Weekly Personal Ozone Exposure and Respiratory Health in a Panel of Greek Schoolchildren.

BACKGROUND: The association of ozone exposure with respiratory outcomes has been investigated in epidemiologic studies mainly including asthmatic children. The findings reported had methodological gaps and inconsistencies. OBJECTIVES: We aimed to investigate effects of personal ozone exposure on various respiratory outcomes in school-age children generally representative of the population during their normal activities. METHODS: We conducted a panel study in a representative sample of school-age children in the two major cities of Greece, Athens and Thessaloniki. We followed 188, 10- to 11-y-old, elementary school students for 5 wk spread throughout the 2013­2014 academic year, during which ozone was measured using personal samplers. At the end of each study week, spirometry was performed by trained physicians, and the fractional concentration of nitric oxide in exhaled air (FeNO) was measured. Students kept a daily time­activity­symptom diary and measured PEF (peak expiratory flow) using peak flow meters. Mixed models accounting for repeated measurements were applied. RESULTS: An increase of 10 µg/m3 in weekly ozone concentration was associated with a decrease in FVC (forced vital capacity) and FEV1 (forced expiratory volume in 1 s) of 0.03 L [95% confidence interval (CI): −0.05, −0.01] and 0.01 L (95% CI: −0.03, 0.003) respectively. The same increase in exposure was associated with a 11.10% (95% CI: 4.23, 18.43) increase in FeNO and 19% (95% CI: −0.53, 42.75) increase in days with any symptom. The effect estimates were robust to PM10 adjustment. No inverse association was found between ozone exposure and PEF. CONCLUSIONS: The study provides evidence that airway inflammation and the frequency of respiratory symptoms increase, whereas lung function decreases with increased ozone exposure in schoolchildren. https://doi.org/10.1289/EHP635.

Effects of particulate air pollution on nasal and lung function development among Greek children: a 19-year cohort study.

The aim was to investigate respiratory symptoms, lung function and nasal airflow development among a cohort of children who were exposed to particulate air pollution. We used questionnaires, spirometry and rhinomanometry, while central-monitored PM10 concentrations were used for exposure assessment. We initially examined 1046 children (10-12 year old) in the heavily polluted town of Ptolemaida, Greece, and 379 children in the cleaner town of Grevena (control group). We re-evaluated 312 of the former and 119 of the latter after 19 years. PM10 concentrations were above permissible levels in Ptolemaida during all study period. At both visits, nasal flow was significantly lower in the study sample. At the follow-up visit, 34.3% had severe nasal obstruction (< 500 ml/s) and 38.5% reported chronic nasal symptoms. Spirometric parameters did not differ compared to the control group. Particulate air pollution had significant and negative effects on nasal but not on lung function development.

Exposure to PM10 as a risk factor for the development of nasal obstruction and chronic obstructive pulmonary disease.

OBJECTIVES: To investigate whether air pollution is a potential risk factor for airways obstruction. METHODS: A prospective cohort study (11.3 +/- 2.9 years) that took place in two areas (Eordea where concentration of PM10 was high and Grevena, Greece). We used the MRC questionnaire, spirometry, and anterior rhinomanometry at both visits. RESULTS: Initially we examined 3046 subjects. After excluding chronic obstructive pulmonary disease (COPD) patients, we re-examined 872 subjects and 168 of them had developed COPD (Grevena: 24.3%, Eordea: 18.5%). Multivariable logistic regression analysis showed that the area of residence and thus exposure to air pollution was not a risk factor for the development of COPD (OR: 0.51, 95% CI: 0.18-1.46, P = 0.21). On the other hand, residence in Eordea was strongly related to the development of severe nasal obstruction (OR: 11.47, 95% CI: 6.15-21.40, P < 0.001). Similar results were found after excluding patients with COPD stage I as well as in the subgroup of never smokers. CONCLUSION: Air pollution was associated with severe nasal obstruction but not with COPD development.

Pegylated liposomal doxorubicin in malignant pleural mesothelioma: a possible guardian for long-term survival.

Malignant pleural mesothelioma is a rare and aggressive malignancy of the pleura correlated with exposure to asbestos, with a medium survival of 11-12 months after diagnosis. A case of a 67-year-old male who had previously worked in the asbestos industry and is a current smoker is reported. The computed tomography evaluation revealed a right pleural mass with pleural thickening, and the pleural biopsy confirmed a diagnosis of malignant pleural mesothelioma. He was treated with chemotherapy consisting of etoposide, paclitaxel, and pegylated liposomal doxorubicin hydrochloride. After completion of chemotherapy, radiologic evaluation confirmed a reduction of pleural thickening and improvement in his symptoms. A complete presentation of each drug formulation and characteristics are also included in this paper. The patient's follow-up is continuing, and computed tomography reveals stable disease 9 years after initial examination.

Clinical differences between influenza A (H1N1) virus and respiratory infection between the two waves in 2009 and 2010.

BACKGROUND: The purpose of the present retrospective study was to examine the clinical differences between patients hospitalized with H1N1 virus and those hospitalized with nonvirus respiratory tract infection in 2009 and 2010. METHODS: Adult patient data were collected from three tertiary hospital centers. Real-time reverse transcriptase polymerase chain reaction testing was used to confirm the diagnosis. We included 106 H1N1-positive patients (52 from 2009 and 54 from 2010). These data were compared with those from 108 patients with H1N1-negative respiratory tract infection (51 patients from 2009 and 57 from 2010). RESULTS: In 2009, the mean age was 36.4 years for H1N1-positive patients versus 46.4 years for H1N1-negative patients, and mean body mass index (BMI) was 26.4 kg/m(2) patients and 28.1 kg/m(2), respectively. In 2009, seven patients required intubation, six of whom were H1N1-positive. In 2010, the mean age was 43.8 years for H1N1-positive patients versus 60.2 years for H1N1-negative patients, and mean BMI was 32.3 kg/m(2) and 26.9 kg/m(2), respectively. In 2010, six patients required intubation, three of whom were H1N1-positive. Abnormal chest x-ray findings were found significantly more frequently in H1N1-negative patients than in H1N1-positive patients. CONCLUSION: In comparison with 2009, H1N1-positive patients in 2010 were older, were more likely to be obese, and had more severe clinical and laboratory perturbations. However, this did not affect their outcomes. H1N1-negative patients were older in comparison with those who were H1N1-positive, and had more severe clinical and laboratory perturbations.

Health costs from hospitalization with H1N1 infection during the 2009-2010 influenza pandemic compared with non-H1N1 respiratory infections.

BACKGROUND: The first positive patient with influenza A (H1N1) was recorded in March 2009 and the pandemic continued with new outbreaks throughout 2010. This study's objective was to quantify the total cost of inpatient care and identify factors associated with the increased cost of the 2009-2010 influenza A pandemic in comparison with nonviral respiratory infection. METHODS: In total, 133 positive and 103 negative H1N1 patients were included from three tertiary care hospitals during the two waves of H1N1 in 2009 and 2010. The health costs for protective equipment and pharmaceuticals and hospitalization (medications, laboratory, and diagnostic tests) were compared between H1N1 positive and negative patients. RESULTS: The objective of the study was to quantify the means of daily and total costs of inpatient care. Overall, cost was higher for H1N1 positive (€61,0117.72) than for H1N1-negative patients (€464,923.59). This was mainly due to the protection measures used and the prolonged hospitalization in intensive care units. In H1N1-negative patients, main contributors to cost included additional diagnostic tests due to concern regarding respiratory capacity and laboratory values, as well as additional radiologic and microbial culture tests. The mean duration of hospitalization was 841 days for H1N1 positive and 829 days for negative patients. CONCLUSION: Cost was higher in H1N1 patients, mainly due to the protection measures used and the increased duration of hospitalization in intensive care units. An automated system to monitor patients would be desirable to reduce cost in H1N1 influenza.

A combination of the IPAG questionnaire and PiKo-6® flow meter is a valuable screening tool for COPD in the primary care setting.

AIMS: To investigate the validity of the International Primary Care Airways Guidelines (IPAG) questionnaire and PiKo-6® (Ferraris Respiratory Europe Ltd.) flow meter as screening tools for diagnosing chronic obstructive pulmonary disease (COPD) in the primary care setting. METHODS: The first 50 patients in 25 general practice offices completed the IPAG questionnaire and underwent spirometry with the handheld PiKo-6® flow meter. The results were compared with official spirometry parameters after bronchodilation. All participants had no previous medical diagnosis of respiratory diseases. RESULTS: Data from 1,078 out of 1,250 subjects (462 males, mean age 65.3 ± 11.4 years) were analysed. The percentage of smokers was 48.4% (38 ± 29 pack-years). COPD was diagnosed in 111 (10.3%) patients. In the subgroup of smokers the sensitivity and specificity for COPD diagnosis were 91% and 49%, respectively, for the IPAG questionnaire; 80% and 95% respectively for the PiKo-6® spirometer; and 72% and 97% for their combination. The negative predictive value of the questionnaire was 97%, whereas the positive predictive value of the questionnaire/ PiKo-6® combination was 82%. Using a cut-off score of 19 points for the IPAG questionnaire, we calculated the best combination of sensitivity (75%) and specificity (72%). CONCLUSIONS: The IPAG questionnaire and the hand-held PiKo-6® spirometer can be used in combination to increase the possibility of an early and accurate diagnosis of COPD in the primary care setting.

Prevalence and risk factors for initiation of smoking in Greek high-school students.

The smoking habits of 9,276 high-school students (15-18 years old) in six cities of Northern Greece were studied using a questionnaire in order to determine the prevalence and possible risk factors for initiation of smoking. We observed that 29.6% of high-school students (32.6% of boys and 26.7% of girls) were current smokers. A percentage of 43.3% had started smoking before the age of 14. Reactive behaviour towards parents' and teachers' advice (40.2%) and the existence of smoking friends (40.1%) were the main reasons of initiation. A well-planned integrated anti-smoking campaign is urgently required, especially among students and teachers.