Advertisement

Air pollutants and atmospheric pressure increased risk of ED visit for spontaneous pneumothorax

Published:April 14, 2018DOI:https://doi.org/10.1016/j.ajem.2018.04.020

      Abstract

      Objective

      To investigate the impact of short-term exposure to air pollutants and meteorological variation on ED visits for primary spontaneous pneumothorax (PSP).

      Material and methods

      We retrospectively identified PSP cases that presented at the ED of our tertiary center between January 2015 and September 2016. We classified the days into three types: no PSP day (0 case/day), sporadic days (1–2 cases/day), and cluster days (PSP, ≥3 cases/day). Association between the daily incidence of PSP with air pollutants and meteorological data were determined using Poisson generalized-linear-model to calculate incidence rate ratio (IRRs) and the use of time-series (lag-1 [the cumulative air pollution level on the previous day of PSP], lag-2 [two days ago], and lag-3 [three days ago]).

      Results

      Using multivariate logistic regression analysis, O3 (p = 0.010), NO2 (p = 0.047), particulate matters (PM)10 (p = 0.021), and PM2.5 (p = 0.008) were significant factors of PSP occurrence. When the concentration of O3, NO2, PM10, and PM2.5 were increased, PSP IRRs increased approximately 15, 16, 3, and 5-fold, respectively. With the time-series analyses, atmospheric pressure in lag-3 was significantly lower and in lag-2, was significantly higher in PSP days compared with no PSP days. Among air pollutant concentrations, O3 in lag-1 (p = 0.017) and lag-2 (p = 0.038), NO2 in lag-1 (p = 0.015) and lag-2 (p = 0.009), PM10 in lag-1 (p = 0.012), and PM2.5 in lag-1 (p = 0.021) and lag-2 (p = 0.032) were significantly different between no PSP and PSP days.

      Conclusion

      Increased concentrations of air pollutants and abrupt change in atmospheric pressure were significantly associated with increased IRR of PSP.

      Keywords

      To read this article in full you will need to make a payment
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to The American Journal of Emergency Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Ozpolat B.
        Is the onset of spontaneous pneumothorax influenced by air pollution meteorological changes, or both?.
        J Thorac Dis. 2010; 2: 1-4
        • Özpolat B.
        • Gözübüyük A.
        • Koçer B.
        • Yazkan R.
        • Dural K.
        • Genç O.
        Meteorologic conditions related to the onset of spontaneous pneumothorax.
        Tohoku J Exp Med. 2009; 217: 329-334
        • Tosca M.A.
        • Ruffoni S.
        • Canonica G.W.
        • Ciprandi G.
        Asthma exacerbation in children: relationship among pollens, weather, and air pollution.
        Allergol Immunopathol. 2014; 42: 362-368
        • Spengos K.
        • Sameli S.
        • Stouraitis G.
        • Kolias A.
        • Koulouri O.
        • Kokkinos Z.
        • et al.
        Seasonal variation of Bell's palsy in Athens, Greece - a hospital-based retrospective evaluation over fifteen years.
        Eur Neurol. 2006; 55: 84-88
        • Yang J.
        • Zhou M.
        • Ou C.Q.
        • Yin P.
        • Li M.
        • Tong S.
        • et al.
        Seasonal variations of temperature-related mortality burden from cardiovascular disease and myocardial infarction in China.
        Environ Pollut. 2017; 224: 400-406
        • Wang W.M.
        • Chen J.
        • Cai R.
        Air quality and acute myocardial infarction in adults during the 2016 Hangzhou G20 summit.
        Environ Sci Pollut Res Int. 2018 Jan; : 27
        • Knezović M.
        • Pintarić S.
        • Mornar Jelavić M.
        • Nesek V.
        • Krstačić G.
        • Vrsalović M.
        • et al.
        Correlation between concentration of air pollutants and occurrence of cardiac arrhythmias in a region with humid continental climate.
        Acta Clin Croat. 2017; 56: 3-9
        • Xia R.
        • Zhou G.
        • Zhu T.
        • Li X.
        • Wang G.
        Ambient air pollution and out-of-hospital cardiac arrest in Beijing, China.
        Int J Environ Res Public Health. 2017; 14: 423
        • Vert C.
        • Sánchez-Benavides G.
        • Martínez D.
        • Gotsens X.
        • Gramunt N.
        • Cirach M.
        • et al.
        Effect of long-term exposure to air pollution on anxiety and depression in adults: a cross-sectional study.
        Int J Hyg Environ Health. 2017; 220: 1074-1080
        • Vert C.
        • Sánchez-Benavides G.
        • Martínez D.
        • Gotsens X.
        • Gramunt N.
        • Cirach M.
        • et al.
        To investigate the effects of air pollution (PM10 and SO2) on the respiratory diseases asthma and chronic obstructive pulmonary disease.
        Turk Thorac J. 2017; 18: 33-39
        • Bobbio A.
        • Dechartres A.
        • Bouam S.
        • Damotte D.
        • Rabbat A.
        • Régnard J.F.
        • et al.
        Epidemiology of spontaneous pneumothorax: gender-related differences.
        Thorax. 2015; 70: 653-658
        • Scott G.C.
        • Berger R.
        • McKean H.E.
        The role of atmospheric pressure variation in the development of spontaneous pneumothoraces.
        Am Rev Respir Dis. 1989; 139: 659-662
        • Suarez-Varel M.M.
        • Martinez-Selva M.I.
        • Llopis-Gonzalez A.
        • Martinez-Jimeno J.L.
        • Plaza-Valia P.
        Spontaneous pneumothorax related with climatic characteristics in the Valencia area (Spain).
        Eur J Epidemiol. 2000; 16: 193-198
        • Bense L.
        Spontaneous pneumothorax related to falls in atmospheric pressure.
        Eur J Respir Dis. 1984; 65: 544-546
        • Smit H.J.
        • Devillé W.L.
        • Schramel F.M.
        • Schreurs A.J.
        • Sutedja T.G.
        • Postmus P.E.
        Atmospheric pressure changes and outdoor temperature changes in relation to spontaneous pneumothorax.
        Chest. 1999; 116: 676-681
        • Alifano M.
        • Forti Parri S.N.
        • Bonfanti B.
        • Arab W.A.
        • Passini A.
        • Boaron M.
        • et al.
        Atmospheric pressure influences the risk of pneumothorax: beware of the storm!.
        Chest. 2007; 131: 1877-1882
        • Abbey D.E.
        • Petersen F.F.
        • Mills P.K.
        • Beeson W.
        Long-term ambient concentrations of total suspended particulates, ozone, and sulfur dioxide and respiratory symptoms in a non-smoking population.
        Arch Environ Health. 1993; 48: 33-46
        • Abbey D.E.
        • Hwang B.L.
        • Burchette R.J.
        Estimated long-term ambient concentrations of PM10 and development of respiratory symptoms in a nonsmoking population.
        Arch Environ Health. 1995; 50: 139-150
        • Bertolaccini L.
        • Cassardo C.
        • Viti A.
        • Terzi A.
        The relationship between meteorological variations and the onset of spontaneous pneumothorax.
        Surg Today. 2013; 43: 345-346
        • OECD
        Regional population density: Asia and Oceania, 2012, inhabitants per square kilometre, TL3 regions.
        OECD Publishing, 2013
        • Environmental Performance Index
        ([accessed on Jan 10, 2018. Yale University: http://epi.yale.edu/])
        • WHO
        Ambient (outdoor) air quality and health.
        in: World Health Organization fact sheets. 2014
        • Pradeau C.
        • Rondeau V.
        • Lévèque E.
        • Guernion P.Y.
        • Tentillier E.
        • Thicoipé M.
        Air pollution and activation of mobile medical team for out-of-hospital cardiac arrest.
        Am J Emerg Med. 2015; 33: 367-372
        • Raza A.
        • Bellander T.
        • Bero-Bedada G.
        • Ishimatsu S.
        • Nakamura T.
        • Birrer R.B.
        Short-term effects of air pollution on out-of-hospital cardiac arrest in Stockholm.
        Eur Heart J. 2014; 35: 861-868
        • Abe T.
        • Tokuda Y.
        • Ohde S.
        • Ishimatsu S.
        • Nakamura T.
        • Birrer R.B.
        The relationship of short-term air pollution and weather to ED visits for asthma in Japan.
        Am J Emerg Med. 2009; 27: 153-159
        • Hasunuma H.
        • Yamazaki S.
        • Tamura K.
        • Hwang Y.H.
        • Ono R.
        • Amimoto Y.
        • et al.
        Association between daily ambient air pollution and respiratory symptoms in children with asthma and healthy children in western Japan.
        J Asthma. 2018; ([Epub ahead of print])https://doi.org/10.1080/02770903.2017.1369988
        • Bertolaccini L.
        • Alemanno L.
        • Rocco G.
        • Cassardo C.
        Air pollution, weather variations and primary spontaneous pneumothorax.
        J Thorac Dis. 2010; 2: 9-15
        • Shim J.M.
        • Park S.U.
        Acidic loadings in south Korean ecosystems by long-range transport and local emissions.
        Atmos Environ. 2004; 38: 5623-5636
        • Bertolaccini L.
        • Viti A.
        • Boschetto L.
        • Pasini A.
        • Attanasio A.
        • Terzi A.
        • et al.
        Analysis of spontaneous pneumothorax in the city of Cuneo: environmental correlations with meteorological and air pollutant variables.
        Surg Today. 2015; 45: 625-629
        • Bulajich B.
        • Subotich D.
        • Mandarich D.
        • Kljajich R.V.
        • Gajich M.
        Influence of atmospheric pressure, outdoor temperature, and weather phases on the onset of spontaneous pneumothorax.
        Ann Epidemiol. 2005; 15: 185-190