Occupational, Environmental, and Climate Medicine Program

Acute differences in blood lipids and inflammatory biomarkers following controlled exposures to cookstove air pollution in the STOVES study

Ethan S Walker
Kristen M Fedak
Nicholas Good
John Balmes
Robert D Brook
Maggie L Clark
Tom Cole-Hunter
Robert B Devlin
Christian L'Orange
Gary Luckasen
John Mehaffy
Rhiannon Shelton
Ander Wilson
John Volckens
Jennifer L Peel
2020

Household air pollution is a leading risk factor for morbidity and premature mortality. Numerous cookstoves have been developed to reduce household air pollution, but it is unclear whether such cookstoves meaningfully improve health. In a controlled exposure study with a crossover design, we assessed the effect of pollution emitted from multiple cookstoves on acute differences in blood lipids and inflammatory biomarkers. Participants (n = 48) were assigned to treatment sequences of exposure to air pollution emitted from five cookstoves and a filtered-air control. Blood lipids and...

The TOPAZ study: a home-based trial of zoledronic acid to prevent fractures in neurodegenerative parkinsonism

Caroline M Tanner
Steven R Cummings
Michael A Schwarzschild
Ethan G Brown
E Ray Dorsey
Alberto J Espay
Nicholas B Galifianakis
Samuel M Goldman
Irene Litvan
Nijee Luthra
Nikolaus R McFarland
Kyle T Mitchell
David G Standaert
Douglas C Bauer
Susan L Greenspan
James C Beck
Kenneth W Lyles
2021

The Trial of Parkinson's And Zoledronic acid (TOPAZ, https://clinicaltrials.gov/ct2/show/NCT03924414 ) is a unique collaboration between experts in movement disorders and osteoporosis to test the efficacy of zoledronic acid, an FDA-approved parenteral treatment for osteoporosis, for fracture prevention in people with neurodegenerative parkinsonism. Aiming to enroll 3,500 participants age 65 years or older, TOPAZ is one of the largest randomized, placebo-controlled clinical trials ever attempted in parkinsonism....

Nonsteroidal Anti-inflammatory Use and LRRK2 Parkinson's Disease Penetrance

Marta San Luciano
Caroline M Tanner
Cheryl Meng
Connie Marras
Samuel M Goldman
Anthony E Lang
Eduardo Tolosa
Birgitt Schüle
J William Langston
Alexis Brice
Jean-Christophe Corvol
Stefano Goldwurm
Christine Klein
Simone Brockman
Daniela Berg
Kathrin Brockmann
Joachim J Ferreira
Meriem Tazir
George D Mellick
Carolyn M Sue
Kazuko Hasegawa
Eng King Tan
Susan Bressman
Rachel Saunders-Pullman
Michael J. Fox Foundation LRRK2 Cohort Consortium
2020

Background: The penetrance of leucine rich repeat kinase 2 (LRRK2) mutations is incomplete and may be influenced by environmental and/or other genetic factors. Nonsteroidal anti-inflammatory drugs (NSAIDs) are known to reduce inflammation and may lower Parkinson's disease (PD) risk, but their role in LRRK2-associated PD is unknown.

Objectives: The objective of this study is to evaluate the association of regular NSAID use and LRRK2-associated PD.

Methods: Symptomatic ("LRRK2-PD") and asymptomatic ("LRRK2-non-PD") participants...

Air pollution interventions and respiratory health: a systematic review

S Saleh
W Shepherd
C Jewell
N L Lam
John Balmes
M N Bates
P S Lai
C A Ochieng
M Chinouya
K Mortimer
2020

BACKGROUND: Indoor and ambient air pollution exposure is a major risk to respiratory health worldwide, particularly in low- and middle-income countries (LMICs). Interventional trials have mainly focused on alternatives to cooking stoves, with mixed results. Beyond cooking, additional sources of particulate matter also contribute to the burden of air pollution exposure. This review explores evidence from current randomised controlled trials (RCTs) on the clinical effectiveness of interventions to reduce particulate matter in LMICs.

METHODS: Twelve databases and the grey literature (e...

Respiratory Impacts of Wildland Fire Smoke: Future Challenges and Policy Opportunities. An Official American Thoracic Society Workshop Report

Mary B Rice
Sarah B Henderson
Allison A Lambert
Kevin R Cromar
John A Hall
Wayne E Cascio
Paul G Smith
Brenda J Marsh
Sarah Coefield
John R Balmes
Ali Kamal
M Ian Gilmour
Chris Carlsten
Kathleen M Navarro
Gwen W Collman
Ana Rappold
Mark D Miller
Susan L Stone
Daniel L Costa
2021

Wildland fires are diminishing air quality on a seasonal and regional basis, raising concerns about respiratory health risks to the public and occupational groups. This American Thoracic Society (ATS) workshop was convened in 2019 to meet the growing health threat of wildland fire smoke. The workshop brought together a multidisciplinary group of 19 experts, including wildland fire managers, public health officials, epidemiologists, toxicologists, and pediatric and adult pulmonologists. The workshop examined the following four major topics: 1) the science of wildland fire incidence and fire...

Air pollution exposure is linked with methylation of immunoregulatory genes, altered immune cell profiles, and increased blood pressure in children

Prunicki M
Cauwenberghs N
Lee J
Zhou X
Movassagh H
Elizabeth Noth
Lurmann F
Hammond K
Balmes JR
Desai M
Wu JC
Nadeau KC
2021

Publication

Cardiopulmonary Impact of Particulate Air Pollution in High-Risk Populations: JACC State-of-the-Art Review

Jonathan D Newman
Deepak L Bhatt
Sanjay Rajagopalan
John R Balmes
Michael Brauer
Patrick N Breysse
Alison G M Brown
Mercedes R Carnethon
Wayne E Cascio
Gwen W Collman
Lawrence J Fine
Nadia N Hansel
Adrian Hernandez
Judith S Hochman
Michael Jerrett
Bonnie R Joubert
Joel D Kaufman
Ali O Malik
George A Mensah
David E Newby
Jennifer L Peel
Jeffrey Siegel
David Siscovick
Betsy L Thompson
Junfeng Zhang
Robert D Brook
2020

Fine particulate air pollution <2.5 μm in diameter (PM2.5) is a major environmental threat to global public health. Multiple national and international medical and governmental organizations have recognized PM2.5 as a risk factor for cardiopulmonary diseases. A growing body of evidence indicates that several personal-level approaches that reduce exposures to PM2.5 can lead to improvements in health endpoints. Novel and forward-thinking strategies including randomized clinical trials are important to validate key aspects (e.g., feasibility, efficacy...

Wildland firefighter exposure to smoke and COVID-19: A new risk on the fire line

Kathleen M Navarro
Kathleen A Clark
Daniel J Hardt
Colleen E Reid
Peter W Lahm
Joseph W Domitrovich
Corey R Butler
John R Balmes
2020

Throughout the United States, wildland firefighters respond to wildfires, performing arduous work in remote locations. Wildfire incidents can be an ideal environment for the transmission of infectious diseases, particularly for wildland firefighters who congregate in work and living settings. In this review, we examine how exposure to wildfire smoke can contribute to an increased likelihood of SARS-CoV-2 infection and severity of coronavirus disease (COVID-19). Human exposure to particulate matter (PM), a component of wildfire smoke, has been associated with oxidative stress and...

Gamma-Butyrolactone Overdose Potentially Complicated by Co-Ingestion of Industrial Solvent N-Methyl-2-Pyrrolidone

Jonathan Melamed
Roy Gerona
Paul D Blanc
Paul Takamoto
Stephanie Conner
Robert Goodnough
2021

Gamma-hydroxybutyrate (GHB) is misused as an intoxicant, either alone or concurrently with other substances. Because GHB is illegal, the precursor chemicals 1,4-butanediol and gamma-butyrolactone are also misused for the same effect, either through pre-ingestion alteration or endogenous metabolism to GHB. We describe a case of a 50-year-old man with a history of polysubstance misuse who experienced an overdose of GHB from gamma-butyrolactone ingestion. The patient also co-ingested a common industrial solvent, N-methyl-2-pyrrolidone (NMP). This co-ingested substance raised theoretical...

Primary graft dysfunction attenuates improvements in health-related quality of life after lung transplantation, but not disability or depression

Nicholas A Kolaitis
Ying Gao
Allison Soong
John R Greenland
Steven R Hays
Jeffrey Golden
Lorriana E Leard
Rupal J Shah
Mary Ellen Kleinhenz
Patricia P Katz
Aida Venado
Jasleen Kukreja
Paul D Blanc
Jonathan P Singer
2020

Disability, depressive symptoms, and impaired health-related quality of life (HRQL) are common among patients with life-threatening respiratory compromise. We sought to determine if primary graft dysfunction (PGD), a syndrome of acute lung injury, attenuates improvements in patient-reported outcomes after transplantation. In a single-center prospective cohort, we assessed disability, depressive symptoms, and HRQL before and at 3- to 6-month intervals after lung transplantation. We estimated the magnitude of change in disability, depressive symptoms, and HRQL with hierarchical segmented...