No2 exposure and lung function decline in a cohort of adults in Mysore, India

Amruta Nori-Sarma; Rajesh Thimmulappa; G. V. Venkataraman; Joshua L. Warren; Jesse D. Berman; Steve D. Whittaker; Erin R. Kulick; Gregory A. Wellenius; P. A. Mahesh; Michelle L. Bell

doi:10.1088/2515-7620/abf2dd

No₂ exposure and lung function decline in a cohort of adults in Mysore, India

Amruta Nori-Sarma, Rajesh Thimmulappa, G. V. Venkataraman, Joshua L. Warren, Jesse D. Berman, Steve D. Whittaker, Erin R. Kulick, Gregory A. Wellenius, P. A. Mahesh, Michelle L. Bell

Environmental Health Sciences

Research output: Contribution to journal › Article › peer-review

4 Scopus citations

Abstract

Increasing air pollution in low-and middle-income countries (LMICs) may be contributing to worsening respiratory health, yet to date most relevant studies have been conducted in industrialized nations. Particularly, there are few studies for India, the world’s second most populated country, and on this country’s poorest populations, who may be at the highest risk. We investigated the influence of long-term nitrogen dioxide (NO₂) exposure at residential location on lung function decline over a 5-year period in a cohort of low-income adults in Mysore, Karnataka, India. In 2012–2014 and in 2017–2018, we conducted standardized interviews and performed in-home field spirometry before and after bronchodilation. We estimated annual average NO₂ in 2017 based on interpolation of seasonal air pollution sampling and used linear mixed effects models with a person-specific random effect to estimate NO₂ versus lung function cross-sectionally at baseline and longitudinally, adjusting for potential confounders (age at baseline, sex, smoking status, and long-term seasonality). Among healthy participants (with no COPD or asthma based on lung function tests),NO₂ levels were associated with a decline in lung function pre-and post-bronchodilation (−21.7 ml [95% CI: −42.1, −1.3] for FEV1 and −22.2 ml [95% CI: −46.8, 2.3] for FVC pre-bronchodilation, −25.2 ml [95% CI: −48.4, −4.1] for FEV1 and −26.6 ml [95% CI: −51.1, −2.2] for FVC post-bronchodilation) per interquartile range (10 ppb) increase in NO₂. Longitudinal impacts of air pollution on lung function were not statistically significant. Results suggest that air pollution exposure is associated with worse lung function among apparently healthy individuals among urban poor communities in India. Future studies should further characterize time-varying air pollution exposures and collect further longitudinal health data in these understudied communities.

Original language	English (US)
Article number	055001
Journal	Environmental Research Communications
Volume	3
Issue number	5
DOIs	https://doi.org/10.1088/2515-7620/abf2dd
State	Published - Apr 29 2021

Bibliographical note

Funding Information:
This work was funded by the US Environment Protection Agency (Grant number: FP-91782101-0) Science to Achieve Results Fellowship, the Air & Waste Management Association’s Air Quality Research and Study fellowship, the DBT-Ramalingaswami Re-entry Fellowship (to R.T), the Yale Tropical Resources Institute, Yale Macmillan Center, Yale Hixon Center for Urban Ecology, the National Heart, Lung, and Blood Institute of the National Institutes of Health (Grant number: T32HL13462), and the National Institute of Environmental Health Sciences of the National Institutes of Health (Grant number: R01-ES02995). This publication was developed under Assistance Agreement No.RD835871 awarded by the US Environmental Protection Agency to Yale University. It has not been formally reviewed by EPA. The views expressed in this document are solely those of the authors and do not necessarily reflect those of the Agency. EPA does not endorse any products or commercial services mentioned in this publication.

Funding Information:
This work was funded by the US Environment Protection Agency (Grant number: FP-91782101-0) Science to Achieve Results Fellowship, the Air & Waste Management Association?s Air Quality Research and Study fellowship, the DBT-Ramalingaswami Re-entry Fellowship (to R.T), the Yale Tropical Resources Institute, Yale Macmillan Center, Yale Hixon Center for Urban Ecology, the National Heart, Lung, and Blood Institute of the National Institutes of Health (Grant number: T32HL13462), and the National Institute of Environmental Health Sciences of the National Institutes of Health (Grant number: R01-ES02995). This publication was developed under Assistance Agreement No.RD835871 awarded by the US Environmental Protection Agency to Yale University. It has not been formally reviewed by EPA. The views expressed in this document are solely those of the authors and do not necessarily reflect those of the Agency. EPA does not endorse any products or commercial services mentioned in this publication.

Publisher Copyright:
© 2021 The Author(s). Published by IOP Publishing Ltd.

Keywords

Air pollution
Field spirometry
India
Lung function
Vulnerable communities

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This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1088/2515-7620/abf2dd

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@article{9afa92ba515f44ce8996b72fb124212b,

title = "No2 exposure and lung function decline in a cohort of adults in Mysore, India",

abstract = "Increasing air pollution in low-and middle-income countries (LMICs) may be contributing to worsening respiratory health, yet to date most relevant studies have been conducted in industrialized nations. Particularly, there are few studies for India, the world{\textquoteright}s second most populated country, and on this country{\textquoteright}s poorest populations, who may be at the highest risk. We investigated the influence of long-term nitrogen dioxide (NO2) exposure at residential location on lung function decline over a 5-year period in a cohort of low-income adults in Mysore, Karnataka, India. In 2012–2014 and in 2017–2018, we conducted standardized interviews and performed in-home field spirometry before and after bronchodilation. We estimated annual average NO2 in 2017 based on interpolation of seasonal air pollution sampling and used linear mixed effects models with a person-specific random effect to estimate NO2 versus lung function cross-sectionally at baseline and longitudinally, adjusting for potential confounders (age at baseline, sex, smoking status, and long-term seasonality). Among healthy participants (with no COPD or asthma based on lung function tests),NO2 levels were associated with a decline in lung function pre-and post-bronchodilation (−21.7 ml [95% CI: −42.1, −1.3] for FEV1 and −22.2 ml [95% CI: −46.8, 2.3] for FVC pre-bronchodilation, −25.2 ml [95% CI: −48.4, −4.1] for FEV1 and −26.6 ml [95% CI: −51.1, −2.2] for FVC post-bronchodilation) per interquartile range (10 ppb) increase in NO2. Longitudinal impacts of air pollution on lung function were not statistically significant. Results suggest that air pollution exposure is associated with worse lung function among apparently healthy individuals among urban poor communities in India. Future studies should further characterize time-varying air pollution exposures and collect further longitudinal health data in these understudied communities.",

keywords = "Air pollution, Field spirometry, India, Lung function, Vulnerable communities",

author = "Amruta Nori-Sarma and Rajesh Thimmulappa and Venkataraman, {G. V.} and Warren, {Joshua L.} and Berman, {Jesse D.} and Whittaker, {Steve D.} and Kulick, {Erin R.} and Wellenius, {Gregory A.} and Mahesh, {P. A.} and Bell, {Michelle L.}",

note = "Funding Information: This work was funded by the US Environment Protection Agency (Grant number: FP-91782101-0) Science to Achieve Results Fellowship, the Air & Waste Management Association{\textquoteright}s Air Quality Research and Study fellowship, the DBT-Ramalingaswami Re-entry Fellowship (to R.T), the Yale Tropical Resources Institute, Yale Macmillan Center, Yale Hixon Center for Urban Ecology, the National Heart, Lung, and Blood Institute of the National Institutes of Health (Grant number: T32HL13462), and the National Institute of Environmental Health Sciences of the National Institutes of Health (Grant number: R01-ES02995). This publication was developed under Assistance Agreement No.RD835871 awarded by the US Environmental Protection Agency to Yale University. It has not been formally reviewed by EPA. The views expressed in this document are solely those of the authors and do not necessarily reflect those of the Agency. EPA does not endorse any products or commercial services mentioned in this publication. Funding Information: This work was funded by the US Environment Protection Agency (Grant number: FP-91782101-0) Science to Achieve Results Fellowship, the Air & Waste Management Association?s Air Quality Research and Study fellowship, the DBT-Ramalingaswami Re-entry Fellowship (to R.T), the Yale Tropical Resources Institute, Yale Macmillan Center, Yale Hixon Center for Urban Ecology, the National Heart, Lung, and Blood Institute of the National Institutes of Health (Grant number: T32HL13462), and the National Institute of Environmental Health Sciences of the National Institutes of Health (Grant number: R01-ES02995). This publication was developed under Assistance Agreement No.RD835871 awarded by the US Environmental Protection Agency to Yale University. It has not been formally reviewed by EPA. The views expressed in this document are solely those of the authors and do not necessarily reflect those of the Agency. EPA does not endorse any products or commercial services mentioned in this publication. Publisher Copyright: {\textcopyright} 2021 The Author(s). Published by IOP Publishing Ltd.",

year = "2021",

month = apr,

day = "29",

doi = "10.1088/2515-7620/abf2dd",

language = "English (US)",

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journal = "Environmental Research Communications",

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T1 - No2 exposure and lung function decline in a cohort of adults in Mysore, India

AU - Nori-Sarma, Amruta

AU - Thimmulappa, Rajesh

AU - Venkataraman, G. V.

AU - Warren, Joshua L.

AU - Berman, Jesse D.

AU - Whittaker, Steve D.

AU - Kulick, Erin R.

AU - Wellenius, Gregory A.

AU - Mahesh, P. A.

AU - Bell, Michelle L.

N1 - Funding Information: This work was funded by the US Environment Protection Agency (Grant number: FP-91782101-0) Science to Achieve Results Fellowship, the Air & Waste Management Association’s Air Quality Research and Study fellowship, the DBT-Ramalingaswami Re-entry Fellowship (to R.T), the Yale Tropical Resources Institute, Yale Macmillan Center, Yale Hixon Center for Urban Ecology, the National Heart, Lung, and Blood Institute of the National Institutes of Health (Grant number: T32HL13462), and the National Institute of Environmental Health Sciences of the National Institutes of Health (Grant number: R01-ES02995). This publication was developed under Assistance Agreement No.RD835871 awarded by the US Environmental Protection Agency to Yale University. It has not been formally reviewed by EPA. The views expressed in this document are solely those of the authors and do not necessarily reflect those of the Agency. EPA does not endorse any products or commercial services mentioned in this publication. Funding Information: This work was funded by the US Environment Protection Agency (Grant number: FP-91782101-0) Science to Achieve Results Fellowship, the Air & Waste Management Association?s Air Quality Research and Study fellowship, the DBT-Ramalingaswami Re-entry Fellowship (to R.T), the Yale Tropical Resources Institute, Yale Macmillan Center, Yale Hixon Center for Urban Ecology, the National Heart, Lung, and Blood Institute of the National Institutes of Health (Grant number: T32HL13462), and the National Institute of Environmental Health Sciences of the National Institutes of Health (Grant number: R01-ES02995). This publication was developed under Assistance Agreement No.RD835871 awarded by the US Environmental Protection Agency to Yale University. It has not been formally reviewed by EPA. The views expressed in this document are solely those of the authors and do not necessarily reflect those of the Agency. EPA does not endorse any products or commercial services mentioned in this publication. Publisher Copyright: © 2021 The Author(s). Published by IOP Publishing Ltd.

PY - 2021/4/29

Y1 - 2021/4/29

N2 - Increasing air pollution in low-and middle-income countries (LMICs) may be contributing to worsening respiratory health, yet to date most relevant studies have been conducted in industrialized nations. Particularly, there are few studies for India, the world’s second most populated country, and on this country’s poorest populations, who may be at the highest risk. We investigated the influence of long-term nitrogen dioxide (NO2) exposure at residential location on lung function decline over a 5-year period in a cohort of low-income adults in Mysore, Karnataka, India. In 2012–2014 and in 2017–2018, we conducted standardized interviews and performed in-home field spirometry before and after bronchodilation. We estimated annual average NO2 in 2017 based on interpolation of seasonal air pollution sampling and used linear mixed effects models with a person-specific random effect to estimate NO2 versus lung function cross-sectionally at baseline and longitudinally, adjusting for potential confounders (age at baseline, sex, smoking status, and long-term seasonality). Among healthy participants (with no COPD or asthma based on lung function tests),NO2 levels were associated with a decline in lung function pre-and post-bronchodilation (−21.7 ml [95% CI: −42.1, −1.3] for FEV1 and −22.2 ml [95% CI: −46.8, 2.3] for FVC pre-bronchodilation, −25.2 ml [95% CI: −48.4, −4.1] for FEV1 and −26.6 ml [95% CI: −51.1, −2.2] for FVC post-bronchodilation) per interquartile range (10 ppb) increase in NO2. Longitudinal impacts of air pollution on lung function were not statistically significant. Results suggest that air pollution exposure is associated with worse lung function among apparently healthy individuals among urban poor communities in India. Future studies should further characterize time-varying air pollution exposures and collect further longitudinal health data in these understudied communities.

AB - Increasing air pollution in low-and middle-income countries (LMICs) may be contributing to worsening respiratory health, yet to date most relevant studies have been conducted in industrialized nations. Particularly, there are few studies for India, the world’s second most populated country, and on this country’s poorest populations, who may be at the highest risk. We investigated the influence of long-term nitrogen dioxide (NO2) exposure at residential location on lung function decline over a 5-year period in a cohort of low-income adults in Mysore, Karnataka, India. In 2012–2014 and in 2017–2018, we conducted standardized interviews and performed in-home field spirometry before and after bronchodilation. We estimated annual average NO2 in 2017 based on interpolation of seasonal air pollution sampling and used linear mixed effects models with a person-specific random effect to estimate NO2 versus lung function cross-sectionally at baseline and longitudinally, adjusting for potential confounders (age at baseline, sex, smoking status, and long-term seasonality). Among healthy participants (with no COPD or asthma based on lung function tests),NO2 levels were associated with a decline in lung function pre-and post-bronchodilation (−21.7 ml [95% CI: −42.1, −1.3] for FEV1 and −22.2 ml [95% CI: −46.8, 2.3] for FVC pre-bronchodilation, −25.2 ml [95% CI: −48.4, −4.1] for FEV1 and −26.6 ml [95% CI: −51.1, −2.2] for FVC post-bronchodilation) per interquartile range (10 ppb) increase in NO2. Longitudinal impacts of air pollution on lung function were not statistically significant. Results suggest that air pollution exposure is associated with worse lung function among apparently healthy individuals among urban poor communities in India. Future studies should further characterize time-varying air pollution exposures and collect further longitudinal health data in these understudied communities.

KW - Air pollution

KW - Field spirometry

KW - India

KW - Lung function

KW - Vulnerable communities

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