Molecular Mechanisms of N-Acetylcysteine in RSV Infections and Air Pollution-Induced Alterations: A Scoping Review.

N-acetylcysteine (NAC) is a mucolytic agent with antioxidant and anti-inflammatory properties. The respiratory syncytial virus (RSV) is one of the most important etiological factors of lower respiratory tract infections, and exposure to air pollution appears to be additionally associated with higher RSV incidence and disease severity. We aimed to systematically review the existing literature to determine which molecular mechanisms mediate the effects of NAC in an RSV infection and air pollution, and to identify the knowledge gaps in this field. A search for original studies was carried out in three databases and a calibrated extraction grid was used to extract data on the NAC treatment (dose, timing), the air pollutant type, and the most significant mechanisms. We identified only 28 studies conducted in human cellular models (n = 18), animal models (n = 7), and mixed models (n = 3). NAC treatment improves the barrier function of the epithelium damaged by RSV and air pollution, and reduces the epithelial permeability, protecting against viral entry. NAC may also block RSV-activated phosphorylation of the epidermal growth factor receptor (EGFR), which promotes endocytosis and facilitates cell entry. EGFR also enhances the release of a mucin gene, MUC5AC, which increases mucus viscosity and causes goblet cell metaplasia; the effects are abrogated by NAC. NAC blocks virus release from the infected cells, attenuates the cigarette smoke-induced shift from necrosis to apoptosis, and reverses the block in IFN-γ-induced antiviral gene expression caused by the inhibited Stat1 phosphorylation. Increased synthesis of pro-inflammatory cytokines and chemokines is induced by both RSV and air pollutants and is mediated by the nuclear factor kappa-B (NF-κB) and mitogen-activated protein kinase (MAPK) signaling pathways that are activated in response to oxidative stress. MCP-1 (monocyte chemoattractant protein-1) and RANTES (regulated upon activation, expressed and secreted by normal T cells) partially mediate airway hyperresponsiveness (AHR), and therapeutic (but not preventive) NAC administration reduces the inflammatory response and has been shown to reduce ozone-induced AHR. Oxidative stress-induced DNA damage and cellular senescence, observed during RSV infection and exposure to air pollution, can be partially reversed by NAC administration, while data on the emphysema formation are disputed. The review identified potential common molecular mechanisms of interest that are affected by NAC and may alleviate both the RSV infection and the effects of air pollution. Data are limited and gaps in knowledge include the optimal timing or dosage of NAC administration, therefore future studies should clarify these uncertainties and verify its practical use.

Improving the Quality of Measurements Made by Alphasense NO2 Non-Reference Sensors Using the Mathematical Methods.

Conventional NO2 monitoring devices are relatively cumbersome, expensive, and have a relatively high-power consumption that limits their use to fixed sites. On the other hand, they offer high-quality measurements. In contrast, the low-cost NO2 sensors offer greater flexibility, are smaller, and allow greater coverage of the area with the measuring devices. However, their disadvantage is much lower accuracy. The main goal of this study was to investigate the measurement data quality of NO2-B43F Alphasense sensors. The measurement performance analysis of Alphasense NO2-B43F sensors was conducted in two research areas in Poland. Sensors were placed near fixed, professional air quality monitoring stations, carrying out measurements based on reference methods, in the following periods: July-November, and December-May. Results of the study show that without using sophisticated correction methods, the range of measured air pollution concentrations may be greater than their actual values in ambient air-measured in the field by fixed stations. In the case of summer months (with air temperature over 30 °C), the long-term mean absolute percentage error was over 150% and the sensors, using the methods recommended by the manufacturer, in the case of high temperatures could even show negative values. After applying the mathematical correction functions proposed in this article, it was possible to significantly reduce long-term errors (to 40-70% per month, regardless of the location of the measurements) and eliminate negative measurement values. The proposed method is based on the recalculation of the raw measurement, air temperature, and air RH and does not require the use of extensive analytical tools.

Inhalation Exposure to PM-Bound Polycyclic Aromatic Hydrocarbons Released from Barbecue Grills Powered by Gas, Lump Charcoal, and Charcoal Briquettes.

The present study seeks to define the possible cancer risk arising from the inhalation exposure to particle (PM)-bound polycyclic aromatic hydrocarbons (PAHs) present in barbecue emission gases and to compare the risk depending on the type of fuel used for grill powering. Three types of fuel were compared: liquid propane gas, lump charcoal, and charcoal briquettes. PM2.5 and PM2.5-100 were collected during grilling. Subsequently, 16 PAHs congeners were extracted from the PM samples and measured quantitatively using gas chromatography. The content of PM-bound PAHs was used to calculate PAHs deposition in the respiratory tract using the multiple path particle dosimetry model. Finally, a probabilistic risk model was developed to assess the incremental lifetime cancer risk (ILCR) faced by people exposed to PAHs. We found a distinctly greater PAHs formation in case of grills powered by charcoal briquettes. The summary concentration of PAHs (Σ16PAH) ranged from <0.002 µg/m3 (gas grill) to 21.52 µg/m3 (grill powered by briquettes). Daily exposure of a grill operator, while grilling meat, to PM2.5-bound PAHs, adjusted to benzo[a]pyrene toxicity equivalent (BaPeq), was 326.9, 401.6, and 0.04 ng/d for lump charcoal, charcoal briquettes, and gas powered grill, respectively. Exposure to PAHs emitted from charcoal briquettes was four orders of magnitude greater than that for gas grill. The ILCR followed a log-normal distribution, with a geometric mean of 8.38 × 10-5 for exposure to PM2.5-bound PAHs emitted from gas grills unloaded with food and as high as 8.68 × 10-1 for the grills loaded with food over charcoal briquettes. The estimated cancer risk for people who would inhale barbecue particles for 5 h a day, 40 days a year exceeds the acceptable level set by the U.S. Environmental Protection Agency. We conclude that the type of heat source used for grilling influences the PM-bound PAHs formation. The greatest concentration of PAHs is generated when grilling over charcoal briquettes. Loading grills with food generates conspicuously more PAHs emissions. Traditional grilling poses cancer risk much above the acceptable limit, as opposed to much less risk involving gas powered grills.

Ambient PM2.5 Exposure and Mortality Due to Lung Cancer and Cardiopulmonary Diseases in Polish Cities.

Air pollution, one of ten most important causes of premature mortality worldwide, remains a major issue also in the EU, with more than 400,000 premature deaths due to exposure to PM2.5 reported yearly. The issue is particularly significant in Poland, where there is the highest concentration of PM2.5 among the UE countries. This study focused on the proportion of mortality due to lung cancer and cardiopulmonary diseases attributable to PM2.5 in eleven biggest Polish cities in the years 2006-2011. The findings demonstrate that the mean annual concentration of PM2.5 varied from 14.3 to 52.5 µg/m3. The average population attributable fractions varied from 0.195 to 0.413 in case of lung cancer and from 0.130 to 0.291 for cardiopulmonary diseases. Such substantial values of this ratio translate into a considerable number of deaths, which ranged between 9.6 and 22.8 cases for lung cancer and 48.6 to 136.6 cases for cardiopulmonary diseases per 100,000 inhabitants. We conclude that the impact of PM2.5 concentration on the incidence of premature deaths is unduly high in Polish cities.

Indoor Exposure to Volatile Organic Compounds in Children: Health Risk Assessment in the Context of Physiological Development.

Indoor air quality is strongly affected by the contamination of ambient air and that related to building and finishing materials and to human activity. Poor ventilation of closed spaces facilitates retention of greater quantity of pollutants. Infants and children are at particular risk of exposure to indoor air pollutants as they undergo rapid physiological and biochemical changes and demonstrate activity patterns unlike those in adults. Health risk assessment in children should be carried out with regard to children-specific factors, since these factors may constitute a source of errors. In this article we weigh up two different: Scenario 1 in which risk assessment was carried out in five age-groups (0-1, 2-3, 4-6, 7-11, and 12-16 years of age) and Scenario 2 encompassing only two age-groups (0-6 and 7-16 years of age). The findings indicate that data on carcinogenic and non-carcinogenic effects obtained by applying the second scenario were overestimated or averaged; either giving much reduced information that may lead to a false judgment on actual risk. This kind of fallacy is avoided when applying the age stratification into a greater number of groups for the health risk assessment in children.

Particulate Matter in the Air of the Underground Chamber Complex of the Wieliczka Salt Mine Health Resort.

This study evaluates the mass concentration and chemical composition of particulate matter (PM), collected in the chamber complex of the underground health resort located in the Wieliczka Salt Mine in southern Poland. Physical and chemical properties of PM were examined from the standpoint of their possible connection with therapeutic effects of the subterranean air in the mine. We found that in three underground spots we measured the average concentration of PM did not exceed 30 µg/m3. Chemical composition of PM was dominated by sodium chloride, making up 88 % of its mass, on average. It was shown that the underground ambient concentration of PM and its chemical composition depended mostly on the nature of the rock material present in the ventilation tunnel of the health resort, filtering the incoming air. The presence and effect of external sources of PM, including patients' activity, also had an impact on the underground PM concentration.

Socioeconomic Effects of Chronic Obstructive Pulmonary Disease from the Public Payer's Perspective in Poland.

Chronic obstructive pulmonary disease (COPD) is currently the third most common cause of death worldwide and the total number of people affected reaches over 200 million. It is estimated that approximately 50 % of persons having COPD are not aware of it. In the EU, it is estimated that the total annual costs of COPD exceed €140 billion, and the expected increase in the number of cases and deaths due to COPD would further enhance economic and social costs of the disease. In this article we present the results of cost analysis of health care benefits associated with the treatment of COPD and with the disease-related incapacity for work. The analysis is based on the data of the National Health Fund and the Social Insurance Institutions, public payers of health benefits in Poland. The annual 2012 expenditures incurred for COPD treatment was €40 million, and the benefits associated with incapacity for work reached more than €55 million. The extent of these expenditures indicates that it is necessary to optimize the functioning system, including the allocation of resources for prevention, social awareness, and detection of COPD at early stages when treatment costs are relatively low.

Pulmonary Function and Incidence of Selected Respiratory Diseases Depending on the Exposure to Ambient PM10.

It is essential in pulmonary disease research to take into account traffic-related air pollutant exposure among urban inhabitants. In our study, 4985 people were examined for spirometric parameters in the presented research which was conducted in the years 2008-2012. The research group was divided into urban and rural residents. Traffic density, traffic structure and velocity, as well as concentrations of selected air pollutants (CO, NO2 and PM10) were measured at selected areas. Among people who live in the city, lower percentages of predicted values of spirometric parameters were noticed in comparison to residents of rural areas. Taking into account that the difference in the five-year mean concentration of PM10 in the considered city and rural areas was over 17 µg/m³, each increase of PM10 by 10 µg/m³ is associated with the decline in FEV1 (forced expiratory volume during the first second of expiration) by 1.68%. These findings demonstrate that traffic-related air pollutants may have a significant influence on the decline of pulmonary function and the growing rate of respiratory diseases.

The influence of particulate matter on respiratory morbidity and mortality in children and infants.

Air pollution is the most important environmental health risk leading to premature mortality, respiratory and other health problems. The aim of this study was to quantify its impact on infants and children in Warsaw (Poland), following the principles of Health Impact Assessment method. Particulate matter (PM(2.5) and PM(10)) was considered as the indicator of air pollution. Exposure-response functions between air pollution and health impacts were employed based on the literature. According to the calculations, around 5,201 asthma symptoms and 234 hospital respiratory admissions were caused annually due to air pollution. Hospitalizations due to cardiovascular problems related to air pollution amounted to 13. The mortality among infants and children is relatively low and occurs mostly in the postneonatal period. Nonetheless, approx. 5 mortality cases were assessed to be air pollution-attributable. The study demonstrates a significant impact of air pollution on infants and children, which is manifested primarily as a range of respiratory problems.

Assessment of Air Pollution Effects on the Respiratory System Based on Pulmonary Function Tests Performed During Spirometry Days.

The Polish Spirometry Day is an initiative aimed at increasing awareness of the causes, symptoms, course, and effects that accompany respiratory diseases, especially asthma and chronic obstructive pulmonary disease (COPD). In 2013, the second edition of the Spirometry Day was held. It gathered 180 medical centers and other institution. The final analysis encompassed a total of 1187 persons from 26 different locations, including rural areas, and smaller and larger city agglomerations. Of this total, 755 persons (63.6 %) completed their spirometry tests for the first time in life. Each person fulfilled a questionnaire regarding the personal information, respiratory diseases, symptoms, lifestyle, and a place of residence. In the total group, 234 (19.7 %) cases of bronchial obstruction were diagnosed. A hundred and thirty four persons with obstruction, among those tested for the first time in life (17.8 %), were unaware of their disease. The lowest values of FEV1 and FEF(1)/FVC, corresponding to the highest percentage of persons with obstruction (27.9 %) were observed in small and medium cities (100,000-500,000 inhabitants). There were differences in the prevalence of obstruction depending on the distance of the place of residence from a busy traffic road. A significant decrease of both spirometric variables was observed among people living in cities above 100,000 inhabitants within a distance lower than 50 m from roads. In general, better spirometry results were observed among inhabitants living more than 150 m from main roads.

Relative risk of lung obstruction in relation to PM10 concentration as assessed by pulmonary function tests.

Epidemiological studies show that long-term exposure to air pollution may increase the relative risk of obstructive lung diseases such as COPD or asthma. The risk of increased obstruction is higher among residents living in close proximity to high traffic routes where there are high concentrations of PM(10). The present study consists of two parts: the measurement of the concentration of air pollutants and of pulmonary function in selected groups of people. The study was conducted in Warsaw, Poland, in seven localizations with typical urban canyon characteristics and roads with high traffic. The control group consisted of people living in other regions of Poland with a significantly lower (p < 0.05) concentration of air pollutants. The study was performed in the years 2008-2012. The incidence of obstructive lung disease was determined according to the GOLD guidelines. The study subjects were all non-smokers. The relative risk of disease took into account different exposure times to air pollutants. The findings indicate that an increase in PM(10) concentration by each 10 µg/m(3) caused an increase in the relative risk of lung obstruction by a factor of 1.27, 1.24, and 1.19 for the residence period in the vicinity to heavy traffic city roads for 20, 30, and 40 years, respectively as compared with the residence of rural unpolluted areas. A decrease in the number of people with lung obstruction with the length of residence actually indicates that people exposed to high concentrations of PM(10) become affected by lung obstruction at a lower age. The study shows a positive relative risk of lung obstruction due to an exposure to high PM(10) emission.

Air Pollution Increases Risk of Occurrence of Intracerebral Haemorrhage but Not of Subarachnoid Haemorrhage: Time-Series Cross-Sectional Study.

(1) Background: Haemorrhagic strokes (HS), including intracerebral (ICH) and subarachnoid haemorrhages (SAH), account for approximately 10-15% of strokes worldwide but are associated with worse functional outcomes and higher rates of mortality, and financial burden than ischemic stroke. There is evidence that confirmed poor air quality may increase the incidence of haemorrhagic strokes. The aim of our study was to evaluate the association between individual ambient air pollutants and the risk of haemorrhagic stroke in an urban environment without high levels of air pollution. (2) Methods: A time-series cross-sectional study design was used. A daily air pollution concentration (Agency of Regional Air Quality Monitoring in the Gdansk Metropolitan Area) and incidence of haemorrhagic strokes (National Health Fund) were obtained and covered the time period from 1 January 2014 to 31 December 2018. A generalised additive model with Poisson regression was used to estimate the associations between 24-h mean concentrations of SO2, NO, NO2, NOx, CO, PM10, PM2.5, and O3 and a daily number of haemorrhagic strokes. (3) Results: The single-day lag model results showed that NO2, NO and NOx exposure was associated with increased risk of ICH (88% events) with RR of 1.059 (95% CI: 1.015-1.105 for lag0), 1.033 (95% CI: 1.007-1.060 for lag0) and 1.031 (95% CI: 1.005-1.056 for lag0), but not for SAH (12% events). Exposure to CO was related to a substantial and statistically significant increase in incidence for 1.031 (95% CI: 1.002-1.061 for lag0) but not for SAH. Higher SO2, PM10, PM2.5, and O3 exposures were not significantly related to both ISC and SAH. (4) Conclusions: In this time-series cross-sectional study, we found strong evidence that supports the hypothesis that transient elevations in ambient NO2, NO and CO are associated with a higher relative risk of intracerebral but not subarachnoid haemorrhage.

Exposure to traffic-related air pollutants as a risk of airway obstruction.

Dynamic increases in the number of vehicles, particularly in large urban areas, cause a visible decline in the average speed of cars. Street networks are not able to efficiently handle generated traffic, which could result in increasing levels of air pollutant emissions and consequently in a greater incidence of people suffering from respiratory diseases. This study presents the effects of investigations on the influence of traffic-related air pollutants on inhabitants of two Polish cities living in the proximity of busy roads. As a control group rural area residents were taken. In 2005-2006 and 2008-2009 respiratory function tests were conducted on a group of 3,506 people (including residents of non-urban areas). The investigation has shown that people living near busy urban roads had a significant increase in the risk of bronchi obstruction.

Spirometry day: a means to enhance social knowledge on respiratory diseases.

The chapter presents the results of pulmonary function tests conducted as part of the Polish Spirometry Day of 2011, an initiative aimed at increasing the awareness of causes, symptoms, and delayed effects of common respiratory diseases, in particular of bronchial asthma and chronic obstructive pulmonary disease, and at demonstrating the role of regular examinations, especially in higher risk groups. The results show that there was a relatively substantial group of persons, 11.2 % of the population sample studied, not being aware of a respiratory disease they had. Furthermore, the results show that quite often, 12.4-16.0 % of the population studied, obstruction was diagnosed in persons who did not have any spirometry tests done before, despite some respiratory symptoms that should raise the attention of general practitioners to perform such tests.

Influence of traffic-related air pollutants on lung function.

We investigated the influence of traffic-related air pollutants on respiratory function, with a focus on the non-smoking residents of the capital city of Warsaw in Poland, who lived close to busy streets. The results demonstrate that people living in some parts of the city show symptoms of bronchial obstruction over four times more often than those from the control group consisting of the inhabitants of a remote region in eastern Poland, with considerably less air pollution. Using multiple regression models it was shown that, apart from the place of living, the floor the apartment is situated on, the length of residence, allergy, and physical activity are the factors that significantly influence the forced expiratory volume in 1 s (FEV1) and the pseudo-Tiffenau index (FEV1/FVC).

Assessment of Low-Level Air Pollution and Cardiovascular Incidence in Gdansk, Poland: Time-Series Cross-Sectional Analysis.

(1) Background: More than 1.8 million people in the European Union die every year as a result of CVD, accounting for 36% of all deaths with a large proportion being premature (before the age of 65). There are more than 300 different risk factors of CVD, known and air pollution is one of them. The aim of this study was to investigate whether daily cardiovascular mortality was associated with air pollutants and meteorological conditions in an urban environment with a low level of air pollution. (2) Methods: Data on daily incidence of strokes and myocardial infarctions in the city of Gdansk were obtained from the National Health Fund (NHF) and covered the period from 1 January 2014 to 31 December 2018. Data on the level of pollution, i.e., SO2, NO, NO2, NOx, CO, PM10, PM2.5, CO2, O3 and meteorological conditions came from the foundation: Agency of Regional Air Quality Monitoring in the Gdansk metropolitan area (ARMAG). Using these data, we calculated mean values with standard deviation (SD) and derived the minimum and maximum values and interquartile range (IQR). Time series regression with Poisson distribution was used in statistical analysis. (4) Results: Stroke incidence is significantly affected by an increase in concentrations of NO, NO2 and NOx with RRs equal to 1.019 (95%CI: 1.001-1.036), 1.036 (95%CI: 1.008-1.064) and 1.017 (95%CI: 1.000-1.034) for every increase in IQR by 14.12, 14.62 and 22.62 µg/m3, respectively. Similarly, myocardial infarction incidence is significantly affected by an increase in concentrations of NO, NO2 and NOx with RRs equal to 1.030 (95%CI: 1.011-1.048), 1.053 (95%CI: 1.024-1.082) and 1.027 (95%CI: 1.010-1.045) for every increase in IQR by 14.12, 14.62 and 22.62 µg/m3, respectively. Both PM10 and PM2.5 were positively associated with myocardial infarction incidence. (5) Conclusions: In this time-series cross-sectional study, we found strong evidence that support the hypothesis that transient elevations in ambient PM2.5, PM10, NO2, SO2 and CO are associated with higher relative risk of ischemic stroke and myocardial infarction incidents.

Exposure to ambient air pollutants and short-term risk for exacerbations of allergic rhinitis: A time-stratified, case-crossover study in the three largest urban agglomerations in Poland.

Allergic rhinitis (AR) affects 10 % of the world population, with an increased prevalence in regions with substantial air pollution, but the association between exposure to air pollutants and the short-term risk of AR exacerbations is unclear. We used a time-series approach to analyze the risk of hospital admissions due to AR over 8 days from exposure to various air pollutants. Distributed lag nonlinear models were used to analyze data gathered between 2012 and 2018 in the three largest urban agglomerations in Poland. The analyses were carried out separately for the warm (April - September) and cold seasons (October - March). Overall, there were 1407 admissions due to AR. In the warm season, the rate ratio (95 % confidence interval) for admission per 10 µg/m3 was 1.202 (1.044, 1.384) for particulate matter less than 10 µm (PM10); 1.094 (0.896, 1.335) for particulate matter less than 2.5 µm (PM2.5); 0.946 (0.826, 1.085) for nitrogen dioxide (NO2); 0.837 (0.418, 1.677) for sulfur dioxide (SO2); and 1.112 (1.011, 1.224) for ozone (O3). In the cold season, the rate ratio for admission per 10 µg/m3 was 1.035 (0.985, 1.088) for PM10; 1.041 (0.977, 1.108) for PM2.5; 1.252 (1.122, 1.398) for NO2; 0.921 (0.717, 1.181) for SO2; and 1.030 (1.011, 1.050) for O3. In conclusion, the risk of admission due to AR increased significantly after exposure to O3 in the warm and cold seasons. Exposure to PM10 was associated with a significantly increased risk of AR hospitalizations in the warm season only, whereas exposure to NO2 was associated with a significantly increased risk of AR admission in the cold season.

Air pollution and long-term risk of hospital admission due to chronic obstructive pulmonary disease exacerbations in Poland: a time-stratified, case-crossover study.

INTRODUCTION: Airborne pollutants may worsen the course of chronic obstructive pulmonary disease (COPD). Previous studies have shown that both particulate and gaseous pollutants increase airway inflammation, which may lead to an exacerbation of COPD. OBJECTIVES: The aim of the study was to investigate the association between exposure to airborne pollutants and the risk of COPD exacerbations in 3 the largest urban agglomerations in Poland: Warsaw, Kraków, and Tricity. PATIENTS AND METHODS: We used a case­crossover approach to analyze data from the years 2011-2018. This time­series study used distributed lag linear-nonlinear models to analyze the risk of hospital admission due to COPD exacerbations during 21 days following the exposure to particulate matter (PM), NO2, and SO2. RESULTS: Overall, there were 26 948 admissions due to COPD exacerbations. During 21 days after exposure, the rate ratio (95% CI) for admissions per 10 µg/m3 was 1.028 (1.008-1.049) for PM10, 1.030 (1.006-1.055) for PM2.5, 1.032 (0.988-1.078) for NO2, and 1.145 (1.038-1.262) for SO2. The risk for admission peaked at 10 days after the exposure to PM10 and PM2.5, whereas for NO2 and SO2 the risk was the greatest on the day of exposure. The proportion (95% CI) of hospitalizations attributable to air pollution was 9.08% (3.10%-15.08%) for PM10, 7.61% (1.27%-13.49%) for PM2.5, 9.77% (-3.63% to 21.48%) for NO2, and 7.70% (2.30%-12.84%) for SO2. CONCLUSIONS: PM2.5, PM10, NO2, and SO2 pollution was associated with an increased risk of COPD exacerbations that needed hospitalization. There were different risk patterns for particulate and gaseous pollutants. Improving air quality in Polish cities could reduce the burden of COPD.

Ambient Air Pollution and Risk of Admission Due to Asthma in the Three Largest Urban Agglomerations in Poland: A Time-Stratified, Case-Crossover Study.

Ambient air pollution in urban areas may trigger asthma exacerbations. We carried out a time-series analysis of the association between the concentrations of various air pollutants and the risk of hospital admission due to asthma over 7 days from exposure. We used distributed lag nonlinear models to analyze data gathered between 2010 and 2018 in the three largest urban agglomerations in Poland. Overall, there were 31,919 asthma hospitalizations. Over 7 days since exposure, the rate ratio (95%CI) for admission per 10 µg/m3 was 1.013 (1.002-1.024) for PM10; 1.014 (1.000-1.028) for PM2.5; 1.054 (1.031-1.078) for NO2; and 1.044 for SO2 (95%CI: 0.986-1.104). For all pollutants, the risk of admission was the greatest on the day of exposure (day 0), decreased below baseline on days 1 and 2, and then increased gradually up to day 6. The proportions (95%CI) of hospitalizations attributable to air pollution were 4.52% (0.80%-8.14%) for PM10; 3.74% (0.29%-7.11%) for PM2.5; 16.4% (10.0%-21.8%) for NO2; and 2.50% (-0.75%-5.36%) for SO2. In conclusion, PM2.5, PM10, NO2, and SO2 pollution was associated with an increased risk of hospital admission due to asthma in the three largest urban agglomerations in Poland over nine years.

Influence of Selected Air Pollutants on Mortality and Pneumonia Burden in Three Polish Cities over the Years 2011-2018.

Poland has one of the worst air qualities in the European Union, particularly regarding concentrations of particulate matter (PM). This study aimed to evaluate the short-term effects of air pollution and weather conditions on all-cause mortality and pneumonia-related hospitalizations in three Polish agglomerations. We investigated data from 2011 to 2018 on a number of health outcomes, concentrations of PM2.5, PM10, nitrogen dioxide (NO2), ozone (O3), and selected meteorological parameters. To examine the impact of air pollutants and weather conditions on mortality and pneumonia burden, we identified optimal general regression models for each agglomeration. The final models explained <24% of the variability in all-cause mortality. In the models with interactions, O3 concentration in Warsaw, NO2, O3, and PM2.5 concentrations in Cracow and PM10 and O3 concentrations in the Tricity explained >10% of the variability in the number of deaths. Up to 46% of daily variability in the number of pneumonia-related hospitalizations was explained by the combination of both factors, i.e., air quality and meteorological parameters. The impact of NO2 levels on pneumonia burden was pronounced in all agglomerations. We showed that the air pollution profile and its interactions with weather conditions exert a short-term effect on all-cause mortality and pneumonia-related hospitalizations. Our findings may be relevant for prioritizing strategies to improve air quality.