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• W4224780980 abstract "The 2018 Lancet Commission on Pollution and Health recognized that exposure to pollution is “the largest environmental cause of disease and premature death in the world today.”1Landrigan P.J. Fuller R. Acosta N.J.R. Adeyi O. Arnold R. Basu N.N. et al.The Lancet Commission on Pollution and Health.Lancet. 2018; 391: 462-512Abstract Full Text Full Text PDF PubMed Scopus (1879) Google Scholar With increasing economic development in low- and middle-income countries, the burden of rising levels of air pollution on respiratory health in large sectors of the global population has been largely unexplored. In the current issue of the Journal of Allergy and Clinical Immunology, Wang et al report their findings on the association between asthma prevalence and average exposure to particulate matter (PM) less than or equal to 2.5 μm (PM2.5) and its individual constituents (black carbon, organic carbon, sulfate, ammonium [NH4+], and nitrate) from the World Health Organization’s Study on Global Ageing and Adult Health cohort.2Wang X. Guo Y. Cai M. Qian Z.M. Zhang S. Zhang Z. et al.Constituents of fine particulate matter and asthma in six low- and middle-income countries.J Allergy Clin Immunol. 2022; 150: 214-222Abstract Full Text Full Text PDF Scopus (7) Google Scholar This large cross-sectional study includes survey data from more than 45,000 adults from low- and middle-income countries, including China, Ghana, India, Mexico, Russia, and South Africa. Most studies use PM mass concentration as their metric of exposure, but given the heterogenous makeup of PM, recent evidence suggests that individual components of PM may be more harmful than others, such that the true impact of PM on asthma may be missed by focusing on PM mass concentration alone.3Lavigne E. Talarico R. van Donkelaar A. Martin R.V. Stieb D.M. Crighton E. et al.Fine particulate matter concentration and composition and the incidence of childhood asthma.Environ Int. 2021; 152: 106486Crossref PubMed Scopus (20) Google Scholar In addition to confirming that exposure to elevated levels of PM2.5 were associated with increased odds of self-reported asthma, Wang et al2Wang X. Guo Y. Cai M. Qian Z.M. Zhang S. Zhang Z. et al.Constituents of fine particulate matter and asthma in six low- and middle-income countries.J Allergy Clin Immunol. 2022; 150: 214-222Abstract Full Text Full Text PDF Scopus (7) Google Scholar found that each of the 5 individual constituents measured were also associated with increased odds of asthma. Of the components examined, NH4+ was associated with the highest adjusted OR of asthma for every increase of 1 SD in NH4+ (adjusted odds ratio = 1.28 [95% CI = 1.17-1.41]). A counterfactual analysis was applied to estimate the number of preventable asthma cases associated with each PM2.5 component by hypothetically setting pollutant concentrations to the fifth percentile of the range of measured levels. Using this approach, Wang et al2Wang X. Guo Y. Cai M. Qian Z.M. Zhang S. Zhang Z. et al.Constituents of fine particulate matter and asthma in six low- and middle-income countries.J Allergy Clin Immunol. 2022; 150: 214-222Abstract Full Text Full Text PDF Scopus (7) Google Scholar found that reductions of black carbon, sulfate, and NH4+ in PM2.5 were associated with the largest decrease in asthma cases; reduction of NH4+ had the largest effect seen among the 5 constituents, with a 22% decline (95% CI = 18.64%-25.84%) in asthma cases, suggesting that NH4+ exposure may be particularly harmful for asthma. This study has several strengths, including the large size of the cohort, approximately equal distribution of urban and rural sites, and multinational design with inclusion of low- and middle-income countries that have not been sufficiently represented in previous studies. Importantly, this study excluded children and did not take into account the relationship between cumulative exposure to PM2.5 over the lifetime and odds of asthma. It is conceivable that the reduction in asthma incidence observed may be an underestimation of the true effect. Other limitations of the study include the lack of data on age of asthma onset, asthma severity, health care expenditures attributable to pollutant exposure, and the presence or absence of comorbid chronic obstructive pulmonary disease (COPD). Exposure to PM over the 3-year period of observation is less relevant to the discussion of asthma incidence in adults who had onset of asthma in childhood. The relationship between asthma prevalence and exposure to PM components may have been confounded by the presence of COPD, as the 2 diseases can occur together, and the symptoms of both diseases are often similar and difficult to distinguish from one another. The finding that NH4+ exposure may be particularly harmful for asthma is supported by emerging literature on the detrimental effects of ammonia (NH3) emissions on human health, including increased mortality4Masselot P. Sera F. Schneider R. Kan H. Lavigne E. Stafoggia M. et al.Differential mortality risks associated with PM2.5 components: a multi-country, multi-city study.Epidemiology. 2022; 33: 167-175Crossref PubMed Scopus (6) Google Scholar and premature death.5Gu B. Zhang L. Van Dingenen R. Vieno M. Van Grinsven H.J. Zhang X. et al.Abating ammonia is more cost-effective than nitrogen oxides for mitigating PM2.5 air pollution.Science. 2021; 374: 758-762Crossref PubMed Scopus (58) Google Scholar NH3 can drift long distances and react with atmospheric sulfur dioxide and nitrate oxidants in urban areas to form NH4+, a component of PM2.5 that then settles as smog. PM elicits bronchospasm and increased mucus production, which are hallmarks of asthma (Fig 1). Globally, NH3 emissions are largely (90%) attributable to agricultural sources such as animal manure and crop fertilizer and, to a lesser extent, to burning of fossil fuels.6Behera S.N. Sharma M. Aneja V.P. Balasubramanian R. Ammonia in the atmosphere: a review on emission sources, atmospheric chemistry and deposition on terrestrial bodies.Environ Sci Pollut Res Int. 2013; 20: 8092-8131Crossref PubMed Scopus (532) Google Scholar Because of the increased demand for animal products worldwide and use of chemical fertilizers, agricultural NH3 emissions have increased greatly since the 1960s, resulting in greater contribution of NH3 to PM2.5,5Gu B. Zhang L. Van Dingenen R. Vieno M. Van Grinsven H.J. Zhang X. et al.Abating ammonia is more cost-effective than nitrogen oxides for mitigating PM2.5 air pollution.Science. 2021; 374: 758-762Crossref PubMed Scopus (58) Google Scholar outpacing the contribution of the primarily fossil fuel–derived nitrogen oxides. A global analysis found that from 1990 to 2013, reactive nitrogen constituents of PM2.5 pollution increased the most in areas with rapid economic development including Asia, South America, and South Africa.5Gu B. Zhang L. Van Dingenen R. Vieno M. Van Grinsven H.J. Zhang X. et al.Abating ammonia is more cost-effective than nitrogen oxides for mitigating PM2.5 air pollution.Science. 2021; 374: 758-762Crossref PubMed Scopus (58) Google Scholar The findings of Wang et al2Wang X. Guo Y. Cai M. Qian Z.M. Zhang S. Zhang Z. et al.Constituents of fine particulate matter and asthma in six low- and middle-income countries.J Allergy Clin Immunol. 2022; 150: 214-222Abstract Full Text Full Text PDF Scopus (7) Google Scholar specifically expand our understanding of the impact of NH4+ on asthma prevalence in individuals from low- and middle-income countries that have experienced large increases in reactive nitrogen–rich PM2.5. A Danish study of preschool-aged children reported a positive association between NH3, NH4+, and combined exposure and diagnosis of asthma, but the association was lost after adjustment for region.7Holst G. Thygesen M. Pedersen C.B. Peel R.G. Brandt J. Christensen J.H. et al.Ammonia, ammonium and the risk of asthma: a register-based case-control study in Danish children.Environmental Epidemiology. 2018; 2: e019Crossref Scopus (0) Google Scholar The authors concluded that NH3 may be associated with asthma prevalence in children, but the relationship may have been confounded by other unmeasured factors associated with proximity to sources of NH3 emissions. Another study showed that ambient air NH3 concentration was associated with reduced lung function, but not with asthma symptoms or medication use, in children living in the agricultural region of Yakima Valley, Washington, which is home to numerous concentrated animal feeding operations.8Loftus C. Yost M. Sampson P. Torres E. Arias G. Breckwich Vasquez V. et al.Ambient ammonia exposures in an agricultural community and pediatric asthma morbidity.Epidemiology. 2015; 26: 794-801Crossref PubMed Scopus (34) Google Scholar Close residential proximity to concentrated animal feeding operations was associated with increased odds of self-reported asthma, nasal allergies, uncontrolled asthma, use of asthma medications, and reduced FEV1 value.9Schultz A.A. Peppard P. Gangnon R.E. Malecki K.M.C. Residential proximity to concentrated animal feeding operations and allergic and respiratory disease.Environ Int. 2019; 130: 104911Crossref PubMed Scopus (21) Google Scholar In contrast to agricultural operations in European countries, agricultural operations in the United States have been subjected to little regulation of emissions by the US Environmental Protection Agency through programs such as the Clean Air Act, which sets the National Ambient Air Quality Standards but does not regulate NH3 emissions. Therefore, agricultural operations are not required to measure and report NH3 emissions, resulting in a lack of data on NH3 sources in the United States.10Plautz J. Piercing the haze.Science. 2018; 361: 1060-1063Crossref PubMed Scopus (46) Google Scholar The current standards regulate for sulfur dioxide, PM, nitrogen dioxide, carbon monoxide, ozone, and lead but not agricultural emissions such as NH3 and the greenhouse gases methane, carbon dioxide, and nitrous oxide. Gu et al estimated that reducing NH3 emissions as a strategy for reducing PM2.5 is much more cost-effective than reducing nitrogen oxide emissions and accounts for a fraction of the economic cost associated with pollution-related mortality.5Gu B. Zhang L. Van Dingenen R. Vieno M. Van Grinsven H.J. Zhang X. et al.Abating ammonia is more cost-effective than nitrogen oxides for mitigating PM2.5 air pollution.Science. 2021; 374: 758-762Crossref PubMed Scopus (58) Google Scholar Some of the proposed solutions to the NH3 problem include reducing the use of nitrogen fertilizer and improving strategies for management of livestock manure, with some success in European countries. Solutions focused on NH3 abatement in US agricultural environments are likely to encounter political barriers, and these would need to be complemented with continued efforts to reduce fossil fuel use and PM2.5 precursors in industrial and urban areas. The full scope of the effects that NH3 emissions have on both the environment and our health has yet to be elucidated, including the role of NH3 and NH4+ exposure in asthma and COPD development, morbidity, and costs to health care systems. More than 92% of pollution-related deaths occur in low- and middle-income countries1Landrigan P.J. Fuller R. Acosta N.J.R. Adeyi O. Arnold R. Basu N.N. et al.The Lancet Commission on Pollution and Health.Lancet. 2018; 391: 462-512Abstract Full Text Full Text PDF PubMed Scopus (1879) Google Scholar that are also experiencing rapid economic development and urbanization, trends that have also increased greenhouse gas emissions and accelerated the climate crisis. It is imperative that as researchers we educate and collaborate with policymakers to prioritize our understanding of how the complex mixtures that we breathe influence human health while at the same time developing strategies to protect our environment. Innovative and cost-effective strategies to reduce NH3 emissions to reduce the burden of PM2.5 are only a first step in a global effort to protect human health. Constituents of fine particulate matter and asthma in 6 low- and middle-income countriesJournal of Allergy and Clinical ImmunologyVol. 150Issue 1PreviewEvidence concerning the effects of different chemical components of particulate matter with an aerodynamic diameter of 2.5 μm or less (PM2.5) on asthma is limited, and the methodology to compare the relative importance of different PM2.5 components is lacking. Full-Text PDF" @default.
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• W4224780980 title "From the farm to the big city: Emerging health effects of agricultural emissions on asthma" @default.
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