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Efectos de la contaminación ambiental sobre los pulmones en personas no fumadorasMónica M. Medina Fajardo1Tutora: Maylin J. Pe?aloza Parra2Estudiante de Medicina, Facultad de Medicina de la Pontificia Universidad Javeriana, Bogotá D.C., Colombia?Profesora Instructora, Departamento de Medicina Preventiva y Social, Facultad Medicina, Pontificia Universidad JaverianaIntroducciónLa contaminación del medio ambiente se encuentra entre los principales riesgos para la salud en todo el mundo y se estima que para 2050 superará en gran medida las muertes asociadas a enfermedad respiratoria y cardiovascular en todas las edades ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1007/s00038-017-0960-y","ISBN":"0123456789","ISSN":"1420911X","abstract":"OBJECTIVES Ambient air pollution is among the leading risks for health worldwide and by 2050 will largely overcome deaths due to unsafe sanitation and malaria, but local evidence from Latin America (LA) is scarce. We aimed to summarize the effect of short-term exposure to fine particulate air pollution (PM2.5) on morbidity and mortality in Latin America and evaluate evidence coverage and quality, using systematic review and meta-analysis. METHODS The comprehensive search (six online databases and hand-searching) identified studies investigating the short-term associations between PM2.5 and daily health events in LA. Two reviewers independently accessed the internal validity of the studies and used random-effect models in the meta-analysis. RESULTS We retrieved 1628 studies. Nine were elected for the qualitative analysis and seven for the quantitative analyses. Each 10 ?g/m(3) increments in daily PM2.5 concentrations was significantly associated with increased risk for respiratory and cardiovascular mortality in all-ages (polled RR = 1.02, 95% CI, 1.02-1.02 and RR = 1.01, 95% CI , 1.01-1.02, respectively). CONCLUSIONS Short-term exposure to PM2.5 in LA is significantly associated with increased risk for respiratory and cardiovascular mortality. Evidence is concentrated in few cities and some presented high risk of bias.","author":[{"dropping-particle":"","family":"Fajersztajn","given":"Laís","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Saldiva","given":"Paulo","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Pereira","given":"Luiz Alberto Amador","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Leite","given":"Victor Figueiredo","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Buehler","given":"Anna Maria","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"International Journal of Public Health","id":"ITEM-1","issue":"7","issued":{"date-parts":[["2017"]]},"page":"729-738","publisher":"Springer International Publishing","title":"Short-term effects of fine particulate matter pollution on daily health events in Latin America: a systematic review and meta-analysis","type":"article-journal","volume":"62"},"uris":[""]}],"mendeley":{"formattedCitation":"(1)","plainTextFormattedCitation":"(1)","previouslyFormattedCitation":"(1)"},"properties":{"noteIndex":0},"schema":""}(1). La contaminación del aire se describe generalmente en términos de: material particulado (PM), ozono (O3), dióxido de azufre (SO2), óxidos de nitrógeno (NOx), monóxido de carbono (CO), benceno y plomo (Pb). De estos, el PM afecta a más personas que cualquier otro contaminante ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1016/j.envint.2017.09.010","ISSN":"18736750","abstract":"Background The link between PM2.5 exposure and adverse health outcomes is well documented from studies across the world. However, the reported effect estimates vary across studies, locations and constituents. We aimed to conduct a meta-analysis on associations between short-term exposure to PM2.5 constituents and mortality using city-specific estimates, and explore factors that may explain some of the observed heterogeneity. Methods We systematically reviewed epidemiological studies on particle constituents and mortality using PubMed and Web of Science databases up to July 2015.We included studies that examined the association between short-term exposure to PM2.5 constituents and all-cause, cardiovascular, and respiratory mortality, in the general adult population. Each study was summarized based on pre-specified study key parameters (e.g., location, time period, population, diagnostic classification standard), and we evaluated the risk of bias using the Office of Health Assessment and Translation (OHAT) Method for each included study. We extracted city-specific mortality risk estimates for each constituent and cause of mortality. For multi-city studies, we requested the city-specific risk estimates from the authors unless reported in the article. We performed random effects meta-analyses using city-specific estimates, and examined whether the effects vary across regions and city characteristics (PM2.5 concentration levels, air temperature, elevation, vegetation, size of elderly population, population density, and baseline mortality). Results We found a 0.89% (95% CI: 0.68, 1.10%) increase in all-cause, a 0.80% (95% CI: 0.41, 1.20%) increase in cardiovascular, and a 1.10% (95% CI: 0.59, 1.62%) increase in respiratory mortality per 10 μg/m3 increase in PM2.5. Accounting for the downward bias induced by studies of single days, the all-cause mortality estimate increased to 1.01% (95% CI: 0.81, 1.20%). We found significant associations between mortality and several PM2.5 constituents. The most consistent and stronger associations were observed for elemental carbon (EC) and potassium (K). For most of the constituents, we observed high variability of effect estimates across cities. Conclusions Our meta-analysis suggests that (a) combustion elements such as EC and K have a stronger association with mortality, (b) single lag studies underestimate effects, and (c) estimates of PM2.5 and constituents differ across regions. Accounting for PM mass in constituent's …","author":[{"dropping-particle":"","family":"Achilleos","given":"Souzana","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Kioumourtzoglou","given":"Marianthi Anna","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"Da","family":"Wu","given":"Chih","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Schwartz","given":"Joel D.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Koutrakis","given":"Petros","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Papatheodorou","given":"Stefania I.","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Environment International","id":"ITEM-1","issue":"October","issued":{"date-parts":[["2017"]]},"page":"89-100","publisher":"Elsevier","title":"Acute effects of fine particulate matter constituents on mortality: A systematic review and meta-regression analysis","type":"article-journal","volume":"109"},"uris":[""]}],"mendeley":{"formattedCitation":"(2)","plainTextFormattedCitation":"(2)","previouslyFormattedCitation":"(2)"},"properties":{"noteIndex":0},"schema":""}(2). Dicho material particulado es una mezcla compleja de sólidos y compuestos líquidos; de acuerdo a las fuentes de emisión y a su tama?o, mayor será su potencial para generar impacto en la salud, como sucede con las partículas finas con diámetro aerodinámico ≤ 2.5 μm (PM2.5) que tienen mayor posibilidad de penetración en el tracto respiratorio ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1016/j.envpol.2018.12.060","ISSN":"18736424","abstract":"Background: Fine particulate matter (Particulate matter with diameter ≤ 2.5 μm) is associated with multiple health outcomes, with varying effects across seasons and locations. It remains largely unknown that which components of PM 2.5 are most harmful to human health. Methods: We systematically searched all the relevent studies published before August 1, 2018, on the associations of fine particulate matter constituents with mortality and morbidity, using Web of Science, MEDLINE, PubMed and EMBASE. Studies were included if they explored the associations between short term or long term exposure of fine particulate matter constituents and natural, cardiovascular or respiratory health endpoints. The criteria for the risk of bias was adapted from OHAT and New Castle Ottawa. We applied a random-effects model to derive the risk estimates for each constituent. We performed main analyses restricted to studies which adjusted the PM 2.5 mass in their models. Results: Significant associations were observed between several PM 2.5 constituents and different health endpoints. Among them, black carbon and organic carbon were most robustly and consistently associated with all natural, cardiovascular mortality and morbidity. Other potential toxic constituents including nitrate, sulfate, Zinc, silicon, iron, nickel, vanadium, and potassium were associated with adverse cardiovascular health, while nitrate, sulfate and vanadium were relevant for adverse respiratory health outcomes. Conclusions: Our analysis suggests that black carbon and organic carbon are important detrimental components of PM 2.5 , while other constituents are probably hazardous to human health. However, more studies are needed to further confirm our results.","author":[{"dropping-particle":"","family":"Yang","given":"Yang","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Ruan","given":"Zengliang","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Wang","given":"Xiaojie","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Yang","given":"Yin","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Mason","given":"Tonya G.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lin","given":"Hualiang","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Tian","given":"Linwei","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Environmental Pollution","id":"ITEM-1","issued":{"date-parts":[["2019"]]},"page":"874-882","publisher":"Elsevier Ltd","title":"Short-term and long-term exposures to fine particulate matter constituents and health: A systematic review and meta-analysis","type":"article-journal","volume":"247"},"uris":[""]}],"mendeley":{"formattedCitation":"(3)","plainTextFormattedCitation":"(3)","previouslyFormattedCitation":"(3)"},"properties":{"noteIndex":0},"schema":""}(3). PM2.5 es una mezcla compleja de varios constituyentes como carbón elemental (o negro, o CE) y orgánico (BC ú OC) que son emitidos por: el tráfico (CE), fuentes de combustión (CE, OC), vegetación (OC) o a partir de reacciones fotoquímicas atmosféricas (OC). El PM2.5 se ha asociado a corto plazo con enfermedad cardiovascular y enfermedades respiratorias. Otras fuentes de combustión como la quema de biomasa que genera la producción de potasio (K) se asocia con aumento de hospitalizaciones por enfermedad pulmonar y mortalidad cardiovascular. Partículas derivadas de la combustión del aceite, particularmente vanadio (V) y níquel (Ni), se han asociado con admisión hospitalaria por las mismas patologías antes mencionadas. Por último, el nitrato (NO3) y el sulfato (SO42?) son iones secundarios a la oxidación de óxidos de nitrógeno y gases de azufre emitidos durante la combustión de fósiles y carbón que a su vez han sido implicados en un aumento de enfermedad cardiovascular y respiratoria ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1016/j.envint.2017.09.010","ISSN":"18736750","abstract":"Background The link between PM2.5 exposure and adverse health outcomes is well documented from studies across the world. However, the reported effect estimates vary across studies, locations and constituents. We aimed to conduct a meta-analysis on associations between short-term exposure to PM2.5 constituents and mortality using city-specific estimates, and explore factors that may explain some of the observed heterogeneity. Methods We systematically reviewed epidemiological studies on particle constituents and mortality using PubMed and Web of Science databases up to July 2015.We included studies that examined the association between short-term exposure to PM2.5 constituents and all-cause, cardiovascular, and respiratory mortality, in the general adult population. Each study was summarized based on pre-specified study key parameters (e.g., location, time period, population, diagnostic classification standard), and we evaluated the risk of bias using the Office of Health Assessment and Translation (OHAT) Method for each included study. We extracted city-specific mortality risk estimates for each constituent and cause of mortality. For multi-city studies, we requested the city-specific risk estimates from the authors unless reported in the article. We performed random effects meta-analyses using city-specific estimates, and examined whether the effects vary across regions and city characteristics (PM2.5 concentration levels, air temperature, elevation, vegetation, size of elderly population, population density, and baseline mortality). Results We found a 0.89% (95% CI: 0.68, 1.10%) increase in all-cause, a 0.80% (95% CI: 0.41, 1.20%) increase in cardiovascular, and a 1.10% (95% CI: 0.59, 1.62%) increase in respiratory mortality per 10 μg/m3 increase in PM2.5. Accounting for the downward bias induced by studies of single days, the all-cause mortality estimate increased to 1.01% (95% CI: 0.81, 1.20%). We found significant associations between mortality and several PM2.5 constituents. The most consistent and stronger associations were observed for elemental carbon (EC) and potassium (K). For most of the constituents, we observed high variability of effect estimates across cities. Conclusions Our meta-analysis suggests that (a) combustion elements such as EC and K have a stronger association with mortality, (b) single lag studies underestimate effects, and (c) estimates of PM2.5 and constituents differ across regions. Accounting for PM mass in constituent's …","author":[{"dropping-particle":"","family":"Achilleos","given":"Souzana","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Kioumourtzoglou","given":"Marianthi Anna","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"Da","family":"Wu","given":"Chih","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Schwartz","given":"Joel D.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Koutrakis","given":"Petros","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Papatheodorou","given":"Stefania I.","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Environment International","id":"ITEM-1","issue":"October","issued":{"date-parts":[["2017"]]},"page":"89-100","publisher":"Elsevier","title":"Acute effects of fine particulate matter constituents on mortality: A systematic review and meta-regression analysis","type":"article-journal","volume":"109"},"uris":[""]}],"mendeley":{"formattedCitation":"(2)","plainTextFormattedCitation":"(2)","previouslyFormattedCitation":"(2)"},"properties":{"noteIndex":0},"schema":""}(2).El mecanismo fisiopatológico subyacente por el cual los constituyentes PM2.5 están asociados con efectos cardiorrespiratorios está basado en un proceso inflamatorio secundario al estrés oxidativo, las células estimuladas por PM (neutrófilos, eosinófilos, monocitos, mastocitos, linfocitos TCD8, Células Natural Killers) generan numerosos mediadores inflamatorios como IL-6, IL-8, TNF-α, MCP-1 y MIP2α, estos generan una segunda oleada de mediadores que incluyen enzimas como la MMP-9 y la MMP-12, implicadas en el remodelado tisular. Se ha propuesto que las PM presentes en el humo de biomasa pueden activar los canales iónicos TRP de diversas células pulmonares, provocando un incremento del Ca2+ en el citoplasma y una cascada de se?alización intracelular cuyas consecuencias traerían un aumento de la producción de dichos mediadores pro-inflamatorios. Por otra parte, Nitrato (NO3), sulfato (SO42?) y el carbón elemental han sido vinculados con cambios en la vascularización del pulmón y en disminución de la metilación del ADN. La producción de potasio (K), vanadio (V) y níquel (Ni) se asocia a procesos procoagulantes e inflamatorios locales ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"author":[{"dropping-particle":"","family":"Newell","given":"Katherine","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Kartsonaki","given":"Christiana","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lim","given":"Kin Bong Hubert","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Kurmi","given":"Om","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Environmental Health","id":"ITEM-1","issue":"41","issued":{"date-parts":[["2018"]]},"page":"1-14","publisher":"Environmental Health","title":"Cardiorespiratory health effects of gaseous ambient air pollution exposure in low and middle income countries: a systematic review and meta-analysis","type":"article-journal","volume":"17"},"uris":[""]}],"mendeley":{"formattedCitation":"(4)","plainTextFormattedCitation":"(4)","previouslyFormattedCitation":"(4)"},"properties":{"noteIndex":0},"schema":""}(4).A nivel epidemiológico la contaminación ambiental resulta ser una de las mayores amenazas para la salud, se calcula que se producen 2.9 millones de muertes anuales al a?o, más del 85% por dicha exposición. Es una situación con distribución generalizada que ha despertado alarmas en la población mundial, especialmente en los países en vía de desarrollo, como Colombia, a nivel de salud pública. Tiene una creciente importancia ya que los niveles de PM2.5 han aumentado rápidamente, secundario al crecimiento económico e industrialización no planificada, que a menudo se acompa?a de ínfimos controles ambientales adecuados ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"author":[{"dropping-particle":"","family":"Newell","given":"Katherine","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Kartsonaki","given":"Christiana","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lim","given":"Kin Bong Hubert","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Kurmi","given":"Om","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Environmental Health","id":"ITEM-1","issue":"41","issued":{"date-parts":[["2018"]]},"page":"1-14","publisher":"Environmental Health","title":"Cardiorespiratory health effects of gaseous ambient air pollution exposure in low and middle income countries: a systematic review and meta-analysis","type":"article-journal","volume":"17"},"uris":[""]}],"mendeley":{"formattedCitation":"(4)","plainTextFormattedCitation":"(4)","previouslyFormattedCitation":"(4)"},"properties":{"noteIndex":0},"schema":""}(4). Teniendo en cuenta esta carga atribuible de enfermedad por la contaminación ambiental, así como los potenciales efectos a nivel pulmonar, en la actualidad no se tiene certeza de las características de la exposición nociva, no existen recomendaciones preventivas y las experiencias de implementación de políticas públicas al respecto son escasas. Por lo cual el objetivo de esta revisión narrativa es responder a la pregunta: ?Qué efectos tiene la contaminación ambiental sobre los pulmones en personas no fumadoras? MétodosPara la realización de esta revisión no sistemática/narrativa de la literatura se llevó a cabo una estrategia de búsqueda en dos bases de datos en línea (Medline a través de PubMed y Cochrane) en el mes de Abril del 2019. Se utilizaron los términos MeSH: “Environmental Pollution" OR "Air Pollution” OR "Traffic-Related Pollution" OR "Environmental Pollutants" OR "Vehicle Emissions" OR "Air Pollutants" AND "Lung" OR "Lung Diseases” OR "pulmonar” OR "respiratory" NOT "Tobacco Use" OR "Tobacco Smoke Pollution" OR "Smokers". Se filtró por: Revisiones Sistemáticas, Metanálisis, Guías Práctica Clínica, 5 a?os y Humanos. El resultado de la búsqueda arrojó: 43 guías de práctica clínica, de las cuales se seleccionaron 4 por título y resumen, 633 artículos de revisión y al filtrar por metanálisis o revisiones sistemáticas en PubMed un total de 142 artículos y en Cochrane 102 artículos. Revisamos los títulos y resúmenes de 920 estudios de los cuales 30 cumplieron con nuestros criterios de inclusión, 9 fueron eliminados por estar repetidos.Para una estrategia de búsqueda detallada se tuvieron en cuenta los siguientes criterios: a) Revisiones Sistemáticas, Metanálisis, Guías Práctica Clínica de los últimos 5 a?os. (b) Estudios que reportaron visitas diarias a la sala de emergencia, ingresos hospitalarios, y / o mortalidad por enfermedad cardiovascular y pulmonar ICD-10 J00-J99 (causas respiratorias) y, ICD-9390–459, ICD-10 I00-I99 (casos cardiovasculares). (c) Estudios publicados en las siguientes revistas: Environmental Pollution, Environmental Science and Pollution Research, y Environmental Health. Y criterios de exclusión: (a) Población fumadora, título no concordante con la temática, población embarazada y fuera del rango de publicación 2014 a 2019.Resultados Nuestro estudio identificó 25 artículos que reportaron resultados para enfermedad pulmonar secundaria a contaminación ambiental. La mayoría de las cohortes están ubicadas en: Norte América, Asia y Europa, con sólo unas pocas cohortes en Latinoamérica ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1097/EDE.0000000000000847","ISBN":"0000000000000","ISSN":"15315487","abstract":"BACKGROUND Concentrations of outdoor nitrogen dioxide (NO2) have been associated with increased mortality. Hazard ratios (HRs) from cohort studies are used to assess population health impact and burden. We undertook meta-analyses to derive concentration-response functions suitable for such evaluations and assessed their sensitivity to study selection based upon cohort characteristics. METHODS We searched online databases and existing reviews for cohort studies published to October 2016 reporting HRs for NO2 and mortality. We calculated meta-analytic summary estimates using fixed/random effects models. RESULTS We identified 48 articles analyzing 28 cohorts. Meta-analysis of HRs found positive associations between NO2 and all-cause (1.02 (95% CI: 1.01, 1.03); prediction interval (PI): (0.99, 1.06) per 10?g/m increment in NO2), cardiovascular (1.03 (95% CI: 1.02,1.05); PI: (0.98, 1.08)) , respiratory (1.03 (95% CI: 1.01,1.05); PI: (0.97, 1.10)) and lung cancer mortality (1.05 (95% CI: 1.02,1.08); PI: (0.94, 1.17)) with evidence of substantial heterogeneity between studies. In subgroup analysis, summary HRs varied by age at cohort entry, spatial resolution of pollution estimates, and adjustment for smoking and body mass index at the individual level; for some sub-groups the HR was close to unity, with lower confidence limits below 1. CONCLUSIONS Given the many uncertainties inherent in the assessment of this evidence base and the sensitivity of health impact calculations to small changes in the magnitude of the HRs, calculation of the impact on health of policies to reduce long-term exposure to NO2 should use prediction intervals and report ranges of impact rather than focusing upon point estimates.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.","author":[{"dropping-particle":"","family":"Atkinson","given":"Richard W.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Butland","given":"Barbara K.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Anderson","given":"H. Ross","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Maynard","given":"Robert L.","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Epidemiology","id":"ITEM-1","issue":"4","issued":{"date-parts":[["2018"]]},"page":"460-472","title":"Long-term concentrations of nitrogen dioxide and mortality","type":"article-journal","volume":"29"},"uris":[""]}],"mendeley":{"formattedCitation":"(5)","plainTextFormattedCitation":"(5)","previouslyFormattedCitation":"(5)"},"properties":{"noteIndex":0},"schema":""}(5). Las PM2.5 y sus componentes: SO4 2?,amonio (NH4), EC, carbón negro (BS), OC, sodio (Na), magnesio (Mg), aluminio (Al), silicio (Si), cloro (Cl), K, calcio (Ca), titanio (Ti), V, manganeso (Mn), hierro (Fe), Ni, Cu y Zn, fueron los principales contaminantes identificados. Los efectos más prevalentes fueron la enfermedad pulmonar obstructiva crónica (EPOC), asma, neumonía y cáncer pulmonar, con una alta variabilidad entre las diferentes poblaciones ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"author":[{"dropping-particle":"","family":"Newell","given":"Katherine","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Kartsonaki","given":"Christiana","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lim","given":"Kin Bong Hubert","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Kurmi","given":"Om","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Environmental Health","id":"ITEM-1","issue":"41","issued":{"date-parts":[["2018"]]},"page":"1-14","publisher":"Environmental Health","title":"Cardiorespiratory health effects of gaseous ambient air pollution exposure in low and middle income countries: a systematic review and meta-analysis","type":"article-journal","volume":"17"},"uris":[""]}],"mendeley":{"formattedCitation":"(4)","plainTextFormattedCitation":"(4)","previouslyFormattedCitation":"(4)"},"properties":{"noteIndex":0},"schema":""}(4) ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1016/j.lfs.2018.12.036","ISSN":"1879-0631","PMID":"30582950","abstract":"This review aims to systematically review and synthesize scientific evidence for the influence of air pollution exposure and outdoor exercise on health. We conducted a literature search in the PubMed, Cochrane, EMBASE, and Web of Science for articles that evaluated the combination effect of air pollution exposure and exercise on health. Questionnaires regarding exposure history, or studies examining indoor air pollution were excluded. Each included study needs to have clear exercise intervention plan. The pooled estimates of the combination effect of air pollution exposure and outdoor exercise on health were calculated in the meta-analysis. The quality of each included study was assessed and the quality of evidence for each outcome assessed in the meta-analysis was also measured. Twenty-five studies were identified. Six studies addressed ozone exposure, four diesel exhaust exposure, six traffic-related air pollution, ten particulate matter (PM) exposure. Only peak expiratory flow (effect size [ES] = ?0.238, 95% confidence interval [CI] = ?0.389, ?0.088) was found to be significantly decreased after exercise intervention in a polluted environment in the meta-analysis. Seven studies reported exposure to air pollutant during exercise was associated with an increased risk of airway inflammation and decrements in pulmonary function. Six studies discovered that exposure of traffic pollution or high PM during exercise may contribute to changes in blood pressure, systemic conduit artery function and micro-vascular function. The combination effect of air pollution and exercise was found to be associated with the increased risk of potential health problems of cardiopulmonary function, immune function, and exercise performance.","author":[{"dropping-particle":"","family":"Qin","given":"Fei","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Yang","given":"Yan","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Wang","given":"Song-Tao","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Dong","given":"Ya-Nan","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Xu","given":"Min-Xiao","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Wang","given":"Zhong-Wei","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Zhao","given":"Jie-Xiu","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Life sciences","id":"ITEM-1","issue":"11","issued":{"date-parts":[["2019"]]},"page":"153-164","publisher":"Elsevier","title":"Exercise and air pollutants exposure: A systematic review and meta-analysis.","type":"article-journal","volume":"218"},"uris":[""]}],"mendeley":{"formattedCitation":"(6)","plainTextFormattedCitation":"(6)","previouslyFormattedCitation":"(6)"},"properties":{"noteIndex":0},"schema":""}(6).Es importante resaltar que se identificaron cinco factores que podrían explicar el 82% de la variabilidad entre los resultados de los estudios: concentración PM2.5, temperatura ambiental, vegetación, tama?o de población anciana y densidad poblacional. Se encontró que hubo un incremento de 1.10% (IC 95%: 0.59, 1.62%; n ciudades = 86) en la mortalidad respiratoria por un aumento de 10 μg / m3 en las PM2.5. Las altas temperaturas mostraron un efecto positivo para aumentar la concentración de las PM2.5. Las ciudades con abundante vegetación mostraron una disminución en la concentración de dichas partículas. Existe una relación entre el tiempo de exposición a la contaminación con los desenlaces pulmonares, por lo que a mayor población anciana mayor tiempo de exposición y por consiguiente mayor probabilidad de desarrollar enfermedad pulmonar secundaria. Y la densidad poblacional se relacionó con un aumento de la contaminación secundario a que hay mayor demanda de alimentos, bienes materiales y mayor generación de residuos ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1016/j.envint.2017.09.010","ISSN":"18736750","abstract":"Background The link between PM2.5 exposure and adverse health outcomes is well documented from studies across the world. However, the reported effect estimates vary across studies, locations and constituents. We aimed to conduct a meta-analysis on associations between short-term exposure to PM2.5 constituents and mortality using city-specific estimates, and explore factors that may explain some of the observed heterogeneity. Methods We systematically reviewed epidemiological studies on particle constituents and mortality using PubMed and Web of Science databases up to July 2015.We included studies that examined the association between short-term exposure to PM2.5 constituents and all-cause, cardiovascular, and respiratory mortality, in the general adult population. Each study was summarized based on pre-specified study key parameters (e.g., location, time period, population, diagnostic classification standard), and we evaluated the risk of bias using the Office of Health Assessment and Translation (OHAT) Method for each included study. We extracted city-specific mortality risk estimates for each constituent and cause of mortality. For multi-city studies, we requested the city-specific risk estimates from the authors unless reported in the article. We performed random effects meta-analyses using city-specific estimates, and examined whether the effects vary across regions and city characteristics (PM2.5 concentration levels, air temperature, elevation, vegetation, size of elderly population, population density, and baseline mortality). Results We found a 0.89% (95% CI: 0.68, 1.10%) increase in all-cause, a 0.80% (95% CI: 0.41, 1.20%) increase in cardiovascular, and a 1.10% (95% CI: 0.59, 1.62%) increase in respiratory mortality per 10 μg/m3 increase in PM2.5. Accounting for the downward bias induced by studies of single days, the all-cause mortality estimate increased to 1.01% (95% CI: 0.81, 1.20%). We found significant associations between mortality and several PM2.5 constituents. The most consistent and stronger associations were observed for elemental carbon (EC) and potassium (K). For most of the constituents, we observed high variability of effect estimates across cities. Conclusions Our meta-analysis suggests that (a) combustion elements such as EC and K have a stronger association with mortality, (b) single lag studies underestimate effects, and (c) estimates of PM2.5 and constituents differ across regions. Accounting for PM mass in constituent's …","author":[{"dropping-particle":"","family":"Achilleos","given":"Souzana","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Kioumourtzoglou","given":"Marianthi Anna","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"Da","family":"Wu","given":"Chih","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Schwartz","given":"Joel D.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Koutrakis","given":"Petros","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Papatheodorou","given":"Stefania I.","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Environment International","id":"ITEM-1","issue":"October","issued":{"date-parts":[["2017"]]},"page":"89-100","publisher":"Elsevier","title":"Acute effects of fine particulate matter constituents on mortality: A systematic review and meta-regression analysis","type":"article-journal","volume":"109"},"uris":[""]}],"mendeley":{"formattedCitation":"(2)","plainTextFormattedCitation":"(2)","previouslyFormattedCitation":"(2)"},"properties":{"noteIndex":0},"schema":""}(2) ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.3390/ijerph14060646","ISSN":"16604601","abstract":"Objective: This study aimed to assess the quantitative effects of short-term exposure of ambient nitrogen dioxide (NO2) on respiratory disease (RD) mortality and RD hospital admission in China through systematic review and meta-analysis. Methods: A total of 29 publications were finally selected from searches in PubMed, Web of Science, CNKI and Wanfang databases. Generic inverse variance method was used to pool effect estimates. Pooled estimates were used to represent the increased risk of RD mortality and RD hospital admission per 10 μg/m3 increase in NO2 concentration. Results: Positive correlations were found between short-term NO2 exposure and RD in China. RD mortality and RD hospital admission respectively increased by 1.4% (95% CI: 1.1%, 1.7%) and 1.0% (95% CI: 0.5%, 1.5%) per 10 μg/m3 increase in NO2 concentration. Differences were observed across geographic regions of China. The risk of RD mortality due to NO2 was higher in the southern region (1.7%) than in the north (0.7%). Conclusions: Evidence was found that short-term exposure to NO2 was associated with an increased risk of RD mortality and RD hospital admission in China and these risks were more pronounced in the southern regions of the country, due in part to a larger proportion of elderly persons with increased susceptibility to NO2 in the population compared with the north.","author":[{"dropping-particle":"","family":"Sun","given":"Jiyao","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Barnes","given":"Andrew J.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"He","given":"Dongyang","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Wang","given":"Meng","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Wang","given":"Jian","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"International Journal of Environmental Research and Public Health","id":"ITEM-1","issue":"6","issued":{"date-parts":[["2017"]]},"title":"Systematic review and meta-analysis of the association between ambient nitrogen dioxide and respiratory disease in China","type":"article-journal","volume":"14"},"uris":[""]}],"mendeley":{"formattedCitation":"(7)","plainTextFormattedCitation":"(7)","previouslyFormattedCitation":"(7)"},"properties":{"noteIndex":0},"schema":""}(7). En cuanto a la enfermedad pulmonar obstructiva crónica (EPOC), una exposición prolongada a gases o partículas aéreas se ha asociado con la limitación del flujo de aire persistente debido a un aumento de la respuesta inflamatoria en la vía aérea ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.2147/COPD.S161555 LK - ","ISSN":"1178-2005","abstract":"Chronic obstructive pulmonary disease (COPD) is one of the main contributors to the global burden of disease. The aim of this systematic review was to quantify the disease burden of COPD in China and to determine the risk factors of the disease. The number of studies included in the review was 47 with an average quality assessment score of 7.70 out of 10. Reported COPD prevalence varied between 1.20% and 8.87% in different provinces/cities across China. The prevalence rate of COPD was higher among men (7.76%) than women (4.07%). The disease was more prevalent in rural areas (7.62%) than in urban areas (6.09%). The diagnostic rate of COPD patients in China varied from 23.61% to 30.00%. The percentage of COPD patients receiving outpatient treatment was around 50%, while the admission rate ranged between 8.78% and 35.60%. Tobacco exposure and biomass fuel/solid fuel usage were documented as two important risk factors of COPD. COPD ranked among the top three leading causes of death in China. The direct medical cost of COPD ranged from 72 to 3,565 USD per capita per year, accounting for 33.33% to 118.09% of local average annual income. The most commonly used scales for the assessment of quality of life (QoL) included Saint George Respiratory Questionnaire, Airways Questionnaire 20, SF-36, and their revised versions. The status of QoL was worse among COPD patients than in non-COPD patients, and COPD patients were at higher risks of depression. The COPD burden in China was high in terms of economic burden and QoL. In view of the high smoking rate and considerable concerns related to air pollution and smog in China, countermeasures need to be taken to improve disease prevention and management to reduce disease burdens raised by COPD.","author":[{"dropping-particle":"","family":"B.","given":"Zhu","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Y.","given":"Wang","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"J.","given":"Ming","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"W.","given":"Chen","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"L.","given":"Zhang","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"International Journal of COPD","id":"ITEM-1","issued":{"date-parts":[["2018"]]},"page":"1353-1364","title":"Disease burden of COPD in china: A systematic review","type":"article-journal","volume":"13"},"uris":[""]}],"mendeley":{"formattedCitation":"(8)","plainTextFormattedCitation":"(8)","previouslyFormattedCitation":"(8)"},"properties":{"noteIndex":0},"schema":""}(8). El tabaco inhalado es el factor más conocido que contribuye al desarrollo y la progresión de dicha enfermedad ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1007/s11356-018-1629-7","ISSN":"16147499","abstract":"Exposure to nitrogen dioxide (NO2) has long been linked to elevated mortality and morbidity from epidemiological evidences. However, questions remain unclear whether NO2 acts directly on human health or being an indicator of other ambient pollutants. In this study, random-effect meta-analyses were performed on examining exposure to nitrogen oxide (NOx) and its association with chronic obstructive pulmonary disease (COPD). The overall relative risk (RR) of COPD risk related to a 10 μg/m3 increase in NO2 exposure increased by 2.0%. The pooled effect on prevalence was 17% with an increase of 10 μg/m3 in NO2 concentration, and 1.3% on hospital admissions, and 2.6% on mortality. The RR of COPD cases related to NO2 long-term exposure was 2.5 and 1.4% in short-term exposure. The COPD effect related with a 10 μg/m3 increase in exposure to a general outdoor-sourced NO2 was 1.7 and 17.8% to exposure to an exclusively traffic-sourced NO2; importantly, we did observe the effect of NO2 on COPD mortality with a large majority in lag0. Long-term traffic exerted more severe impairments on COPD prevalence than long-term or short-term outdoor effect; long-term mortality effect on COPD was serious in single model from this meta-analysis. Overall, our study reported consistent evidence of the potential positive association between NO2 and COPD risk. ? 2018 Springer-Verlag GmbH Germany, part of Springer Nature","author":[{"dropping-particle":"","family":"Zhang","given":"Zili","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Wang","given":"Jian","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lu","given":"Wenju","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Environmental Science and Pollution Research","id":"ITEM-1","issue":"15","issued":{"date-parts":[["2018"]]},"page":"15133-15145","publisher":"Environmental Science and Pollution Research","title":"Exposure to nitrogen dioxide and chronic obstructive pulmonary disease (COPD) in adults: a systematic review and meta-analysis","type":"article-journal","volume":"25"},"uris":[""]}],"mendeley":{"formattedCitation":"(9)","plainTextFormattedCitation":"(9)","previouslyFormattedCitation":"(9)"},"properties":{"noteIndex":0},"schema":""}(9), sin embargo, actualmente hay evidencia epidemiológica sugestiva que la exposición prolongada a la contaminación ambiental se asocia con el desarrollo de esta entidad ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.2147/COPD.S122282","abstract":"Background: Short-term exposure to major air pollutants (O 3 , CO, NO 2 , SO 2 , PM 10 , and PM 2.5) has been associated with respiratory risk. However, evidence on the risk of chronic obstructive pulmonary disease (COPD) exacerbations is still limited. The present study aimed at evaluating the associations between short-term exposure to major air pollutants and the risk of COPD exacerbations. Methods: After a systematic search up until March 30, 2016, in both English and Chinese electronic databases such as PubMed, EMBASE, and CNKI, the pooled relative risks and 95% confidence intervals were estimated by using the random-effects model. In addition, the population-attributable fractions (PAFs) were also calculated, and a subgroup analysis was conducted. Heterogeneity was assessed by I 2. Results: In total, 59 studies were included. In the single-pollutant model, the risks of COPD were calculated by each 10 μg/m 3 increase in pollutant concentrations, with the exception of CO (100 μg/m 3). There was a significant association between short-term exposure and COPD exacer-bation risk for all the gaseous and particulate pollutants. The associations were strongest at lag0 and lag3 for gaseous and particulate air pollutants, respectively. The subgroup analysis not only further confirmed the overall adverse effects but also reduced the heterogeneities obviously. When 100% exposure was assumed, PAFs ranged from 0.60% to 4.31%, depending on the pollutants. The adverse health effects of SO 2 and NO 2 exposure were more significant in low-/middle-income countries than in high-income countries: SO 2 , relative risk: 1.012 (95% confidence interval: 1.001, 1.023); and NO 2 , relative risk: 1.019 (95% confidence interval: 1.014, 1.024). Conclusion: Short-term exposure to air pollutants increases the burden of risk of COPD acute exacerbations significantly. Controlling ambient air pollution would provide benefits to COPD patients.","author":[{"dropping-particle":"","family":"Li","given":"Jinhui","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Tang","given":"Robert","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Qiu","given":"Hong","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Huang","given":"Qingyuan","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Mason","given":"Tonya G","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Tian","given":"Linwei","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"International Journal of COPD","id":"ITEM-1","issued":{"date-parts":[["2016"]]},"page":"11-3079","title":"Major air pollutants and risk of COPD exacerbations: a systematic review and meta-analysis","type":"article-journal"},"uris":[""]}],"mendeley":{"formattedCitation":"(10)","plainTextFormattedCitation":"(10)","previouslyFormattedCitation":"(10)"},"properties":{"noteIndex":0},"schema":""}(10). Varios estudios han mostrado un aumento en las tasas de morbilidad y mortalidad, en relación a exacerbaciones de EPOC después de la exposición a niveles elevados de contaminación aérea ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1016/j.envres.2016.08.018","ISSN":"10960953","abstract":"Background Epidemiological studies have shown an increase in morbidity and mortality rates in patients with chronic obstructive pulmonary disease (COPD) following exposure to elevated levels of air pollution. Panel studies have been used to assess short-term effects of air pollution which are not detected by registry studies, specifically lung function and symptoms. The aim of this systematic review was to assess the evidence of panel studies on acute effects of air pollution among patients with COPD. Methods We searched the PubMed database, and identified additional studies by inspecting reference lists and literature reviews. We identified and summarized 25 panel studies that were published between 1993 and February 2016. Results were presented in forest plots and effect estimates of sufficiently comparable outcomes and pollutants were summarized by a random-effects meta-analysis. Results Meta-analysis showed that a 10 ?g/m3 increase in ambient levels of particles less than 10 ?m in diameter (PM10) had a small, but statistically significant impact on FEV1 (?3.38 mL, 95% CI ?6.39 to ?0.37) and PEF (?0.61 L/min, ?1.20 to ?0.01). There was significant heterogeneity across the included studies. A forest plot showing associations between PM10 and respiratory symptoms was also suggestive of an adverse effect of particulate air pollution, but this was not formally tested in a meta-analysis due to the heterogeneity of outcomes. Results for gaseous pollutants were inconsistent for lung function or symptoms. Conclusions Evidence from the identified panel studies indicated statistically significant associations of particulate matter air pollution with lung function in patients with COPD.","author":[{"dropping-particle":"","family":"Bloemsma","given":"Lizan D.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Hoek","given":"Gerard","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Smit","given":"Lidwien A.M.","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Environmental Research","id":"ITEM-1","issued":{"date-parts":[["2016"]]},"page":"458-468","publisher":"Elsevier","title":"Panel studies of air pollution in patients with COPD: Systematic review and meta-analysis","type":"article-journal","volume":"151"},"uris":[""]}],"mendeley":{"formattedCitation":"(11)","plainTextFormattedCitation":"(11)","previouslyFormattedCitation":"(11)"},"properties":{"noteIndex":0},"schema":""}(11). Por ejemplo, un metanálisis reciente demostró que se produjo un aumento del 3,1% en hospitalizaciones y un 2,5% en la mortalidad por EPOC secundario a un aumento de 10 mg / m3 en la exposición diaria a PM2.5 ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1016/j.envres.2016.08.018","ISSN":"10960953","abstract":"Background Epidemiological studies have shown an increase in morbidity and mortality rates in patients with chronic obstructive pulmonary disease (COPD) following exposure to elevated levels of air pollution. Panel studies have been used to assess short-term effects of air pollution which are not detected by registry studies, specifically lung function and symptoms. The aim of this systematic review was to assess the evidence of panel studies on acute effects of air pollution among patients with COPD. Methods We searched the PubMed database, and identified additional studies by inspecting reference lists and literature reviews. We identified and summarized 25 panel studies that were published between 1993 and February 2016. Results were presented in forest plots and effect estimates of sufficiently comparable outcomes and pollutants were summarized by a random-effects meta-analysis. Results Meta-analysis showed that a 10 ?g/m3 increase in ambient levels of particles less than 10 ?m in diameter (PM10) had a small, but statistically significant impact on FEV1 (?3.38 mL, 95% CI ?6.39 to ?0.37) and PEF (?0.61 L/min, ?1.20 to ?0.01). There was significant heterogeneity across the included studies. A forest plot showing associations between PM10 and respiratory symptoms was also suggestive of an adverse effect of particulate air pollution, but this was not formally tested in a meta-analysis due to the heterogeneity of outcomes. Results for gaseous pollutants were inconsistent for lung function or symptoms. Conclusions Evidence from the identified panel studies indicated statistically significant associations of particulate matter air pollution with lung function in patients with COPD.","author":[{"dropping-particle":"","family":"Bloemsma","given":"Lizan D.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Hoek","given":"Gerard","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Smit","given":"Lidwien A.M.","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Environmental Research","id":"ITEM-1","issued":{"date-parts":[["2016"]]},"page":"458-468","publisher":"Elsevier","title":"Panel studies of air pollution in patients with COPD: Systematic review and meta-analysis","type":"article-journal","volume":"151"},"uris":[""]}],"mendeley":{"formattedCitation":"(11)","plainTextFormattedCitation":"(11)","previouslyFormattedCitation":"(11)"},"properties":{"noteIndex":0},"schema":""}(11). Las partículas principalmente asociadas fueron PM2.5, dióxido de nitrógeno (NO2), ozono (O3), SO2 y monóxido de carbono (CO) ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.2147/COPD.S161555 LK - ","ISSN":"1178-2005","abstract":"Chronic obstructive pulmonary disease (COPD) is one of the main contributors to the global burden of disease. The aim of this systematic review was to quantify the disease burden of COPD in China and to determine the risk factors of the disease. The number of studies included in the review was 47 with an average quality assessment score of 7.70 out of 10. Reported COPD prevalence varied between 1.20% and 8.87% in different provinces/cities across China. The prevalence rate of COPD was higher among men (7.76%) than women (4.07%). The disease was more prevalent in rural areas (7.62%) than in urban areas (6.09%). The diagnostic rate of COPD patients in China varied from 23.61% to 30.00%. The percentage of COPD patients receiving outpatient treatment was around 50%, while the admission rate ranged between 8.78% and 35.60%. Tobacco exposure and biomass fuel/solid fuel usage were documented as two important risk factors of COPD. COPD ranked among the top three leading causes of death in China. The direct medical cost of COPD ranged from 72 to 3,565 USD per capita per year, accounting for 33.33% to 118.09% of local average annual income. The most commonly used scales for the assessment of quality of life (QoL) included Saint George Respiratory Questionnaire, Airways Questionnaire 20, SF-36, and their revised versions. The status of QoL was worse among COPD patients than in non-COPD patients, and COPD patients were at higher risks of depression. The COPD burden in China was high in terms of economic burden and QoL. In view of the high smoking rate and considerable concerns related to air pollution and smog in China, countermeasures need to be taken to improve disease prevention and management to reduce disease burdens raised by COPD.","author":[{"dropping-particle":"","family":"B.","given":"Zhu","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Y.","given":"Wang","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"J.","given":"Ming","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"W.","given":"Chen","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"L.","given":"Zhang","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"International Journal of COPD","id":"ITEM-1","issued":{"date-parts":[["2018"]]},"page":"1353-1364","title":"Disease burden of COPD in china: A systematic review","type":"article-journal","volume":"13"},"uris":[""]}],"mendeley":{"formattedCitation":"(8)","plainTextFormattedCitation":"(8)","previouslyFormattedCitation":"(8)"},"properties":{"noteIndex":0},"schema":""}(8) ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1007/s11356-018-1629-7","ISSN":"16147499","abstract":"Exposure to nitrogen dioxide (NO2) has long been linked to elevated mortality and morbidity from epidemiological evidences. However, questions remain unclear whether NO2 acts directly on human health or being an indicator of other ambient pollutants. In this study, random-effect meta-analyses were performed on examining exposure to nitrogen oxide (NOx) and its association with chronic obstructive pulmonary disease (COPD). The overall relative risk (RR) of COPD risk related to a 10 μg/m3 increase in NO2 exposure increased by 2.0%. The pooled effect on prevalence was 17% with an increase of 10 μg/m3 in NO2 concentration, and 1.3% on hospital admissions, and 2.6% on mortality. The RR of COPD cases related to NO2 long-term exposure was 2.5 and 1.4% in short-term exposure. The COPD effect related with a 10 μg/m3 increase in exposure to a general outdoor-sourced NO2 was 1.7 and 17.8% to exposure to an exclusively traffic-sourced NO2; importantly, we did observe the effect of NO2 on COPD mortality with a large majority in lag0. Long-term traffic exerted more severe impairments on COPD prevalence than long-term or short-term outdoor effect; long-term mortality effect on COPD was serious in single model from this meta-analysis. Overall, our study reported consistent evidence of the potential positive association between NO2 and COPD risk. ? 2018 Springer-Verlag GmbH Germany, part of Springer Nature","author":[{"dropping-particle":"","family":"Zhang","given":"Zili","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Wang","given":"Jian","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lu","given":"Wenju","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Environmental Science and Pollution Research","id":"ITEM-1","issue":"15","issued":{"date-parts":[["2018"]]},"page":"15133-15145","publisher":"Environmental Science and Pollution Research","title":"Exposure to nitrogen dioxide and chronic obstructive pulmonary disease (COPD) in adults: a systematic review and meta-analysis","type":"article-journal","volume":"25"},"uris":[""]}],"mendeley":{"formattedCitation":"(9)","plainTextFormattedCitation":"(9)","previouslyFormattedCitation":"(9)"},"properties":{"noteIndex":0},"schema":""}(9) ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.2147/COPD.S122282","abstract":"Background: Short-term exposure to major air pollutants (O 3 , CO, NO 2 , SO 2 , PM 10 , and PM 2.5) has been associated with respiratory risk. However, evidence on the risk of chronic obstructive pulmonary disease (COPD) exacerbations is still limited. The present study aimed at evaluating the associations between short-term exposure to major air pollutants and the risk of COPD exacerbations. Methods: After a systematic search up until March 30, 2016, in both English and Chinese electronic databases such as PubMed, EMBASE, and CNKI, the pooled relative risks and 95% confidence intervals were estimated by using the random-effects model. In addition, the population-attributable fractions (PAFs) were also calculated, and a subgroup analysis was conducted. Heterogeneity was assessed by I 2. Results: In total, 59 studies were included. In the single-pollutant model, the risks of COPD were calculated by each 10 μg/m 3 increase in pollutant concentrations, with the exception of CO (100 μg/m 3). There was a significant association between short-term exposure and COPD exacer-bation risk for all the gaseous and particulate pollutants. The associations were strongest at lag0 and lag3 for gaseous and particulate air pollutants, respectively. The subgroup analysis not only further confirmed the overall adverse effects but also reduced the heterogeneities obviously. When 100% exposure was assumed, PAFs ranged from 0.60% to 4.31%, depending on the pollutants. The adverse health effects of SO 2 and NO 2 exposure were more significant in low-/middle-income countries than in high-income countries: SO 2 , relative risk: 1.012 (95% confidence interval: 1.001, 1.023); and NO 2 , relative risk: 1.019 (95% confidence interval: 1.014, 1.024). Conclusion: Short-term exposure to air pollutants increases the burden of risk of COPD acute exacerbations significantly. Controlling ambient air pollution would provide benefits to COPD patients.","author":[{"dropping-particle":"","family":"Li","given":"Jinhui","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Tang","given":"Robert","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Qiu","given":"Hong","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Huang","given":"Qingyuan","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Mason","given":"Tonya G","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Tian","given":"Linwei","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"International Journal of COPD","id":"ITEM-1","issued":{"date-parts":[["2016"]]},"page":"11-3079","title":"Major air pollutants and risk of COPD exacerbations: a systematic review and meta-analysis","type":"article-journal"},"uris":[""]}],"mendeley":{"formattedCitation":"(10)","plainTextFormattedCitation":"(10)","previouslyFormattedCitation":"(10)"},"properties":{"noteIndex":0},"schema":""}(10) ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1016/j.envres.2016.08.018","ISSN":"10960953","abstract":"Background Epidemiological studies have shown an increase in morbidity and mortality rates in patients with chronic obstructive pulmonary disease (COPD) following exposure to elevated levels of air pollution. Panel studies have been used to assess short-term effects of air pollution which are not detected by registry studies, specifically lung function and symptoms. The aim of this systematic review was to assess the evidence of panel studies on acute effects of air pollution among patients with COPD. Methods We searched the PubMed database, and identified additional studies by inspecting reference lists and literature reviews. We identified and summarized 25 panel studies that were published between 1993 and February 2016. Results were presented in forest plots and effect estimates of sufficiently comparable outcomes and pollutants were summarized by a random-effects meta-analysis. Results Meta-analysis showed that a 10 ?g/m3 increase in ambient levels of particles less than 10 ?m in diameter (PM10) had a small, but statistically significant impact on FEV1 (?3.38 mL, 95% CI ?6.39 to ?0.37) and PEF (?0.61 L/min, ?1.20 to ?0.01). There was significant heterogeneity across the included studies. A forest plot showing associations between PM10 and respiratory symptoms was also suggestive of an adverse effect of particulate air pollution, but this was not formally tested in a meta-analysis due to the heterogeneity of outcomes. Results for gaseous pollutants were inconsistent for lung function or symptoms. Conclusions Evidence from the identified panel studies indicated statistically significant associations of particulate matter air pollution with lung function in patients with COPD.","author":[{"dropping-particle":"","family":"Bloemsma","given":"Lizan D.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Hoek","given":"Gerard","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Smit","given":"Lidwien A.M.","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Environmental Research","id":"ITEM-1","issued":{"date-parts":[["2016"]]},"page":"458-468","publisher":"Elsevier","title":"Panel studies of air pollution in patients with COPD: Systematic review and meta-analysis","type":"article-journal","volume":"151"},"uris":[""]}],"mendeley":{"formattedCitation":"(11)","plainTextFormattedCitation":"(11)","previouslyFormattedCitation":"(11)"},"properties":{"noteIndex":0},"schema":""}(11). Un aumento de 100 mg / m3 en PM2.5 se asoció con una disminución de la FEV1 del 2% en pacientes con EPOC. Niveles mínimos de PEF fueron relacionados con concentraciones crecientes de SO2, CO y O3 en pacientes sin EPOC ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1016/j.envres.2016.08.018","ISSN":"10960953","abstract":"Background Epidemiological studies have shown an increase in morbidity and mortality rates in patients with chronic obstructive pulmonary disease (COPD) following exposure to elevated levels of air pollution. Panel studies have been used to assess short-term effects of air pollution which are not detected by registry studies, specifically lung function and symptoms. The aim of this systematic review was to assess the evidence of panel studies on acute effects of air pollution among patients with COPD. Methods We searched the PubMed database, and identified additional studies by inspecting reference lists and literature reviews. We identified and summarized 25 panel studies that were published between 1993 and February 2016. Results were presented in forest plots and effect estimates of sufficiently comparable outcomes and pollutants were summarized by a random-effects meta-analysis. Results Meta-analysis showed that a 10 ?g/m3 increase in ambient levels of particles less than 10 ?m in diameter (PM10) had a small, but statistically significant impact on FEV1 (?3.38 mL, 95% CI ?6.39 to ?0.37) and PEF (?0.61 L/min, ?1.20 to ?0.01). There was significant heterogeneity across the included studies. A forest plot showing associations between PM10 and respiratory symptoms was also suggestive of an adverse effect of particulate air pollution, but this was not formally tested in a meta-analysis due to the heterogeneity of outcomes. Results for gaseous pollutants were inconsistent for lung function or symptoms. Conclusions Evidence from the identified panel studies indicated statistically significant associations of particulate matter air pollution with lung function in patients with COPD.","author":[{"dropping-particle":"","family":"Bloemsma","given":"Lizan D.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Hoek","given":"Gerard","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Smit","given":"Lidwien A.M.","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Environmental Research","id":"ITEM-1","issued":{"date-parts":[["2016"]]},"page":"458-468","publisher":"Elsevier","title":"Panel studies of air pollution in patients with COPD: Systematic review and meta-analysis","type":"article-journal","volume":"151"},"uris":[""]}],"mendeley":{"formattedCitation":"(11)","plainTextFormattedCitation":"(11)","previouslyFormattedCitation":"(11)"},"properties":{"noteIndex":0},"schema":""}(11). NO2 generó un aumento de 1.013 de las hospitalizaciones por EPOC con un IC del 95% de 1.005 a 1.021, un riesgo de 2.6% para mortalidad y de 2.5% para desarrollo de la enfermedad ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.2147/COPD.S122282","abstract":"Background: Short-term exposure to major air pollutants (O 3 , CO, NO 2 , SO 2 , PM 10 , and PM 2.5) has been associated with respiratory risk. However, evidence on the risk of chronic obstructive pulmonary disease (COPD) exacerbations is still limited. The present study aimed at evaluating the associations between short-term exposure to major air pollutants and the risk of COPD exacerbations. Methods: After a systematic search up until March 30, 2016, in both English and Chinese electronic databases such as PubMed, EMBASE, and CNKI, the pooled relative risks and 95% confidence intervals were estimated by using the random-effects model. In addition, the population-attributable fractions (PAFs) were also calculated, and a subgroup analysis was conducted. Heterogeneity was assessed by I 2. Results: In total, 59 studies were included. In the single-pollutant model, the risks of COPD were calculated by each 10 μg/m 3 increase in pollutant concentrations, with the exception of CO (100 μg/m 3). There was a significant association between short-term exposure and COPD exacer-bation risk for all the gaseous and particulate pollutants. The associations were strongest at lag0 and lag3 for gaseous and particulate air pollutants, respectively. The subgroup analysis not only further confirmed the overall adverse effects but also reduced the heterogeneities obviously. When 100% exposure was assumed, PAFs ranged from 0.60% to 4.31%, depending on the pollutants. The adverse health effects of SO 2 and NO 2 exposure were more significant in low-/middle-income countries than in high-income countries: SO 2 , relative risk: 1.012 (95% confidence interval: 1.001, 1.023); and NO 2 , relative risk: 1.019 (95% confidence interval: 1.014, 1.024). Conclusion: Short-term exposure to air pollutants increases the burden of risk of COPD acute exacerbations significantly. Controlling ambient air pollution would provide benefits to COPD patients.","author":[{"dropping-particle":"","family":"Li","given":"Jinhui","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Tang","given":"Robert","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Qiu","given":"Hong","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Huang","given":"Qingyuan","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Mason","given":"Tonya G","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Tian","given":"Linwei","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"International Journal of COPD","id":"ITEM-1","issued":{"date-parts":[["2016"]]},"page":"11-3079","title":"Major air pollutants and risk of COPD exacerbations: a systematic review and meta-analysis","type":"article-journal"},"uris":[""]}],"mendeley":{"formattedCitation":"(10)","plainTextFormattedCitation":"(10)","previouslyFormattedCitation":"(10)"},"properties":{"noteIndex":0},"schema":""}(10).La exposición postnatal a los principales componentes de la contaminación del aire como dióxido de nitrógeno (NO2), PM2.5, carbono negro (BC), dióxido de azufre (SO2) y O3, a excepción de PM10, se correlacionan con una mayor incidencia de sibilancias, asma y exacerbaciones moderadas o graves en la ni?ez ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1371/journal.pone.0174050","ISBN":"1111111111","ISSN":"19326203","abstract":"Background Several observational studies have suggested that outdoor air pollution may induce or aggravate asthma. However, epidemiological results are inconclusive due to the presence of numerous moderators which influence this association. The goal of this study was to assess the relationship between outdoor air pollutants and moderate or severe asthma exacerbations in children and adults through a systematic review and multilevel meta-analysis. Material and methods We searched studies published in English on PubMed, Scopus, and Google Scholar between January 2000 and October 2016. Studies following a case-crossover design with records of emergency departments and/or hospital admissions as a surrogate of moderate or severe asthma exacerbations were selected. A multilevel meta-analysis was employed, taking into account the potential clustering effects within studies examining more than one lag. Odds ratios (ORs) and 95% confidence intervals were estimated. A subgroup analysis in children aged 0 to 18 years and a sensitivity analysis based on the quality of the included studies as defined in the Newcastle-Ottawa Scale were performed. Publication bias was evaluated through visual inspection of funnel plots and by a complementary search of grey literature. (Prospero Registration number CRD42015032323). Results Database searches retrieved 208 records, and finally 22 studies were selected for quantitative analysis. All pollutants except SO2 and PM10 showed a significant association with asthma exacerbations (NO2: 1.024; 95% CI: 1.005,1.043, SO2: 1.039; 95% CI: 0.988,1.094), PM10: 1.024; 95% CI: 0.995,1.053, PM2.5: 1.028; 95% CI: 1.009,1.047, CO: 1.045; 95% CI: 1.005,1.086, O3: 1.032; 95% CI: 1.005,1.060. In children, the association was significant for NO2, SO2 and PM2.5. Conclusion This meta-analysis provides evidence of the association between selected air pollutants and asthma exacerbations for different lags.","author":[{"dropping-particle":"","family":"Orellano","given":"Pablo","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Quaranta","given":"Nancy","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Reynoso","given":"Julieta","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Balbi","given":"Brenda","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Vasquez","given":"Julia","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"PLoS ONE","id":"ITEM-1","issue":"3","issued":{"date-parts":[["2017"]]},"page":"1-15","title":"Effect of outdoor air pollution on asthma exacerbations in children and adults: Systematic review and multilevel meta-analysis","type":"article-journal","volume":"12"},"uris":[""]}],"mendeley":{"formattedCitation":"(12)","plainTextFormattedCitation":"(12)","previouslyFormattedCitation":"(12)"},"properties":{"noteIndex":0},"schema":""}(12). Por otra parte, un metanálisis mostró un efecto significativamente positivo entre la exposición prenatal de PM10 con asma infantil (OR = 1.08, IC 95% = 1.05–1.12, I2 = 30.4%) al igual que con NO2 y SO2 ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1016/j.envres.2017.08.038","ISSN":"10960953","abstract":"Background and objectives There has been no clear consensus about whether prenatal exposure to air pollution contributes to the development of wheezing and asthma in children. We conducted a systematic review to analyze the association between exposure to different pollutants during pregnancy and the development of childhood wheezing and asthma. Methods We systematically reviewed epidemiological studies published through June 6, 2017 available in the MEDLINE and Web of Science databases. We included studies that examined the association between prenatal exposure to any air pollutants except tobacco smoke and the incidence or prevalence of “wheezing” or “asthma” from birth to 14 years of age. We extracted key characteristics of each included study using a template of predefined data items. We used the Critical Appraisal Skills Programme checklists to assess the validity of each included study. We conducted overall and subgroup meta-analyses for each summary exposure-outcome association. Pooled odds ratios (OR) with 95% confidence intervals (CI) were estimated by using a random effects model. Results Eighteen studies met our eligibility criteria. There was notable variability in exposure assessment methods. The overall random effects risk estimates (95% CI) of different pollutants were 1.04 (0.94–1.15) aromatic hydrocarbons (PAH), 1.04 (1.01–1.07) NO2, 1.4 (0.97–2.03) PM2.5 for childhood wheeze and 1.07 (1.01–1.14) NO2, 1 (0.97–1.03) PM2.5, 1.02 (0.98–1.07) SO2, 1.08 (1.05–1.12) PM10 for childhood asthma. Minimal heterogeneity was seen for PAH and SO2, while some heterogeneity was observed for PM10, PM2.5 and NO2. Conclusions The overall and subgroup risk estimates from the meta-analyses showed statistically significant associations between prenatal exposures to NO2, SO2, and PM10 and the risk of wheezing and asthma development in childhood. There is insufficient evidence to show an effect of prenatal exposure to BC, CO, and O3 on childhood wheezing and asthma. Further studies are needed to examine the individual compounds’ effects.","author":[{"dropping-particle":"","family":"Hehua","given":"Zhang","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Qing","given":"Chang","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Shanyan","given":"Gao","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Qijun","given":"Wu","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Yuhong","given":"Zhao","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Environmental Research","id":"ITEM-1","issue":"36","issued":{"date-parts":[["2017"]]},"page":"519-530","publisher":"Elsevier Inc.","title":"The impact of prenatal exposure to air pollution on childhood wheezing and asthma: A systematic review","type":"article-journal","volume":"159"},"uris":[""]}],"mendeley":{"formattedCitation":"(13)","plainTextFormattedCitation":"(13)","previouslyFormattedCitation":"(13)"},"properties":{"noteIndex":0},"schema":""}(13). Dicha contaminación del aire puede estar relacionada con las exacerbaciones del asma por estrés oxidativo, remodelación de las vías respiratorias e inflamación. Específicamente, la exposición al O3 causa inflamación de las vías respiratorias e hipersensibilidad y disminuye en la función pulmonar, el SO2 conduce principalmente a la broncoconstricción, NO2 probablemente desencadena una inflamación bronquial y PM genera remodelación a nivel alveolar ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.3390/ijerph14030312","ISSN":"16604601","abstract":"Background: Current levels of traffic-related air pollution (TRAP) are associated with the development of childhood asthma, although some inconsistencies and heterogeneity remain. An important part of the uncertainty in studies of TRAP-associated asthma originates from uncertainties in the TRAP exposure assessment and assignment methods. In this work, we aim to systematically review the exposure assessment methods used in the epidemiology of TRAP and childhood asthma, highlight recent advances, remaining research gaps and make suggestions for further research. Methods: We systematically reviewed epidemiological studies published up until 8 September 2016 and available in Embase, Ovid MEDLINE (R), and \"Transport database\". We included studies which examined the association between children's exposure to TRAP metrics and their risk of \"asthma\" incidence or lifetime prevalence, from birth to the age of 18 years old. Results: We found 42 studies which examined the associations between TRAP and subsequent childhood asthma incidence or lifetime prevalence, published since 1999. Land-use regression modelling was the most commonly used method and nitrogen dioxide (NO?) was the most commonly used pollutant in the exposure assessments. Most studies estimated TRAP exposure at the residential address and only a few considered the participants' mobility. TRAP exposure was mostly assessed at the birth year and only a few studies considered different and/or multiple exposure time windows. We recommend that further work is needed including e.g., the use of new exposure metrics such as the composition of particulate matter, oxidative potential and ultra-fine particles, improved modelling e.g., by combining different exposure assessment models, including mobility of the participants, and systematically investigating different exposure time windows. Conclusions: Although our previous meta-analysis found statistically significant associations for various TRAP exposures and subsequent childhood asthma, further refinement of the exposure assessment may improve the risk estimates, and shed light on critical exposure time windows, putative agents, underlying mechanisms and drivers of heterogeneity.","author":[{"dropping-particle":"","family":"Khreis","given":"Haneen","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Nieuwenhuijsen","given":"Mark J.","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"International Journal of Environmental Research and Public Health","id":"ITEM-1","issue":"3","issued":{"date-parts":[["2017"]]},"page":"1-19","title":"Traffic-related air pollution and childhood asthma: Recent advances and remaining gaps in the exposure assessment methods","type":"article-journal","volume":"14"},"uris":[""]}],"mendeley":{"formattedCitation":"(14)","plainTextFormattedCitation":"(14)","previouslyFormattedCitation":"(14)"},"properties":{"noteIndex":0},"schema":""}(14). Por otra parte, se encontró una asociación positiva entre todos los contaminantes (PM10, PM2.5, SO2, NO2, O3, excepto CO) y la neumonía pediátrica ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1016/j.envpol.2017.07.063","ISSN":"18736424","abstract":"Ambient air pollution has been associated with respiratory diseases in children. However, its effects on pediatric pneumonia have not been meta-analyzed. We conducted a systematic review and meta-analysis of the short-term association between ambient air pollution and hospitalization of children due to pneumonia. We searched the Web of Science and PubMed for indexed publications up to January 2017. Pollutant-specific excess risk percentage (ER%) and confidence intervals (CI) were estimated using random effect models for particulate matter (PM) with diameter ≤ 10 (PM10) and ≤2.5 μm (PM2.5), sulfur dioxide (SO2), ozone (O3), nitrogen dioxide (NO2), and carbon monoxide (CO). Results were further stratified by subgroups (children under five, emergency visits versus hospital admissions, income level of study location, and exposure period). Seventeen studies were included in the meta-analysis. The ER% per 10 μg/m3 increase of pollutants was 1.5% (95% CI: 0.6%–2.4%) for PM10 and 1.8% (95% CI: 0.5%–3.1%) for PM2.5. The corresponding values per 10 ppb increment of gaseous pollutants were 2.9% (95% CI: 0.4%–5.3%) for SO2, 1.7% (95% CI: 0.5%–2.8%) for O3, and 1.4% (95% CI: 0.4%–2.4%) for NO2. ER% per 1000 ppb increment of CO was 0.9% (95% CI: 0.0%–1.9%). Associations were not substantially different between subgroups. This meta-analysis shows a positive association between daily levels of ambient air pollution markers and hospitalization of children due to pneumonia. However, lack of studies from low-and middle-income countries limits the quantitative generalizability given that susceptibilities to the adverse effects of air pollution may be different in those populations. The meta-regression in our analysis further demonstrated a strong effect of country income level on heterogeneity.","author":[{"dropping-particle":"","family":"Nhung","given":"Nguyen Thi Trang","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Amini","given":"Heresh","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Schindler","given":"Christian","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Kutlar Joss","given":"Meltem","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Dien","given":"Tran Minh","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Probst-Hensch","given":"Nicole","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Perez","given":"Laura","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Künzli","given":"Nino","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Environmental Pollution","id":"ITEM-1","issued":{"date-parts":[["2017"]]},"page":"1000-1008","publisher":"Elsevier Ltd","title":"Short-term association between ambient air pollution and pneumonia in children: A systematic review and meta-analysis of time-series and case-crossover studies","type":"article-journal","volume":"230"},"uris":[""]}],"mendeley":{"formattedCitation":"(15)","plainTextFormattedCitation":"(15)","previouslyFormattedCitation":"(15)"},"properties":{"noteIndex":0},"schema":""}(15). Mehta et al. Informó que un incremento de 10 mg / m3 de PM2.5 se asoció con un 12% (IC 95%: 3% e30%) mayor riesgo de neumonía ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1007/s11356-018-3769-1","ISSN":"16147499","abstract":"Exposure to indoor air pollution increases the risk of pneumonia in children, accounting for about a million deaths globally. This study investigates the individual effect of solid fuel, carbon monoxide (CO), black carbon (BC) and particulate matter (PM)2.5 on pneumonia in children under 5 in low- and middle-income countries. A systematic review was conducted to identify peer-reviewed and grey full-text documents without restrictions to study design, language or year of publication using nine databases (Embase, PubMed, EBSCO/CINAHL, Scopus, Web of Knowledge, WHO Library Database (WHOLIS), Integrated Regional Information Networks (IRIN), the World Meteorological Organization (WMO)-WHO and Intergovernmental Panel on Climate Change (IPCC). Exposure to solid fuel use showed a significant association to childhood pneumonia. Exposure to CO showed no association to childhood pneumonia. PM2.5 did not show any association when physically measured, whilst eight studies that used solid fuel as a proxy for PM2.5 all reported significant associations. This review highlights the need to standardise measurement of exposure and outcome variables when investigating the effect ofair pollution on pneumonia in children under 5. Future studies should account for BC, PM1 and the interaction between indoor and outdoor pollution and its cumulative impact on childhood pneumonia.","author":[{"dropping-particle":"","family":"Adaji","given":"Enemona Emmanuel","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Ekezie","given":"Winifred","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Clifford","given":"Michael","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Phalkey","given":"Revati","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Environmental Science and Pollution Research","id":"ITEM-1","issue":"4","issued":{"date-parts":[["2019"]]},"page":"3208-3225","publisher":"Environmental Science and Pollution Research","title":"Understanding the effect of indoor air pollution on pneumonia in children under 5 in low- and middle-income countries: a systematic review of evidence","type":"article-journal","volume":"26"},"uris":[""]}],"mendeley":{"formattedCitation":"(16)","plainTextFormattedCitation":"(16)","previouslyFormattedCitation":"(16)"},"properties":{"noteIndex":0},"schema":""}(16). Esta asociación se observó incluso en regiones donde los niveles de contaminación son bastante bajos, como en Australia y Nueva Zelanda, donde las medias diarias de PM2.5 son 11 mg / m3, mucho más bajo que el valor medio diario recomendado por la Pauta de calidad del aire de la Organización Mundial de la Salud que es 25 mg / m3) ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1016/j.jaci.2019.03.024","ISSN":"00916749","author":[{"dropping-particle":"","family":"Jung","given":"Chau-Ren","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Chen","given":"Wei-Ting","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Tang","given":"Yu-Hsin","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Hwang","given":"Bing-Fang","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Journal of Allergy and Clinical Immunology","id":"ITEM-1","issued":{"date-parts":[["2019"]]},"publisher":"American Academy of Allergy, Asthma & Immunology","title":"Fine particulate matter exposure during pregnancy and infancy periods and incident asthma","type":"article-journal"},"uris":[""]}],"mendeley":{"formattedCitation":"(17)","plainTextFormattedCitation":"(17)"},"properties":{"noteIndex":0},"schema":""}(17).El desarrollo industrial se asocia a la aparición de efectos ambientales y factores de riesgo debido a la liberación industrial de químicos peligrosos, que en ocasiones resultan carcinogénicos ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1016/j.envint.2018.09.018","ISSN":"18736750","abstract":"Background: Lung cancer is one of the most common cancers in the world. Higher incidence of lung cancer may be associated with residential proximity to a petrochemical industrial complex (PIC) due to exposure to various carcinogens, although results from previous epidemiologic studies remain inconclusive. Because disease burden due to residential inequality is a public health and societal concern, this study analyzed published data to estimate lung cancer incidence in association with residential proximity to PICs. Methods: We performed a meta-analysis on selected epidemiologic studies that met the following criteria: lung cancer incidence was coded by the International Classification of Diseases; exposure groups were clearly defined as residents living near PICs; and confidence intervals were available or calculable from original articles. We further applied a population attributable factor (PAF) method to estimate disease burden attributable to living near PICs in 22 European Union (EU) countries. Results: Meta-analysis included six studies with a total of 466,066 residents living near PICs in six countries. Residents living near PICs had a 19% higher risk of lung cancer compared to those who lived farther away (95% CI = 1.06–1.32). By sex, risks were higher and more significant for females (RR = 1.29; 95% CI = 1.09–1.54; P = 0.004) than males (RR = 1.12; 95% CI = 0.95–1.33; P = 0.173). By location, only groups in Europe had a significantly greater risk of lung cancer with exposure to PICs (95% CI = 1.03–1.33; P = 0.019), although groups in other locations showed similar trends. By bona fide observation, observation of residents for at least seven years provided sufficient latency to estimate risk (RR = 1.25; 95% CI = 1.17–1.34; P < 0.001). Regarding burden of lung cancer in 22 EU countries, 494 males and 478 females were attributed to living in the vicinity of a PIC annually. Conclusions: Lung cancer incidence is significantly higher in individuals living near PICs. This result provides strong epidemiologic evidence for further policy to regulate potential pollutants near PICs. Highlights: Higher incident rates of lung cancer for residents living close to petrochemical industry complex","author":[{"dropping-particle":"","family":"Lin","given":"Cheng Kuan","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Hsu","given":"Yu Tien","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Christiani","given":"David C.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Hung","given":"Huei Yang","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lin","given":"Ro Ting","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Environment International","id":"ITEM-1","issue":"May","issued":{"date-parts":[["2018"]]},"page":"404-414","publisher":"Elsevier","title":"Risks and burden of lung cancer incidence for residential petrochemical industrial complexes: A meta-analysis and application","type":"article-journal","volume":"121"},"uris":[""]}],"mendeley":{"formattedCitation":"(18)","plainTextFormattedCitation":"(18)","previouslyFormattedCitation":"(17)"},"properties":{"noteIndex":0},"schema":""}(18). 17 estudios mostraron que los residentes que viven más cerca de las grandes industrias tienen 1.19 veces (95% IC = 1.06–1.32) mayor riesgo de cáncer de pulmón en comparación con los que viven lejos debido a la mayor exposición ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"author":[{"dropping-particle":"","family":"Biggeri","given":"Annibale","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Barbone","given":"Fabio","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lagazio","given":"Corrado","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Bovenzi","given":"Massimo","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Stanta","given":"Giorgio","non-dropping-particle":"","parse-names":false,"suffix":""}],"id":"ITEM-1","issue":"7","issued":{"date-parts":[["2019"]]},"page":"750-754","title":"Air Pollution and Lung Cancer in Trieste , Italy : Spatial Analysis of Risk as a Function of Distance from Sources Author ( s ): Annibale Biggeri , Fabio Barbone , Corrado Lagazio , Massimo Bovenzi and Giorgio Stanta Source : Environmental Health Perspectives , Vol . 104 , No . 7 ( Jul ., 1996 ), pp . 750-754 Published by : The National Institute of Environmental Health Sciences Stable URL : REFERENCES Linked references are available on JSTOR for this article : You may need to log in to JSTOR to access the linked references . digitize , preserve and extend access to Environmental Health Perspectives Air Pollution and Lung Cancer in Trieste , Italy : Spatial Analysis of Risk as a Function of Distance from Sources","type":"article-journal","volume":"104"},"uris":[""]}],"mendeley":{"formattedCitation":"(20)","plainTextFormattedCitation":"(20)","previouslyFormattedCitation":"(19)"},"properties":{"noteIndex":0},"schema":""}(20). Por otro lado, se realizó un estudio de casos y controles de cáncer de pulmón en mujeres no fumadoras en zonas rurales de China y descubrieron que el aumento de la diversidad en la microbiota del pulmón se asociaba con un mayor riesgo de cáncer de pulmón, específicamente se vinculó el microorganismo phylum Fusobacteria, con un mayor riesgo. Este estudio se sumó a la hipótesis emergente de que la microbiota del tracto respiratorio puede contribuir al riesgo de cáncer pulmonar. Sin embargo dichos hallazgos deben replicarse en muestras de mayor tama?o, y se resalta la necesidad de investigaciones adicionales relacionadas con el papel de las comunidades bacterianas en cáncer pulmonar ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1002/em.22291","ISSN":"0893-6692","author":[{"dropping-particle":"","family":"Hosgood","given":"H. 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DiscusiónLa contaminación ambiental supone la presencia de una variedad de componentes químicos y biológicos en el aire que respiramos y que son especialmente nocivos para nuestros pulmones. Los que resultaron un común denominador para la generación de EPOC, asma, neumonía y cáncer, fueron: dióxido de nitrógeno (NO2), PM2.5, carbono negro (BC), dióxido de azufre (SO2), monóxido de carbono (CO) y O3, por lo que queda la inquietud de: ?qué determina el desarrollo de cada patología si etiológicamente son los mismos elementos ambientales los que las generan?, ?será la concentración PM2.5?, ?la temperatura ambiental?, ?la cantidad de vegetación?, ?el tama?o de población anciana o la densidad poblacional?. Ninguno de los estudios mencionados en esta revisión plantean un rango de tiempo necesario de exposición para presentar estos efectos a nivel pulmonar ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1016/j.prrv.2018.03.005","ISSN":"15260550","abstract":"Outdoor air pollution is increasingly identified as a contributor to respiratory and cardiovascular disease. Pro-inflammatory particles and gases are inhaled deep into the lungs, and are associated with impaired lung growth and exacerbations of chronic respiratory diseases. The magnitude of these effects are of interest to patients and families, and have been assessed in studies specific to CF. Using systematic review methodology, we sought to collate these studies in order to summarise the known effects of air pollution in cystic fibrosis, and to present information on decreasing personal air pollution exposures.","author":[{"dropping-particle":"","family":"Brugha","given":"Rossa","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Edmondson","given":"Claire","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Davies","given":"Jane C.","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Paediatric Respiratory Reviews","id":"ITEM-1","issued":{"date-parts":[["2018"]]},"page":"80-86","publisher":"Elsevier Ltd","title":"Outdoor air pollution and cystic fibrosis","type":"article-journal","volume":"28"},"uris":[""]}],"mendeley":{"formattedCitation":"(21)","plainTextFormattedCitation":"(21)","previouslyFormattedCitation":"(20)"},"properties":{"noteIndex":0},"schema":""}(21) ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1111/all.12456","abstract":"Exposure to high molecular weight sensitizers of biological origin is an important risk factor for the development of asthma and rhinitis. Most of the causal allergens have been defined based on their reactivity with IgE antibodies, and in many cases, the molecular structure and function of the allergens have been established. Significant information on allergen levels that cause sensitization and allergic symptoms for several major environmental and occupational allergens has been reported. Monitoring of high molecular weight allergens and allergen carrier particles is an important part of the management of allergic respiratory diseases and requires standardized allergen assessment methods for occupational and environmental (indoor and outdoor) allergen exposure. The aim of this EAACI task force was to review the essential points for monitoring environmental and occupational allergen exposure including sampling strategies and methods, processing of dust samples, allergen analysis, and quantification. 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Adicionalmente aún no es posible establecer la conexión entre la contaminación ambiental y la demanda por enfermedad respiratoria en la población Colombiana dado que no hay estudios en nuestro país que puedan ilustrarnos en torno a esta temática ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"ISBN":"978-84-945873-7-5","author":[{"dropping-particle":"","family":"Diego Roza","given":"Carmen","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Cruz Carmona","given":"MJesus","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Ferrer Sancho","given":"Jaime","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Fernández ?lvarez","given":"Ramón","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Marín Martínez","given":"Belén","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Martínez González","given":"Cristina","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Rodríguiez Portal","given":"José Antonio","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Romero Valero","given":"Fernando José","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Villena Garrido","given":"María Victoria","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Sociedad Espa?ola de Neumología y Cirugía Torácica SEPAR","id":"ITEM-1","issue":"8","issued":{"date-parts":[["2017"]]},"page":"44","title":"[ Normativa SEPAR 72. Recomendaciones sobre el diagnóstico y el manejo de la patología pleural y pulmonar por asbesto ]","type":"article-journal","volume":"53"},"uris":[""]}],"mendeley":{"formattedCitation":"(23)","plainTextFormattedCitation":"(23)","previouslyFormattedCitation":"(22)"},"properties":{"noteIndex":0},"schema":""}(23)ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1157/13071586","ISSN":"03002896","abstract":"Dadas las repercusiones del uso del asbesto sobre la salud y sobre las enfermedades respiratorias, el Comité Científico de la Sociedad Espa?ola de Neumología y Cirugía Torácica (SEPAR) ha encargado al grupo de Enfermedades Respiratorias de Origen Laboral (EROL) la realización de esta normativa, con el objetivo de proporcionar a los neumólogos una guía clara, concisa y actualizada de la enfermedad y los procesos diagnósticos relacionados con el asbesto.","author":[{"dropping-particle":"","family":"Isidro ontes","given":"I.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Abu Shams","given":"K.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Alday","given":"E.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Carretero Sastre","given":"J.L.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Ferrer Sancho","given":"J.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Freixa Blanxart","given":"A.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Monsó Molas","given":"E.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Pascal Martínez","given":"I.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Rodríguez Becerra","given":"E.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Rodríguez Panadero","given":"F.","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Archivos de Bronconeumología","id":"ITEM-1","issue":"3","issued":{"date-parts":[["2005"]]},"page":"153-168","title":"Normativa sobre el asbesto y sus enfermedades pleuropulmonares","type":"article-journal","volume":"41"},"uris":[""]}],"mendeley":{"formattedCitation":"(24)","plainTextFormattedCitation":"(24)","previouslyFormattedCitation":"(23)"},"properties":{"noteIndex":0},"schema":""}(24). Por otra parte, las guías de práctica clínica que se encuentran en las bases de datos hablan acerca de las enfermedades pleuropulmonares secundarias a la exposición a asbesto, más no a la diferentes partículas de la contaminación ambiental, lo cual nos deja sin una pauta diagnóstica o terapéutica para enfrentarnos a esta problemática ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.5271/sjweh.3462","ISSN":"03553140","abstract":"The International Expert Meeting on Asbestos, Asbestosis, and Cancer was convened in Helsinki on 20-22 January 1997 to discuss disorders of the lung and pleura in association with asbestos and to agree upon state-of the-art criteria for their diagnosis and attribution with respect to asbestos. The group decided to name this document The Helsinki Criteria. The requirement for diagnostic criteria was perceived in part because of new developinents in diagnostic methods, with better identification of asbestos-related disorders. Such developments enhance awareness of health hazards imposed by asbestos, lead to practical prevention and appropriate compensation, and also provide an opportunity to carry out international comparisons. They also provide possible models for the risk assessment of other mineral dusts. The meeting was attended by 19 participants from 8 countries not produciilg asbestos. The chairmen were Professor Douglas W Henderson (Flinders Medical Centre, Australia) and Professor Jorma Rantanen (Finnish Institute of Occupational Health, Finland). The group was a multidisciplinary gathering of pathologists, radiologists, occupational and pulmonary physicians, epidemiologists, toxicologists, industrial hygienists, and clinical and laboratory scientists specializing in tissue fiber analysis. Collectively, the group has published over 1000 articles on asbestos and associated disorders. 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En este estudio utilizaron el flujo espiratorio máximo (PEF), como un indicador de la función pulmonar, representada por la fuerza del músculo respiratorio y el grado de obstrucción de la vía aérea ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1016/j.lfs.2018.12.036","ISSN":"1879-0631","PMID":"30582950","abstract":"This review aims to systematically review and synthesize scientific evidence for the influence of air pollution exposure and outdoor exercise on health. We conducted a literature search in the PubMed, Cochrane, EMBASE, and Web of Science for articles that evaluated the combination effect of air pollution exposure and exercise on health. Questionnaires regarding exposure history, or studies examining indoor air pollution were excluded. Each included study needs to have clear exercise intervention plan. The pooled estimates of the combination effect of air pollution exposure and outdoor exercise on health were calculated in the meta-analysis. The quality of each included study was assessed and the quality of evidence for each outcome assessed in the meta-analysis was also measured. Twenty-five studies were identified. Six studies addressed ozone exposure, four diesel exhaust exposure, six traffic-related air pollution, ten particulate matter (PM) exposure. Only peak expiratory flow (effect size [ES] = ?0.238, 95% confidence interval [CI] = ?0.389, ?0.088) was found to be significantly decreased after exercise intervention in a polluted environment in the meta-analysis. Seven studies reported exposure to air pollutant during exercise was associated with an increased risk of airway inflammation and decrements in pulmonary function. Six studies discovered that exposure of traffic pollution or high PM during exercise may contribute to changes in blood pressure, systemic conduit artery function and micro-vascular function. The combination effect of air pollution and exercise was found to be associated with the increased risk of potential health problems of cardiopulmonary function, immune function, and exercise performance.","author":[{"dropping-particle":"","family":"Qin","given":"Fei","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Yang","given":"Yan","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Wang","given":"Song-Tao","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Dong","given":"Ya-Nan","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Xu","given":"Min-Xiao","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Wang","given":"Zhong-Wei","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Zhao","given":"Jie-Xiu","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Life sciences","id":"ITEM-1","issue":"11","issued":{"date-parts":[["2019"]]},"page":"153-164","publisher":"Elsevier","title":"Exercise and air pollutants exposure: A systematic review and meta-analysis.","type":"article-journal","volume":"218"},"uris":[""]}],"mendeley":{"formattedCitation":"(6)","plainTextFormattedCitation":"(6)","previouslyFormattedCitation":"(6)"},"properties":{"noteIndex":0},"schema":""}(6). Según los resultados apareció una mejora significativa en el PEF después del ejercicio aeróbico a pesar de la exposición a O3. En cuanto a su mecanismo, explican estos artículos, que la contaminación del aire puede promover la producción de radicales libres que inducen inflamación, y el ejercicio inhibe sustancialmente ese aumento como un sistema de defensa antioxidante con la depuración de radicales libres ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1016/j.lfs.2018.12.036","ISSN":"1879-0631","PMID":"30582950","abstract":"This review aims to systematically review and synthesize scientific evidence for the influence of air pollution exposure and outdoor exercise on health. We conducted a literature search in the PubMed, Cochrane, EMBASE, and Web of Science for articles that evaluated the combination effect of air pollution exposure and exercise on health. Questionnaires regarding exposure history, or studies examining indoor air pollution were excluded. Each included study needs to have clear exercise intervention plan. The pooled estimates of the combination effect of air pollution exposure and outdoor exercise on health were calculated in the meta-analysis. The quality of each included study was assessed and the quality of evidence for each outcome assessed in the meta-analysis was also measured. Twenty-five studies were identified. Six studies addressed ozone exposure, four diesel exhaust exposure, six traffic-related air pollution, ten particulate matter (PM) exposure. Only peak expiratory flow (effect size [ES] = ?0.238, 95% confidence interval [CI] = ?0.389, ?0.088) was found to be significantly decreased after exercise intervention in a polluted environment in the meta-analysis. Seven studies reported exposure to air pollutant during exercise was associated with an increased risk of airway inflammation and decrements in pulmonary function. Six studies discovered that exposure of traffic pollution or high PM during exercise may contribute to changes in blood pressure, systemic conduit artery function and micro-vascular function. The combination effect of air pollution and exercise was found to be associated with the increased risk of potential health problems of cardiopulmonary function, immune function, and exercise performance.","author":[{"dropping-particle":"","family":"Qin","given":"Fei","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Yang","given":"Yan","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Wang","given":"Song-Tao","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Dong","given":"Ya-Nan","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Xu","given":"Min-Xiao","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Wang","given":"Zhong-Wei","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Zhao","given":"Jie-Xiu","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Life sciences","id":"ITEM-1","issue":"11","issued":{"date-parts":[["2019"]]},"page":"153-164","publisher":"Elsevier","title":"Exercise and air pollutants exposure: A systematic review and meta-analysis.","type":"article-journal","volume":"218"},"uris":[""]}],"mendeley":{"formattedCitation":"(6)","plainTextFormattedCitation":"(6)","previouslyFormattedCitation":"(6)"},"properties":{"noteIndex":0},"schema":""}(6). A partir de esto se podría concluir que el ejercicio físico compensa el impacto de la contaminación del aire, no obstante, en la evidencia científica actual sigue siendo insuficiente esta información debido a que no hay ningún ensayo controlado aleatorio para la intervención con ejercicio ante la exposición a contaminación ambiental. Para esclarecer estos resultados se requieren estudios futuros que examinen diferentes programas de ejercicios (intensidad del ejercicio, duración del ejercicio, y modo de ejercicio), diferentes exposiciones a la contaminación del aire (componente y dosis), y su efecto en la salud. Por ahora lo que sabemos es que el principal mecanismo biológico responsable de los efectos antitumorales es la contracción muscular que genera moléculas con efectos endocrinos conocidas como “mioquinas”, las cuales son fuertes candidatos para lograr efectos anticancerígenos. Un ejemplo es la proteína SPARC que regula la proliferación y migración celular y de esta manera suprime por medio de apoptosis la formación de células malignas. Similarmente, el ejercicio aumenta los niveles de calprotectina, la cual también induce a la muerte celular programada. Por otro lado, la actividad física genera reducción en la cantidad de tejido adiposo, lo cual disminuye también múltiples mediadores que promueven el cáncer tales como las hormonas sexuales esteroideas, los factores de crecimiento de la insulina, citoquinas inflamatorias y adipocitoquinas ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1016/j.lfs.2018.12.036","ISSN":"1879-0631","PMID":"30582950","abstract":"This review aims to systematically review and synthesize scientific evidence for the influence of air pollution exposure and outdoor exercise on health. We conducted a literature search in the PubMed, Cochrane, EMBASE, and Web of Science for articles that evaluated the combination effect of air pollution exposure and exercise on health. Questionnaires regarding exposure history, or studies examining indoor air pollution were excluded. Each included study needs to have clear exercise intervention plan. The pooled estimates of the combination effect of air pollution exposure and outdoor exercise on health were calculated in the meta-analysis. The quality of each included study was assessed and the quality of evidence for each outcome assessed in the meta-analysis was also measured. Twenty-five studies were identified. Six studies addressed ozone exposure, four diesel exhaust exposure, six traffic-related air pollution, ten particulate matter (PM) exposure. Only peak expiratory flow (effect size [ES] = ?0.238, 95% confidence interval [CI] = ?0.389, ?0.088) was found to be significantly decreased after exercise intervention in a polluted environment in the meta-analysis. Seven studies reported exposure to air pollutant during exercise was associated with an increased risk of airway inflammation and decrements in pulmonary function. Six studies discovered that exposure of traffic pollution or high PM during exercise may contribute to changes in blood pressure, systemic conduit artery function and micro-vascular function. The combination effect of air pollution and exercise was found to be associated with the increased risk of potential health problems of cardiopulmonary function, immune function, and exercise performance.","author":[{"dropping-particle":"","family":"Qin","given":"Fei","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Yang","given":"Yan","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Wang","given":"Song-Tao","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Dong","given":"Ya-Nan","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Xu","given":"Min-Xiao","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Wang","given":"Zhong-Wei","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Zhao","given":"Jie-Xiu","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Life sciences","id":"ITEM-1","issue":"11","issued":{"date-parts":[["2019"]]},"page":"153-164","publisher":"Elsevier","title":"Exercise and air pollutants exposure: A systematic review and meta-analysis.","type":"article-journal","volume":"218"},"uris":[""]}],"mendeley":{"formattedCitation":"(6)","plainTextFormattedCitation":"(6)","previouslyFormattedCitation":"(6)"},"properties":{"noteIndex":0},"schema":""}(6). Otro mecanismo protector inducido por la actividad física incluye la disminución del rol de la adipohormona leptina, la cual induce proliferación celular por vías de MAPK y PI3K/AKT, al igual que promueve la producción de IL-6 y disminuye la expresión de TNF, de esta manera disminuyendo la inflamación que activa la carcinogénesis y mejorando la respuesta inmune ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1016/j.lfs.2018.12.036","ISSN":"1879-0631","PMID":"30582950","abstract":"This review aims to systematically review and synthesize scientific evidence for the influence of air pollution exposure and outdoor exercise on health. We conducted a literature search in the PubMed, Cochrane, EMBASE, and Web of Science for articles that evaluated the combination effect of air pollution exposure and exercise on health. Questionnaires regarding exposure history, or studies examining indoor air pollution were excluded. Each included study needs to have clear exercise intervention plan. The pooled estimates of the combination effect of air pollution exposure and outdoor exercise on health were calculated in the meta-analysis. The quality of each included study was assessed and the quality of evidence for each outcome assessed in the meta-analysis was also measured. Twenty-five studies were identified. Six studies addressed ozone exposure, four diesel exhaust exposure, six traffic-related air pollution, ten particulate matter (PM) exposure. Only peak expiratory flow (effect size [ES] = ?0.238, 95% confidence interval [CI] = ?0.389, ?0.088) was found to be significantly decreased after exercise intervention in a polluted environment in the meta-analysis. Seven studies reported exposure to air pollutant during exercise was associated with an increased risk of airway inflammation and decrements in pulmonary function. Six studies discovered that exposure of traffic pollution or high PM during exercise may contribute to changes in blood pressure, systemic conduit artery function and micro-vascular function. The combination effect of air pollution and exercise was found to be associated with the increased risk of potential health problems of cardiopulmonary function, immune function, and exercise performance.","author":[{"dropping-particle":"","family":"Qin","given":"Fei","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Yang","given":"Yan","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Wang","given":"Song-Tao","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Dong","given":"Ya-Nan","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Xu","given":"Min-Xiao","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Wang","given":"Zhong-Wei","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Zhao","given":"Jie-Xiu","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Life sciences","id":"ITEM-1","issue":"11","issued":{"date-parts":[["2019"]]},"page":"153-164","publisher":"Elsevier","title":"Exercise and air pollutants exposure: A systematic review and meta-analysis.","type":"article-journal","volume":"218"},"uris":[""]}],"mendeley":{"formattedCitation":"(6)","plainTextFormattedCitation":"(6)","previouslyFormattedCitation":"(6)"},"properties":{"noteIndex":0},"schema":""}(6). Nuestro estudio tuvo limitaciones, como que las fuentes específicas asociadas con los efectos adversos a nivel respiratorio variaron entre los diferentes estudios, relacionado con las diferencias en el dise?o de los mismos, las diferentes poblaciones incluidas y la heterogeneidad de la mezcla de partículas que se trabajaron. Además, el limitado número de estudios en Latinoamérica nos limitó para sacar conclusiones a nivel de nuestra población Colombiana. ConclusiónLos efectos que tiene la contaminación ambiental sobre los pulmones en personas no fumadoras se resaltaron en esta revisión en torno a las patologías más prevalentes, como la enfermedad pulmonar obstructiva crónica (EPOC), asma, neumonía y cáncer pulmonar. Estas entidades tienen un alto impacto sobre la mortalidad y morbilidad de la población a nivel mundial. La Organización Mundial de la Salud estima que globalmente 1 de cada 8 muertes (aproximadamente 7 millones de personas en 2012) son atribuibles a la contaminación del aire. El 92% de la población mundial vive en áreas donde la calidad del aire no cumple con los objetivos de la OMS y se estima que la contaminación es responsable de la pérdida de 69.7 millones de a?os de vida ajustados por discapacidad en todo el mundo. Es posible concluir entonces que el estilo de vida y el comportamiento con el que la población vive tienen un gran impacto sobre estas enfermedades. La industrialización es el principal factor de riesgo para desarrollar cáncer pulmonar, al igual que el aumento de microbiota ?Serán los antibióticos la solución a este problema?. Los mecanismos fisiopatológicos mediante los cuales los componentes ambientales generan deterioro incluyen: proceso inflamatorio por estrés oxidativo, fibrosis constante de la vía aérea y da?o del ADN mediante mutaciones genómicas y enzimáticas. El ejercicio sugiere contrarrestar el da?o de la contaminación a nivel pulmonar, por su efecto antioxidante, ?será éste el pilar del tratamiento? Es necesario mencionar que todavía se requieren de más estudios, principalmente de ensayos clínicos controlados con respecto al tema de la actividad física para encaminar mejor la prevención y/o tratamiento de esta problemática en un futuro.Para finalizar, la exposición a la contaminación del aire no es simplemente un asunto de individuos, dependen de la legislación transnacional, con políticas de salud, transporte y energía que se centren en reducir la generación de gases y partículas tóxicas en nuestro ambiente para disminuir el impacto a nivel de la salud ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1016/j.prrv.2018.03.005","ISSN":"15260550","abstract":"Outdoor air pollution is increasingly identified as a contributor to respiratory and cardiovascular disease. Pro-inflammatory particles and gases are inhaled deep into the lungs, and are associated with impaired lung growth and exacerbations of chronic respiratory diseases. The magnitude of these effects are of interest to patients and families, and have been assessed in studies specific to CF. Using systematic review methodology, we sought to collate these studies in order to summarise the known effects of air pollution in cystic fibrosis, and to present information on decreasing personal air pollution exposures.","author":[{"dropping-particle":"","family":"Brugha","given":"Rossa","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Edmondson","given":"Claire","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Davies","given":"Jane C.","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Paediatric Respiratory Reviews","id":"ITEM-1","issued":{"date-parts":[["2018"]]},"page":"80-86","publisher":"Elsevier Ltd","title":"Outdoor air pollution and cystic fibrosis","type":"article-journal","volume":"28"},"uris":[""]}],"mendeley":{"formattedCitation":"(21)","plainTextFormattedCitation":"(21)","previouslyFormattedCitation":"(20)"},"properties":{"noteIndex":0},"schema":""}(21), es por esto que necesitamos iniciar un cambio de manera urgente, con el fin de evitar que esta problemática genere peores consecuencias.BibliografíaADDIN Mendeley Bibliography CSL_BIBLIOGRAPHY 1. 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