the increased risk of pneumonia in PWH, including alterations in immunity, which lead to persistently elevated markers of immune activation and inflammation, as well as environmental and behavioral risk factors, and a higher prevalence of COPD, which is both a consequence of and a risk factor for pneumonia.9,93–96

Globally, tuberculosis is the leading infectious cause of death among PWH;97 PWH are 19 times more likely to develop TB disease than their seronegative counterparts.98,99 Pulmonary TB has been found to cause permanent scarring, bronchiectasis, pleural fibrosis, damage to small and large airways, as well as lung parenchymal damage, all of which may contribute to permanent lung function impairment.20,100 Whereas during the treatment phase of TB this impairment is typically restrictive, there is increasing evidence of a relationship between prior pulmonary TB infection and the subsequent development of obstruction and COPD.20,87 Rates differ significantly by the population under study, but pulmonary TB has been found to lead to airway obstruction in 18.4–86% of people in the general population.100 HIV is now recognized as a risk factor for post-TB lung disease, although the extent of this relationship is currently under study.87,100–104 There is some evidence to suggest that HIV may be associated with reduced severity of post-TB lung disease, but this is an area that merits further evaluation.100,105,106

Chronic CMV Infection

CMV is an important and omnipresent coinfection in HIV that has been associated with cardiovascular and cerebrovascular disease, other non-AIDS events, and increased mortality.107–112 Given the high rates of CMV antibody seropositivity among PWH, CMV IgG titers are commonly used as markers of CMV activity and have been shown to correlate with adverse outcomes.112,113 However, studies of CMV’s effect on lung function and COPD in PWH are limited. While chronic CMV infection in children with perinatally acquired HIV on ART has been associated with an abnormal FEV1,114 CMV’s association with COPD and other chronic lung diseases in adults with HIV has not been evaluated. Emerging data from the general population, however, suggest that chronic CMV infection is associated with COPD,115 and that higher CMV IgG titers are associated with COPD-related mortality.113 CMV is also associated with abnormal DLco in solid organ transplant recipients, although this has not been studied in PWH.116–118

There are several proposed mechanisms for CMV-mediated systemic immune effects, including persistent immune activation, endothelial dysfunction, and alterations in the gut microbiome.17,119–121 Similar biomarker activation patterns are noted in PWH with CMV and those with COPD. For example, sCD163, sCD14, and IL-6 are increased in both CMV IgG-positive PWH122–124 and PWH with lung function abnormalities, including both abnormal spirometry and abnormal DLco.10,121 These data suggest that there may be a shared mechanistic pathway between chronic CMV infection and chronic lung disease in PWH, but further work is needed to understand and characterize this relationship.

HIV-Specific Influences on COPD Pathogenesis

Several HIV-specific mechanisms may contribute to the increased incidence and accelerated development of COPD in PWH. Chronic HIV infection and the direct effects of HIV-related proteins on lung cells, altered lung and systemic immune responses (both immunosuppressive and pro-inflammatory), altered airway and gut microbial communities, impaired response to pathogens, and toxicity from antiretroviral therapies may all contribute to COPD pathogenesis in this population.23,24,125–132

HIV Infection

As the lung acts as a reservoir for HIV even after viral suppression, chronic HIV infection may directly contribute to COPD pathogenesis in various ways.132–134 Newly replicated viral particles released slowly over time bind to and interact with many cell types within the lung, which can lead to direct injury, oxidative stress, low-level chronic inflammation, and impaired response to pathogens.128,135 Although other cell types in the lung may be infected, alveolar macrophages are the best studied reservoir of HIV in the lung.132 HIV infection impairs macrophage phagocytic activity, thus hindering response to pathogens.127,132 HIV also skews the macrophage phenotype towards a pro-inflammatory and protease-producing phenotype through the release of a host of cytokines, chemokines, oxidants, and proteases, all of which contribute to COPD pathology. Cytokine and chemokine signaling in HIV-infected macrophages trigger a pro-inflammatory response including neutrophil and lymphocyte infiltration. Kaner et al found that alveolar macrophage expression of proteases such as matrix metalloproteinases 9 and 12 (MMP-9, MMP-12) is higher in PWH who smoke with emphysema than their seronegative counterparts.131 In murine models, MMPs degrade the extracellular matrix, directly contributing to emphysematous tissue destruction.136

Altered Adaptive Immune Responses

COPD development is not only mediated by HIV direct effects, but also by the altered cell-mediated adaptive immune responses in PWH, in particular, altered CD4+ T-cell responses. Numerous studies have shown a relationship between low CD4+ T cell counts and COPD or accelerated lung function decline, although conflicting data also exists.23,125,126,137 T cell exhaustion is typically seen in response to chronic antigen stimulation, such as chronic viral infection, and results in decreased functionality. In PWH, CD4+ T cells show signs of exhaustion even in the presence of ART, with an increased expression of programmed cell death protein-1 (PD-1), as well as impaired proliferative capacity.130,138,139 Furthermore, in PWH with COPD, airway mucosal CD4+ T cell numbers are depleted and poorly responsive to pathogens.130 These findings suggest that dysfunctional CD4+ T cell responses may uniquely contribute to COPD pathogenesis in PWH.

Activated and dysfunctional CD8+ T cells also appear to contribute to the disordered adaptive immune response in chronic HIV infection, and thus could contribute to COPD pathogenesis.138,139 PWH show persistent expansion of CD8+ T cells in blood and alveolar compartments, and the decreased CD4+/CD8+ ratio is associated with lung abnormalities even in PWH on ART.140,141 These expanded CD8+ T cell populations also show dysfunction, which is typically indicative of an accelerated aging or “immunosenescent” response. Like CD4+ T cells, CD8+ T cells display exhaustion markers, including PD-1, and a low proliferative capacity.138,139 The expanded population skews towards memory T cell and terminally differentiated CD8+ T cell populations unable to respond to new insults. Despite their impaired function, these exhausted T-cells produce a low-grade inflammatory response at mucosal surfaces, which is considered central to COPD pathology.

Changes to the Airway Epithelium

Alterations to the airway epithelium, the main barrier protecting the lungs from outside insults, such as cigarette smoke, air pollution, and inhaled toxins, can also play a major role in COPD pathogenesis. HIV has both direct and indirect effects on the airway epithelium, contributing to disordered barrier function, decreased mucociliary clearance, and generation of pro-inflammatory mediators. For example, HIV enters epithelial cells and disrupts cell–cell adhesion.129 HIV-associated proteins released from other infected cells disrupt epithelial tight junctions and induce oxidative stress.142 HIV and cigarette smoke synergistically disrupt mucociliary clearance, additively suppressing CFTR expression to decrease mucus hydration in cell culture models and inducing goblet cell metaplasia/hyperplasia to increase mucus production in simian models.143,144 Finally, when HIV binds specifically to basal cells, epithelial progenitor cells release proteases such as MMP-9 and pro-inflammatory mediators that induce migration and proliferation of macrophages and neutrophils.145

Changes in the Lung and Gut Microbiome

Lastly, shifts in both the lung and the gut microbiome can also contribute to chronic inflammatory responses in the lung and, hence, COPD pathogenesis. Data are conflicting on whether lung microbial communities differ in PWH based on 16S sequencing.146–148 However, subtle differences in the microbiome at the species or strain level or at a functional level cannot be discerned via these sequencing methods. It is plausible that at least a subset of PWH experience pathologic microbial alterations in the airways because of a more hospitable environment for pathogen growth. If present in PWH, microbiome perturbations could contribute to chronic airway inflammation. Furthermore, microbial translocation from a compromised gut mucosa, stimulating a chronic systemic inflammatory response, may contribute to lung disease in PWH as has been seen in asthma and pulmonary infections.149

Diagnosis and Clinical Findings of COPD in PWH

Screening and Diagnosis

COPD remains both underdiagnosed and misdiagnosed in people with HIV.150,151 While currently the US Preventative Services Task Force does not recommend screening for COPD in the general population,152 higher COPD prevalence among PWH raises the question whether screening should be done in this subpopulation. Currently, there are no screening and diagnostic criteria specific to PWH. While several studies have evaluated different screening approaches, no conclusive recommendations can be made regarding COPD screening and diagnosis in PWH at this time.150,153–156 For example, a group in Canada offered screening spirometry to all patients in an HIV clinic;156 notably, less than a third of the invited participants agreed to participate, and only 11% had airflow obstruction.

Recruitment and retention throughout the screening-to-diagnosis cascade have been major challenges in all studies. For example, a group in Italy implemented a three-step case-finding program, involving a 5-question screening questionnaire (which included questions about age, smoking history, cough and sputum production, shortness of breath, and exercise limitation), portable spirometry, and diagnostic spirometry.150 They found that 282 participants (19.6%) had a positive screening questionnaire, defined as having a positive answer to at least three questions, but only 33 participants ultimately completed diagnostic spirometry, of whom 22 met criteria for COPD. High participant dropout at each step of the screening process has been similarly reported elsewhere,153–155 even when the authors bypassed the screening spirometry and had a shorter questionnaire.155 Even within these limitations, COPD prevalence based on the screening outcomes has been consistently higher than the known COPD prevalence in each respective clinic,154 further underscoring the underappreciated burden of chronic lung disease in this population. Additional challenges with screening this high-risk population include lack of a high-performing, validated screening questionnaire in PWH and poor correlation between respiratory symptoms and obstruction on pulmonary function tests (PFTs).155 To our knowledge, qualitative studies focused on identifying patient, provider, or systems-level issues contributing to high dropout rates in screening studies among PWH have not been conducted. Having diagnostic spirometry available at the time of a positive screening questionnaire may help reduce high dropout rates.

Any PWH suspected of having COPD should undergo diagnostic testing with, at a minimum, portable spirometry and, in our opinion, full PFTs with pre- and post-bronchodilator spirometry, total lung capacity and lung volumes if spirometry is abnormal, and DLco measurement. Chest radiography demonstrates classic findings (Figure 2) mostly in individuals with advanced disease but is useful in ruling out alternative etiologies that also present with respiratory symptoms similar to those of COPD. Occasionally, additional testing such as chest computed tomography (CT) scans may be warranted to characterize the observed PFT abnormalities, and certain CT findings such as the presence of large bulla (Figure 3) may lead to consideration of additional therapies (eg, bullectomy).

Figure 2 Chest radiograph from person with HIV and COPD demonstrating hyperinflation, flattened diaphragms, and bilateral bullous lung disease (Courtesy of Laurence Huang, MD).

Figure 3 Chest computed tomography from the same person with HIV and COPD demonstrating large, bilateral bullae. This individual eventually underwent bullectomy with dramatic improvement in his respiratory status (Courtesy of Laurence Huang, MD).

Longitudinal Lung Function Trajectories of COPD in PWH

While there is a paucity of data on the natural history of COPD in PWH, lung function declines faster in PWH compared to HIV-negative controls, even when HIV is well-controlled and smoking rates are comparable.6,7,157 Notably, findings from the Pittsburgh HIV Lung Cohort suggested that there may be distinct lung function trajectories among PWH, in which differences in the rate of decline are associated with specific symptoms and distinct profiles of elevated immune activation biomarkers.26 Importantly, this study did not exclusively enroll individuals with COPD. In the general population, COPD studies have shown that lung function decline accelerates as COPD severity increases,158 but whether similar trajectories are seen in PWH is an area currently under study. In a study evaluating factors associated with lung function decline among PWH by Li et al, the authors found that lung function decline occurred more rapidly in older individuals and those with GOLD stage 1 than those with GOLD stage 0 COPD.126 Taken together, these studies suggest that PWH with COPD may demonstrate distinct lung function trajectories when compared to their seronegative counterparts, although additional study is needed in this area.

Lung Function Trajectories in People with Perinatally Acquired HIV

While this review is focused on COPD in adults with HIV, the growing number of individuals with perinatally acquired HIV and their lung function trajectory should also be considered. Children and adolescents with HIV have a higher risk of pulmonary infections, including TB, and even with early ART initiation they remain more vulnerable to small airways dysfunction and risk of obstructive lung disease and other pulmonary abnormalities on spirometry and imaging.159–166 Even children who were exposed to but not infected with HIV remain at risk for abnormal lung function.167 Further, lung function in children seems to be affected by the timing of maternal ART initiation (pre-pregnancy versus during pregnancy).167 In addition, lung development and the ability to reach maximal lung function is impaired by HIV, repeat infections, smoking, pollution, and poverty, which in turn increases the risk for the development of chronic lung disease in adulthood.168,169 As this vulnerable population ages, we are likely to see an increased burden of chronic obstructive disease earlier in life. As most of our understanding of lung function trajectories in PWH with COPD comes from adult PWH from higher income settings, focused efforts for early screening, diagnosis, and management of this condition are needed in areas with high prevalence of adolescents and adults with perinatally acquired HIV.

Diffusing Capacity for Carbon Monoxide

Abnormal diffusing capacity for carbon monoxide is the most prevalent finding on PFTs in PWH, even when spirometry is normal.29,170 DLco impairment is non-specific and can be attributed to emphysema, fibrosis, pulmonary hypertension, or anemia. In PWH, it is also often associated with prior respiratory infections such as PJP, TB, or bacterial pneumonia, and the DLco abnormality may persist long after clinical and radiographic resolution of infection.89,126 Other risk factors for abnormal DLco include HIV infection, CD4 < 200 cells/mm,3 intravenous drug use, and hepatitis C infection.29,101,170–172

DLco abnormalities can predict the development, symptoms, and outcomes of COPD. Among people who smoke, DLco can become abnormal before spirometric criteria for COPD are met; DLco may also be a marker of early emphysema prior to the development of spirometric obstruction, small airways disease, or early vascular abnormalities.173–175 While there are additional and unique risk factors for abnormal DLco in PWH compared to the general population, perhaps suggestive of an HIV-specific lung function abnormality,10,176 it is also plausible that isolated DLco abnormalities may serve as a marker for early COPD in some patients. Among PWH, abnormal DLco, like abnormal FEV1, is an independent predictor of worse respiratory symptoms (such as dyspnea, cough, and mucus production),170 as well as a worse 6-minute walk test.177,178 Finally, abnormal DLco is an independent predictor of mortality in PWH with COPD.179,180

Imaging Findings in PWH with COPD

New techniques for quantitative imaging assessment have allowed in-depth characterization of imaging abnormalities in people with COPD. As current GOLD criteria define COPD based on chronic respiratory symptoms,2 chest imaging findings such as emphysema describe the structural abnormalities that drive this clinical entity. In the general population of people who smoke, studies have found that evidence of small airways disease and air trapping on imaging could predict COPD development and faster spirometry decline.181,182 Importantly, multiple imaging findings such as early interstitial lung abnormalities,183 pulmonary artery to aorta ratio >1,184 pulmonary arterial vascular pruning,185 progression186 and homogeneity of emphysema,187 airway wall thickness,188,189 and air trapping have all been associated with disease severity and adverse outcomes in COPD.181

Studies in PWH have shown a high prevalence of emphysema even in individuals without overt respiratory disease.190 In addition, Leung et al found that people with low DLco and a combination of centrilobular and paraseptal emphysema were more likely to have progression of emphysema,191 and significant emphysema burden was associated with increased mortality.192 Elevated TNFα and IL-1β, soluble CD14, nadir CD4, and low CD4/CD8 ratio are also independently associated with emphysema in PWH,140,193,194 although reports of a direct association of HIV with emphysema are contradictory.194,195 While the exact mechanisms are an area of active investigation, HIV-mediated chronic inflammation and immune dysregulation likely play an important role in emphysema formation.

Symptoms, Exacerbations, and Mortality

Compared to HIV-negative individuals, PWH with COPD have a higher respiratory symptom burden, worse quality of life, and an increased risk for COPD exacerbations.24,196–202 For example, PWH with emphysema have a worse chronic cough, increased mucus production, and decreased 6-minute walk distance compared to HIV-negative controls.198 In PWH who inject drugs, obstructive lung disease has been associated with more severe dyspnea than in their seronegative counterparts.203 In addition, PWH perform worse on six-minute walk testing.178 While COPD is associated with increased frailty in individuals with and without HIV, physical limitation scores are worse among PWH.204,205 Finally, COPD in PWH is not only often comorbid with cardiovascular disease, but also a risk factor for myocardial infarction206 and has been associated with increased mortality.180,192

Management of COPD in PWH

PWH have historically been excluded from large randomized controlled trials of COPD treatments. Therefore, there are very few HIV-specific data on COPD management, and instead general COPD guidelines for both chronic disease management and COPD exacerbations are applied to PWH.207 These management strategies include guideline-driven inhaler therapy, pulmonary rehabilitation, routine vaccinations, surgical or bronchoscopic lung volume reduction in qualifying patients, and management of other medical comorbidities.2 Here, we will focus on a few HIV-specific considerations.

Smoking Cessation

Given the high smoking prevalence among PWH and the excess morbidity and mortality associated with smoking in this population, smoking cessation remains a fundamental aspect of COPD care in PWH. Unfortunately, prescribing rates for smoking cessation therapies have been low for PWH with tobacco use disorder for many reasons, including competing clinical priorities, lack of time, low rates of provider training in smoking cessation interventions, and limited knowledge of nicotine replacement therapies and varenicline.208,209 In addition, PWH face additional challenges on the path to sustained smoking cessation that are due to HIV-related stigma, high rates of comorbid substance use, anxiety and depression, financial instability, lack of insurance, low level of education, and racial biases.210–213 Tailoring smoking cessation therapies to this population is an active area of research.209,214–226 Increased awareness among HIV care providers of the importance of smoking cessation, financial support for smoking cessation initiatives, and intervention studies inclusive of PWH are needed to identify the best ways to support smokers with HIV on their path to quitting.

Choice of Inhalers

Special attention should be paid in the treatment of COPD to PWH who are taking ritonavir or other boosted ART regimens. Ritonavir and cobicistat block the CYP3A4 isozyme and can increase the concentration of most corticosteroids. As a result, use of inhaled corticosteroids (ICS) in patients on these medications has been reported to cause Cushing’s syndrome.227–230 Beclomethasone is the ICS drug with the best side effect profile and can be used in PWH treated with ritonavir or cobicistat.230 In PWH who are receiving ritonavir or cobicistat, an added consequence is the inability to use any combination medication for COPD that includes an ICS as fluticasone- and budesonide-containing combination inhaler therapies are contraindicated and beclomethasone is only available as a single, standalone inhaler. Given the already elevated risk of pulmonary tuberculosis and other pneumonias in this population, additional caution should be applied when using ICS, as they can increase the risk of lung infections in this already vulnerable population.231,232

Modulation of Chronic Inflammation

While no HIV-specific COPD therapies exist, there is an interest in the role of modulating chronic inflammation to improve lung function and clinical outcomes. For example, in a small double-blind pilot clinical RCT of rosuvastatin taken daily for the management of COPD in PWH, Morris et al showed that after 24 weeks of daily rosuvastatin therapy, FEV1 stabilized and DLco improved significantly.233 Another trial studied the role of weekly azithromycin in HIV-related chronic lung disease, defined as an irreversible obstructive defect with minimal radiographic abnormalities, in children and adolescents.234 While the authors found no improvement in lung function parameters after 72 weeks of treatment, they noted an increased time to and fewer total exacerbations. Furthermore, data in the general population have shown benefit of using angiotensin converting enzyme inhibitors (ACEi) or angiotensin receptor blockers (ARBs) in slowing down the progression of emphysema on chest CT in COPD, albeit with no effect on longitudinal lung function on spirometry.235 A randomized controlled trial by MacDonald et al measured pneumoprotein levels as a proxy for lung function decline in PWH with COPD randomized to placebo or losartan treatment, but did not see any significant changes in the pneumoprotein plasma concentrations after 12 months of follow-up.236 Finally, an NHLBI-funded multi-site randomized controlled trial evaluating the influence of twice daily doxycycline on change in DLco among PWH who smoke is currently underway.237 In sum, findings from prior studies suggest that targeting chronic inflammation has the potential to improve lung function of PWH with COPD, but currently there are no definitive data to support any single drug’s use.

Prevention of COPD in PWH

Smoking Cessation

Smoking is perhaps the single most important modifiable risk factor for COPD among PWH. Evidence suggests that PWH may metabolize nicotine more rapidly than HIV-uninfected smokers,238 which could have important implications for the effectiveness of smoking cessation interventions among this population. A growing body of literature is focused on identifying effective smoking cessation interventions among PWH; Table 1 summarizes the randomized controlled trials that have been conducted or have recently completed enrollment on smoking cessation in PWH.218,220,225,226,239–262 For example, O’Cleirigh et al found that among 41 PWH who smoke and reported motivation to quit, those who were randomized to receive cognitive behavioral therapy for smoking cessation and anxiety/depression treatment in addition to nicotine replacement therapy were more likely to quit smoking compared to those who received nicotine replacement therapy alone,225 highlighting the importance of focusing concomitantly on smoking cessation and mental health in this population. A Cochrane review summarizing 14 randomized controlled trials of smoking cessation interventions among PWH in the United States found that pairing behavioral interventions with medications may facilitate short-term abstinence in comparison to medications alone but did not appear to facilitate long-term abstinence.263 Further, a systematic review of smoking cessation interventions among PWH found that successful smoking cessation was most likely when the intervention included cellphone-based technology.264 Although long-term smoking cessation is the goal, any reduction in exposure to tobacco products is likely to have significant health impacts. Using a Monte Carlo microsimulation model, Reddy et al demonstrated that sustained smoking cessation among PWH could result in over 260,000 expected years of life gained.44 This per-person survival gain is more than the life expectancy gained with early ART initiation or improved ART adherence, and among the general population is more than the life expectancy gained by initiating statins for primary cardiovascular disease prevention or clopidogrel for secondary cardiovascular disease prevention. Therefore, encouraging and supporting smoking cessation must remain a priority in the care for PWH.

Table 1 Summary of Randomized Controlled Trials of Smoking Cessation in People with HIV

Air Pollution Mitigation

Interventions aimed at reducing personal air pollution exposure can be categorized into policy-level approaches (regional, national, international) and personal-level approaches. Overall, there is no level of air pollution exposure below which there are no negative health impacts. In fact, evidence suggests that the greatest gains in health per unit reduction in air pollution exposure may occur at the lowest end of the exposure spectrum.265 While attention is being paid to regional and national air quality guidelines, individuals with HIV can adopt behavioral changes that may reduce their personal exposure. Evidence to guide these decisions is still an area of active research. In 2019, Carlsten et al published a summary of 10 key approaches to reduce personal exposure to outdoor and indoor pollution sources, including: using close-fitting face masks when exposure is unavoidable; preferential use of active transport (walking or cycling) rather than motorized transport; choosing travel routes that minimize near-road air pollution exposure; optimizing driving style and vehicle settings when in polluted conditions; moderating outdoor physical activity when and where air pollution levels are high; monitoring air pollution levels to inform when individuals should act to minimize exposure; minimizing exposure to household air pollution by using clean fuels, optimizing household ventilation, and adopting efficient cookstoves where possible; and using portable indoor air cleaners.266 Unfortunately, the data supporting these strategies are not of high quality, which highlights the importance of future work focused on carefully designed studies leveraging implementation science methodology to characterize the feasibility, acceptability, and effectiveness of behavioral interventions focused on improving air pollution-associated lung disease.

Infection Prevention

As pulmonary infections, many of which are preventable, have been implicated in the development of COPD among PWH, infection prevention is important for mitigating COPD risk. First, early ART initiation is imperative, as many pulmonary infections such as PJP are opportunistic infections and develop in the setting of high HIV viral loads and low CD4 counts. Primary prophylaxis for PJP prevention is recommended in PWH with CD4 counts <200 cells/mm3 and considered in those with CD4% <14%.267 Given the high morbidity and mortality associated with pneumococcal infection in PWH, pneumococcal immunization has been recommended in all adults with HIV.268 Consistent with general population recommendations, PWH should also receive annual flu vaccination, as well as the full COVID-19 vaccination series. Given the increased risk of TB disease and its associated mortality among PWH, screening for TB is recommended for all PWH at the time of HIV diagnosis and once a CD4 count ≥200 cells/mm3.269 PWH should be tested annually only if they have a history of a negative test for latent TB infection and are at high-risk for repeated or ongoing exposure to people with active TB disease.269 Among PWH diagnosed with latent TB, TB preventive treatment reduces both mortality and progression to active TB and thus should be offered to all PWH with a positive TB screening test without evidence of active TB disease.269,270

Future Directions

Although progress has been made in understanding the underlying mechanisms of COPD among PWH, significant knowledge gaps remain. For example, there are many cross-sectional studies evaluating the prevalence of COPD among PWH but only limited data on the natural disease course of COPD in PWH and whether it differs from the general population. Additionally, while studies suggest that PWH demonstrate a higher risk of COPD and a higher symptom burden, there are no HIV-specific screening guidelines for COPD in PWH. Further research is also needed on the interplay between risk factors such as mode of HIV transmission, biologic sex, aging, CMV infection, air pollution, and TB, as well as a deeper understanding of the epidemiology, development, and progression of chronic lung disease in PWH. Management strategies designed specifically for PWH with COPD are also warranted. Lastly, while much progress has been made in understanding the mechanistic pathways that render PWH particularly vulnerable to developing COPD, we remain limited in our ability to counteract these pathways and prevent COPD development. These are only a few examples highlighting the multiple avenues for future research, all of which have the potential to substantially improve both our scientific understanding of COPD among PWH and our ability to effectively prevent and treat this deadly, irreversible condition.

Conclusions

COPD is highly prevalent among PWH. With an aging global population of PWH, high rates of cigarette smoking, and air pollution, COPD is a growing health challenge, and improved diagnosis and treatment of COPD in PWH will become increasingly important. Further research is needed to understand the underlying mechanisms driving COPD in PWH, as well as HIV-specific screening and treatment modalities.

Disclosure

Katerina L Byanova and Rebecca Abelman are co-first authors for this study. Dr. Byanova was supported by NIH F32 HL166065. Dr. Abelman was supported by NIH T32 AI060530 and K12 HL143961. Dr. North was supported by NIH K23 HL154863. Dr. Christenson was supported by NIH R01 HL143998, she also reports personal fees from AstraZeneca, Sanofi, Regeneron, GlaxoSmithKline, Amgen, MJH Holdings LLC: Physicians’ Education Resource, Glenmark Pharmaceuticals, and Axon Advisors, outside the submitted work. Dr. Huang was supported by NIH R01 HL128156, R01 HL128156-07S2, and R01 HL143998.

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214. Cui Q, Robinson L, Elston D, et al. Safety and tolerability of varenicline tartrate (Champix((R))/Chantix((R))) for smoking cessation in HIV-infected subjects: a pilot open-label study. AIDS Patient Care STDS. 2012;26(1):12–19. doi:10.1089/apc.2011.0199

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233. Morris A, Fitzpatrick M, Bertolet M, et al. Use of rosuvastatin in HIV-associated chronic obstructive pulmonary disease. AIDS. 2017;31(4):539–544. doi:10.1097/QAD.0000000000001365

234. Ferrand RA, McHugh G, Rehman AM, et al. Effect of once-weekly azithromycin vs placebo in children with HIV-associated chronic lung disease: the BREATHE randomized clinical trial. JAMA Netw Open. 2020;3(12):e2028484. doi:10.1001/jamanetworkopen.2020.28484

235. Parikh MA, Aaron CP, Hoffman EA, et al. Angiotensin-converting inhibitors and angiotensin II receptor blockers and longitudinal change in percent emphysema on computed tomography. the multi-ethnic study of atherosclerosis lung study. Ann Am Thorac Soc. 2017;14(5):649–658. doi:10.1513/AnnalsATS.201604-317OC

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237. Doxycycline for emphysema in people living with HIV (The DEPTH Trial). Weill Medical College of Cornell University; 2023. Available from: beta.clinicaltrials.gov/study/NCT05382208?distance=50&cond=HIV&term=copd%20doxycycline&rank=2. Accessed March 1, 2023.

238. Ashare RL, Thompson M, Leone F, et al. Differences in the rate of nicotine metabolism among smokers with and without HIV. AIDS. 2019;33(6):1083–1088. doi:10.1097/QAD.0000000000002127

239. Stanton CA, Papandonatos GD, Shuter J, et al. Outcomes of a tailored intervention for cigarette smoking cessation among latinos living with HIV/AIDS. Nicotine Tob Res. 2015;17(8):975–982. doi:10.1093/ntr/ntv014

240. Tseng TY, Krebs P, Schoenthaler A, et al. Combining text messaging and telephone counseling to increase varenicline adherence and smoking abstinence among cigarette smokers living with HIV: a randomized controlled study. AIDS Behav. 2017;21(7):1964–1974. doi:10.1007/s10461-016-1538-z

241. Gritz ER, Danysh HE, Fletcher FE, et al. Long-term outcomes of a cell phone-delivered intervention for smokers living with HIV/AIDS. Clin Infect Dis. 2013;57(4):608–615. doi:10.1093/cid/cit349

242. Vidrine DJ, Arduino RC, Gritz ER. Impact of a cell phone intervention on mediating mechanisms of smoking cessation in individuals living with HIV/AIDS. Nicotine Tob Res. 2006;8 Suppl 1(1):S103–108. doi:10.1080/14622200601039451

243. Vidrine DJ, Arduino RC, Lazev AB, Gritz ER. A randomized trial of a proactive cellular telephone intervention for smokers living with HIV/AIDS. AIDS. 2006;20(2):253–260. doi:10.1097/01.aids.0000198094.23691.58

244. Vidrine DJ, Marks RM, Arduino RC, Gritz ER. Efficacy of cell phone-delivered smoking cessation counseling for persons living with HIV/AIDS: 3-month outcomes. Nicotine Tob Res. 2012;14(1):106–110. doi:10.1093/ntr/ntr121

245. Ingersoll KS, Cropsey KL, Heckman CJ. A test of motivational plus nicotine replacement interventions for HIV positive smokers. AIDS Behav. 2009;13(3):545–554. doi:10.1007/s10461-007-9334-4

246. Lloyd-Richardson EE, Stanton CA, Papandonatos GD, et al. Motivation and patch treatment for HIV+ smokers: a randomized controlled trial. Addiction. 2009;104(11):1891–1900. doi:10.1111/j.1360-0443.2009.02623.x

247. Moadel AB, Bernstein SL, Mermelstein RJ, Arnsten JH, Dolce EH, Shuter J. A randomized controlled trial of a tailored group smoking cessation intervention for HIV-infected smokers. J Acquir Immune Defic Syndr. 2012;61(2):208–215. doi:10.1097/QAI.0b013e3182645679

248. Cropsey KL, Hendricks PS, Jardin B, et al. A pilot study of screening, brief intervention, and referral for treatment (SBIRT) in non-treatment seeking smokers with HIV. Addict Behav. 2013;38(10):2541–2546. doi:10.1016/j.addbeh.2013.05.003

249. Cropsey KL, Jardin BF, Burkholder GA, Clark CB, Raper JL, Saag MS. An algorithm approach to determining smoking cessation treatment for persons living with HIV/AIDS: results of a pilot trial. J Acquir Immune Defic Syndr. 2015;69(3):291–298. doi:10.1097/QAI.0000000000000579

250. Humfleet GL, Hall SM, Delucchi KL, Dilley JW. A randomized clinical trial of smoking cessation treatments provided in HIV clinical care settings. Nicotine Tob Res. 2013;15(8):1436–1445. doi:10.1093/ntr/ntt005

251. Manuel JK, Lum PJ, Hengl NS, Sorensen JL. Smoking cessation interventions with female smokers living with HIV/AIDS: a randomized pilot study of motivational interviewing. AIDS Care. 2013;25(7):820–827. doi:10.1080/09540121.2012.733331

252. Pengpid S, Peltzer K, Puckpinyo A, et al. Screening and concurrent brief intervention of conjoint hazardous or harmful alcohol and tobacco use in hospital out-patients in Thailand: a randomized controlled trial. Subst Abuse Treat Prev Policy. 2015;10(1):22. doi:10.1186/s13011-015-0018-1

253. Mercie P, Arsandaux J, Katlama C, et al. Efficacy and safety of varenicline for smoking cessation in people living with HIV in France (ANRS 144 Inter-ACTIV): a randomised controlled phase 3 clinical trial. Lancet HIV. 2018;5(3):e126–e135. doi:10.1016/S2352-3018(18)30002-X

254. Mussulman LM, Faseru B, Fitzgerald S, Nazir N, Patel V, Richter KP. A randomized, controlled pilot study of warm handoff versus fax referral for hospital-initiated smoking cessation among people living with HIV/AIDS. Addict Behav. 2018;78:205–208. doi:10.1016/j.addbeh.2017.11.035

255. Ashare RL, Thompson M, Serrano K, et al. Placebo-controlled randomized clinical trial testing the efficacy and safety of varenicline for smokers with HIV. Drug Alcohol Depend. 2019;200:26–33. doi:10.1016/j.drugalcdep.2019.03.011

256. Ditre JW, LaRowe LR, Vanable PA, De Vita MJ, Zvolensky MJ. Computer-based personalized feedback intervention for cigarette smoking and prescription analgesic misuse among persons living with HIV (PLWH). Behav Res Ther. 2019;115:83–89. doi:10.1016/j.brat.2018.10.013

257. Gryaznov D, Chammartin F, Stoeckle M, et al. Smartphone app and carbon monoxide self-monitoring support for smoking cessation: a randomized controlled trial nested into the Swiss HIV cohort study. J Acquir Immune Defic Syndr. 2020;85(1):e8–e11. doi:10.1097/QAI.0000000000002396

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Oxygen Cylinders, Concentrators Market is poised to witness robust growth over the forecast period. Increasing geriatric population base will serve as a high impact rendering factor.

In the evolving landscape of healthcare, the Oxygen Cylinders and Concentrators Market is gearing up for substantial growth, with a projected market size of US$ 6.77 billion and a commendable CAGR of 5.15%. Dive into our comprehensive analysis to uncover the driving forces, regional dynamics, and future opportunities in this vital industry.

The Impact of COVID-19:
The global pandemic has cast a unique shadow on the market, affecting leaders, followers, and disruptors differently based on regional variations in lockdown measures. Our detailed report explores the short-term and long-term repercussions, aiding decision-makers in crafting strategic plans adaptable to specific regions and segments.

A Breath of Fresh Growth:
The Oxygen Cylinders and Concentrators Market are on the brink of robust expansion, propelled by factors such as the increasing geriatric population, which is more susceptible to respiratory disorders like COPD. Lifestyle choices, including smoking and exposure to dust particles, are contributing to a surge in respiratory issues, further fuelling market growth.

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The Symphony of Market Dynamics: Brewing Growth and Challenges

Healthcare Dominance:
The healthcare segment takes center stage, securing the largest revenue share due to a substantial number of patients reliant on oxygen. Rising cases of respiratory disorders, accidents, and surgeries are driving the demand for oxygen concentrators. Explore how these devices are becoming integral in treating conditions like COPD, chronic hypoxemia, and even severe sleep apnea.

North America Leading the Charge:
In 2017, North America held the highest revenue share, with the U.S. oxygen cylinders and concentrators market claiming over 85% of the regional pie. Factors such as the prevalence of respiratory diseases, early diagnosis, developed healthcare infrastructure, and increasing per capita income are contributing to the region's dominance. Uncover the nuances that make North America a key player in the market's growth.

Oxygen Cylinders, Concentrators Market Segment Analysis:

Healthcare segment of Oxygen Cylinders, Concentrators Market accounted for the largest revenue share in 2017 owing to the substantial number of patients’ dependent on oxygen. Increasing incidence of respiratory disorders such as COPD, asthma will fuel industry growth over the forecast years. Oxygen concentrators are used to deliver supplementary oxygen to individuals suffering from COPD, chronic hypoxemia, and pulmonary enema.

by Product

They are also used in adjunct treatment for severe sleep apnoea. Moreover, oxygen is also required during surgery and intensive care treatment. The increasing number of accidents and fatalities requiring immediate hospitalization and operation along with the rising number of surgeries should further propel demand.

by Application

  • • Healthcare
    • Pharmaceutical &amp
    • Biotechnology
    • Manufacturing
    • Aerospace &amp
    • Automotive
    • Others

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Who are Oxygen Cylinders, Concentrators Market Key Players?

  • • Chart Industries
    • Inogen, Invacare
    • Koninklijke Philips N.V.
    • Catalina Cylinders
    • Air Liquide
    • MeBer
    • HERSILL
    • Tecno Gaz
    • Cramer Decker
    • Cramer Decker
    • Invacare
    • DeVilbiss Healthcare LLC
    • Nidek Medical Products, Inc.
    • O2 Concepts
    • Teijin Limited
    • Royax
    • Jiuxin Medical Technology Co., Ltd.
    • Vygon
    • OSI Systems
    • Smith’s Medical
    • Becton, Dickinson and Company
    • Drägerwerk AG & Co. KGaA
    • Teleflex Incorporated
    • Fisher & Paykel Healthcare Corporation Limited
    • Taiyo Nippon Sanso Corporation

Table of content for the Oxygen Cylinders, Concentrators Market includes:

Part 01: Executive SummaryPart 02: Scope of the Oxygen Cylinders, Concentrators Market ReportPart 03: Oxygen Cylinders, Concentrators Market LandscapePart 04: Oxygen Cylinders, Concentrators Market SizingPart 05: Oxygen Cylinders, Concentrators Market Segmentation by TypePart 06: Five Forces AnalysisPart 07: Customer LandscapePart 08: Geographic LandscapePart 09: Decision FrameworkPart 10: Drivers and ChallengesPart 11: Market TrendsPart 12: Vendor LandscapePart 13: Vendor Analysis

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Navigating Regional Dynamics:
Understand the Oxygen Cylinders and Concentrators Market in North America and Asia Pacific by analyzing market segments. Our report provides a clear representation of competitive analysis, guiding investors through factors like type, price, financial position, product portfolio, growth strategies, and regional presence.

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Oxygen Conservation Devices Market

Oxygen Conservation Devices Market

The Oxygen Conservation Devices Market is estimated for 2023 for the forecast period 2023-2030, as highlighted in a new report published by Coherent Market Insights.

Market Overview:

Oxygen conservation devices aid in conserving the flow of oxygen by delivering a controlled amount of oxygen to patients based on their breathing patterns. They help patients breathe more deeply and prolong the use of oxygen tanks.

Market Dynamics:

The oxygen conservation devices market is expected to witness significant growth over the forecast period owing to the rising incidences of chronic respiratory diseases such as COPD and asthma. As per the WHO, around 65 million people suffer from moderate to severe COPD worldwide. Moreover, the increasing healthcare expenditure and better access to healthcare facilities also contributes to market growth. Government initiatives to spread awareness regarding respiratory diseases and availability of reimbursement for oxygen therapy further drives the adoption of oxygen conservation devices. Additionally, technological advancements in oxygen delivery devices have improved patient comfort and compliance, thereby fueling market expansion.

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** Note - This Report Sample Includes:

‣ Brief Overview to the research study.

‣ Table of Contents The scope of the study's coverage

‣ Leading market participants

‣ Structure of the report's research framework

‣ Coherent Market Insights' research approach

Major companies in Oxygen Conservation Devices Market are:

✤ Medline Industries Inc.
✤ Invacare Corporation
✤ Responsive Respiratory Inc.
✤ Drive Medical
✤ DeVilbiss Healthcare Ltd.
✤ Precision Medical Inc.
✤ Hersill S.L.
✤ Inogen Inc.
✤ Essex Industries Inc.

Note: Major Players are sorted in no particular order.

Rising prevalence of chronic respiratory diseases is driving the oxygen conservation devices market

The prevalence of chronic respiratory diseases such as chronic obstructive pulmonary disease (COPD) and asthma is increasing significantly across the world. As per WHO estimates, around 65 million people suffer from moderate to severe COPD globally. COPD is projected to be the third leading cause of death worldwide by 2030. Oxygen conservation devices help these patients reduce their oxygen usage and dependency on oxygen supply, thereby offering significant cost benefits to the healthcare systems. These devices are playing a pivotal role in managing COPD and other respiratory disorders effectively at home, improving patient outcomes and quality of life. Their ability to maximize oxygen therapy is fueling the demand from healthcare providers and patients.

Growing geriatric population is propelling the adoption of oxygen conservation devices

The global geriatric population, aged 65 years or older, is expected to nearly double by 2050. Older adults are more susceptible to developing chronic health conditions like respiratory diseases due to age-related physiological changes and decline in the immune system. With life expectancy rising, the risk of respiratory disorders is also rising among the elderly. As oxygen conserving techniques can help senior citizens minimize supplemental oxygen usage and stay active for longer duration between cylinder replacements, their popularity is surging rapidly. Manufacturers are actively developing innovative products specifically targeting the unique needs of the aging population to further penetrate the market.

Stringent regulatory environment for new product approval is impeding market growth

Medical device companies dealing with oxygen therapy equipment have to comply with stringent regulations of authorities like the U.S. FDA and the European Commission to gain approvals for new products. The approval process involves rigorous clinical testing and documentation which is a costly and time-consuming process. Even minor changes or upgrades in existing devices require prior regulatory clearance. This poses regulatory hurdles, increases the product development cycle and delays the launch of advanced solutions. It hampers quick innovations and technical advancements to meet evolving care needs. Regulatory issues have emerged as a major restraint hampering the development and commercialization of novel oxygen conservation devices.

Advent of 3D printing offers a major opportunity

3D printing or additive manufacturing has emerged as a breakthrough technology that is revolutionizing the medical devices industry. This innovative production method provides significant benefits like reduced cost of production, design customization capability and compact size. Its application in designing oxygen conserving devices can unlock new opportunities. Companies are leveraging 3D printing to develop patient-specific oxygen conserving solution and meet the diverse requirements of individual diseases. This technology brings product miniaturization, making devices more wearable. It also enables mass-customization and rapid prototyping, accelerating the product development cycle. 3D printing is opening up new avenues for producing next-gen portable and integrated devices, giving an impetus to market development.

Adoption of telehealth and remote monitoring trend is gaining traction

With the COVID-19 pandemic accelerating the digital health transformation, telehealth and remote patient monitoring solutions are witnessing tremendous growth. Oxygen conservation device manufacturers are actively developing smart connected versions integrated with mobile apps, sensors and cloud computing. These digital devices monitor patients' vital parameters from home and alert care teams in case of emergencies. The data is available seamlessly to physicians for timely interventions. This technology trend allows continuous supervision of patients, improves adherence to therapy regimens and clinical outcomes. It brings improved access to specialty care and greater independence. As healthcare shifts from institutions to homes, the demand for telehealth-enabled oxygen conservation products is expected to surge dramatically over the coming years.

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Highlights of the global Oxygen Conservation Devices Market report:

→ This analysis provides market size (US$ Million) and compound annual growth rate (CAGR%) for the forecast period (2023-2030), using 2021 as the base year. It also covers the global Oxygen Conservation Devices Market in-depth.

→ It offers enticing investment proposition matrices for this sector and explains the likely future growth of key revenue streams.

→ Additionally, this study offers crucial insights into market forces, limitations, opportunities, new product introductions or approvals, market trends, regional perspective, and competitive tactics used by top rivals.

→ Based on the following factors: company highlights, product portfolio, significant highlights, financial performance, and strategies, it covers key players in the global Oxygen Conservation Devices Market.

→ Marketers and company leaders will be able to make wise decisions about next product launches, type updates, market expansion, and marketing strategies thanks to the insights from this research.

→ A wide spectrum of industry stakeholders are covered by the global Oxygen Conservation Devices Market research, including investors, vendors, product producers, distributors, new entrants, and financial analysts.

→ The many strategy matrices used in researching the global Oxygen Conservation Devices Market will aid stakeholders in making decisions.

The research was developed through the synthesis, analysis, and interpretation of data gathered from multiple sources on the parent market. Additionally, analysis has been done of the economic circumstances and other economic indicators and factors to evaluate their respective impact on the Oxygen Conservation Devices Market, along with the present impact, so as to develop strategic and informed projections about the scenarios in the market. This is mostly due to the developing countries' unmet potential in terms of product pricing and revenue collection.

Key Questions Answered In The Report:

• Which regional market will experience the greatest and most rapid growth?

• Who are the top five Oxygen Conservation Devices Market players?

• How will the Oxygen Conservation Devices Market evolve over the next six years?

• What application and product will dominate the Oxygen Conservation Devices Market?

• What are the market drivers and constraints for Oxygen Conservation Devices Market?

• What will be the Oxygen Conservation Devices Market's CAGR and size during the forecast period?

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About Coherent Market Insights

Coherent Market Insights is a global market intelligence and consulting organization that provides syndicated research reports, customized research reports, and consulting services. We are known for our actionable insights and authentic reports in various domains including aerospace and defense, agriculture, food and beverages, automotive, chemicals and materials, and virtually all domains and an exhaustive list of sub-domains under the sun. We create value for clients through our highly reliable and accurate reports. We are also committed in playing a leading role in offering insights in various sectors post-COVID-19 and continue to deliver measurable, sustainable results for our clients.

This release was published on openPR.

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Chronic Obstructive Pulmonary Disease (COPD) is a progressive respiratory condition that affects nearly 50 million people in India, causing persistent breathing difficulties and reducing the overall quality of life. COPD is an umbrella term which encompasses chronic bronchitis and emphysema and is characterized by persistent airflow limitation and difficulty in breathing. 

COPD often results from long-term exposure to irritating gases or particulate matter, most commonly from cigarette smoke. Additional risk factors of COPD include untreated asthma, exposure to air pollution, exposure to biomass fuel and second-hand smoke.

How Heated Steam Therapy Works

Lungs
Unsplash/Representational image

While existing COPD treatments aim to alleviate symptoms and improve lung function, they may fall short in repairing the underlying damage to the lung tissue. Moderate to severe cases often require more targeted approaches to address the structural changes and promote healing within the lungs.

Heated steam therapy (Bronchoscopic thermal vapour ablation) via bronchoscope represents a cutting-edge treatment designed to directly target damaged lung tissue. This minimally invasive procedure involves the introduction of heated steam into the airways through a bronchoscope, a thin, flexible tube equipped with a light and camera. While heated steam therapy holds great promise, it is essential to carefully select patients based on the type and severity of their COPD and overall health. The procedure may be most beneficial for individuals with emphysema localized to upper parts of the lung who have not responded optimally to traditional treatments.

The procedure begins with the insertion of a bronchoscope into the patient's airways, allowing the medical professional to visualize the affected areas. Once the bronchoscope is in position, heated steam is carefully delivered to the targeted regions within the lungs. The controlled application of heat aims to promote tissue repair and reduce inflammation.

Benefits of Heated Steam Therapy:

Lungs
researchgate

- Precision Targeting: Unlike systemic treatments, heated steam therapy precisely targets the affected areas within the lungs, maximizing its therapeutic impact.

- Minimally Invasive: The procedure is minimally invasive, reducing the risks associated with more invasive surgical interventions. Patients typically experience shorter recovery times and fewer complications.

- Improved Lung Function: By promoting tissue repair and regeneration, heated steam therapy aims to enhance lung function, potentially leading to improved breathing and overall quality of life.

Heated steam therapy (Bronchoscopic thermal vapour ablation) via bronchoscope represents a groundbreaking advancement in the field of COPD treatment. By directly addressing damaged lung tissue this innovative approach offers hope to individuals with moderate to severe COPD who seek not only symptom relief despite optimal medical therapy. 

As research and clinical trials continue to unfold, heated steam therapy (Bronchoscopic thermal vapour ablation) may become a transformative option, heralding a new era in the management of chronic respiratory conditions. Always consult with healthcare professionals to determine the most suitable treatment approach based on individual health circumstances.

About the author: Dr. Vivek Singh is the Director, Respiratory and Sleep Medicine, Medanta, Gurugram. All views/opinions expressed in the article are of the author. 

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A lawsuit has been filed over what has been identified as the cannabis industry’s first asthma workplace death.

The mother of a worker who died from an asthma attack at a Massachusetts cannabis processing plant in 2022 has brought wrongful death claims against the cannabis firm, its safety manager, and the contractors responsible for the plant’s duct and ventilation systems.

The cannabis firm, Trulieve, has not yet responded to the lawsuit but previously defended its workplace operations in October 2022 while contesting three citations and penalties by the Occupational Safety and Health Administration (OSHA).

The worker’s mother, Laura Bruneau, claims that the death of her daughter Lorna McMurrey was the result of negligence by the cannabis facility’s owners, along with their safety manager, in allegedly failing to provide adequate safety training and failing to maintain their machinery to minimize exposure to airborne cannabis dust and/mold inside the facility.

In addition, the suit alleges negligence by a general contractor and two mechanical contractors in the design and installation of the building’s HVAC system, which the suit claims not only failed to adequately ventilate but also leaked, causing mold to grow.

In January 2022, McMurrey, 27, collapsed for the second time in a matter of months while working in the “pre-roll” production room at the Trulieve cannabis production facility located in Holyoke. She had suffered a similar attack in November 2021. On both occasions she was hospitalized for a severe asthma attack as a result of exposure to hazardous airborne ground cannabis dust and/or mold, according to the complaint. Three days after her collapse in January, McMurrey died in the hospital with her mother at her bedside.

Cannabis Industry Reports First Worker Death From Asthma Attack

An analysis by Massachusetts public health and federal workplace safety officials determined that McMurrey died of occupational asthma due to the exposure to ground cannabis. They said this was the cannabis production industry’s first reported occupational asthma death and identified allergic diseases such as asthma as a growing concern in the cannabis industry.

The Bruneau complaint filed in Hampden County Superior Court against Trulieve describes the “pre-roll” production room where McMurrey was assigned as a small room, with poor ventilation, four grinding machines, and up to 10 workers. The grinding machines break the cannabis flower down into smaller matter. A separate machine shakes the ground cannabis into tubes, creating pre-rolled joints.

The suit claims that emissions from the grinding machines made the air in the room thick with sticky cannabis dust, sometimes referred to as kief. The cannabis dust/kief would “cover workers from head to toe, and often workers would leave the facility covered in the sticky substance,” according to the complaint.

The “pre-roll” room was equipped with a “shop-vac” used to vacuum up and filter dust particles that were not being adequately ventilated by the HVAC system. Even when the shop-vac was in use, dust was visible in the air during the grinding process, the suit claims.

Machine Filter

On November 9, 2021, when McMurrey was working in the “pre-roll” room, the filter in one of the grinding machines was removed and found to be “extremely contaminated and filled with ground moldy cannabis product.” The removal of this filter, and the subsequent release of the moldy cannabis dust, caused McMurrey to experience severe difficulty breathing. Her supervisor called an ambulance. McMurrey suffered an asthma attack.

Subsequently, on January 4, 2022, McMurrey was again working in the “pre-roll” room when she again began experiencing serious difficulty breathing and collapsed. Despite treatment in the hospital over three days, McMurrey never regained consciousness, and passed away on January 7, 2022.

The suit maintains that McMurrey was never provided any particularized safety training or information as to the risks of cannabis dust or mold and that Trulieve “knowingly and negligently” exposed workers to a hazardous work environment. It also maintains that the firm’s safety manager did not require that McMurrey be reassigned and failed to impose any safety protocol in response to McMurrey’s first medical incident.

The suit alleges that Trulieve knew or should have known that increased exposure to the dust/mold put workers at risk for developing respiratory and allergic disease, including asthma.

“This is especially true where multiple other workers at the facility reported experiencing allergic and asthmatic responses, including coughing, difficulty breathing, skin rashes, hives and itching, and allergic and asthmatic responses were widespread among workers in the production room and commonly known” to the company and the safety manager, the complaint says.

HVAC Leaks

The complaint further alleges that in addition to failing to adequately ventilate, the HVAC system leaked, causing dry cannabis flower to develop mold. Trulieve and the contractors did nothing to repair the issues, according to the suit.

Trulieve was also responsible for the design and servicing of the grinding machines, which the suit claims were defective because they could be operated without their proper air filters. The suit says the grinding machines were “often operated without air filters and were operated in this manner on the date of the Incident.”

The suit seeks unspecified damages to compensate for the decedent’s injuries, including but not limited to pain and suffering, and mental and emotional distress, economic losses, medical costs and other relief “as may be appropriate.”

OSHA found the company had a written hazard communication plan but it did not address issues around handling cannabis material or allergic reactions to cannabis dust. OSHA initially proposed a $35,219 fine for three citations. Trulieve settled with OSHA this past July for $14,502 over one citation related to classification of hazardous materials.

A November 2023 report by federal and Massachusetts officials found that at the time of the incident, the company had workers’ compensation insurance at the Holyoke plant as required by state law. Since the incident, the company has closed this facility and its three retail shops in the state.

Those investigators wrote that this was the first occupational asthma fatality in the U.S. cannabis workforce. They also concluded that McMurrey did not have asthma prior to starting at the cannabis facility in May 2021.

Bruneau’s attorneys had not replied by press time to a question about whether any workers’ compensation claims had been filed over the incident.

Trulieve had not responded to a request for comment by press time.

Trulieve Statement

In an October 2022 statement reported by NBC Boston, Trulieve said it stood by its record of worker health protections at the Holyoke facility.

Trulieve stated that it “installed and at all times operated appropriate industrial air handling systems” and that the Holyoke facility had a “special industrial air filtration system that exchanges the air in the grinding room and has been certified by an independent engineer.”

The company stated that all of the facility’s air quality samples tested by OSHA complied with relevant standards.

The cannabis firm also said it provided personal protection equipment to all employees and that it followed appropriate protocols, including promptly calling 911 and administering cardiopulmonary resuscitation (CPR), before emergency responders took over.

Trulieve purchased the 150-year old Holyoke property, which was originally a mill and later a furniture restoration business, in 2019 and renovated it over several years. The final space was more than 150,000 square feet, with the majority used for cultivation.

Trulieve currently operates 190 retail dispensaries and over 4 million square feet of cultivation and processing capacity in the U.S.

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November 28, 2023, New Delhi: Both short and long-term exposure to air pollution can lead to a wide range of diseases, including stroke, chronic obstructive pulmonary disease, trachea, bronchus and lung cancers, aggravated asthma and lower respiratory infections. According to a World Bank report “Catalysing Clean Air in India” released in August 2021, the air pollution levels in India are among the highest in the world, posing a heavy threat to the country's health and economy. All of India’s 1.4 billion people are exposed to unhealthy levels of ambient PM 2.5 – the most harmful pollutant - emanating from multiple sources. These small particulates with a diameter of less than 2.5 microns, is about one-thirtieth the width of a human hair. Exposure to PM 2.5 can cause such deadly illnesses as lung cancer, stroke, and heart disease. Ambient and indoor air pollution is estimated to have caused 1.7 million premature deaths in India in 2019.

Latest estimates by the European Environment Agency (EEA) show that fine particulate matter (PM2.5) continues to cause the most substantial health impact. In a report released in October 2023, EEA states that air pollution is the single largest environmental health risk in Europe and a major cause of premature death and disease. Children and adolescents are particularly vulnerable because their bodies, organs and immune systems are still developing. Air pollution damages health during childhood and increases the risk of diseases later in life, yet children can do little to protect themselves or influence air quality policies.

In India, Delhi and NCR cities continue to suffer from the highest levels of air pollution during the months of October and November. The AQI levels rose to 450 in late October and touched 1000 day after Diwali and have continued to be in the 300-600 range last week. With thousand plus posts and comments received from residents of Delhi and NCR on the subject of toxic air in the last 30 days especially around the health impact felt, LocalCircles through a new survey has strived to find out how residents of Delhi NCR are coping and what are the various health issue they are experiencing. The survey received over 9,000 responses from residents of Delhi, Noida, Ghaziabad, Gurugram & Faridabad. 67% respondents were men while 33% respondents were women.

100% of Delhi NCR families surveyed indicated that they have had one or more members suffer due to air pollution

The air quality was expected to improve post Diwali but in several parts of Delhi NCR it is still in the AQI 300-600 range, including in several upmarket areas where vehicular traffic is heavy. The survey asked “Have you or members of your family in Delhi-NCR experienced/ are experiencing any ailment over the last 30 days due to air pollution?” Alarmingly, 100% of the 9740 Delhi NCR families who responded to the query indicated that they have had one or more members suffer due to pollution.

100% of Delhi NCR families surveyed indicated that they have had one or more members suffer due to air pollution

89% of Delhi NCR families surveyed either had or have someone suffering from sore throat and cough; 78% have someone who has suffered or is suffering from breathing difficulties

The survey next asked “What are all the ailments you or members of your family in Delhi NCR have experienced / are experiencing over the last 30 days due to air pollution?” Some among the 9,740 families surveyed indicated more than one ailment with 89% stating “sore throat and/ or cough”; 78% indicating “breathing difficulty/ asthma”; 67% indicated “runny nose and/or congestion”; 67% indicated “burning eyes”; 56% of respondents indicated “anxiety and/ or difficulty in concentrating”; 44% indicated “headache”; and 22% admitted to “difficulty in sleeping”. To sum up, 89% of Delhi NCR families surveyed either had or have someone suffering from sore throat and cough; 78% have someone who has suffered or is suffering from breathing difficulties.

89% of Delhi NCR families surveyed either had or have someone suffering from sore throat and cough; 78% have someone who has suffered or is suffering from breathing difficulties

Comparison of new survey results that concluded on November 23rd with that on October 31st shows that in 3 weeks, the percentage of Delhi NCR families with one or more individuals suffering from sore throat and/or cough has risen from 75% to 89% due to continuing high air pollution.

In 3 weeks percentage of Delhi NCR families with one or more individuals suffering from sore throat and/or cough has risen from 75% to 89%

Similarly, in the case of Delhi NCR families with one or more individuals suffering from congestion and/ or runny nose the percentage has risen from 38% to 67% in just three weeks.

In 3 weeks percentage of Delhi NCR families with one or more individuals suffering from congestion and/ or runny nose has risen from 38% to 67%

In the case of Delhi NCR families with one or more individuals suffering from breathing difficulty and/ or asthma, the percentage has more than doubled from 38% to 78% in three weeks, indicating that breathing problems are set to increase unless the air quality improves.

In 3 weeks percentage of Delhi NCR families with one or more individuals suffering from breathing difficulty and/ or asthma has risen from 38% to 78%

In summary, 100% of the families surveyed in Delhi NCR have indicated that one or more individuals in their household was either unwell earlier or is now due to the impact of air pollution, which remains at severe levels. The latest survey shows that 89% of the families surveyed have stated that one or more individuals in their family are unwell with “sore throat and/ or cough”; 78% indicated “breathing difficulty/ asthma”; 67% indicated “runny nose and/or congestion”; 67% indicated “burning eyes”; 56% of respondents indicated “anxiety and/ or difficulty in concentrating”; 44% indicated “headache”; and 22% admitted to “difficulty in sleeping”. In fact, the percentage of those unwell has risen sharply whether breathing difficulty/ asthma, or sore throat/ cough, or runny nose/ congestion. If the air pollution levels don’t come down sharply more people in these families are likely to fall sick and those suffering through the last 3 weeks may further experience deterioration in their health conditions. While people continue to experience short, medium and long term impact on their health due to toxic air, stubble burning in neighbouring states continues and so does manual road cleaning and garbage burning in Delhi and NCR cities with many wondering if those in administration are still on the job and addressing root causes.

Survey Demographics

The survey received over 9,000 responses from residents of Delhi, Noida, Ghaziabad, Gurugram & Faridabad. 67% respondents were men while 33% respondents were women. The survey was conducted via LocalCircles platform and all participants were validated citizens who had to be registered with LocalCircles to participate in this survey.

About LocalCircles

LocalCircles, India’s leading Community Social Media platform enables citizens and small businesses to escalate issues for policy and enforcement interventions and enables Government to make policies that are citizen and small business centric. LocalCircles is also India’s # 1 pollster on issues of governance, public and consumer interest. More about LocalCircles can be found on www.localcircles.com

All content in this report is a copyright of LocalCircles. Any reproduction or redistribution of the graphics or the data therein requires the LocalCircles logo to be carried along with it. In case any violation is observed LocalCircles reserves the right to take legal action.

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New York: Breathing unfiltered air from rush-hour traffic can significantly increase passengers’ blood pressure up to 24 hours later, revealed an alarming study, even as New Delhi and the nearby regions of Gurugram, Ghaziabad have been gripped with bad air quality for about a month.

Subhan Bakery InstagramSubhan Bakery Instagram

Long-term exposure to traffic-related air pollution — a complex mixture of exhaust from tailpipes, brake and tire wear, and road dust — has been linked to increased rates of cardiovascular disease, asthma, lung cancer and death.

The new study, detailed in the Annals of Internal Medicine, showed that the inhalation of traffic-related air pollution while in a car with unfiltered air was associated with a 4.5 mm Hg increase in blood pressure — comparable to the effect of a high-sodium diet.

MS Education AcademyMS Education Academy

This change in blood pressure occurred rapidly, peaked within 60 minutes of exposure, and persisted over 24 hours.

“We know that modest increases in blood pressure like this, on a population level, are associated with a significant increase in cardiovascular disease,” said Joel Kaufman, a physician and professor of environmental and occupational health sciences at University of Washington, US.

“There is a growing understanding that air pollution contributes to heart problems. The idea that roadway air pollution at relatively low levels can affect blood pressure this much is an important piece of the puzzle we’re trying to solve,” he added.

But using high-quality HEPA filters in cars blocked out 86 per cent of particulate pollution, revealed the study. However, the findings raise questions about ultrafine particles, an unregulated and little-understood pollutant that has become a source of growing concern among public health experts.

Traffic-related air pollution contains high concentrations of ultrafine particles — less than 100 nanometers in diameter, much too small to be seen.

In the study, unfiltered air contained high levels of ultrafine particles, though the overall level of pollution as measured by fine particle concentration (PM 2.5) was relatively low, equivalent to an AQI of 36.

“Ultrafine particles are the pollutant that were most effectively filtered in our experiment — in other words, where the levels are most dramatically high on the road and low in the filtered environment,” Kaufman said. “So, the hint is that ultrafines may be especially important (for blood pressure). To actually prove that requires further research, but this study provides a very strong clue as to what’s going on,” Kaufman said.



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Since mid-October 2023, the World Health Organization (WHO) has been monitoring data from Chinese surveillance systems that have been showing an increase in respiratory illness in children in northern China.

Chinese authorities attributed this increase to lifting of COVID-19 restrictions and the arrival of the cold season, and due to circulating known pathogens such as influenza, Mycoplasma pneumoniae, respiratory syncytial virus (RSV), and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Mycoplasma pneumonia and RSV are known to affect children more than adults.

Pneumonia

Pneumonia is a form of acute respiratory infection that is most commonly caused by viruses or bacteria. It can cause mild to life-threatening illness in people of all ages; however, it is the single largest infectious cause of death in children worldwide.

Pneumonia killed more than 808 000 children under the age of 5 in 2017, accounting for 15% of all deaths of children under 5 years. People at-risk for pneumonia also include adults over the age of 65 and people with preexisting health problems.

When an individual has pneumonia, the alveoli are filled with pus and fluid, which makes breathing painful and limits oxygen intake. These infections are generally spread by direct contact with infected people. Vaccines can help prevent pneumonia.

Influenza

Influenza (Flu) is a common cause of pneumonia, especially among younger children, the elderly, pregnant women, or those with certain chronic health conditions or who live in a nursing home.

Influenza is a highly contagious viral infection that is one of the most severe illnesses of the winter season. Influenza is spread easily from person to person, usually when an infected person coughs or sneezes.

Pneumonia is a serious infection or inflammation of the lungs. The air sacs fill with pus and other liquid, blocking oxygen from reaching the bloodstream. If there is too little oxygen in the blood, the body's cells cannot work properly, which can lead to death.

As flu strains change each year, it is necessary to get a flu vaccination each season to make sure you are protected against the most current strains. Pneumonia vaccinations are usually only necessary once, although a booster vaccination may be recommended for some individuals.

Walking Pneumonia

In recent days, there has been a surge in cases of infection by the bacterium mycoplasma pneumoniae Mycoplasma pneumonia reported in multiple hospitals across China, with children being the most affected. This year, the infection has occurred earlier than usual and has shown a trend toward affecting younger children, leading pediatricians to warn that this year could see a widespread outbreak of Mycoplasma pneumonia.

The Mycoplasma pneumoniae bacterium is one of the most recognized of all human pathogens, and there are different known species. These bacteria can cause many symptoms, including dry cough, fever, and mild shortness of breath on exertion. Mycoplasma pneumonia can spread easily among children.

Most people with respiratory infections caused by Mycoplasma pneumoniae don’t develop pneumonia. For this reason, Mycoplasma pneumonia is known as atypical pneumonia and is sometimes called walking pneumonia.

Mycoplasma pneumonia spreads quickly through contact with respiratory fluids in crowded areas, like schools, college campuses, and nursing homes. When someone coughs or sneezes, moisture containing the bacteria is released into the air, and others around them can easily breathe the bacteria in.

About 7 to 20 percent of cases of community-acquired (outside of a hospital) pneumonia happen as a result of infection by atypical bacterial microorganisms. Of these, Mycoplasma pneumoniae causes the most infections, though only about 10% of people infected will actually develop pneumonia.

Mycoplasma pneumonia symptoms are different from those of typical pneumonia caused by common bacteria, like Streptococcus and Haemophilus. Patients usually do not have severe shortness of breath, high fever, and a productive cough with Mycoplasma pneumonia. Instead, they have a low-grade fever, dry cough, mild shortness of breath, and fatigue.

Mycoplasma pneumonia may mimic an upper respiratory infection or common cold rather than a lower respiratory infection or pneumonia. A dry cough is the most common sign of infection.

In some cases, Mycoplasma pneumonia infection can become dangerous. If you have asthma, Mycoplasma pneumonia can make your symptoms worse. Mycoplasma pneumonia can also develop into a more severe case of pneumonia. In rare cases, untreated Mycoplasma pneumonia can be fatal.

Respiratory Syncytial Virus

Respiratory syncytial virus (RSV) causes mild illness in most children and adults. However, pneumonia can be serious, requiring treatment and sometimes hospitalization. Rarely, for people at high risk, pneumonia can be fatal.

For some infants, older adults, and people with certain health conditions, an RSV infection can become severe and lead to other health conditions, like bronchiolitis and pneumonia.

RSV typically stays confined to the upper airways. In certain situations, though, it can move into the lungs. While rare, this is when RSV-related pneumonia may develop. RSV is the leading cause of pneumonia in children under age 1.

Symptoms of RSV may be as mild as a runny nose and sore throat. When pneumonia develops, you may notice symptoms that happen slowly or suddenly. Symptoms may include cough with yellow, green, or bloody sputum, fever, chills, shallow or rapid breathing patterns, rapid pulse rate, chest pain with deep breaths or coughing, fatigue, and low appetite.

Don't Press Pandemic Panic Button

Scientists have cautioned against concerns of a potential new pandemic following the World Health Organization's request for more information from China regarding an increase in respiratory illnesses and pneumonia clusters among children.

While some worry that this surge might signal the emergence of another dangerous pathogen capable of triggering a pandemic, scientists believe, based on current information, it's more likely an increase in common respiratory infections like the flu. Similar rises in respiratory infections were observed globally after COVID-19 lockdowns were lifted, potentially including a resurgence of COVID itself.

Prevention Tips

Based on the available information, WHO recommends that people in China follow measures to reduce the risk of respiratory illness, which include recommended vaccines against influenza, COVID-19 and other respiratory pathogens as appropriate; keeping distance from people who are ill; staying home when ill; getting tested and medical care as needed; wearing masks as appropriate; ensuring good ventilation; and practicing regular handwashing.

WHO does not recommend any specific measures for travellers to China. In general, persons should avoid travel while experiencing symptoms suggestive of respiratory illness, if possible; in case of symptoms during or after travel, travellers are encouraged to seek medical attention and share travel history with their health care provider.

WHO advises against the application of any travel or trade restrictions based on the current information available on this event.

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Cars move along an S-curved freewayShare on Pinterest
Experts say air pollution can affect people who live near freeways. Amos Chapple/Stocksy
  • Traffic-related air pollution was associated with a significant increase in blood pressure among car passengers, a study finds.
  • Researchers report that the blood pressure increase is on par with other cardiovascular risk factors such as lack of exercise or excessive salt intake.
  • Experts note that cabin air filters and other filtration devices, including masks, can lower exposure to dangerous air pollution particles.

People wearing masks while driving alone in their cars may not be so foolish after all.

The N95 masks used to help prevent the spread of COVID-19 might also filter out highway air pollution that a new study says can cause a serious and sustained spike in blood pressure.

The study, published in the Annals of Internal Medicine, reports that riding in automobiles and breathing unfiltered air was associated with a 4.5 mm Hg increase in blood pressure.

The blood pressure increase from exposure to traffic-related air pollution (TRAP) was found to peak within 60 minutes and persist for up to 24 hours, according to the researchers from the University of Washington.

“Traffic-related air pollution, even at levels now considered low, appears to cause a substantial increase in blood pressure,” Dr. Joel Kaufman, a study corresponding editor and a University of Washington professor, epidemiologist, and environmental health expert, told Medical News Today. “This is an effect of breathing traffic-related particles, since it was not from the stress of being in a car, driving a car, or noise; the study design is able to account for all those things by using sham filtration vs real filtration, and the subjects were passengers and not drivers.”

“It was stunning how quickly this led to a rise in blood pressure and that it persisted for so long,” Dr. John Higgins, a sports cardiologist at the McGovern Medical School at UTHealth in Houston who was not involved in the study, told Medical News Today. “Maybe we need to think about high efficiency particulate air (HEPA) filters in automobiles or cities doing something about air pollution.”

The study findings suggest that daily commuters breathing unfiltered highway air pollution could be experiencing dangerously elevated blood pressure throughout the workweek and perhaps even more if they drive on the weekends as well, said Higgins.

“Our group has previously showed that diesel exhaust exposure increased blood pressure,” said Kaufman. “The roadway traffic study was designed to test those findings in a real-world setting by isolating the effects of traffic-related air pollution (TRAP).”

TRAP may include ultrafine particles known as PM 2.5, black carbon, oxides of nitrogen, carbon monoxide, carbon dioxide, and other particulate matter.

According to the Environmental Protection Agency (EPA), past studies have suggested that PM 2.5 particles are linked to a wide range of cardiovascular problems, including heart attacks, irregular heartbeat, asthma and other breathing problems, and premature death.

“PM 2.5 particles can get through the lining of blood vessels and into the circulatory system, affecting the heart and vascular tone, including arterial stiffness,” Dr. Loren Wold, a researcher and professor at The Ohio State University Wexner Medical Center who studies the cardiovascular effects of air pollution who wasn’t involved in the study, told Medical News Today. “That’s what causes elevated blood pressure.”

In the experimental study, researchers drove 16 subjects ages 22 to 45 years of age through traffic in Seattle, Washington, for three days.

For two days, unfiltered air was allowed to flow into the vehicle. On the third, a HEPA filter was installed.

Study subjects did not know whether the car had a HEPA filter — which can screen out dangerous PM 2.5 particles along with other pollutants — or an ineffective sham filter.

Blood pressure was monitored up to 24 hours before, during, and after the drives.

Kaufman and his colleagues said they found that the drives in vehicles with unfiltered TRAP were associated with significant net increases in blood pressure compared with drives with HEPA in-vehicle filtration.

The 4.5 mm Hg rise in blood pressure detected was significant, researchers said. For every 20 mm Hg systolic or 10 mm Hg diastolic increase in blood pressure, mortality from heart disease and stroke doubles.

Higgins said the TRAP-related blood pressure increase detected in the study was similar to that caused by poor diet, lack of activity, or smoking.

“These are the size of effects from things like salt in the diet that are well-known to increase blood pressure,” said Kaufman. “Elevated blood pressures are major risk factors for heart disease, stroke, and kidney disease. The concern is partly for each individual, but [also the impact on the whole population. The overall effect of millions of people having these exposures is probably a lot of otherwise preventable cases of stroke, heart attacks, heart failure, and kidney disease.”

The study also demonstrated that the effects of air pollution on blood pressure may be reduced with effective cabin air filtration, Kaufman said.

However, most cars are not equipped with HEPA filters, nor are such passenger cabin air filters available for every make and model of automobile.

“Regular filters don’t work that well in the car, as you can tell when you can smell the exhaust from another vehicle with a bad muffler on the road,” noted Higgins.

“A good practice is to change the cabin air filter in your car just like you do the in-house filter on your furnace,” about once a year, said Wold.

Wold said that while a HEPA cabin air filter would be ideal, even a regular filter can eliminate some PM 2.5 sized particles, especially if the car’s climate control system is set to recirculate cabin air rather than bringing in air from outside the vehicle.

And yes, wearing an N95 mask while driving can also filter out PM 2.5 air pollution particles as well as preventing the spread of communicable diseases such as COVID-19.

The study also highlights the potential health risks of TRAP exposure among people other than automobile drivers or passengers, such as those who live close to highways, factories, or airports, said Kaufman.

Dr. Edo Paz, a cardiologist and senior medical vice president of medical affairs at the online cardiovascular health company Hello Heart, told Medical News Today that there is “some clinical evidence that air filtration in indoor environments is associated with decreases in blood pressure within two weeks.”

Wold said that homeowners in communities with high levels of TRAP can increase the efficiency of their furnace HEPA filters by setting the system to circulate air every 15 minutes or so, rather than turning on the blower only when the heat or air conditioning comes on.

“Any smart thermostat should allow you to set your system on continuous circulation,” he said.

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November 28, 2023

4 min read


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Key takeaways:

  • Allergists should ask patients about the regularity, quantity and quality of their sleep.
  • STOP-BANG assesses eight risk factors that predict obstructive sleep apnea.

ANAHEIM, Calif. — Allergists can screen patients for obstructive sleep apnea, according to a presentation at the American College of Allergy, Asthma & Immunology Annual Scientific Meeting.

“A really terrible question to ask a patient is, ‘How are you sleeping?’” Brian D. Robertson, MD, FACAAI, chief medical officer at NightWare, said during his presentation.



snoring

About 50% of people who snore also have obstructive sleep apnea. Image: Adobe Stock

Instead, he continued, physicians should ask patients if they wake up and go to sleep at the same time every day, how many hours of sleep they get each night, and if they still feel sleepy when they wake up.

Brian D. Robertson

“Ask about the regularity of their sleep, the quantity of their sleep, and the quality of their sleep,” said Robertson, who also is the incoming chair of the ACAAI respiratory sleep-related disorders committee. “If they’re answering, ‘Well, my sleep’s all over the place,’ that’s a problem, and they need to go see a sleep doctor.”

Excessive daytime sleepiness or fatigue is among the most common symptoms of obstructive sleep apnea, Robertson said, and it increases the risks for motor vehicle accidents by a factor of two to seven.

“I was in the military,” Robertson said. “I’ve had patients tell me they’ve fallen asleep flying planes, flying helicopters and, very scary, falling asleep while riding a motorcycle.”

Drowsy driving is a major contributor to risks for these patients and for the people around them, Robertson said.

“Nobody dies of anything in sleep medicine except behind the wheel of a vehicle,” he said.

Fragmented sleep or awakenings, snoring and witnessed apneas also are common symptoms.

Sleep-related choking and gasping are common too, which a lot of people believe is GERD, Robertson continued.

“But reflux is associated with apnea, and we take that seriously too,” he said.

OSA symptoms also include decreased vigilance, loss of cognitive or memory function and impaired concentration, morning dry mouth, mood disorders, morning headaches, GERD, nocturia/enuresis, and impotence or decreased libido.

“If they say, ‘I get, like, less than 6 hours a night’ — adults especially — they need to go see a sleep doctor, too,” Robertson said.

Multiple comorbidities are associated with OSA as well, Robertson continued, including drug-resistant hypertension (83%), congestive heart failure (76%), dysrhythmias (58%), pulmonary hypertension (77%), type 2 diabetes (70%), morbid obesity (males: 90%; females: 50%), and GERD (60%).

Atrial fibrillation (49%), stroke (90%) and trisomy 21 are associated with OSA as well, Robertson continued, all of which indicate the need for polysomnography.

“A good night’s sleep is taken for granted in this country,” Robertson said. “It’s partly electronics, and the fact that we can keep the day going through electricity instead of just when it gets dark, we fall asleep.”

Allergists with concerns about their patients’ sleep can screen for STOP-BANG, which is an acronym of eight risk factors, to determine if they should be referred to a sleep doctor.

The first factor is snoring.

“Do you snore? It’s about 50-50 for sleep apnea,” Robertson said.

Next is tiredness.

“Do you feel tired during the day?” he asked.

Third is observed, as in whether someone has observed the patient stop breathing while they were sleeping.

The fourth factor is high blood pressure, and the fifth is a BMI greater than 35 kg/m2. Sixth is age 50 years or older.

The seventh factor is neck circumference of greater than 43 cm for men and 41 cm for women.

“Men almost always know their neck size because that’s how shirts are sized. Women may not know that so much,” Robertson said.

The final factor is male gender.

“Three or more positive responses here indicates a high risk for sleep apnea,” Robertson said. “If you have a man who snores and sometimes is tired and falls asleep watching TV, that guy needs a sleep study.”

Robertson acknowledged that these criteria are very common, adding that almost every patient who came into his sleep clinic when he was practicing at Walter Reed National Military Center qualified for some kind of sleep study.

“It doesn’t take much,” he said.

Part of this is because it is impossible for patients to judge the quality of their sleep while they are sleeping, Robertson said.

“They don’t give you good histories. They don’t know what’s going on because they’re asleep,” he said. “You really have to put them in a lab to figure things out.”

Allergists can screen children too, Robertson said, with some differences between them and adults.

“Children don’t get really sleepy, like you’d guess. What they get is hyperactive, and they get inattentive,” Robertson said.

Robertson also associated ADHD and allergic rhinitis with OSA.

“You’ve seen these patients in your clinic because kids with allergic rhinitis get diagnosed with ADHD a lot more than kids without allergic rhinitis,” he said. “Especially if they have obesity too.”

Children who have enlarged tonsils may have OSA as well, Robertson said.

“Sleep apnea is fundamentally a mechanical problem. It’s a not enough space problem. There’s not enough space to breathe in the airway,” he said.

When patients fall asleep, their airway relaxes and collapses. But in patients with OSA, Robertson explained, the airway collapses completely, and patients will not be able to breathe unless they wake up.

“The patient wakes up so they can open up their airway and breathe. They fall asleep again, it collapses again, they wake up to breathe,” he said. “You’ll see these chains of events.”

Finally, snoring is another sign of OSA in children.

“Every once in a while, if they have a cold, don’t worry about it,” Robertson said. “But if it’s a chronic problem, that’s something to pay attention to.”

Robertson noted the pressing need caused by the prevalence of OSA, particularly among men, postmenopausal women, and certain populations of children, and why specialists such as allergists should become more involved in its diagnosis.

“There are not enough sleep doctors, frankly, in the world to take care of all of the people who have this particular issue, and we need the help from other clinicians,” he said.


Sources/Disclosures

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Source:

Robertson BD. Sleep apnea and the allergist. Presented at: ACAAI Annual Scientific Meeting; Nov. 9-13, 2023; Anaheim, California.


Disclosures:
Robertson reports employment as chief medical officer of NightWare.

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Jaipur: Vehicles stuck in a traffic jam at Pink City Jaipur ahead of Prime Minister Narendra Modi roadshow for the 'Rajasthan Assembly elections 2023' in Jaipur , Monday, Nov. 20, 2023.(IANS/Ravishankar Vyas)

New York, November 28 (IANS) Breathing unfiltered air from rush-hour traffic can significantly increase passengers’ blood pressure up to 24 hours later, revealed an alarming study, even as New Delhi and the nearby regions of Gurugram, Ghaziabad have been gripped with bad air quality for about a month.

Long-term exposure to traffic-related air pollution -- a complex mixture of exhaust from tailpipes, brake and tire wear, and road dust -- has been linked to increased rates of cardiovascular disease, asthma, lung cancer and death.

The new study, detailed in the Annals of Internal Medicine, showed that the inhalation of traffic-related air pollution while in a car with unfiltered air was associated with a 4.5 mm Hg increase in blood pressure -- comparable to the effect of a high-sodium diet.

This change in blood pressure occurred rapidly, peaked within 60 minutes of exposure, and persisted over 24 hours.

“We know that modest increases in blood pressure like this, on a population level, are associated with a significant increase in cardiovascular disease,” said Joel Kaufman, a physician and professor of environmental and occupational health sciences at University of Washington, US.

“There is a growing understanding that air pollution contributes to heart problems. The idea that roadway air pollution at relatively low levels can affect blood pressure this much is an important piece of the puzzle we’re trying to solve,” he added.

But using high-quality HEPA filters in cars blocked out 86 per cent of particulate pollution, revealed the study. However, the findings raise questions about ultrafine particles, an unregulated and little-understood pollutant that has become a source of growing concern among public health experts.

Traffic-related air pollution contains high concentrations of ultrafine particles -- less than 100 nanometers in diameter, much too small to be seen.

In the study, unfiltered air contained high levels of ultrafine particles, though the overall level of pollution as measured by fine particle concentration (PM 2.5) was relatively low, equivalent to an AQI of 36.

"Ultrafine particles are the pollutant that were most effectively filtered in our experiment -- in other words, where the levels are most dramatically high on the road and low in the filtered environment,” Kaufman said. “So, the hint is that ultrafines may be especially important (for blood pressure). To actually prove that requires further research, but this study provides a very strong clue as to what’s going on," Kaufman said.

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By Dr. Greg Zerovnik

Contributing Writer

11/28/2023 at 12:49 PM

SAN BERNARDINO, CALIF. – A new monoclonal antibody and new anti-viral vaccines are coming for the first time to provide protection against RSV, Respiratory Syncytial (sin-SISH-uhl) Virus. LaSalle Medical Associates clinics will be providing these breakthroughs to patients this fall.

“RSV is a cold-like virus that is usually mild but can put some people in the hospital,” says Dr. Cheryl Emoto, Medical Director of LaSalle Medical Associates. “For the first time this fall, young infants and seniors (those with the highest risk for severe disease) now have a way to prevent it.”

The Centers for Disease Control and Prevention notes that “Most people recover in a week or two, but RSV can be serious. Infants and older adults are more likely to develop severe RSV and need hospitalization. Vaccines are available to protect older adults from severe RSV. Monoclonal antibodies are available to protect infants.”

The CDC goes on to note that RSV is “one of the most common causes of childhood illness and is the most common cause of hospitalization among infants [emphasis ours].” It usually starts in the fall and peaks in the winter, but this can vary.

Monoclonal antibodies and vaccines may now prevent RSV. A monoclonal antibody is a clone of a unique white blood cell (white blood cells are the body’s own infection fighters) given to augment and reinforce the body’s natural defenses. It’s the option available for infants who are entering their first RSV season. They are not used when someone already has RSV.

Up until now, almost all children have contracted RSV by the time they reach 24 months, so the new prevention regimen has the potential to prevent illness and potential complications such as bronchitis and pneumonia, making life easier for both infants and their parents or caretakers.

For older adults, the CDC estimates that between 60 to 100 thousand are hospitalized every year. resulting in 6,000 to 10,000 deaths. The most at-risk cohorts are older adults, adults with chronic heart or lung disease, those with weakened immune systems or certain underlying medical conditions and residents in nursing homes or long-term care facilities.

Complications may include asthma, chronic obstructive pulmonary disease (COPD, a chronic disease of the lungs that makes it hard to breathe), and congestive heart failure—when the heart can’t pump enough blood and oxygen through the body.

Additionally, this year, there is now a regimen for pregnant women that keeps the developing fetus safe from infection. Now is the time to contact your healthcare provider to schedule an appointment for preventive care, especially if you are pregnant, have an infant under 8 months of age or are 60 years of age or older.

LaSalle Medical Associates serves more than 350,000 patients in their clinics and statewide Independent Physicians Association Group (IPA) who are covered by Medi-Cal, Medicare, and Covered California, as well as those covered by Blue Cross, Blue Shield, Brand New Day, Molina, Care 1st, Health Net and Inland Empire Health Plan (IEHP).

LaSalle staff also help people who come into a clinic without any insurance to become enrolled for a variety of state and federal health coverage.

For more information call (909) 890-0407 or go online to LaSalleMedical.com.

Tags: (IEHP)and clinicsand Covered Californiaas well as those covered by Blue CrossasthmaBlue ShieldBrand New DayCare 1stCDCchronic obstructive pulmonary diseaseCOPDdelivering high-quality patient caredoctorsFresnoHealth NethospitalsInland Empire Health PlanKingsLos AngelesMaderamedi-calmedicareMolinaRespiratory Syncytial VirusriversideRSVSan BernardinoSan Bernardino and Tulare counties.

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 The Winter season is wonderful in terms of food and drink, but the risk of some diseases caused by bacteria increases in this season.

Winter Health

The winter season has started. people like the winter season but from a health point of view this season brings with it many risks. health experts say that the risk of certain diseases increases during the winter season. In such a situation, people should be cautious about their health. Let us know which diseases increase the risk in the winter season and which people need to be especially cautious in this cold season.

 

winter season diseases

Many types of viruses and bacteria become active during the winter season. These bacteria enter the body through breathing and make the body sick. Due to this, respiratory infections spread very quickly and widely. In such a situation, the risk of lung infection along with cold increases. Apart from this, people who have weak immunity have an increased risk of getting pneumonia in this season. 

In the winter season, cold and dry air causes diseases like asthma and bronchitis. Migraine pain also triggers more rapidly during the winter season. people who already suffer from headaches or migraine are at risk of migraine attacks in this season. Apart from this, people who have blood pressure problems, their bp may increase more in this season. Due to low temperatures in the winter season, the blood vessels become temporarily thin, due to which the bp increases and there is difficulty in the proper flow of blood in the blood veins.

 Which people should take special care?

During the winter season, special care should be taken by those people whose immune system is weak. people who are suffering from high bp should also take special care at this time. Small children and infants get pneumonia easily in this season, hence special care should be taken of them. people who suffer from asthma, bronchitis, or respiratory diseases should also be cautious about their health during this season.



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SALT LAKE CITY — An inversion is expected to build this week across the Wasatch Front, and Utah schools may keep students inside if the air quality gets too bad.

School nurses and administrators will monitor daily pollution levels.  Pollution levels will be provided by the Utah Department of Environmental Quality. Faculty can also look at other monitoring websites like Purple Air to assess risk levels in their area.

Then, Utah school districts, like Weber and Alpine, will compare that information to inversion air quality index charts from the DEQ. Combining the two pieces of information will help them determine whether kids may play outside or not.

“Just depending on where that [PM 2.5 level] is at on a daily basis will help us determine whether we need to restrict or even eliminate outdoor activities,” said Lane Findley with the Weber County School District.

According to the air quality index chart from the DEQ, some air quality levels may be safe for certain children but harmful to those with respiratory problems like asthma.

Air quality index chart from the Department of Air Quality. air.utah.gov.

(Air quality index chart from the Department of Air Quality. (air.utah.gov.))

Nurses and school administrators will check those daily PM 2.5 particle levels. After that, they will decide whether to keep all children inside or just those children with breathing issues.

Schools are also prepared to keep all children inside during recess if the temperature gets too low for safe outdoor activity.


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traffic pollution
Credit: Unsplash/CC0 Public Domain

For more than a century, American cities have been sliced and diced by high-traffic roadways. Interstate highways and wide arterials are now a defining feature of most metropolitan areas, their constant flow of cars spewing pollution into nearby neighborhoods.

Researchers have only just begun to understand the health risks posed by all that pollution. Long-term exposure to traffic-related air pollution—a complex mixture of exhaust from tailpipes, brake and tire wear, and road dust—has been linked to increased rates of cardiovascular disease, asthma, lung cancer and death.

New research from the University of Washington suggests those health risks are also seen in people traveling busy roads. A study published Nov. 28 in the Annals of Internal Medicine found that unfiltered air from rush-hour traffic significantly increased passengers' blood pressure, both while in the car and up to 24 hours later.

"The body has a complex set of systems to try to keep blood pressure to your brain the same all the time. It's a very complex, tightly regulated system, and it appears that somewhere, in one of those mechanisms, traffic-related air pollution interferes with blood pressure," said Joel Kaufman, a UW physician and professor of environmental and occupational health sciences who led the study.

An earlier experiment by Kaufman's lab found that exposure to diesel exhaust fumes increased blood pressure in a controlled environment. The roadway traffic study was designed to test that finding in a real-world setting by isolating the effects of traffic-related air pollution.

Researchers drove healthy participants between the ages of 22 and 45 through rush-hour Seattle traffic while monitoring their blood pressure. On two of the drives, unfiltered road air was allowed to enter the car, mirroring how many of us drive. On the third, the car was equipped with high-quality HEPA filters that blocked out 86% of particulate pollution. Participants did not know whether they were on a clean air drive or a roadway air drive.

Breathing unfiltered air resulted in net blood pressure increases of more than 4.50 mm Hg (millimeters of mercury) when compared to drives with filtered air. The increase occurred rapidly, peaking about an hour into the drive and holding steady for at least 24 hours. Researchers did not test past the 24-hour mark.

The size of the increase is comparable to the effect of a high-sodium diet.

"We know that modest increases in blood pressure like this, on a population level, are associated with a significant increase in cardiovascular disease," Kaufman said. "There is a growing understanding that air pollution contributes to heart problems. The idea that roadway air pollution at relatively low levels can affect blood pressure this much is an important piece of the puzzle we're trying to solve."

The findings also raise questions about ultrafine particles, an unregulated and little-understood pollutant that has become a source of growing concern among public health experts. Ultrafine particles are less than 100 nanometers in diameter, much too small to be seen. Traffic-related air pollution contains high concentrations of ultrafine particles. In the study, unfiltered air contained high levels of ultrafine particles, though the overall level of pollution as measured by fine particle concentration (PM 2.5) was relatively low, equivalent to an AQI of 36.

"Ultrafine particles are the pollutant that were most effectively filtered in our experiment—in other words, where the levels are most dramatically high on the road and low in the filtered environment," Kaufman said. "So, the hint is that ultrafines may be especially important [for blood pressure]. To actually prove that requires further research, but this study provides a very strong clue as to what's going on."

Traffic-related air pollution is the main cause of air quality variation from community to community in most U.S. metropolitan areas.

"This study is exciting because it takes the gold-standard design for laboratory studies and applies it in an on-roadway setting, answering an important question about the health effects of real-world exposures. Studies on this topic often have a challenging time separating the effects of pollution from other roadway exposures like stress and noise, but with our approach the only difference between drive days was air pollution concentration," said Michael Young, a former UW postdoctoral fellow in the Department of Environmental and Occupational Health Sciences and lead author of the new study. "The findings are valuable because they can reproduce situations that millions of people actually experience every day."

More information:
Blood Pressure Effect of Traffic-Related Air Pollution, Annals of Internal Medicine (2023). DOI: 10.7326/M23-1309

Citation:
Breathing highway air increases blood pressure, research finds (2023, November 27)
retrieved 28 November 2023
from medicalxpress.com/news/2023-11-unfiltered-traffic-related-air-significant-blood.html

This document is subject to copyright. Apart from any fair dealing for the purpose of private study or research, no
part may be reproduced without the written permission. The content is provided for information purposes only.



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Newswise — For more than a century, American cities have been sliced and diced by high-traffic roadways. Interstate highways and wide arterials are now a defining feature of most metropolitan areas, their constant flow of cars spewing pollution into nearby neighborhoods.  

Researchers have only just begun to understand the health risks posed by all that pollution. Long-term exposure to traffic-related air pollution — a complex mixture of exhaust from tailpipes, brake and tire wear, and road dust — has been linked to increased rates of cardiovascular disease, asthma, lung cancer and death.  

New research from the University of Washington suggests those health risks are also seen in people traveling busy roads. A study published Nov. 28 in the Annals of Internal Medicine found that unfiltered air from rush-hour traffic significantly increased passengers’ blood pressure, both while in the car and up to 24 hours later. 

“The body has a complex set of systems to try to keep blood pressure to your brain the same all the time. It’s a very complex, tightly regulated system, and it appears that somewhere, in one of those mechanisms, traffic-related air pollution interferes with blood pressure," said Joel Kaufman, a UW physician and professor of environmental and occupational health sciences who led the study.  

An earlier experiment by Kaufman’s lab found that exposure to diesel exhaust fumes increased blood pressure in a controlled environment. The roadway traffic study was designed to test that finding in a real-world setting by isolating the effects of traffic-related air pollution. 

Researchers drove healthy participants between the ages of 22 and 45 through rush-hour Seattle traffic while monitoring their blood pressure. On two of the drives, unfiltered road air was allowed to enter the car, mirroring how many of us drive. On the third, the car was equipped with high-quality HEPA filters that blocked out 86% of particulate pollution. Participants did not know whether they were on a clean air drive or a roadway air drive. 

Breathing unfiltered air resulted in net blood pressure increases of more than 4.50 mm Hg (millimeters of mercury) when compared to drives with filtered air. The increase occurred rapidly, peaking about an hour into the drive and holding steady for at least 24 hours. Researchers did not test past the 24-hour mark.  

The size of the increase is comparable to the effect of a high-sodium diet. 

“We know that modest increases in blood pressure like this, on a population level, are associated with a significant increase in cardiovascular disease,” Kaufman said. “There is a growing understanding that air pollution contributes to heart problems. The idea that roadway air pollution at relatively low levels can affect blood pressure this much is an important piece of the puzzle we’re trying to solve.” 

The findings also raise questions about ultrafine particles, an unregulated and little-understood pollutant that has become a source of growing concern among public health experts. Ultrafine particles are less than 100 nanometers in diameter, much too small to be seen. Traffic-related air pollution contains high concentrations of ultrafine particles. In the study, unfiltered air contained high levels of ultrafine particles, though the overall level of pollution as measured by fine particle concentration (PM 2.5) was relatively low, equivalent to an AQI of 36.  

"Ultrafine particles are the pollutant that were most effectively filtered in our experiment – in other words, where the levels are most dramatically high on the road and low in the filtered environment,” Kaufman said. “So, the hint is that ultrafines may be especially important [for blood pressure]. To actually prove that requires further research, but this study provides a very strong clue as to what’s going on.” 

Traffic-related air pollution is the main cause of air quality variation from community to community in most U.S. metropolitan areas. 

“This study is exciting because it takes the gold-standard design for laboratory studies and applies it in an on-roadway setting, answering an important question about the health effects of real-world exposures. Studies on this topic often have a challenging time separating the effects of pollution from other roadway exposures like stress and noise, but with our approach the only difference between drive days was air pollution concentration,” said Michael Young, a former UW postdoctoral fellow in the Department of Environmental and Occupational Health Sciences and lead author of the new study. "The findings are valuable because they can reproduce situations that millions of people actually experience every day.” 

This research was funded by the U.S. Environmental Protection Agency and the National Institutes of Health.  

Other authors are Karen Jansen, Kristen Cosselman, James Stewart, Timothy Larson, Coralynn Sack and Sverre Vedal of the UW Department of Environmental and Occupational Health Sciences; Timothy Gould of the UW Department of Civil and Environmental Engineering; and Adam Szpiro of the Department of Biostatistics. 



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Among young children who contract respiratory syncytial virus (RSV) in the first 2 years of life, the risk for developing respiratory morbidity later in childhood is greater among children who contract RSV over the age of 6 months, according to study findings published in Open Forum Infectious Diseases.

Investigators studied children who contracted RSV in their first 2 years of life, exploring which perinatal and sociodemographic factors may have contributed to respiratory morbidity (ie, asthma, wheezing, or acute lower respiratory infection) later in childhood.

The investigators conducted a population-based cohort study using administrative data that included more than a quarter of a million births in Western Australia between 2000 and 2009, with follow-up through December 2012. Children with a confirmed RSV test prior to 2 years of age (n=4151) were included in analysis.

The investigators found as the child age at RSV infection increased, the likelihood of subsequent respiratory morbidity also increased. Compared with children experiencing RSV at less than 3 months of age (IR of subsequent respiratory morbidity, 16.2/1000 child-years; 95% CI, 13.5-19.4), children with first RSV episode at an older age experienced higher rates of subsequent respiratory morbidity (3 months to less than 6 months IR, 17.2/1000 child-years; 6 months to less than 12 months IR, 23.6/1000 child-years; 12 months to less than 24 months IR, 22.4/1000 child-years). 

Early RSV exposure in the first 6 months of life resulted in a relatively lower incidence of later respiratory morbidity compared with RSV exposure after 6 months of age.

Investigators also found that the highest incidence of respiratory morbidity following early-life RSV infection occurred in children 2 to less than 4 years of age (IR, 41.8/1000 child-years; 95% CI, 37.5-46.6), followed by children 4 to less than 6 years of age (IR, 13.0/1000 child-years), and children at least 6 years of age (IR, 5.7/1000 child-years).

Gestational age at birth had the largest influence on the likelihood of experiencing later respiratory morbidity; as gestational age decreased, incidence rates of subsequent respiratory morbidity increased. The highest incidence occurred among children with gestational age less than 28 weeks (IR, 50.8/1000 child-years; 95% CI, 33.5-77.2; gestational age 29 to 32 weeks IR, 30.3/1000 child-years; gestational age 33 to 36 weeks IR, 18.4/1000 child-years; gestational age at least 37 weeks IR, 18.4/1000 child-years).

Overall, the researchers identified the risk factors for subsequent respiratory morbidity as: extreme prematurity (<28 weeks, adjusted hazard ratio [aHR], 2.22; 95% CI, 1.40-3.53), low socioeconomic index (aHR, 1.76), age at first RSV episode (6 to <12 months, aHR, 1.42), and maternal history of asthma (aHR, 1.33).

In comparing respiratory morbidity in boys vs girls, the researcher found that boys testing negative for RSV in the first 2 years of life had a 1.38-times greater risk for later respiratory morbidity vs girls.  In evaluation the effect of a mother who smoked during pregnancy, the researchers found that children of mothers who smoked during pregnancy had a 1.01-times greater risk for later respiratory morbidity than children of mothers who did not smoke.

Study limitations include the use of ICD codes to identify outcomes. Additionally, not all respiratory infection-coded admissions were tested for RSV, which could have resulted in sampling bias.

“Early RSV exposure in the first 6 months of life resulted in a relatively lower incidence of later respiratory morbidity compared with RSV exposure after 6 months of age,” the study authors concluded. “Our results would support a recommendation to offer nirsevimab for children approaching their second RSV season (therefore over the age of 6 months).”

Disclosure: This research was supported by Merck Sharp & Dohme (Australia) Pty. Ltd. Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

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Nov 27 (Reuters) - Chevron (CVX.N) was working to recover operations at a 245,271 barrels per day refinery in Richmond, California, the company said on Monday, after a power cut at the facility triggered the release of large flames and black smoke from smoke stacks.

Flaring activity at Chevron Richmond has stopped, but intermittent flaring is still possible due to operational adjustments at the refinery, the company said on the social platform X, formerly known as Twitter.

It earlier reported a series of unplanned unit shutdowns causing flaring from four smoke stacks, which could potentially lead to a release of sulphur dioxide, in a Hazmat filing.

Smoke was visible in the surrounding community, with the Bay Area Air Quality agency asking residents to avoid smoke exposure after receiving 51 complaints, the pollution control agency said on X.

Short-term exposure to colorless sulphur dioxide can harm the respiratory system and make breathing difficult, the U.S. Environment Protection Agency (EPA) says on its website, posing a risk to sufferers of asthma, particularly children.

Contra Costa County Health Department said in a statement that "the air monitoring does not show any public health impact at this time."

Reporting by Harshit Verma in Bengaluru; Editing by Sandra Maler, Robert Birsel

Our Standards: The Thomson Reuters Trust Principles.

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