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Air pollution impairs the function of blood vessels in the lungs

"This is the first human study to report an influence of air pollution on pulmonary vascular function," said lead author Dr Jean-Francois Argacha, a cardiologist at the University Hospital (UZ) Brussels, Belgium. "This is a major public health issue for people living in polluted urban areas where exercise could damage the lungs and potentially lead to decompensated heart failure." Air pollution consists of particles (particulate matter [PM] of different sizes) and gases (nitrogen dioxide, ozone, etc). The first vascular bed in contact with air pollutants is the pulmonary circulation yet few studies have investigated the impact.


The individual study examined the effect of air pollution on pulmonary circulation in ten healthy male volunteers exposed to pollutants in a chamber with standardised conditions. The volunteers were exposed to ambient air or dilute diesel exhaust with a PM2.5 concentration of 300 ?g/m3 for two hours in a randomised, crossover study design. The effects on pulmonary vascular resistance were assessed with echocardiography at rest and during a cardiac stress test in which the drug dobutamine is given to simulate heart function during exercise.

The population study showed a negative effect of PM10, PM2.5 and ozone on pulmonary circulation on the same day and over five and ten days. Specifically, increases in these pollutants were associated with reduced pulmonary acceleration time and increased pulmonary acceleration slope. Increases in PM10 and PM2.5 over ten days were associated with worse right ventricle function. The negative impact of PM10 on pulmonary circulation was more pronounced in patients with obstructive sleep apnoea.

Dr Argacha said: "Air pollution was associated with increased pulmonary vascular tone which makes it more difficult for blood to flow to the lungs. Longer exposure to air pollution exposure seems necessary to impair right ventricular systolic function."

Regarding how to minimise the health risks, Dr Argacha said: "Our main advice is to limit physical activities during heavy air pollution. More studies are needed before specific recommendations on intensity and duration of exercise can be given. Emission controls such as particulate filters have reduced tailpipe emissions, but other sources such as engine crankcases, tyres and brake wear are becoming important. No strong evidence exists on effectiveness of face masks to eliminate or reduce particle exposure."

The average exposure of the Brussels population to particulate matter, nitrogen dioxide and ozone was calculated from a fixed monitoring station and compiled in a database by the Belgian Interregional Environment Agency.

The 2005 World Health Organization (WHO) recommendations on air pollution levels were set for PM2.5 at a maximal daily mean concentration of 25 μg/m3 and a maximal annual mean concentration of 10 μg/m3. European Union (EU) standards from 2008 differ from those of the WHO, with no recommendation for daily exposure and an annual mean concentration set at 25 μg/m3. Consequently in Belgium the WHO's daily mean concentration for PM2.5 is exceeded 17.5% of days, but the annual mean level of PM2.5 remains below the recommended value from the EU.