Human health effects of air pollution

Background: Pulmonary rehabilitation is recognized as a core component of the management of individuals with chronic respiratory disease. Since the 2006 American Thoracic Society (ATS)/European Respiratory Society (ERS) Statement on Pulmonary Rehabilitation, there has been considerable growth in our knowledge of its efficacy and scope.

Purpose: The purpose of this Statement is to update the 2006 document, including a new definition of pulmonary rehabilitation and highlighting key concepts and major advances in the field.

Methods: A multidisciplinary committee of experts representing the ATS Pulmonary Rehabilitation Assembly and the ERS Scientific Group 01.02, “Rehabilitation and Chronic Care,” determined the overall scope of this update through group consensus. Focused literature reviews in key topic areas were conducted by committee members with relevant clinical and scientific expertise. The final content of this Statement was agreed on by all members.

Results: An updated definition of pulmonary rehabilitation is proposed. New data are presented on the science and application of pulmonary rehabilitation, including its effectiveness in acutely ill individuals with chronic obstructive pulmonary disease, and in individuals with other chronic respiratory diseases. The important role of pulmonary rehabilitation in chronic disease management is highlighted. In addition, the role of health behavior change in optimizing and maintaining benefits is discussed.

Conclusions: The considerable growth in the science and application of pulmonary rehabilitation since 2006 adds further support for its efficacy in a wide range of individuals with chronic respiratory disease

Read More: http://www.atsjournals.org/doi/abs/10.1164/rccm.201309-1634ST

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An official American thoracic society/European respiratory society statement: Key concepts and advances in pulmonary rehabilitation

Air pollution is a heterogeneous, complex mixture of gases, liquids, and particulate matter. Epidemiological studies have demonstrated a consistent increased risk for cardiovascular events in relation to both short- and long-term exposure to present-day concentrations of ambient particulate matter. Several plausible mechanistic pathways have been described, including enhanced coagulation/thrombosis, a propensity for arrhythmias, acute arterial vasoconstriction, systemic inflammatory responses, and the chronic promotion of atherosclerosis. The purpose of this statement is to provide healthcare professionals and regulatory agencies with a comprehensive review of the literature on air pollution and cardiovascular disease. In addition, the implications of these findings in relation to public health and regulatory policies are addressed. Practical recommendations for healthcare providers and their patients are outlined. In the final section, suggestions for future research are made to address a number of remaining scientific questions.

https://cdr.lib.unc.edu/downloads/n870zt13s

Air Pollution and Cardiovascular Disease A Statement for Healthcare Professionals From the Expert Panel on Population and Prevention Science of the American Heart Association

Lung function testing: selection of reference values and interpretative strategies.

INTRODUCTION Herein is the discussion of the 2006 A&WMA Critical Review1,2 on “Health Effects of Fine Particulate Air Pollution: Lines that Connect.” In the review, Drs. C. Arden Pope III and Douglas Dockery addressed the epidemiological evidence for the effects of particulate matter (PM) on human health indicators. The review documents substantial progress since the 1997 Critical Review3 in the areas of: (1) short-term exposure and mortality; (2) long-term exposure and mortality; (3) time scales of exposure; (4) the shape of the concentration-response function; (5) cardiovascular disease; and (6) biological plausibility. Invited and contributing discussants agree and disagree with points made in the review. Each discussion is self-contained and adds information relevant to the topic. Joint authorship of this article does not imply that a discussant subscribes to the opinions expressed by others. Commentaries are the opinions of the author only and do not necessarily reflect the positions of their respective organizations. In particular, Dr. Costa’s comments have not been reviewed by U.S. Environmental Protection Agency (EPA) and do not reflect official positions or policies of the agency. CRITICAL REVIEW DISCUSSION ISSN 1047-3289 J. Air & Waste Manage. Assoc. 56:1368–1380

Health effects of fine particulate air pollution: line that connect

BACKGROUND: Inspiratory muscle weakness is a recognised cause of unexplained dyspnoea. It may be suggested by the finding of a low static inspiratory mouth pressure (MIP), but MIP is a difficult test to perform, with a wide normal range; a low MIP may also occur if the patient has not properly performed the manoeuvre. Further investigation conventionally requires balloon catheters to obtain oesophageal (Poes) and transdiaphragmatic pressure (Pdi) during sniffs or phrenic nerve stimulation. Two non-invasive tests of inspiratory muscle strength have recently been described--nasal pressure during a maximal sniff (Sn Pnas) and mouth pressure during magnetic stimulation of the phrenic nerves (Tw Pmo). The use of these two tests in combination might identify patients without inspiratory muscle weakness who are unable to produce a satisfactory MIP or = 80 cm H20 or a Tw Pdi of > or = 20 cm H20. The limit values used to test the hypothesis were Sn Pnas > or = 70 cm H20 or Tw Pmo > or = 12 cm H20. RESULTS: Inspiratory muscle weakness was excluded in 17 of the 30 patients. Fifteen of these would have been identified using Sn Pnas and Tw Pmo, with better results when the two tests were combined. The cut off values selected for Sn Pnas and Tw Pmo were shown by ROC plots to indicate normal strength conservatively, avoiding failure to detect mild degrees of weakness. No patient with global weakness was considered normal by Sn Pnas or Tw Pmo. CONCLUSIONS: In most patients with normal inspiratory strength and a low MIP, Tw Pmo and Sn Pnas used in combination can reliably exclude global inspiratory muscle weakness, reducing the number of patients who need testing with balloon catheters.

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Measurement of sniff nasal and diaphragm twitch mouth pressure in patients.

Every year thousands of doctors and scientists fly to meetings at distant locations. Malcolm Green argues that this is no longer justifiable or necessary, but James Drife (doi: 10.1136/bmj.a351)believes face to face contact is hard to replace

/pdf/are-international-medical-conferences-an-outdated-luxury-the-2dtzofo5mi.pdf

Are international medical conferences an outdated luxury the planet can’t afford? Yes

Malcolm Green revisits an 1848 study of cod liver oil in the treatment of tuberculosis

The Royal Brompton Hospital is well known for studies evaluating the use of streptomycin and other chemotherapy for tuberculosis (TB) in the 1940s to 1960s, but it is less widely known that the physicians at the hospital were already investigating treatments for TB 100 years earlier. This is a report of a study conducted in 1848.



Fig 1 Hospital for Consumption and Diseases of the Chest, Brompton



In their report, the medical officers felt it their duty to bear testimony to the judgement evinced in the selection of the site for the hospital: The hospital is built on a dry gravelly soil, in a suburb of the metropolis long celebrated for its salubrity, sheltered on the north and east by the metropolis and open to the south and west; the wards are lofty and the corridors light and capacious .

542 inpatients with consumption were treated with cod liver oil, in a dose of 1 drachm (3.6 ml) three times a day, gradually increased, in some few cases up to 1.5 ozs (42 ml) per dose. The oil is straw coloured, transparent and free from offensive smell. Patients take it in general …

https://www.bmj.com/content/bmj/343/bmj.d7505.full.pdf

Cod liver oil and tuberculosis

The branching network of airways in the lung poses a complex challenge to both physiologists and physicians. Measurements of lung function have been made for nearly 200 years. Davy (1800) and Hutchinson (1844) were amongst the first to recognise and measure lung volumes. Despite these early discoveries, progress in understanding pulmonary physiology was intermittent. Rohrer (1925) and Rahn (1946) established the concepts of pressure and volume relationships in the lung and Rohrer alluded to the possibility of volume dependent airways resistance, although he did not live long enough to make these measurements himself.1 2 In fact, it was not until the 1960s that the issue of airways resistance was resolved and the distinction drawn between the large and small airways.3 4Small airways are usually defined as those airways of less than 2 mm internal diameter and equate to generations 12–23 of Weibel’s model of lung architecture.3 Although the small airways are themselves tiny, the dichotomously branching pattern of the tracheobronchial tree results in increasingly large numbers of airways in peripheral generations. This results in very low resistance of each generation of small airways, so that in total they contribute only about 10% of the total airway resistance of the tracheobronchial tree.5 6 Thus, most of the small airways can be damaged or destroyed before symptoms occur and before any of the conventional tests of lung function, in particular measurements of airway resistance, show loss of function. This led …

https://thorax.bmj.com/content/thoraxjnl/53/8/629.full.pdf

Small airways: a time to revisit?

A patient with a malignant mesothelioma developed the syndrome of inappropriate secretion of antidiuretic hormone. The electrolyte abnormalities were corrected by treatment with demethylchlortetracycline. Arginine vasopressin concentrations were increased in serum and urine. It is suggested that the syndrome might have been mediated by secretion of antidiuretic hormone from the posterior pituitary, because arginine vasopressin was not detected in the patient's tumor using a sensitive radioimmunoassay.

Malcolm Green

Papers

Measurement of sniff nasal and diaphragm twitch mouth pressure in patients.

Are international medical conferences an outdated luxury the planet can’t afford? Yes

Cod liver oil and tuberculosis

Small airways: a time to revisit?

Mesothelioma Associated with the Syndrome of Inappropriate Secretion of Antidiuretic Hormone1,2