Reviews and feature article
Inflammatory health effects of indoor and outdoor particulate matter

https://doi.org/10.1016/j.jaci.2017.12.981Get rights and content

Information for Category 1 CME Credit

Credit can now be obtained, free for a limited time, by reading the review articles in this issue. Please note the following instructions.

Method of Physician Participation in Learning Process: The core material for these activities can be read in this issue of the Journal or online at the JACI Web site: www.jacionline.org. The accompanying tests may only be submitted online at www.jacionline.org. Fax or other copies will not be accepted.

Date of Original Release: March 2018. Credit may be obtained for these courses until February 28, 2019.

Copyright Statement: Copyright © 2018-2019. All rights reserved.

Overall Purpose/Goal: To provide excellent reviews on key aspects of allergic disease to those who research, treat, or manage allergic disease.

Target Audience: Physicians and researchers within the field of allergic disease.

Accreditation/Provider Statements and Credit Designation: The American Academy of Allergy, Asthma & Immunology (AAAAI) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. The AAAAI designates this journal-based CME activity for a maximum of 1.00 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

List of Design Committee Members: Weidong Wu, PhD, Yuefei Jin, MD, and Chris Carlsten, MD, MPH (authors); Zuhair K. Ballas, MD (editor)

Disclosure of Significant Relationships with Relevant Commercial

Companies/Organizations: The authors declare that they have no relevant conflicts of interest. Z. K. Ballas (editor) disclosed no relevant financial relationships.

Activity Objectives:

  • 1.

    To recognize that particulate matter (PM) can have significant pulmonary and cardiovascular effects.

  • 2.

    To identify some of the inflammatory changes and potential health consequences that can occur with exposure to PM.

Recognition of Commercial Support: This CME activity has not received external commercial support.

List of CME Exam Authors: Evelyn Angulo, MD, Anna Lang, MD, PhD, David Peloza, MD, Cheryl Steiman, MD, and Sameer K. Mathur, MD, PhD.

Disclosure of Significant Relationships with Relevant Commercial

Companies/Organizations: The exam authors disclosed no relevant financial relationships.

Inflammation is a common and essential event in the pathogenesis of diverse diseases. Decades of research has converged on an understanding that all combustion-derived particulate matter (PM) is inflammatory to some extent in the lungs and also systemically, substantially explaining a significant portion of the massive cardiopulmonary disease burden associated with these exposures. In general, this means that efforts to do the following can all be beneficial: reduce particulates at the source, decrease the inflammatory potential of PM output, and, where PM inhalation is unavoidable, administer anti-inflammatory treatment. A range of research, including basic illumination of inflammatory pathways, assessment of disease burden in large cohorts, tailored treatment trials, and epidemiologic, animal, and in vitro studies, is highlighted in this review. However, meaningful translation of this research to decrease the burden of disease and deliver a clear and cohesive message to guide daily clinical practice remains rudimentary. Ongoing efforts to better understand substantial differences in the concentration and type of PM to which the global community is exposed and then distill how that influences inflammation promises to have real-world benefit. This review addresses this complex topic in 3 sections, including ambient PM (typically associated with ground-level transportation), wildfire-induced PM, and PM from indoor biomass burning. Recognizing the overlap between these domains, we also describe differences and suggest future directions to better inform clinical practice and public health.

Section snippets

Inflammatory health effects of ambient (traffic-related) PM exposure

The evidence linking ambient (outdoor) PM (primarily derived from transit of people and goods) to inflammation includes both direct and indirect lines of support. The direct evidence comes primarily from animal and cellular models, which are informative in spite of legitimate questions of applicability to the intact human context and from rare controlled human exposure studies. The indirect evidence comes largely from observational (epidemiologic) studies, which are very important in spite of

Inflammatory health effect associated with wildfire PM

Changes in temperature and precipitation patterns from climate change are increasing wildfire prevalence and severity worldwide.58 Wildfires, in the form of bush, vegetation, forest, peat, heath, and grass fires, can release large amounts of PM and toxic gases that adversely affect air quality and health. Of the various pollutants released from wildfires, PM is considered to be the most harmful to public health because it is present at higher concentrations than other hazardous substances and

Inflammatory health effects of PM from indoor biomass combustion

In contrast to outdoor PM pollution, indoor PM pollution is more heterogeneous, with wide variations in pollutants and sources between countries. It is estimated that we spend an average of approximately 90% of our lifetimes indoors.86 Therefore household air quality is critical for human health. Currently, indoor PM exposure has developed into a major concern that contributes to adverse cardiopulmonary effects.87, 88

Indoor PM pollution is attributed mainly to cooking fumes, outdoor origin of

Conclusions and future directions

All particle-rich combustion products appear to be proinflammatory, both in the lung and systemically, although there do appear to be considerable source-specific differences in local and regional inflammatory patterns. For example, wildfire smoke seems particularly toxic to the lung macrophages, perhaps even more so than other combustion-derived PM. If this is confirmed, and future research must prioritize this understanding, there are significant implications to clinicians and public health

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    Supported by grants from the National Natural Science Foundation of China (81573112 and 81373030) and the Canada Research Chairs Program.

    ∗

    These authors contributed equally to this work.

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