Gianna Melillo

 since 2019 and has a BA in philosophy and journalism & professional writing from The College of New Jersey. 

It is no secret that air pollution—in particular, that which is a result of climate change—has had serious ramifications on air quality and human health around the world. One 

 found that even short-term exposure to nitrogen dioxide (NO

), which largely stems from fuel combustion and automobile traffic, has a linear association with increased risk of total, cardiovascular, and 

The COVID-19 pandemic brought several serious health conditions, like obesity and diabetes, into the limelight. But it has also provided an opportunity to better understand air pollution and the impact virus transmission mitigation behaviors have on respiratory health.

In 2003, during the severe acute respiratory syndrome (SARS) outbreak in China, those infected with SARS who lived in areas with higher air pollution were 

 compared with those residing in less polluted areas.

, concluded both acute and chronic exposure to air pollution can affect COVID-19 epidemiology.

Although the evidence is unclear for acute exposure due to bias present in existing studies, the authors wrote, “Public health interventions that help minimize anthropogenic pollutant source and socioeconomic injustice/disparities may reduce the planetary threat posed by both COVID-19 and air pollution pandemics.”

Over a year into the pandemic, recently published data highlight just how much human actions impact the quality of air we breathe. In the spring of 2020, when dire COVID-19 infection projections turned into reality, metropolises around the globe stood still, and the lack of vehicular traffic led to significant air pollutant decreases seen from 

 that examined the global concentration changes in air pollutants between March and April 2020, researchers found “reductions in air pollutant concentrations have overall improved global air quality likely driven in part by economic slowdowns resulting from the global pandemic.”

Specifically, the researchers examined concentration changes in carbon monoxide (CO), NO

) and compared findings with those recorded during the same months between 2015 and 2019.

 column observations were reduced by approximately 9.19% and 9.57%, in March and April 2020, respectively

On a regional scale, after accounting for the effects of meteorological variability, most monitoring sites in Europe, the United States, China, and India showed declines in CO, NO

 concentrations occurred during the same period

Four major city case studies in New York, New York; Milan, Italy; Wuhan, China; and New Delhi, India, showed reduction trends similar to those observed on the regional scale and an increase in ozone concentration

 can be attributed to “lower than normal emissions of NO due to restrictions placed on industrial activities and travel. Therefore, this increase in O

 concentrations is mainly explained by an unprecedented reduction in [nitrogen oxides] emissions leading to a lower O

titration by [nitric oxide],” the researchers explained.

“It is evident the lockdown orders associated with COVID-19 have had a profound impact on our atmospheric environment,” they concluded.

Not only will cleaner air result in superior health outcomes, it will also help reduce costs of diseases associated with air pollution, including 

, Alzheimer disease, multiple sclerosis, 

Exposure reduction due to mask-wearing and stay-at-home orders have also contributed to anecdotal reports of reduced exacerbations among patients with chronic obstructive pulmonary disease (COPD).

“Many patients with COPD got the message that they were at increased risk and have been doing, I would say overall, a fairly good job of staying at home,” said Meilan King Han, MD, a professor of internal medicine in the Division of Pulmonary and Critical Care at the University of Michigan in an 

“We know that in normal times, exacerbations would be due to things like normal colds and other non–COVID-19 viruses. The interesting thing is that overall, we're seeing patients having fewer exacerbations simply because they're heeding the CDC guidance and staying at home,” she said.

Similar situations have played out across the asthma, allergy, and immunology fields. Three recently published studies focusing on populations in the United Kingdom and South Korea found the number of individuals receiving care for asthmatic episodes decreased during the pandemic, the 

Center for Infectious Disease Research and Policy

Although investigations were not designed to determine causation, “researchers suggest that behavioral changes in care-seeking or asthma management, lower air pollution due to lockdown, lower exposure to seasonal allergies, and the like may have contributed to the observed changes.”

Visits to allergists have gone down, too. In the spring of 2020, “our usual pollen sufferers were having a lot less exacerbations,” allergist and immunologist Courtney Blair, MD, told 

This could be due to the fact that at the time, patients were concerned about COVID-19 exposure and did not want to go to doctors’ offices.

But when it comes to mitigation efforts, “mask-wearing for our pollen sufferers seemed to benefit them quite a bit. When they did leave the house, they were inhaling less particulates from pollen especially,” said Blair, who also serves as the president of the 

Greater Washington Allergy, Asthma, and Immunology Society

 and is a fellow of the American Academy of Allergy, Asthma and Immunology.

Numerous patients and parents have reported their kids are much less sick this year, as they are either at home or the measures taken to prevent COVID-19 have cut down on rates of seasonal virus spread, she added.

Human-caused climate change has also contributed to longer and more 

, which not only will have implications on human health, but could also raise associated medical costs. “The strong link between warmer weather and pollen seasons provides a crystal-clear example of how climate change is already affecting peoples' health across the US,” 

“In our patient population, we’ve had less exacerbations,” but discerning the root cause of the drop—whether it is reductions in air pollutants or mitigation efforts—is a challenge, Blair noted. However, the decrease in viral spread of all viruses in the last 12 months “probably is the most critical factor that people are just getting sick less.”

One obvious solution to the issues wrought by air pollution, as evidenced by the COVID-19 lockdowns, is to curb emissions and cut air pollution in general. 

 of data collected in 2015 found that reducing PM

 in nearly 1000 European cities to World Health Organization target 

 (no more than an annual mean of 10 mcg/m

) could save approximately 50,000 lives each year.

Furthermore, achieving the lowest levels of the 2 pollutants measured in any European city in 2015 would prevent “an estimated 124,729 premature deaths from PM

 exposure and 79,435 premature deaths from NO

 (ALA) found more than 40% of Americans—amounting to over 135 million individuals—live in areas with unhealthy levels of ozone and particle pollution. Notably, the report also found people of color are 3 times more likely to be breathing the most polluted air compared with White individuals, a factor that could contribute to the stark 

 seen in COVID-19 infection and death rates in the United States.

 by the ALA include transitioning from fossil fuels and combustion to clean renewable electricity and zero-emission transportation.

In California, lawmakers are attempting to do just that by curbing diesel PM

 (DPM) emissions. According to the ALA, “Los Angeles remains the city with the worst ozone pollution in the nation, as it has for all but 1 of the 22 years tracked by the ‘State of the Air’ report... And Bakersfield, California, returned to the most polluted slot for year-round particle pollution for the second year in a row.”

 of the effects of California’s authority under the 

 to regulate air pollution more stringently than the federal government revealed the state’s sector-based policies have been highly effective relative to the rest of the country in reducing mobile-source DPM emission.

While in office, former President Donald Trump took a more relaxed role in cracking down on environmental infractions perpetrated by industries. Within several months of him taking office, the Environmental Protection Agency prosecuted fewer alleged violations of air and water regulations, NPR 

“To improve health in communities disproportionately affected by these emissions, we point to opportunities to further reduce DPM emissions in California, in the US more broadly, and in parts of the world where countries have less aggressive vehicle emissions policies than the United States,” the researchers wrote.

Businesses, including Walmart, Apple, McDonalds, and Starbucks have also called on the Biden administration to reduce greenhouse gas emissions to at least half of levels reported in 2005 by 2030. In 2019, emissions were measured at just 13% below 2005 levels, marking a 1.8% decrease from the previous year, according to 

 from the International Energy Agency estimates global carbon dioxide emissions from energy will rise by 5% this year and noted the economic rebound from the pandemic could be “anything but sustainable” for the climate.

That increase amounts to 33 billion metric tons of emissions this year, up 1.5 billion metric tons from 2020 levels and marks the single largest increase in more than a decade, Reuters reports. For context, 33 billion metric tons is approximately equal to 73 trillion pounds.

“The expected rise in coal use dwarves that of renewables by almost 60%, despite accelerating demand for solar, wind, and hydro power. More than 80% of the projected growth in coal demand in 2021 is set to come from Asia, led by China,” the article reads.

 the United States will aim to cut carbon emissions by over 50% of its 2005 levels by the year 2030. However, the administration has not released a plan as to how it will achieve this goal. Biden is expected to announce more details at the White House’s virtual Earth Day Climate summit 

When it comes to a health perspective, reducing greenhouse gases and human emitted pollutants will be “the way that the world is going to get better,” said Blair. But ultimately efforts against climate change will “necessitate so many actors to make change over time, everything from politics to industry to individual choices, and then health care providers supporting the choices that are right for the patient both in the immediate, medium, and long term.”

Articles

With unprecedented pauses in air pollution emissions in spring 2020 and ongoing virus mitigation behaviors around the world, the COVID-19 pandemic presents an opportunity to better understand the impact of poor air quality on human health. 

COVID-19: An Opportunity to Assess Global Air Quality and Its Impact on Health 

Ambient air pollutants such as nitrogen dioxide (NO2) and ozone may be associated with increased 

 presented at the American Academy of Neurology’s 73rd Annual Meeting, being held virtually April 17-22, 2021.

NO2 is an air pollutant generated from automobiles and fuel combustion. It is also involved in the secondary formation of particulate matter (PM), and even short-term exposure to the pollutant can increase the risk of 

Previous research has explored the relationship between the effects of 

 on migraine and found that higher relative humidity was associated with greater odds of migraine onset in warm season months. However, 

 conducted in 2019 found a weak positive association between air pollutants and higher odds of migraines in the cold season.

To better understand the implications of environmental exposures for migraine in patients in one geographical region, investigators used a migraine probability algorithm (MPA) to assess migraine cases and controls among Sutter Health patients in Northern California.

“Prior studies report associations between fine particles (PM2.5), NO2, and ozone and migraine-related emergency department (ED) visits,” authors wrote. “To our knowledge, none have evaluated the importance of methane super-emitters or oil and gas wells, nor have any considered alternative proxies for migraine exacerbation beyond ED visits,” they added.

Between 2014 and 2018, a total of 89,575 migraine cases were identified at the health system, in addition to 270,564 frequency-matched controls. “Exposures included 2015 annual average block group-level PM2.5 and NO2 concentrations, inverse-distance weighted (IDW) methane emissions from super-emitters within 10km of participant residences between 2016–2018, and 2015 IDW active oil and gas wells within 10km of participant residences,” researchers explained.

To evaluate the association between environmental exposures and migraine case status and severity, researchers used logistic and negative binomial mixed models controlled for age, sex, race/ethnicity, Medicaid eligibility, primary care visits, population density and community poverty. Migraine severity was defined as an MRP score greater than 100, triptan prescriptions, neurologist visits, urgent care migraine visits and ED migraine visits.

For each 5 parts per billion increase in NO2­, there was a 2% increased odds of migraine case status (95% CI, 1.00-1.05)

For each 100,000 kg/hour increase in IDW methane emissions, the odds of case status increased (odds ratio [OR] 1.04; 95% CI, 1.00-1.08)

PM2.5 was linearly associated with neurology visits, migraine-specific urgent care visits, and MPA score >100, but not triptans or ED visits

NO2­ was associated with migraine-specific urgent care and ED visits, but not other severity measures

Despite these links, overall, researchers “observed limited associations between continuous measures of methane emissions and proximity to oil and gas wells and migraine severity.”

Elser H, Morello-Frosch R, Jacobson A, et al. Air pollution, methane super-emitters, and oil and gas wells in Northern California: the relationship with migraine headache prevalence and exacerbation. Presented at: American Academy of Neurology 73rd Annual Meeting; April 17-22, 2021; Virtual. Accessed April 20, 2021. https://index.mirasmart.com/AAN2021/PDFfiles/AAN2021-001194.html

Research presented at the American Academy of Neurology's annual meeting indicates some air pollutants may be associated with increased rates of migraine prevalence and severity. 

Some Air Pollutants Linked With Increased Migraine Prevalence, Severity 

 from The Environmental Determinants of Diabetes in the Young (TEDDY) study indicates many parents view TEDDY participation as a way to monitor for 

 (T1D), marking a benefit of enrollment in a longitudinal study that offers no prevention, the authors wrote. 

Results also show positive islet autoantibody (IA) notification increases short- and long-term monitoring behaviors, while for IA-negative and positive children, first-degree relative (FDR) parents engage in glucose monitoring, even when not instructed to do so.

TEDDY follows approximately 9000 children across the United States and Europe with high-risk human leucocyte antigen (HLA) DQ genotypes from birth to age 15 to determine environmental factors that may contribute to T1D development. Both children from the general population (GP) and those with an FDR with diabetes are included in the study. Although screening began in 

, data on parental monitoring behaviors were collected annually, and the current analysis examines parental monitoring behaviors during the study’s first 7 years.

“While a number of studies have documented changes that individuals or their parents may undertake to prevent diabetes, fewer studies have examined behaviors to monitor for the occurrence of diabetes in those at genetic risk,” the researchers wrote. Little is also known about the characteristics of parents who engage in these behaviors or if their actions increase or alter responses to information about increased diabetes risk.

A total of 8676 HLA-eligible patients joined the study before 4.5 months of age, and as part of TEDDY, “families are asked to participate in clinic visits every 3 months during the first 4 years of the child's life and for every 6 months thereafter up to the age of 15 years or the diagnosis of T1D,” the authors wrote.

At each study visit, patients underwent IA testing, and based on results, risk information was relayed to parents. After 1 year, 7319 participants were still enrolled in TEDDY and patients were divided into 3 cohorts. Analyses revealed:

In IA-negative children, the most common monitoring behavior was participating in TEDDY study tasks; up to 49.8% and 44.2% of mothers and fathers, respectively, reported this.

Longitudinally, in IA-negative children, monitoring behaviors appear to remain relatively stable over time after an initial increase in children aged 6 to 15 months.

Among FDRs, 7% to 10% reported watching for diabetes symptoms and 7% to 9% reported monitoring the child's glucose, for mothers and fathers, respectively.

After IA-positive notification, all monitoring behaviors significantly increased in GP parents; only glucose monitoring increased in FDR parents, and these behaviors continued for up to 4 years.

FDR status, accurate diabetes risk perception, and anxiety were associated with glucose monitoring in IA-positive and IA-negative cohorts.

Up to 11% of FDR mothers and 8% of FDR fathers endorsed glucose monitoring, and the increased reporting in FDR compared with GP families was even more pronounced than what was observed for all monitoring behaviors.

Findings indicate that parents perceive TEDDY participation as a way to monitor for the onset of T1D—an accurate perception, as all children enrolled are more intensively monitored depending on IA-positive status and clinical signs of diabetes, the researchers said. Due in part to these monitoring strategies, children in TEDDY exhibit lower rates of diabetic ketoacidosis and less insulin requirements at diagnosis compared with those diagnosed in the community.

Results also show mothers consistently report more monitoring behavior than fathers and that monitoring was more common among older children, first-born children, nonethnic minority children, and FDR families.

“Parents who believe they can do something to prevent T1D likely view monitoring as a way to detect the condition earlier to prevent it, despite the fact that no empirically supported preventive interventions exist at this time,” the researchers wrote.

As monitoring data were self-reported by parents, it may be subject to reporting biases, marking a limitation to the study. The authors also did not have data about how often certain monitoring behaviors occurred and cautioned results may not be generalizable to the GP or FDR families not enrolled in TEDDY.

Overall, “findings suggest that parental monitoring is a complex behavior, differentially impacted by a variety of factors such as demographic and psychological constructs, as well as the level of T1D risk communicated to parents (ie, IA status),” the authors said. “A small but relevant group of parents engage in unnecessary glucose monitoring, despite not being instructed to do so and despite there being no extant literature suggesting that intermittent glucose monitoring may be helpful in predicting the development of T1D,” they added.

Additional education on watchful waiting strategies, or monitoring for symptoms, is warranted as this behavior was reported by relatively few parents in the current analysis and is an easy, noninvasive behavior that can be recommended to high-risk populations.

“Future work within TEDDY will examine monitoring behaviors vis-à-vis study participation to better understand how they may influence study satisfaction, protocol adherence, and study retention,” the researchers concluded.

Smith LB, Lynch KF, Driscoll KA, Johnson SB; the TEDDY Study Group. Parental monitoring for type 1 diabetes in genetically at-risk young children: the TEDDY study. 

. Published online March 11, 2021. doi:10.1111/pedi.13173

An analysis of an ongoing study on children genetically at risk of type 1 diabetes examines the monitoring behaviors of parents. 

Understanding Parental Monitoring of Children Genetically at Risk for T1D 

A significantly higher percentage of women presented to the emergency department (ED) for 

 during the preovulatory interval of their menstrual cycle—when estrogen levels are on the rise and headaches are typically less frequent and severe—compared with other intervals of the cycle, according to an 

Findings may represent a delay in seeking care for perimenstrual attacks or could indicate other factors aside from hormone levels contributing to when women present for headache, authors wrote.

As females exhibit higher prevalence of migraine worldwide (18% vs 6% in males), and because the condition has been historically associated with menstruation, 

 have aimed to analyze estrogen’s role in migraine pathogenesis.

“Hormone levels can impact the severity and frequency of migraine and tension headaches,” authors wrote. They continued, “perimenstrual attacks, thought to be precipitated by falling estrogen levels, are more severe and refractory to treatment. Given this, we hypothesized that there is an increase in ED presentations for headache during the perimenstrual interval.”

 attacks are considered menstrual migraines if they occur within the 5-day window of the 2 days prior to menstruation and the first 3 days of menstruation.

To better understand the relationship between presentation to the ED for headache and intervals of the menstrual cycle in reproductive age women, researchers assessed all first time ED visits for the primary complaint of headache at a single health network.

All women between ages 18 and 42 with data regarding their last menstrual period (LMP) who presented to the Montefiore Health System network between January 2017 and December 2019 were included in the study.

Menstrual cycle phase was based on a 28-day cycle by calculating the time from the start of each woman’s LMP to ED visit, authors explained. “Using day 1 as the start of menstruation, menstrual intervals were defined as preovulatory (days 5-11), periovulatory (days 12-18), postovulatory (days 19-25), and perimenstrual (days 26-4),” they said.

A total of 4996 women with a mean (SD) age of 29.4 (7.1) and who presented to the Montefiore ED for the primary complaint of headache were included in the analysis. Approximately 7% of women were taking hormonal contraceptives at the time of presentation.

1154 (23.1 %) were within the perimenstrual interval

Overall “significantly more women presented during the preovulatory period compared to the perimenstrual (z=2.797, P=.005) and all other intervals,” researchers concluded.

Jicha C and Pavlovic J. Relationship between intervals of the menstrual cycle and presentation to the emergency department for headache. Presented at: American Academy of Neurology 73rd Annual Meeting; April 17-22, 2021; Virtual. Accessed April 19, 2021. https://index.mirasmart.com/AAN2021/PDFfiles/AAN2021-002935.html

Data from a single health system show women who present to the emergency department for headache tend to do so during the preovulatory interval of their menstrual cycle.

Gianna Melillo

Articles

COVID-19: An Opportunity to Assess Global Air Quality and Its Impact on Health

Some Air Pollutants Linked With Increased Migraine Prevalence, Severity

Understanding Parental Monitoring of Children Genetically at Risk for T1D

When in Menstrual Cycle Does Headache Lead to Emergency Department Visit?