Study protocol for a national cohort of adults focused on respiratory health: the American Lung Association Lung Health Cohort (ALA-LHC) Study

IntroductionThe current framework for investigating respiratory diseases is based on defining lung health as the absence of lung disease. In order to develop a comprehensive approach to prevent the development of lung disease, there is a need to evaluate the full spectrum of lung health spanning from ideal to impaired lung health. The American Lung Association (ALA) Lung Health Cohort is a new, population-based, cohort study focused primarily on characterising lung health in members of the millennial generation without diagnosed severe respiratory disease. Participants will be enrolled for the baseline study visit starting in 2021, and funding will be sought to support future study exams as part of a longitudinal cohort study. This study will be crucial for developing a novel paradigm of lung health throughout the adult life course.Methods and analysisThis study will leverage the existing infrastructure of the ALA Airways Clinical Research Centers network to enrol 4000 participants between ages 25 and 35 years old at 39 sites across the USA between April 2021 and December 2024. Study procedures will include physical assessment, spirometry, chest CT scan, accelerometry and collection of nasal epithelial lining fluid, nasal epithelial cells, blood and urine. Participants will complete questionnaires about their sociodemographic characteristics, home address histories and exposures, work history and exposure, medical histories, lung health and health behaviours and activity.Ethics and disseminationThe study was approved by the Johns Hopkins Medicine Institutional Review Board. Findings will be disseminated to the scientific community through peer-reviewed journals and at professional conferences. The lay public will receive scientific findings directly through the ALA infrastructure including the official public website. Deidentified datasets will be deposited to BioLINCC, and deidentified biospecimens may be made available to qualified investigators along with a limited-use datasets.

Healthier Streets: How Superblocks and Congestion Pricing Can Help Reduce Air Pollution in Washington, DC

Cities face big challenges, including environmental threats, livability concerns, lack of new infrastructure, and increasing social inequity, among others. These challenges call for new and innovative ways to address them. Air pollution, a common problem in many cities, causes between 100,000 and 340,000 Americans to die prematurely every year (Fann et al. 2012; Caiazzo et al. 2013; Bowe et al. 2019; and Goodkind et al. 2019) and, out of those premature deaths, 53,000 are due to car pollution (Caiazzo et al. 2013). The Washington DC Metro Area is one of the top 20 cities in the United States with the highest smog pollution, highlighting the need for new regulations to reduce air pollution (American Lung Association 2020). Federal policies aimed at lowering the maximum concentration of air pollutants allowed by the EPA could improve public health, but cities can also reduce air pollution levels through policymaking. DC currently has two main transportation and sustainability plans to improve public transportation, infrastructure, and combat climate change. Cities similar to DC, such as Barcelona and London, have applied superblocks, restricted car access city areas, and congestion pricing policies respectively, aimed at reducing air pollution and improving quality of life. Fortunately, DC has many of the characteristics needed to successfully implement superblocks in areas of the city where residential housing and businesses share space, and congestion pricing in highly congested areas. I recommend the District Department of Transportation to establish pilot programs for each of these policies to reduce air pollution levels in the city.

Novel investigation of perovskite membrane based electrochemical nitric oxide control phenomenon

The combustion of hydrocarbon fuels within the automotive industry results in harmful and reactive incomplete combustion byproducts. Specifically, nitric oxide emissions (NO) lead to increased smog, acid rain, climate change, and respiratory inflammation within the population [Nitrogen Dioxide | American Lung Association]. Current methods for treating combustion exhaust include the catalytic converter in conjunction with nitrogen oxide traps. However, there is no active, continuous reduction method that does not require restrictions on the combustion environment (Hirata in Catal Surv Asia 18:128–133, 2014). Here, a small voltage potential oscillation across a newly designed electro-chemical catalytic membrane significantly reduces NO emissions. A ceramic membrane consisting of two dissimilar metal electrodes, sandwiching a dielectric layer, is able to achieve an NO reduction in excess of 2X that of a platinum group metal (PGM) three way catalytic converter. An analysis of the exhaust effluent from the membranes indicates N2O as a precursor to N2 and O2 formation, without the introduction of ammonia (NH3), during the reaction of NO indicating a divergence from current literature. Our results demonstrate how an oscillatory electric potential on a catalytic surface may alter anticipated reaction chemistry and interaction between the catalytic surface and fluid flow.

Screening of flour mill workers for respiratory morbidities: a cross-sectional study in rural Bangalore

Background: Flour mill workers are highly exposed to organic wheat flour dust with a large diversity of antigenic/allergic component leading to respiratory morbidity and skin allergies. This work environment may affect workers health and safety if the effects are unchecked periodically.Methods: A cross-sectional study was conducted among 194 workers of 4 flour mills in Bangalore Rural district. Prior permission (factory) and informed consent *(workers) were obtained. Pre-structured interview-schedule was administered. Peak expiratory flow rate (PEFR) readings were measured by using wrights flow meter and best of 3 readings recorded. Respiratory morbidity was assessed on PEFR classification - based on American lung association (ALA) colour coding - red, yellow and green zones. Respiratory morbidity was compared with years of experience, type of work, smoking habits and usage of appropriate PPEs. Data was analyzed using Epi-info 08.Results: Among 194 workers studied, 188 were males, 6 were females. They were in the age group of 15-50 years. 143 (73.7%) were engaged in work with direct dust exposure. 84 (43%) were working for more than 3 years, 50 (25%) between 1-3 years and 60 (30%) for less than a year. 7.2% regularly smoked. According to ALA classification, PEFRs of 71 (36%) of the workers were classified into RED, 91 (46%) to yellow and 32 (16%) to green zones respectively. Usage of PPEs was only among 126 (64%).Conclusions: Respiratory morbidity among flour mill workers was high. Adequate use of PPEs was low. Half of the workers fell into yellow zone that had a potential to fall into red zone if external factors were not considered.

Highlights of thoracic oncology from the 2018 ERS International Congress

Lung cancer is a substantial global burden for patients, healthcare professionals and healthcare systems. Multiple scientific international and national initiatives are tackling the various problems associated with this disease, which is currently the leading cause of cancer-related mortality worldwide. During the European Respiratory Society International Congress 2018 in Paris, France, lung cancer experts gathered to present the most recent aspects of lung cancer care, and discuss the need for joint initiatives and an international lung cancer alliance, aiming to provide high quality, accessible health care. The US experience and American Lung Association/American Thoracic Society implementation guide on lung cancer screening programmes, the key features of optimising and implementing such programmes, the challenges of treatment in the subset of patients where lung cancer is combined with interstitial lung disease, and novel lung cancer biomarkers and immunotherapy were among the most anticipated issues covered during the congress.